VRHA Weekly Update
In this Issue January 8, 2018

VRHA News Virginia News National News Mark your calendar
Resources
Funding Opportunities
VRHA Site

Join the Rural Health Policy Institute!
WashingtonCapitol
Feb 6-8, 2018 Washington, D.C.
Now, more than ever, the politically powerful
are listening to rural America.

Join VRHA, NRHA, and an estimated 500 more rural health advocates from across the nation for the largest,
and arguably the most important,
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VRHA News

Introducing Dr. Powell

On November 20, 2017,  Lauren R. Powell, MPA, PhD,  joined the Office of Health Equity as the new  office director.  Although a native of Indianapolis, Indiana, Dr. Powell joins us from Boston, Massachusetts, where she has an established track-record as a community-engaged social epidemiologist and health disparities researcher. She recently completed her Master’s in Public Administration at the Harvard Kennedy School of Government, and Doctor of Philosophy in Clinical and Population Health Research at the University of Massachusetts Medical School. Her bachelor’s degree is in Biochemistry from Xavier University of Louisiana.
 
Dr. Powell is passionate about how public health organizations can better address the social determinants of health.  She most recently worked as a health equity consultant, leading the Cambridge Public Health Department toward strategies to infuse health equity into all practices, with an emphasis on systems-driven solutions. Dr. Powell has conducted numerous speaking engagements and serves as a facilitator for audiences to help connect the dots between social policy and health inequities.
         
Dr. Powell is excited to work diligently towards achieving health equity for all Virginians! She welcomes opportunities to forge new and innovative collaborations and can be reached at: lauren.powell@vdh.virginia.gov or 804-864-7425.
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Members in the News

From WCYB

One member of an authority who has worked to get Lee County, Virginia's only hospital back open called Tuesday's announcement "a special Christmas gift" for the locality. That announcement was the sale of the former Lee Regional Medical Center in Pennington Gap to Americore Health, LLC of Florida. The move was approved by [VRHA member] Lee County Hospital Authority and has been in the works over the past two years.

Wellmont Health System cited unprecedented changes in health care including rising costs as some of their reasons for closing the center in September 2013. That left the closest emergency medical care option over 30 minutes to an hour away for some residents.

The authority did not announce an opening date for the hospital but did note the facility's Certificate of Public Need is already in place.

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FLEX Coordinator Search

The VDH Office of Minority Health is in search of a new FLEX Coordinator. This position is responsible for the management of two Federal Office of Rural Health grant programs; the Federal Medicare Rural Hospital Flexibility Grant Program (FLEX) and the Small Rural Hospital Improvement Grant Program (SHIP).

Vist the job posting for additional information.

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Virginia News

Legislative Watch

Recently introduced legislation that could have an impact on health and healthcare in rural Virginia:

HB 234: Health insurance; synchronization of medications. Requires any health plan providing prescription drug coverage to permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for a partial supply if the prescribing provider or the pharmacist determines the fill or refill to be in the best interest of the enrollee and the enrollee requests or agrees to a partial supply for the purpose of synchronizing the enrollee's medications. 

HB 197: Prescription monitoring program. Updates to the existing program.

HB 185: Health insurance; coverage for limited drug refills. Requires health benefit plans to cover a limited refill for up to a five days' supply of a Schedule VI drug that is dispensed by a pharmacist for a covered person whose dispensed drugs are lost, destroyed, or otherwise rendered unusable as a consequence of a natural or man-made disaster that displaces the person from his residence. 

HB 155: Clinics for the treatment of opioid addiction; location. Provides that the prohibition on locating clinics for the treatment of persons with opiate addiction through the use of methadone or opioid replacements other than opioid replacements approved for the treatment of opioid addiction by the U.S. Food and Drug Administration within one-half mile of a public or private licensed day care center or a public or private K-12 school shall not apply to an applicant for a license to operate in its current location or to relocate an existing facility when the facility is currently located within one-half mile of a public or private licensed day care center or a public or private K-12 school in the City of Richmond, has been licensed and operated as a facility to provide treatment for persons with opiate addiction through the use of methadone or other opioid replacements by another provider immediately prior to submission of the application for a license, and, upon issuance of the license, will be operated by a behavioral health authority. 

HB 148: Prescription Monitoring Program; requirements of prescribers; prescriptions for opioids. Requires a prescriber to request and review information from the Prescription Monitoring Program prior to issuing a prescription for opioids, including a refill of an existing prescription for opioids. Currently, a prescriber is only required to request information from the Prescription Monitoring Program prior to initiating a new course of treatment that includes the prescribing of opioids anticipated at the onset to last more than seven consecutive days. 

HB 21: Reproductive health services. Requires health benefit plans to cover the costs of specified health care services, drugs, devices, products, and procedures related to reproductive health.

HB 348: State plan for medical assistance; eligibility. Requires the Board of Medical Assistance Services to include in the state plan for medical assistance provision for the payment of medical assistance on behalf of individuals described in 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII) who are under 65 years of age and not otherwise eligible for medical assistance and whose household income does not exceed 133 percent of the federal poverty level for a family of that size. 

HB 333: Prescription Monitoring Program; requirements of prescribers; exceptions. Provides that a prescriber initiating a new course of treatment to a human patient that includes the prescribing of opioids, anticipated at the onset of treatment to last more than seven consecutive days, shall not be required to request information about the patient from the Prescription Monitoring Program if the purpose of the prescription is the management of pain associated with cancer. 

HB 322: Possession and administration of naloxone. Adds employees of the Department of Corrections who are designated as probation and parole officers or correctional officers to the list of individuals who may possess and administer naloxone or other opioid antagonist, provided that they have completed a training program. 

HB 313: Prescription Monitoring Program; notification of top prescribers. Provides that the Director of the Department of Health Professions shall annually review data collected by the Prescription Monitoring Program to identify those prescribers who, based on such data, fall within the top 10 percent of prescribers by quantity of covered substances prescribed and shall notify such prescribers thereof. 

SB 171: Henrietta Lacks Commission; report; sunset. Creates the Henrietta Lacks Commission to establish, through a public-private partnership, the Henrietta Lacks Life Sciences Center in Halifax County as a cancer research and treatment center designed to (i) transform and accelerate cancer research and treatment through the use of biodata tools, (ii) provide tailored cancer treatment medicine to an underserved portion of rural Southern Virginia, and (iii) incubate new biotech businesses across the Southside Virginia region. The bill has an expiration date of July 1, 2021. 

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Expansion Priority

By Julie Carey - NBC4

Ralph Northam says he is working on an ambitious legislative agenda.

"I think the advantage I have coming in as 73rd governor is that I've been here for 10 years. I have relationships with people on both sides of aisle. They know how I like to do things," Northam told News4 in his first broadcast interview of the new year.

Northam insisted his landslide victory -- fueled by anger towards President Trump -- is a mandate for his top legislative priority: Medicaid expansion.

"No family in Virginia should be one medical illness away from financial demise so, Medicaid expansion is very important and I will do everything I can to make that happen," Northam said.

Read the full article.

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HHS Appointments

Governor-Elect Ralph Northam has announced key appointments for senior leadership positions within the Health and Human Resources secretariat.

  • Daniel Carey, M.D., Secretary of Health and Human Resources
  • Gena Boyle Berger, Deputy Secretary of Health and Human Resources
  • Marvin Figueroa, Deputy Secretary of Health and Human Resources
  • Jennifer Lee, M.D., Director, Virginia Department of Medical Assistance Services
  • David Brown, Director, Virginia Department of Health Professions

Read the full press release with appointee biographies.

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National News

Technology for Treatment

By Tony Pugh - Government Technology

For President Donald Trump’s national emergency on opioid abuse to get traction in Appalachia and the rural South, the treatment effort will have to overcome some stubborn logistical barriers — and an obscure legal hurdle complicated by the president’s own push to reduce regulatory burden.

A shortage of treatment options, transportation limitations and widespread poverty have made opioid abuse hard to stop and even tougher to treat in rural areas where the problem has hit hardest.

To help make anti-addiction medications more available in rural areas, Trump’s emergency declaration called for expanding “telemedicine” services that allow addiction specialists to treat rural patients remotely through video consultations rather than in-person visits.

The National Institutes of Health is even funding a $1.7 million study of a mobile phone and tablet app called “emocha” that could help doctors remotely monitor rural patients’ adherence to daily drug treatments that help fight opioid addiction.

Read the full article.

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Insurers Narrow Coverage

By Tara Bannow - Modern Healthcare

Critical-access hospital Margaret Mary Health in Batesville, Ind., always has its imaging machines plugged in and waiting in case a stroke or trauma patient comes through the door. That can drive up costs for imaging services compared to free-standing imaging centers, which typically operate on set hours and don't handle emergency patients. 

As insurers become more selective about where they'll cover care, rural hospitals say they're disproportionately harmed. Lost revenue from imaging often represents a sizable chunk of their bottom lines. Since many small communities don't have free-standing imaging clinics, the new insurer policy forces patients to travel for those services. 

Read the full article.

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Rural Dementia

By Robert Preidt - Medline Plus

While rates of mental decline and dementia have dropped among American seniors overall, they remain higher in rural areas than in cities, a new study finds.

"The incidence of dementia is expected to double by 2050, largely because of the aging cohort of baby boomers," said senior investigator Regina Shih, of the Rand Corp., in Santa Monica, Calif. "This is the first study to report a rural-urban differential that behooves the scientific and clinical community to address the attendant factors that confer higher risk for dementia in rural seniors," Shih added.

In 2010, rates  of mental decline without dementia were 16.5 percent in rural areas and just under 15 percent in cities, while rates of dementia were about 5 percent in rural areas and 4.4 percent in cities.

Read the full article.

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The Dollar General Economy

By Frank Morris - NPR

The retail economy in rural America has been rough for decades. But where thousands of stores have closed in recent years, Dollar General is thriving, sometimes at the expense of local shops. Dollar Generals are discount stores that sell goods from hand tools to hot dogs. They're reshaping the retail landscape in small towns. And making lots of friends — and enemies — in the process.

When Dollar General moves into a place like Cawker City, Kan., it brings more than cheap merchandise. Cawker City — a town of about 450 people in the remote north central part of the state — lost its last grocery store years ago. Longtime resident Linda Clover says having food for sale in town again is a lifeline for the town's substantial elderly population. She says the new store is both the retail and social hub of her declining little town.

Dollar General is the biggest of the so-called dollar store chains. As is sometimes misconstrued, its merchandise is not restricted to a $1 price tag, unlike at some of the other "dollar store" chains. Chris Merritt, with the Illinois Institute for Rural Affairs, says Dollar General has had a profound impact on rural America.

Read the full article.

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Mark Your Calendar

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

February 6-8: Rural Health Policy Institute - Washington, DC
March 3: Educational Forum on Prescription Drug Abuse - Martinsville
March 4: Educational Forum on Prescription Drug Abuse - Roanoke
April 15-17: MATRC Annual Telehealth Summit - Hershey, PA
May 8: Health Equity Conference - New Orleans, LA
May 8: Rural Medical Education Conference - New Orleans, LA
May 8-11: Annual Rural Health Conference - New Orleans, LA
May 8-11: Rural Hospital Innovation Summit - New Orleans, LA

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Resources

Dental Safety Net
List of clinics in Virginia by locality. 

Chronic Disease in Rural America
This new guide provides an overview of chronic disease generally as well as specific conditions, including heart disease and stroke, cancer, diabetes, chronic respiratory conditions, arthritis, and HIV/AIDS. 

Rural Aging in Place Toolkit
This new toolkit compiles resources and model programs on Aging in Place. Created in collaboration with the University of Minnesota Rural Health Research Center, this toolkit is designed to guide you through creating a sustainable program from development through evaluation. 

Model Program: COPD Re-admission Prevention Program
Genesis HealthCare System, Zanesville, Ohio, created a post-discharge care coordination program with impact not only on readmission rates, but access to acute and chronic care. 

Model Program: Diabetes and Heart Disease Intervention Program
A program based on the CDC's National Diabetes Prevention Program targets rural Mississippi residents at risk of developing type 2 diabetes and heart disease and helps them lose weight and make lifestyle changes. 

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Funding Opportunities

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

Offender Reentry Program
Grants to expand substance use disorder (SUD) treatment and related recovery and reentry services to sentenced adult offenders/ex-offenders with a SUD and/or co-occurring substance use and mental disorders, who are returning to their families and community from incarceration.
Application Deadline: Jan 26, 2018 

Community Access to Child Health (CATCH) Planning and Implementation Grants
Funding to support pediatricians and fellowship trainees in the initial planning and/or pilot stage of implementing innovative community-based projects to increase children's access to medical homes, immunization services, and specific health services not otherwise available.
Application Deadline: Jan 31, 2018 

Community Access to Child Health (CATCH) Resident Grants Program
Grants to support pediatric residents in the planning of community-based child health initiatives that increase children’s access to medical homes, immunization services, and specific health services not otherwise available.
Application Deadline: Jan 31, 2018 

Exploratory/Developmental Surgical Disparities Research (R21)
Grants to support developmental and exploratory research focused on understanding and addressing disparities in surgical care and outcomes in minority and health disparity populations.
Letter of Intent (Optional): May 7, 2018
Application Deadline: Jun 7, 2018 

Discount for Rural Health Coding and Billing Specialist Online Course
Offers a $200 discount on an online self-study course for rural healthcare professionals to attain certification as a Rural Coding and Billing Specialist.
Applications accepted on an ongoing basis 



Sojourns Scholar Leadership Program
Supports innovative clinical, research, education, or policy projects in the field of palliative care and implementation of a leadership career plan for outstanding emerging leaders.
Geographic coverage: Nationwide
Letter of Intent (Required): Feb 1, 2018
Application Deadline: Jun 1, 2018 

Rural Health Network Development Planning Program 
Up to 20 rural public and nonprofit entities forming a consortium of three or more organizations will be awarded total funding of $2 million to assist in the planning and development of an integrated health care network at the local level.  By emphasizing the role of networks, the program creates a platform for medical care providers, social service providers, and community organizations to coalesce key elements of a rural health care delivery system for the purpose of improving local capacity and coordination of care.  Previous Network Planning grantees have focused on behavioral health, care coordination, infrastructure, health information technology, and health education.  
Deadline: February 23

Developmental-Behavioral Pediatrics Training Program
Funding to train healthcare professionals to use valid and reliable screening and diagnostic tools, in addition to providing evidence-based interventions for children with autism spectrum disorder and other developmental disabilities.
Application Deadline: Feb 20, 2018 

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