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July 6, 2023
What's New
FEMA: Prepare for Extreme Heat. With global climate watchers reporting Tuesday, July 4 as the hottest on record, the Federal Emergency Management Agency (FEMA) is striving for widespread awareness and preparation for more intense temperatures. The first step is knowing who is most vulnerable in each community. In rural areas, manual laborers are the most visible but older adults – especially those with medical conditions – who live alone are at increased risk and may go unnoticed. One important tip is to build a support network, check on neighbors, and create a plan for emergencies like a power outage. See the Funding section below for a new grant opportunity from FEMA.
Overdose Deaths Related to Xylazine on the Rise. Last week, the Centers for Disease Control and Prevention released data showing a significant increase – 276 percent in 21 jurisdictions from 2019 to 2022 – in overdose deaths involving Xylazine, a nonopioid sedative that’s been detected in illicitly manufactured fentanyl drug products. Because of inconsistent testing, the numbers are likely underestimated; in 2022, the Drug Enforcement Administration reported 23 percent of seized fentanyl powder and 7 percent of seized fentanyl pills contained xylazine.
Characterizing Social Insecurity in a Rural North Carolina Emergency Department. From May-June 2018, researchers collected 312 survey responses from patients at a rural emergency department and identified three key determinants of social insecurity: 1) access to transportation, 2) food insecurity, and 3) exposure to violence. Findings show significant differences among the three major racial/ethnicity groups represented – Native Americans (34.3 percent), Blacks (33.7 percent), and Whites (27.6 percent).
Obstetric Volume and Severe Maternal Morbidity Among Low-Risk and Higher-Risk Patients Giving Birth at Rural and Urban US Hospitals. In this cross-sectional study of more than 11 million births in urban counties and 519, 953 births in rural counties, researchers identify hospital factors associated with severe maternal morbidity.
The Impact of COVID-19 Funding on Profitability of Critical Access Hospitals. Using data from the Centers for Medicare & Medicaid Services (CMS) researchers report on the challenges faced by CMS-designated Critical Access Hospitals during the federal Public Health Emergency, and the impact of special funding on their financial performance. The report is the work of the Flex Monitoring Team, a consortium of researchers from the Universities of Minnesota, North Carolina-Chapel Hill, and Southern Maine, funded by the Federal Office of Rural Health Policy to evaluate the impact of the Medicare Rural Hospital Flexibility Grant Program (the Flex Program).
GAO Calls for HIT Advisory Nominations – Submit by July 31. The Government Accountability Office (GAO) expects to appoint two or three new members for it’s Health Information Technology Advisory Committee. The appointments will be effective January 1, 2024, and serve a three-year term.
Ongoing: Updates to Requirements for Buprenorphine Prescribing. As announced by the Substance Abuse and Mental Health Services Administration in January 2023, clinicians no longer need a federal waiver to prescribe buprenorphine for treatment of opioid use disorder. Clinicians will still be required to register with the federal Drug Enforcement Agency (DEA) to prescribe controlled medications. Beginning on June 27, the DEA registration will require applicants – both new and renewing – to affirm they have completed a new, one-time, eight-hour training. Exceptions for the new training requirement are practitioners who are board certified in addiction medicine or addiction psychiatry, and those who graduated from a medical, dental, physician assistant, or advanced practice nursing school in the U.S. within five years of June 27, 2023. Rural Health Clinics (RHCs) still have the opportunity to apply for a $3,000 payment on behalf of each provider who trained between January 1, 2019 and January 25, 2023 (when Congress eliminated the waiver requirement). Approximately $900,000 in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted. Send questions to DATA2000WaiverPayments@hrsa.gov.
COVID-19 Resources
Provider Relief Fund Reporting Period 5. The Provider Relief Fund (PRF) Reporting Portal is open from July 1 to September 30, 2023 at 11:59 p.m. ET. Providers who received one or more PRF (General or Targeted) and/or American Rescue Plan Rural payments exceeding $10,000, in the aggregate, from January 1, 2022 to June 30, 2022 must report on their use of funds during Reporting Period 5 to comply with PRF Reporting Requirements. More information and resources can be found on the PRF Reporting webpage.
HHS/DoD National Emergency Tele-Critical Care Network. A joint program of the U.S. Department of Health & Human Services (HHS) and the U.S. Department of Defense (DoD) is available at no cost to hospitals caring for COVID-19 patients. Teams of critical care clinicians - critical care physicians, nurses, respiratory therapists, and other specialized clinical experts – are available to deliver virtual care through telemedicine platforms, such as an app on a mobile device. Hear from participating clinicians, and email to learn more and sign up.
Mobilizing Health Care Workforce via Telehealth. ProviderBridge.org was created through the CARES Act by the Federation of State Medical Boards and HRSA’s Office for the Advancement of Telehealth. The site provides up-to-date information on emergency regulation and licensing by state as well as a provider portal to connect volunteer health care professionals to state agencies and health care entities.
Online Resource for Licensure of Occupational Therapists, Physical Therapists, Psychologists, and Social Workers. The site provides up-to-date information on emergency regulation and licensing in each state.
Funding and Opportunities
VA Grants for Transportation of Veterans in Highly Rural Areas – July 30. Grants from the U.S. Department of Veterans Affairs (VA) will go to new organizations providing transportation to VA medical centers. Eligible applicants are VA-recognized veteran service organizations and state veteran entities that do not currently have a grant under this program.
FEMA Training for Community Preparedness – August 9. The Federal Emergency Management Agency (FEMA) welcomes applications from state, local, tribal, and territorial governments as well as eligible non-profit organizations including colleges and universities. Grantees will develop and deliver a community-level training curriculum that incorporates FEMA’s strategic priorities for disaster response and recovery. This year, for the first time, FEMA designed the grant with two distinct focus areas, "Build Tribal Capacities to Improve Readiness and Resilience" and "Rural Preparedness for Equitable Outcomes." (See page 6 in the Notice of Funding Opportunity.) A primary objective is engaging entire communities, with representation from underserved segments, for inclusion on the emergency management team. Examples of learning solutions include online training, in-person instructor-led training, synchronous, virtual instructor-led training, asynchronous, virtual instructor-led training, or facilitated workshops and seminars.
CMS Seeking Researchers for Health Data Access Program – August 15. The Centers for Medicare & Medicaid Services (CMS) will fund three (3) individual researchers who will focus on minority health research through the CMS Virtual Research Data Center (VRDC). The program supports specific applied research projects that use CMS data to identify, document, assess, and evaluate health disparities among Medicare, Medicaid, and CHIP enrollees. These researchers will conduct health services research focusing on, but not limited to, racial and ethnic minority groups; people with disabilities; members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community; individuals with limited English proficiency; individuals residing in rural areas; and individuals adversely affected by persistent poverty or inequality.
USDA Grants for Education and Research at 1890 Land-Grant Institutions – August 30. The U.S. Department of Agriculture (USDA) aims to advance cultural diversity in the food and agricultural sciences workforce by attracting and educating more students from underrepresented groups. Health-related priorities for the $28 million going to universities designated as 1890 Land-Grant Institutions include food and water quality, nutrition affecting obesity, family and consumer sciences, and expanded opportunities for rural small business.
EPA Solar for All Competition – September 26. As part of the Inflation Reduction Act passed by Congress last year, the U.S. Environmental Protection Agency (EPA) will invest a total of $7 billion to help finance greenhouse gas- and air pollution-reducing projects at the community level. An expected 60 awards – each ranging from $25 million to $400 million – will go to states, territories, Tribal governments, municipalities, and eligible nonprofit recipients. Grantees will use funds to expand existing low-income solar programs or design and deploy new Solar for All programs nationwide.
Rural Health Research
Research in this section is provided by the HRSA/FORHP-supported Rural Health Research Gateway. Sign up to receive alerts when new publications become available.
Spatial Clustering of COVID-19 Mortality Rates Across Counties and by Noncore, Micropolitan, and Metropolitan County Characteristics, December 2020–January 2021. Among the key findings from the RUPRI Center for Rural Health Policy Analysis: a higher percentage of clusters of high mortality rates were in noncore and micropolitan counties; these clusters had the highest average nursing home bed density and the highest average proportion of Medicare beneficiaries with multiple chronic conditions.
Differences in the Merit-Based Incentive Payment System (MIPS) Performance of Clinicians in Metropolitan and Nonmetropolitan Counties in 2018. The Merit-based Incentive Payment System (MIPS) is a pay-for-performance system for clinicians under the Medicare Quality Payment Program designed to reward clinicians providing higher quality of care and lower costs. This study from the RUPRI Center for Rural Health Policy Analysis compared clinicians' MIPS performance in 2018 based on their practice location, size, and minority population proportion.
Policy Updates
Send questions to ruralpolicy@hrsa.gov.
Listening Session: Partnership for Quality Management – Monday, July 10 at 2:00 pm ET. Stakeholders in ongoing efforts to set measures for health care quality are encouraged to attend this two-hour listening session. Contracted by the Centers for Medicare & Medicaid Services to continue the work previously conducted by the Measure Applications Partnership, Batelle will discuss the Guidebook of Policies and Procedures for Pre-Rulemaking Measure Review and requests comments on the new process for quality measurement by July 21. The listening session will include discussion of the new committees, which will have a nomination deadline of July 30.
Medicare Promoting Interoperability Program Hardship Exception Application – July 31. Critical Access Hospitals (CAHs) and others designated by the Centers for Medicare & Medicaid Services may be exempted from the Medicare Promoting Interoperability payment adjustment if they can show that compliance with the requirement for being a meaningful EHR user would result in a significant hardship. Eligible hospitals and CAHs may submit a hardship exception application each year for a maximum of 5 years.
Comments Requested: Proposed Changes to Medicare Home Health Program – August 29. On June 30, 2023, the Centers for Medicare & Medicaid Services (CMS) issued the calendar year 2024 Home Health Prospective Payment System Rate Update proposed rule, which would update Medicare payment policies and rates for home health agencies. This rule includes proposals to apply a permanent prospective payment adjustment to the home health 30-day period payment rate to account for increases in aggregate expenditures, as a result of the difference between assumed behavior changes and actual behavior changes, due to the implementation of the Patient-Driven Groupings Model and 30-day unit of payment. CMS is also proposing several revisions to the Medicare provider enrollment to clarify certain aspects of the provider enrollment process and is soliciting comments regarding access to home health aide services.
Learning Events and Technical Assistance
HRSA Strategy to Address Intimate Partner Violence - Wednesday, July 12 from 1:00-2:00pm ET. Join HRSA's Office of Women's Health, Bureau of Primary Health Care, and HIV/AIDS Bureau for a one-hour webinar, "Overview of the 2023 - 2025 HRSA Strategy to Address Intimate Partner Violence (IPV)." The webinar will outline the Strategy’s aims, objectives, and activities for HRSA bureaus and offices to prevent and respond to IPV. View and download the Strategy from the OWH IPV webpage.
AgriSafe Mental Health: QPR for Farmers and Farm Families – Wednesday, July 12 at 1:00 pm ET. Over the last decade, farmers and farm families have experienced increasing pressures resulting in high levels of stress, mental health, and suicide. QPR training teaches laypeople and professionals to recognize and respond to mental health crises using the approach of Question, Persuade, and Refer. In this 1.5 hour QPR training we will provide: information on the unique challenges farmers face that can lead to stress, depression, and suicide, examples implementing each QPR component with someone at risk for suicide, and information on how to help someone at risk of suicide.
Telehealth Implementation of Trauma-Focused Treatment – Wednesday, July 12, 2023 at 3:00 pm ET. Dr. Regan Stewart and Dr. Rosaura Orengo-Aguayo will present on telehealth implementation of trauma-focused treatment to increase equity in access to care for underserved youth in the US and Puerto Rico. Hosted by the HRSA Telehealth Centers of Excellence, this webinar will explore: (1) ways to increase equity in access to telehealth services for child trauma and treatment, (2) implementation and dissemination efforts for providing training and technical assistance for trauma-focused telehealth programs in low resourced contexts, and (3) clinical perspectives of implementing telehealth with trauma-exposed youth. Please visit the HRSA Telehealth Centers of Excellence website to learn more about this project.
HRSA Virtual Job Fair 101 (Health Care Facilities/Sites Only) – Monday, July 17 at 2:00 pm ET. This webinar is for National Health Service Corps or Nurse Corps approved health care facilities (sites) interested in attending a future Virtual Job Fair. Attendees will learn about the Virtual Job Fair, how to increase chances of selection, find out what to expect during the event, and more.
Accessing Emergency Preparedness and Response Resources for Rural Communities – Tuesday, July 18 at 1:00 pm ET. The Rural Health Information Hub hosts this one-hour session, with officials at federal, state, and local levels sharing expertise and resources for preparedness, response, and recovery.
CMS National Stakeholder Call – Tuesday, July 18 at 1:00 pm ET. Leaders at the Centers for Medicare & Medicaid Services (CMS) will hold the third quarterly call for national and local stakeholders to discuss progress of the CMS Strategic Plan.
Resource of the Week
ASTHO on Rural Maternal Health. The Association of State and Territorial Health Officials (ASTHO) presents state-level strategies to address loss of obstetric services and improving financial barriers to care.
Approaching Deadlines
HRSA Rural Maternity and Obstetrics Management Strategies Program – July 7
NIH Community Level Interventions to Improve Minority Health – July 7
NIH Emergency Award: RADx-UP Research on COVID-19 Interventions – July 10
CDC Social Determinants of Health Accelerator Plans – July 11
CMS Minority Research Grant Program – July 12
HRSA Faculty Loan Repayment Program – July 13
HRSA Substance Use Disorder Treatment and Recovery Loan Repayment Program – July 13
HRSA Sites for Substance Use Disorder Treatment and Recovery Loan Repayment Program – July 13
HRSA Behavioral Health Workforce Education and Training – Children, Adolescents, and Young Adults Program for Professionals – July 14
HRSA Maternity Care Nursing Workforce Expansion Program – July 14
HRSA Medical Student Education Program for Underserved States – July 14
ACL Tribal Long Term Services and Support Resource Center – July 17
DOL Critical Sector Job Quality Grants – July 17
HRSA Enhanced Healthy Start Initiative – July 17
National Environmental Public Health Internship Program – July 17
Region IV Public Health and Primary Care Leadership Institute – July 17
USDA Native Community Development Financial Institution Relending Demonstration Program – July 17
HHS Healthy Families Community-Based Perinatal Health Initiative – July 18
HRSA Pediatric Specialty Loan Repayment Program – July 20
Comments Requested: New Partnership for Quality Measurement – July 21
DRA Delta Leadership Institute Executive Academy – July 26
DHS Rural Emergency Medical Communications Demonstration Project – July 28
VA Grants for Transportation of Veterans in Highly Rural Areas – July 30
ACF Alaska Native Tribal Resource Center on Domestic Violence – July 31
GAO Calls for HIT Advisory Nominations – July 31
Hardship Exceptions for Medicare Promoting Interoperability Program – July 31
Nominations for GAO Health Information Technology Advisory Committee – July 31
HHS Center for Indigenous Innovation and Health Equity – August 1
EPA Brownfields Job Training Grants – August 2
CDC Foundation Seeking Community Data for Overdose Prevention – August 4
ACL Alzheimer’s Disease Programs Initiative – States and Community Grants – August 7
Department of Education Full-Service Community Schools Program – August 8
ACF Culturally Specific Family Violence Prevention – August 11
National Medical Fellowships Health Equity Leaders – August 11
Berkley Rural Public Health Master’s Program – August 13
Dept of Transportation Rural and Tribal Assistance Pilot Program – August 14
CMS Seeking Researchers for Health Data Access Program – August 15
Comments Requested: ACL Updates Older Americans Act – August 15
Rural Healthcare Provider Transition Project – August 15
Comments Requested: CMS Updates Policy for End Stage Renal Disease – August 25
USDA Grants for Education and Research at 1890 Land-Grant Institutions – August 30
EPA Community-Based Research to Mitigate Environmental Health Disparities – August 31
NIH Research to Improve Native American Health (AIDS Related) – September 7
NIH Tobacco Control Policies to Promote Health Equity – September 8
NRHA Rural Health Fellows Program – September 14
EPA Solar for All Competition – September 26
NIH Assessing Real-World Effectiveness of Telehealth Guided Provider-to-Provider Communication in Rural Communities – October 5
UMMC Caregiver University for Alzheimer’s Support – Quarterly deadlines until October 10
American Psychological Foundation Grant for Rural First Responders Mental Health Interventions – October 15
NIH Pilot Interventions to Integrate Social Care and Medical Care for Diabetes, Digestive, and Kidney Diseases – October 19
NIH Researching Social Networks to Promote Behavior Change – November 3
Ongoing Opportunities
HRSA Needs Rural Reviewers for Grant Applications
Economic Development Administration Public Works/Economic Assistance Program (CARES Act Funding)
Extended Public Comment Period for FCC’s COVID-19 Telehealth Program
FCC Affordable Connectivity Program for Broadband Service
SAMHSA 988 Suicide and Crisis Lifeline Volunteer and Job Opportunities
USDA Emergency Rural Health Care Grants (Track One only) – September 2023 or until funds run out
ACF Low Income Home Energy Assistance Program
ACF Rural Community Development Program for Rural Water Systems
Addiction Policy Forum: Sites for Anti-Stigma Pilot
AgriSafe Mental Health Training for Agricultural Producers & Families
AHRQ Health Services Research Demonstration and Dissemination Grants – October 2023
American Association of Birth Centers (AABC) Foundation - Accreditation Grants
American Heart Association Rural Health Care Outcomes Accelerator
American Indian Public Health Resource Center Technical Assistance
AmeriCorps American Connection Corps for Broadband in Rural Areas
Appalachian Regional Commission J-1 Visa Waivers for Doctors
ASA Rural Access to Anesthesia Care Scholarship
Burroughs Wellcome Fund Seed Grants for Climate Change and Health – Quarterly through August 2023
CDC Direct Assistance to State, Tribal, Local, and Territorial Health Agencies
CDC Training Pediatric Medical Providers to Recognize ACEs
CORH Targeted Technical Assistance for Rural Hospitals Program
Delta Region Community Health Systems Development Program
Delta Regional Authority Community Infrastructure Fund
Delta Doctors J-1 Visa Waiver Program
Department of Commerce: Economic Development Assistance Programs
DRA Technical Assistance for Delta Region Community Health Systems Development
EPA Drinking Water State Revolving Fund
EPA Water Infrastructure and Innovation Program
FEMA/SAMHSA Post-Disaster Crisis Counseling Assistance and Training Program
GPHC & RWJF: Rapid Cycle Research and Evaluation Grants for Cross-Sector Alignment
HRSA Seeking Nominations for Migrant Health Advisory
HRSA Technical Assistance for Look-Alike Initial Designation for the Health Center Program
Housing Assistance Council: Housing Loans for Low-Income Rural Communities
HUD Distressed Cities and Persistent Poverty Technical Assistance Program
HUD Hospital Mortgage Insurance Program
IHS Tribal Forensic Healthcare Training
IHS/DOD Medical Supplies and Equipment for Tribes (Project TRANSAM)
NARHC Certified Rural Health Clinic Professional Course
National Health Resource Center on Domestic Violence Technical Assistance
Native Americans into Medicine
Host Sites for National Environmental Public Health Internship
NIH Addressing the Impact of Structural Racism and Discrimination – Various dates until October 2025
NIH Native American Research Centers for Health – Various dates until July 2026
NIH Project Talk Initiative Host Site Applications
NIH Researching Mental Health Practices in Low-Resource Settings – September 2024
NIH Researching Social, Behavioral, and Economic Impact of COVID-19 in Underserved/Vulnerable Populations – September 2024
NIH Researching the Role of Work in Health Disparities – Various dates until September 2024
NIH Special Interest Research – Pandemic Impact on Vulnerable Children and Youth – May 2024
NIH Researching Barriers to Care for HIV-Associated Comorbidities – May 2025
NIH Research to Address Vaccine Hesitancy in Health Disparity Populations – June 2026
Nominations for Federal Advisory Commission on HIV, Viral Hepatitis, and Sexually Transmitted Diseases
NRHA Chief Nursing Officer Certification Program for Rural Hospitals
Oweesta Native CDFI Loan Funds and Technical Assistance
Primary Care Development Corporation Community Investment Loans
Rural Community Assistance Corporation Community Facility Loans for Western States and Pacific Islands
Rural Community Assistance Corporation Environmental Infrastructure Loans for Western States
Rural Graduate Medical Education Planning and Development
RTT Collaborative: Rural Training Track Directors University
RWJF Investigator-Initiated Research to Build a Culture of Health
RWJF Pioneering Ideas Brief Proposals
SAMHSA Crisis Counseling Assistance and Training Program for Communities Post-Disaster
SAMHSA Training to Provide Medication Assisted Treatment
SBA Guaranteed Loans for Small Business
Southeast Rural Community Assistance Loans
Tribal Grant Writing Training
Treasury Department Opportunity Zone Economic Development Program
United South and Eastern Tribes, Inc Tribal Health Program Support
USDA Community Facilities Program
USDA Community Food Projects Technical Assistance
USDA Drinking Water and Waste Disposal for Rural and Native Alaskan Villages
USDA Economic Impact Initiative Grants
USDA Emergency Community Water Assistance Grants
USDA Healthy Food Financing Initiative Technical Assistance
USDA Multifamily Housing Loan Guarantees
USDA Intermediary Relending Program
USDA Rural Business Development Grants
USDA Rural Business Investment Program
USDA Rural Energy Savings Program
USDA SEARCH – Special Evaluation Assistance for Rural Communities and Households (for Water/Waste Projects)
USDA Summer Food Program
USDA Technical Assistance for Healthy Food Financing Initiative
USDA Telecommunications Infrastructure Loans and Loan Guarantees
USDA Funding for Rural Water and Waste Disposal Projects
USDA Water and Waste Disposal Grants to Alleviate Health Risks on Tribal Lands and Colonias
USDOT Rural Opportunities to Use Transportation for Economic Success (R.O.U.T.E.S)
Veterans Affairs Health Professional Scholarship Program
Veterans Affairs Virtual Living Room - Using Technology to Address the Critical Healthcare Needs of Veterans in Rural Areas
WWAMI Area Health Education Center Scholars Program
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