VRHA Weekly Update
In this Issue January 29, 2018

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Winter newsletter





Despite Thursday’s vote, Medicaid Expansion is still a key budget item.  Expansion (with a provider assessment) results in over $400 million in state savings for the biennium. Those savings are incorporated throughout the budget.

VRHA is asking you to promote a straightforward Medicaid Expansion through the budget process. While there may not be other opportunities for public testimony at a committee hearing, legislators must hear our voices through phone calls, visits, social media and local press.  EVERY legislator will be voting on the state’s budget for the next biennium by the last day of session on March 10. They need to hear from you!

In addition – we must focus on members of the House Appropriations and Senate Finance HHR Subcommittees. Please take a moment and email or call your Delegate and Senator as well as the members of the key committees listed below to express your opinion on why Medicaid expansion is important to you and to your community. 

Visit the General Assembly website to find contact information. Here are some key points to use.

  • House Appropriations HHR: Dels. Garrett (Chair), Ingram, Landes, Stolle, Pillion, Sickles, James, Aird
  • Senate Finance HHR: Sens. Hanger (Chair), Howell, Norment, Newman, Barker, Dunnavant, Stuart, Dance

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Rx Abuse Forums

VRHA is partnering with One Care of Southwest Virginia to offer Prescription Drug Abuse Forums.  The spring events are scheduled for March 3rd in Martinsville and March 4th in Roanoke.

See the event webpage for details.

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Members in the News

By Terran S. Young - Coalfield Progress

”How do you tell a story that no one wants to hear?”

That is what [VRHA member] Wendy Welch asks about her new book Fall or Fly: The Strangely Hopeful Story of Foster Care and Adoption in Appalachia, which came out on Jan. 3. She describes the book as “bleakly honest but not bleak.”

Welch, who owns Tales of the Lonesome Pine bookstore in Big Stone Gap with her husband Jack Beck, has lived in the region for about 35 years. She said it was her book Public Health in Appalachia, which discusses the disproportionately high amounts of poverty, preventable illnesses and hunger in Appalachia, that laid the groundwork for Fall or Fly.

Read the full article.

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Virginia News

Expansion Bills Killed

By Gregory  S. Schneider - Washington Post

If this is the year Virginia finally expands Medicaid, the effort got off to a rough start Thursday when a GOP-controlled Senate committee killed a package of bills on a party-line vote.

The chairman of the Senate Education and Health Committee warned several times before the vote that “this is only round one” of a long process. And the key battle over Medicaid is likely to come in the still-developing budget process in the House of Delegates.

But Thursday’s committee action highlighted the party divide that remains even after the issue of expanding Medicaid helped drive big Democratic wins in the fall statewide elections. Polls show a majority of Virginians support expanding access to health care, and the hospital industry and several regional chambers of commerce have come out in favor of expansion.

Read the full article.

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Fix for Patrick

By Bob Brown - Richmond Times-Dispatch

The Virginia House of Delegates voted unanimously Monday to pass an emergency fix meant to help reopen a hospital in rural Virginia a week after Senate Democrats blocked the measure to pressure a Republican senator over Medicaid expansion.

The bill would extend the license of a shuttered hospital in Patrick County in the hopes of speeding up the process of finding a new operator and reopening it. The Pioneer Community Hospital of Patrick County, the county’s only hospital, announced it was closing last September due to financial difficulties.

Read the full article and related story from the Roanoke Times.

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Rural Caucus Leaders

From the Va Rural Center

The Rural Caucus for the General Assembly of Virginia elected its two key leaders for the 2018 session in its first meeting of the year, the Center for Rural Virginia announced. Senator Frank Ruff will serve as Chairman and Del. Keith Hodges as Vice Chairman.

“We’re very excited to have these two accomplished individuals leading the Rural Caucus into 2018, building on recent successes,” said Kristie Helmick Proctor, Executive Director of the Center for Rural Virginia, which supports the Rural Caucus. “With deep rural roots, Senator Ruff and Delegate Hodges are looking forward to working with other members of the organization, the General Assembly and Governor’s office to boost prosperity across the rural areas of the Commonwealth.”

Read the full article.

Legislation Watch

Recently introduced bills which could have an impact on health and healthcare in rural Virginia:

HB1524: Board of Medicine; regulations related to retention of patient records; time. Directs the Board of Medicine to amend regulations governing retention of patient records by health practitioners

HB1532: Health education; prescription drugs. Requires the health education program required for each public elementary and secondary school student to include an age-appropriate program of instruction on the safe use of and risks of abuse of prescription drugs

HB1538: Global reform waiver. Directs the Secretary of Health and Human Resources to apply for a waiver to allow for transformation of the Commonwealth's existing program of medical assistance services through the implementation of a person-centered model of medical assistance services that improves outcomes and reduces costs

HB1584: Health insurance; balance billing for ancillary services. Prohibits an out-of-network health care provider from charging a covered person who is insured through a health benefit plan an amount for ancillary services that is greater than the allowed amount the carrier is obligated to pay to the covered person.

HB 1604Health instruction; mental health. Requires health instruction to incorporate standards that recognize the multiple dimensions of health by including mental health and the relationship of physical and mental health so as to enhance student understanding, attitudes, and behavior that promote health, well-being, and human dignity. The bill also directs the Board of Education to review and update the health Standards of Learning for students in grades nine and 10 to include mental health. 

HB 1606: Certificate of public need; psychiatric beds and services. Eliminates the requirement for a certificate of public need for certain projects involving mental hospitals or psychiatric hospitals and intermediate care facilities established primarily for the medical, psychiatric, or psychological treatment and rehabilitation of individuals with substance abuse.

SB933: Health insurance; copayments for prescription drugs; disclosures. Prohibits any contract between a health carrier or its pharmacy benefits manager and a pharmacy or pharmacist from containing a provision that requires an enrollee to make a copayment for a covered prescription drug in an amount that exceeds the lesser of (i) the applicable copayment for the prescription drug or (ii) the cash price the enrollee would pay for the prescription drug if the enrollee purchased the prescription drug without using the enrollee's health plan.

SB953: Health instruction; mental health. Requires health instruction to incorporate standards that recognize the multiple dimensions of health by including mental health and the relationship of physical and mental health so as to enhance student understanding, attitudes, and behavior that promote health, well-being, and human dignity. 

SB956 & HB1549:  Virginia Health Care Access Program. Establishes the Virginia Health Care Access Program (the Program) to (i) develop and fund programs to improve access to health care services for recipients of medical assistance and other medically needy, low-income underinsured and uninsured residents of the Commonwealth; (ii) support the financial stability of rural hospitals and access to health care in rural areas of the Commonwealth; and (iii) fund programmatic and financial support for health professional education provided by public and private teaching hospitals within the Commonwealth.

SB964: Health insurance; catastrophic health plans. Requires health carriers to offer catastrophic plans in the individual market in every locality in the Commonwealth in which they offer any health benefit plan.

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National News

Aging in Rural America

From Tivity Health

Academic, business, and healthcare leaders from across the country gathered in Washington, D.C. to bring focus to a new approach to solving the challenges facing those aging in rural communities. The discussion comes at an important time. Each day more than 10,000 Americans are turning 65, and the total number of adults over 65 is increasing more rapidly in rural areas than in the nation overall. Today one in four older adults lives in a small town or other rural area.

Panelists emphasized problems such as lack of transportation, sparser healthcare services, minimal access to high-speed broadband service, social isolation, and the macro impact of these barriers on health and quality of life.

Dr. Joe Coughlin, founder and director of the Massachusetts Institute of Technology AgeLab emphasized the challenge of building an age-ready nation. “From transportation, to infrastructure, to housing, all must be re-engineered to be ready to accommodate this massive aging population. Though many sectors of our economy will be seeing waves of retirements, this should be seen as an opportunity for workplaces to utilize the unique skills and institutional knowledge of older workers. In addition, companies from all sectors have an opportunity to introduce innovative products and services that will support the desire of this demographic to age in place in their community, whether that is in New York City or small-town America.” 

“A central point to remember in the crisis facing rural-dwelling older adults is that access to quality care, close to home, must be addressed to truly achieve better health outcomes,” said Alan Morgan, CEO of the National Rural Health Association. “Rural hospitals play a crucial role in delivering that care. Providing concrete solutions to healthcare workforce shortages is absolutely necessary for the health and economic vitality of rural communities.” 

Read the full article.

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Shutdown Deal

By Jessica Seigel - National Rural Health Association

The government shutdown ended after Senate Democrats and Republicans reached a deal on a short term funding package. The House quickly passed the legislation and sent it to the President's desk for a signature. The government shutdown began at midnight on Friday after members of the Senate could not break the 60-vote threshold necessary to pass a Continuing Resolution (CR) to keep the government open.

The CR that was passed only provides funding through midnight on February 8, leaving some concerned that we may be on the verge of a shutdown again in just a few weeks. Additionally, while the CR funds the Children's Health Insurance Program (CHIP) for six-years, it does not include any funding for Medicare Extenders or Community Health Centers. The funding for these programs, which are essential to ensuring accessible, affordable care for rural Americans, lapsed on October 1st without Congressional action.

NRHA will continue to monitor this situation and work to ensure that Medicare Extenders and Community Health Centers funding are included in any short or long term funding package.

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Tax Squeeze

By Wendell Potter - Jamestown Sun

One of the selling points for the tax bill President Trump signed into law a few weeks ago is that it will spur job growth because corporations will use money they otherwise would have paid in taxes to hire more workers.

But for rural areas and small towns, one provision of the new law may result in the closure of one of their biggest employers – their hospital.

Rural hospitals in general operate on much thinner margins than most big city hospitals, margins so thin that dozens have been forced to close in recent years. In fact, almost all the U.S. hospitals that have been shuttered in recent years have been in rural areas. A recent study by the North Carolina Rural Health Research Program found that 80 rural hospitals have closed since 2010 and that 673 more are vulnerable to closing. And that was before the tax bill was passed.

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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Implementing Medication-Assisted Treatment for Opioid Use Disorder in Rural Primary Care:  Environmental Scan
The two-volume report examines factors that may limit access to medication-assisted treatment (MAT) for opioid use disorder (OUD) in rural primary care settings. Three innovative models of care, including the Vermont Hub and Spoke model, Project ECHO (Extension for Community Health Care Outcomes) from New Mexico, and the Office-Based Opioid Treatment with Buprenorphine (OBOT-B) Collaborative Care Model from Massachusetts, may help overcome a number of the challenges faced when implementing MAT services in rural primary care. Peer-reviewed articles and grey literature on implementing MAT for OUD were examined. The second volume of the report includes links and descriptions to nearly 250 tools and resources to support the delivery of MAT in rural primary care settings.

About Half of Rural Counties Now Experiencing More Deaths than Births
Map showing natural decrease in population in rural counties, before and after 2010. Identifies rural counties that had a natural increase, that had a natural decrease in 2006-2009, and those with a natural decrease that was new since 2010. Based on population data from 2000 through 2016.

Communicating about Opioids in Appalachia: Challenges, Opportunities, and Best Practices
Describes how opioids are affecting Appalachia and offers suggestions on how community-based organizations can promote prevention and treatment, and eliminate the stigma of addiction.

Competence Revisited in a Rural Context
Results of a national survey of 171 undergraduate and graduate medical educators and practicing physicians, with the goal of developing a list of competency domains for working in rural communities and assessing their importance in education and practice.

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Funding Opportunities

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

Rita & Alex Hillman Foundation: Hillman Innovations in Care Program
The goal of the Hillman Innovations in Care Program, an initiative of the Rita & Alex Hillman Foundation, is to advance leading-edge, nursing-driven models of care that will improve the health and healthcare of vulnerable populations. The program seeks to support patient- and family-centered approaches that challenge conventional strategies, improve health outcomes, lower costs, and show potential for national replicability. The Foundation is particularly interested in the areas of maternal and child health, care of older adults, and chronic illness management. At least two grants of up to $600,000 are awarded each year to nonprofit organizations, government agencies, and faith-based organizations throughout the country.
The application deadline is March 5, 2018; invited full proposals will be due June 4, 2018.

Weyerhaeuser Family Foundation Children's Initiative
The Weyerhaeuser Family Foundation’s Children's Initiative provides support to direct service programs throughout the United States that create and promote stability, resilience, and healing for children who have witnessed domestic violence. Eligible programs must provide direct, age-appropriate services to children up to 14 years of age who have witnessed domestic violence, include a plan for an outcome-based assessment of the program activities, enhance the relationship between the child and parent or primary caregiver, and be a new program (within the first year of development). The average grant size is $25,000.
The deadline for Stage One Applications is March 1, 2018; invited Stage Two Applications are due August 1, 2018.

Garrett Lee Smith Campus Suicide Prevention Grant
Grants to develop a comprehensive, collaborative, and evidence-based approach to: (1) enhance mental health services for all college students, including those at risk for suicide, depression, serious mental illness, and/or substance use disorders that can lead to school failure; (2) prevent mental and substance use disorders; (3) promote help-seeking behavior and reduce negative public attitudes; and (4) improve the identification and treatment of at-risk college students so they can successfully complete their studies.
Application Deadline: Feb 20, 2018
Health Workforce Research Center Cooperative Agreement Program
Funding to support and disseminate research on trends in health workforce. In this cycle, two centers will be funded, one focused on health equity in health workforce education and training, and the other on behavioral health workforce.
Application Deadline: Apr 12, 2018

Pragmatic Clinical Studies to Evaluate Patient-Centered Outcomes
Funding for research that compares two or more alternatives for addressing prevention, diagnosis, treatment, or management of a disease or symptom; improving healthcare system-level approaches to managing care; or eliminating health or healthcare disparities.
Letter of Intent (Required): Feb 13, 2018
Application Deadline: May 16, 2018 

Robert Wood Johnson Foundation’s Change Leadership Programs
Four change leadership programs, designed by the Robert Wood Johnson Foundation to extend the influence and impact of leaders working to build a Culture of Health. The Interdisciplinary Research Leaders Program has a rural focus in 2018.
Application Deadline: Feb 21, 2018 

Rural PREP Microresearch Grants
Funding for locally generated and implemented, community-based research projects leading to local solutions to problems in underserved rural communities in the areas of primary care, population health, and workforce training.
Application Deadline: Mar 1, 2018 

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