VRHA Weekly Update
In this Issue  May 1, 2017

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Newsletter available






Magellan Overview

Magellan Complete Care of Virginia is a new, integrated health plan serving the Commonwealth Coordinated Care (CCC) Plus program.  CCC Plus is slated to begin on August 1, 2017.

Magellan is inviting VRHA members to join them to learn more about the health plan and how Magellan will partner with health care providers through the CCC Plus program.
Date: Tuesday, May 23, 2017
Time: 2:30 p.m.-3:30 p.m.
Webinar Access Link:      https://magellanhealth.zoom.us/j/534364651
Audio Access Phone Line: +1 408 638 0968 (US Toll) or +1 646 558 8656 (US Toll)
Webinar ID Number: 534 364 651
For general questions about Magellan Complete Care of Virginia or to join the network, please contact Magellan at 1-855-202-1900 or VAMLTSSProvider@MagellanHealth.com.

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Members in the News

By Margaret Carmel - News & Advance

Slowly but surely, work continues toward a new medical clinic in the town of Appomattox. [VRHA member] Blue Ridge Medical Center and Horizon Behavioral Health plan to provide primary care, pediatrics and mental health care all under one roof. 

BRMC and Horizon have their eyes on an office building at the former Thomasville Furniture plant. BRMC CEO Peggy Whitehead said they like the building because of its central and easily visible location and mature landscaping.

“It really depends on if we can nail the funding,” Whitehead said. “It would be awesome if we could get in there sometime in the summer, but it depends on the funding and finding a doctor to fill that position.”

Read the full article.

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More Members in the News

By Glenna Crabtree-Bullins - SWVA Today
The Saltville Medical Center, operated by [VRHA member] Southwest Virginia Community Health Systems (SVCHS), provides medication-assisted treatment (MAT) for patients with substance use disorders. The treatment includes medications to assist with withdrawal from alcohol, tobacco, opioids and other kinds of drugs.
According to Marcy Rosenbaum, LCSW, CSAC, behavior health director at the facility, “A new addition to our substance abuse treatment services is New Day Recovery in Saltville. This is a primary care office evidenced-based addiction treatment service that provides MAT in conjunction with intensive counseling and medication controls to help people recover from addictions. The most common addiction treated at New Day Recovery is opioid addiction.”

Read the full article.

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Virginia News

Drone Delivery

By Allee Mead

A drone was accepted into the Smithsonian’s National Air and Space Museum collection after completing the first drone delivery approved by the Federal Aviation Administration (FAA). Media from four different continents covered the drone’s historic flight, which took place in Wise County, Virginia, during the largest medical outreach event in the United States. The Health Wagon and Remote Area Medical® (RAM) have partnered on the RAM – Wise Health Expedition since 2000, but July 2015 marked the first time that the rural event received medicine delivered by drone.
“It was a very significant moment,” says Dr. Teresa Gardner Tyson, the Health Wagon’s executive director. “To know that we were making history here in far southwest Virginia, it was just incredible to be a part of that.”
In 2015, RAM had been approached about the potential of drone usage. When the organization shared the phone call with Gardner Tyson, she recommended using a drone to deliver medication and medical supplies to patients.
The call could not have come at a better time: Wise County had received a record 42 inches of snow in February 2015, so people living in mountainous terrain were unable to drive to the pharmacy to pick up their needed prescriptions. Even the National Guard, called in to assist residents after the snowfall, struggled to deliver medicine like insulin to patients. Given the many obvious needs that drones could address in their area, the Health Wagon and RAM were eager to participate in a test event.

Read the full article.

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Covering Virginians

From Virginia Organizing

Since the U.S. Supreme Court decided in 2012 to uphold the Affordable Care Act (ACA), but make Medicaid expansion in states optional, the Virginia General Assembly has been stalling and delaying coverage for hundreds of thousands of Virginians. One community hospital has closed as a result of the refusal to expand Medicaid, and Virginia has declined billions of dollars in federal funding to support expansion.

Opponents of Medicaid expansion often stated that they did not think the ACA would last and had hopes that the law would be repealed with a new Congress and new President. After years of failed attempts to repeal the ACA, Congressional leadership introduced a replacement plan known as the American Health Care Act. This flawed bill also failed to garner the support of the majority. Most recently, there have been signals from Washington, D.C. that this dangerous bill could be reintroduced with even more harmful provisions.

Read the full article.

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National News

White House Rural Task Force

By Erin Mahn Zumbrun - National Rural Health Association

The National Rural Health Association applauds President Donald Trump's Executive Order establishing a White House Rural Task Force. 

"Since the day after the election, NRHA has strongly urged President Trump to make rural health care a priority in the Administration and to build upon the White House Rural Council established under President Obama," said Alan Morgan, NRHA CEO. "President Trump is taking the first important step in that direction by creating the White House Rural Task Force."

The well-intentioned White House Rural Council under the Obama Administration made important inroads but left much work undone. This new task force must act swiftly as a cohesive force within the Administration to advance policies that allow rural communities to prosper and grow. "Time is imperative because of the current rural health crisis," said Morgan.

Since 2010, 78 rural hospitals have closed because of extensive reimbursement cuts. One in three rural hospitals is financially vulnerable; at the current closure rate, more than 25% of rural hospitals will close in less than a decade. Closures of this magnitude will create a massive national crisis in access to emergency services as well as detrimentally harm rural economies that already severely suffer.

In fact, economic recovery has not returned to rural America. At the peak of the Great Recession, rural counties were losing 200,000 jobs per year and rural unemployment stood at nearly 10 percent. Nearly 90% of the jobs that have returned after the Great Recession have been to urban, not rural areas and according to the USDA annual report, rural unemployment numbers are still far below pre-2008 levels. Poverty rates and child hunger rates also continue to remain unacceptably high.

In most rural communities, health care represents the largest, or second largest, employer in the community (one rural hospital can represent as much as 20% of the local economy). Therefore, NRHA calls upon the Task Force to promote policies that keep rural hospital doors open and invest in the chronic workforce shortages plaguing rural America.

"If the Task Force is to meet its goal of reinvigorating the economy of rural America, it must remember that health care is a critical component of economic stability," said Morgan. "You cannot have a healthy rural economy without a healthy rural community. Quality rural health care saves lives, provides skilled jobs, attracts businesses, and reinvests millions back into rural communities."

We hope the Executive Order is a starting point. Rural America is waiting. 

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Moms at Risk

By Casey Ross - Stat

Clare Shirley shuffled through the darkness to the bathroom. The pain, pulsing through the pit of her stomach, came again and again, taking her breath away. She could barely move. Two days from her due date, Clare quickly realized what was happening. She woke her husband, Dan. Their first baby was coming — fast. But to deliver safely, they’d have to make it through a 2 1/2 hour journey across a rugged landscape to the big-city hospital in Duluth.

There was a closer hospital. But it had shut its labor and delivery service just before Clare became pregnant, unable to afford to renovate or hire enough staff to meet modern clinical standards.

It is a common story in rural America. Financial pressures, insurance problems, and doctor shortages forced more than 200 hospitals to close their birthing units between 2004 and 2014, according to the University of Minnesota’s Rural Health Research Center. That’s left millions women of reproductive age facing longer drives to deliver babies — who sometimes arrive en route.

The long drives, understandably, increase anxiety. They also make mothers and babies less safe; studies show these distances bring with them increased rates of complications and infant deaths, as well as longer stays in neonatal intensive care units. But many women have no choice.

Read the full article.

Lost Sense of Security

By Amy Goldstein - Washington Post

This town of the Tennessee Delta, seat of a county that once grew the most cotton east of the Mississippi, relied for decades on a little public hospital built during the Great Depression a few blocks from the courthouse square. But these days, plywood boards are nailed up behind the hospital’s sliding glass entrances. Black paint is smudged across signs over its doorways. The nearest ER is more than a half-hour ambulance ride away.

The demise of Haywood Park Community Hospital three years ago this summer added Brownsville to an epidemic of dying hospitals across rural America. Nearly 80 have closed since 2010, including nine in Tennessee, more than in any state but Texas. Many more are considered fragile — downstream victims of federal health policies, shifts in medical practice and the limited tolerance of distant corporate owners for empty beds and financial losses.

In every rural community, the ripple effects of a lost hospital are profound, reverberating beyond the inability of would-be patients to get immediate care. Many of the best jobs in town vanish. Local leaders trying to recruit new industry face an extra hurdle.

Read the full article.

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No Insurers

By Sarah Kliff - Vox

What happens to Obamacare in places where no insurers want to sell?
Right now there are 16 counties in Tennessee where no health insurer wants to sell Obamacare coverage. Iowa could be next: Half its Obamacare insurers announced this month that they would no longer participate in the marketplace. That leaves 94 of the state's 99 counties with just one insurer — and regulators there aren't totally sure that plan, Medica, will stick around.
"We don't have any commitment from the two carriers that remain that they will be there," says Doug Ommen, Iowa's insurance commissioner. "They're not required to file with us until June. Certainly we're hopeful, but unless Congress acts, our market will continue to be very unstable."
What happens if no one wants to sell coverage? Does the law have any fallback plan?
The short answer is no. There is no backup plan for places where no insurer wants to sell Obamacare coverage.

Read the full article.

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IPPS & LTCH Proposed Rule

From the Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS)  issued a proposed rule that would update 2018 Medicare payment and polices when patients are admitted into hospitals. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care.

CMS is committed to transforming the health care delivery system – and the Medicare program – by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improve outcomes. In addition to the payment and policy proposals, CMS is releasing a Request for Information to solicit ideas for regulatory, policy, practice and procedural changes to better achieve transparency, flexibility, program simplification and innovation. This will inform the discussion on future regulatory action related to inpatient and long-term hospitals.

Click here for major provisions of the proposed rule, including the Request for Information (RFI), the proposed revisions to the application and re-application procedures for National Accrediting Organizations, the proposed changes to termination notices, and the extension of the Rural Community Hospital Demonstration. CMS will accept comments on the proposed rule and the RFI until June 13, 2017. 

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Mark Your Calendar

For more information about these and other events, visit the VRHA Calendar

May 9: Rural Medical Education Conference - San Diego, CA
May 9-12: 40th Annual Rural Health Conference - San Diego, CA
May 9-12: Rural Hospital Innovation Summit - San Diego, CA
May 19: Aging in Appalachia Conference - Marion
May 23: Synthetic Narcotic & Opioid Abuse Prevention Seminar - Big Stone Gap
May 23: Magellan Complete Care of Virginia - webinar
June 8: Virginia Health Care Conference - Richmond
June 21: Responding to Natural Disasters in Rural Communities  - webinar
August 16: A Focus on Suicide Prevention in Rural Communities  - webinar

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CDC’s Guideline for Prescribing Opioids
This online training series aims to help you apply CDC’s recommendations in your clinical setting through interactive patient scenarios, videos, knowledge checks, tips, and resources. You will gain a better understanding of the recommendations, the risks and benefits of prescription opioids, nonopioid options, patient communication, and risk mitigation.

Economic Data in the Appalachian Region
The Appalachian Regional Commission uses data from the Census Bureau’s American Community Survey to provide state and county-level information on population, age, race and ethnicity, housing occupancy, education, labor force, employment, income, health insurance coverage, disability, and veteran status, for the 13 Appalachian states. The report includes breakdowns by five levels of urban to rural county types.

Diabetes Self-Management Education Programs in Nonmetropolitan Counties
New data from the Centers for Disease Control and Prevention show that, despite higher prevalence of diabetes in rural areas of the country, a significant number of rural counties do not have a clinical practice or program that educates individuals on diabetes prevention or care.  According to the latest release in the CDC’s Morbidity and Mortality Weekly Report Rural Health Series, 62% of non-metropolitan counties did not have diabetes self-management education (DSME). Preventive care and self-management such as routine medical visits, glucose self-monitoring, and healthy dietary and physical activity can prevent or delay costly complications.   The report discusses factors impacting this lack of availability of DSME programs in rural communities as well as the need to strategically address rural disparities in diabetes care and outcomes.

These findings also emphasize the need for chronic care management in rural communities.  FORHP has joined with the CMS Office of Minority Health this year on a nationwide education initiative about the mutual benefit of the patient-provider partnership in managing chronic conditions.  To join this effort, check out Connected Care for details about new chronic care management services and resources for patients, as well as billing codes and specific requirements for Rural Health Clinics and Federally Qualified Health Centers.  

The Rural Health Information Hub also has a wealth of information and resources on diabetes prevention and management, including toolkits and case studies on effective programs in rural communities.

Medicare Learning Network eNewsletter

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Funding Opportunities

For funding opportunities without a specific deadline, please visit the VRHA Resources page

Department of Agriculture
The Rural Cooperative Development Grant program provides support to improve the economic condition of rural areas by assisting in the startup, expansion, or operational improvement of rural cooperatives and other business entities.
The application deadline is May 26, 2017.

Kendal Charitable Funds: Promising Innovations
Kendal Charitable Funds is dedicated to supporting improvements in serving older adults that are reflective of a pioneering spirit in the field of aging. Kendal’s Promising Innovations grants are intended for nonprofit organizations that work to meet the needs of a burgeoning population of elders. In 2017, the program is seeking proposals that support aging in place and combat isolation of older adults through engagement in purposeful and meaningful ways within the greater community, designed to affirm their value and connectedness. The program hopes to identify factors that lead to isolation and to address them before and/or after they occur, especially utilizing new, replicable models. Grants will range up to $50,000 for a two-year period. Several smaller requests may be granted rather than one or two larger ones.
Letters of intent must be submitted by May 19, 2017; invited proposals will be due on August 4, 2017.

Relatives as Parents Program
Grants to support the creation or expansion of healthcare, mental health services, and other supportive services for grandparents and other relatives who have taken on the responsibility of surrogate parenting due to the absence of the parents.
Geographic coverage: Nationwide
Application Deadline: Jun 15, 2017 

Health Data for Action
The HD4A program will fund innovative research that uses the available data to answer important research questions. Applicants under this Call for Proposals (CFP) will write a proposal for a research study using data from either the Health Care Cost Institute (HCCI) or athenahealth
Deadline: May 24

New Connections: Increasing Diversity of RWJF Programming
A career development program for early career researchers, providing support to grantees and other individuals who are part of a network of eligible researchers. Through grantmaking, mentorship, career development and networking, New Connections enhances the research capacity of its grantees and network members. The researchers in this program come from multiple disciplines (health, social sciences, business, urban planning, architecture and engineering); work to build the case for a Culture of Health with strong qualitative and quantitative research skills; and produce and translate timely research results.
Deadline: May 16

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