HHS released the Rural Action Plan, the first HHS-wide assessment of rural healthcare efforts in more than 18 years and the product of HHS’s Rural Task Force, a group of experts and leaders across the department first put together by Secretary Alex Azar in 2019.
This action plan provides a roadmap for HHS to strengthen departmental coordination to better serve the millions of Americans who live in rural communities across the United States. Eighteen HHS agencies and offices took part in developing the plan, which includes 71 new or expanded activities for FY 2020 and beyond.
Efforts that will be undertaken in FY 2020 include nine new rural-focused administrative or regulatory actions, three new rural-focused technical assistance efforts, 14 new rural research efforts, and five new rural program efforts. These efforts build on 94 new rural-focused projects the HHS Rural Task Force identified as having launched over the past three years.
The Rural Action Plan examines the key challenges facing rural communities related to issues such as emerging health disparities, chronic disease burden, high rates of maternal mortality and limited access to mental health services. The plan lays out a four-point strategy to transform rural health and human services, with a number of actions that can be launched within weeks or months. The four points of the strategy are:
1. Building a sustainable health and human services model for rural communities, including actions such as:
- Funding the Rural Healthcare Providers Transition Project, a new program to provide support for hospitals and rural health clinics transitioning to value-based models.
- Expanding the Community Health Aide Program, which provides education and training of tribal community health providers to increase access to quality healthcare, health promotion and disease prevention services.
- Funding the Integrated Rural Community Care project to connect federally qualified health centers with rural hospitals to better coordinate preventive, primary and emergency healthcare.
2. Leveraging technology and innovation, including:
- Supporting a new HHS Health Challenge to leverage technology to improve screening and management of post-partum depression for rural women.
- Providing more than $8 million in grant funding for the Telehealth Network Grant Program to provide emergency care consults via telehealth to rural providers without emergency care specialists.
- Developing new flexibility for Medicare Advantage (MA) plans to improve access to managed care options in rural areas through changes in network adequacy assessments for MA plans and to take into account the impact of telehealth providers in contracted networks.
3. Focusing on preventing disease and mortality, including:
- Creating the Healthy Rural Hometown Initiative, a new initiative to identify strategies to address the growing rural disparities related to the five leading causes of avoidable death, including stroke, heart disease, cancer, respiratory disease and injury/substance use.
- Investing over $2 million in additional funding for rural cancer control grants with a focus on geographically underserved rural areas with deep and/or persistent poverty, building on a multi-year research effort to increase prevention efforts and enhance cancer treatment efforts in rural communities.
- Investing more than $2 million in funding in 2020 as part of a four-year $8 million project to identify evidence-based interventions that can reduce health risks faced by rural Americans.
4. Increasing rural access to care, including:
- Issuing a new policy brief examining the workforce shortage challenges state-based licensure restrictions create for rural residents by failing to let healthcare clinicians practice to the full extent of their training.
- Investing $5 million in FY 2020 to recruit and train EMS personnel in rural areas.
- Awarding $8.25 million to 11 communities who develop new rural residency programs through the Rural Residency Planning and Development Program.
The Rural Action Plan will work to improve rural healthcare, including:
· The Centers for Medicare & Medicaid Services (CMS) finalized wage index reform to increase payment to hospitals in low wage areas, including many rural hospitals, allowing them to invest more to improve quality, put them on a more level playing field with their higher wage counterparts, and attract more talent.
· CMS created two new ways for Medicare to pay providers specifically for forms of “virtual care,” delivered remotely. Healthcare providers can now be paid for remote patient monitoring, virtual assessments and review of electronically transmitted images.
· HRSA launched the Rural Communities Opioid Response program, funding multi-sector consortia in rural areas to enhance their ability to implement and sustain prevention, treatment, and recovery services in underserved rural areas, with more than $157 million in 47 states awarded to date.
· Through the Rural Tribal COVID-19 Response Program, HRSA awarded $15 million to 52 Tribes, Tribal organizations, urban Indian health organizations, and other health services providers to Tribes across 20 states to prepare, prevent, and respond to COVID-19 in rural tribal communities.
· Through the CARES Act, HRSA invested $150 million to over 1,700 rural hospitals to prepare, prevent, and respond to COVID-19. Of this amount, approximately $1 million was allocated to 12 tribal hospitals across 3 states to build up their capacity for fighting COVID-19 in their communities, including through further expansions of telehealth, purchases of PPE, and boosting testing capacity.
As the Rural Action Plan was developed, the HHS Rural Task Force also played a key role in the COVID-19 pandemic response, ensuring that HHS accounted for the unique challenges faced by rural communities. In April, the Centers for Disease Control and Prevention created a Minority Health/Rural Health Team as part of its pandemic response, ensuring a targeted focus on the needs rural communities were facing in dealing with COVID-19. The Task Force also worked with the Provider Relief Fund created in the CARES Act to develop a targeted allocation to rural providers of more than $10 billion to support rural hospitals, rural health clinics, community health centers and tribal providers.
