Policy Guidance and Updates

Informational Video: https://www.youtube.com/watch?v=qJZ_Zin5iko

Support Provided: Ten new programs are selected each year to participate in the project.

Program Duration: 3 years

Program Goals:

• Improve financial position and increase operational efficiencies
• Implement quality improvements that support an evidenced-based culture for improved health outcomes
• Address workforce recruitment and retention needs
• Increase use of telemedicine to fill service gaps and access to care
• Ensure access to and availability of Emergency Medical Services
• Integrate social services to address socio-economic challenges
• Enhance coordination of care and develop a community care coordination plan
• Strengthen the local health care delivery system to position for population health

For more information, contact Bethany Adams at 859-806-2940 or drchsd-program@ruralcenter.org.

Process to receive vaccines:

1. Complete the Rural Health Clinic COVID-19 Vaccine Distribution Program Readiness Assessment
   1. Will be required to attest to/provide information about ability to meet storage requirements, current vaccine data reporting, staffing and processes, and contact information
   2. MUST KNOW YOUR VTrcKS PIN
   3. If you don’t know your VTrcKS PIN, contact State Immunization Manager
      1. Stacy Hall, 504-568-2600, stacy.hall@la.gov, dhh.louisiana.gov
2. After completing the Readiness Assessment, sign and return conditions of participation document to RHCVaxDistribution@hrsa.gov
3. Set up Vaccine Provider Order Portal (VPoP) account
   1. Will receive email from VPoP with instructions within about 1 week after submitting Conditions of Participation Agreement and the Readiness Assessment
4. Create a vaccine order in VPoP
   1. HRSA places shipment orders on Thursdays to be delivered to clinics the following week (Monday/Tuesday)
   2. Minimum dosage orders
      1. Pfizer: 450 (decreased from 1,170)
      2. Moderna: 100
      3. Johnson & Johnson: 100
5. Track your HRSA allocated inventory daily by logging stock on hand through VPoP
   1. Only vaccines supplied through HRSA’s federally allocated vaccine program should be managed in VPoP
6. Follow state priority guidelines in administering the vaccines. You will be required to store, handle and administer vaccines according to stated requirements, and meet necessary reporting requirements.

CDC has advised that concerns about wasting unused doses in a small-volume environment is secondary to the imperative to get “shots in the arms.”

Eligible facilities include Rural Health Clinics (RHCs) that are active, certified by CMS, have CMS Certification Numbers (CCNs), and are listed in the CMS Survey and Certification’s Quality, Certification and Oversight Reports (QCOR); and organizations that own and operate RHCs meeting the qualifications above. Verify your eligibility through Quality Certification and Oversight Reports (QCOR).

Webinar Archive:

Rural COVID-19 Support Webinar

Monday, June 16, 2021

• Presentation Recording
• Presentation Slides

Additional resources:

• HRSA RHCVD Program Website
• CDC COVID-19 Vaccine Quick Reference Guide for Healthcare Professionals
• CDC Identification, Disposal, and Reporting of COVID-19 Vaccine Wastage
• NRHA COVID-19 Vaccine Talking Points
• NRHA COVID-19 Vaccine Resources
• HRSA RHCVD Questions: RHCVaxDistribution@hrsa.gov
• Allowable Expenses Health Resources and Services Administration Rural Health Clinic (RHC) COVID-19 Program Infographic

Rural Health Clinics (RHCs) that met the requirements for the RHC COVID-19 Testing Program should have received a one-time allocation of up to $100,000 per clinic site automatically deposited in the bank account of the corresponding Tax Identification Number (TIN) organization around June 10, 2021 (some payments, including those issued via paper check, may have a longer processing time) with the payment description COVID*ARPAct*RHCCTMPmt*HHS.GOV.

RHCs do not have to apply for payments for this program. However, RHCs that received the RHC COVID-19 Testing and Mitigation funds and are not current with reporting of testing data on rhccovidreporting.com will not have received automatic payments and may have the opportunity to catch up for future program consideration, dependent on the availability of funds.

RHCs can utilize this funding for a variety of COVID-19 testing and mitigation activities. See more information on allowable expenses.

RHCs receiving COVID-19 Testing and Mitigation funds are required to submit monthly reports by the last day of each month during the duration of this initiative (January 1, 2021-December 31, 2022) is to be entered in the reporting portal, rhccovidreporting.com. RHCs receiving funds in June 2021 will begin reporting July 31, 2021.  Information to be submitted for reporting include the number of tests conducted, the number of positive tests, and data related to COVID-19 mitigation activities.

If you have additional RHC COVID-19 Testing Program data reporting questions, please contact the National Association of Rural Health Clinics (NARHC) or the National Organization of State Offices of Rural Health (NOSORH).

For additional questions: RHCCOVID-19Testing@hrsa.gov.

Technical assistance webinars:

NARHC COVID-19 Testing and Mitigation Webinar

Increase your confidence and ensure this funding is used to expand your testing and mitigation efforts within your clinics and communities.

Tuesday, June 29, 2021

• Presentation Recording
• Presentation Transcript
• Presentation Slides

Please contact RHCcovidreporting@narhc.org for additional information.

Webinar Archive:

Rural COVID-19 Support Webinar

Monday, June 16, 2021

• Presentation Recording
• Presentation Slides

Additional Resources:

• Allowable Expenses Health Resources and Services Administration Rural Health Clinic (RHC) COVID-19 Program Infographic

Complete the survey if you are associated with an RHC that meets the following qualifications:

• Had a binding written agreement with an outside unrelated party for the construction or establishment of a Provider-Based Rural Health Clinic by December 31, 2020; and
• Did not have an 855a or PECOS application submitted to CMS by December 31, 2020

COVID-19 Vaccination Required for Health Care Workers Update

Deadline: January 4, 2022

Effective November 5, 2021, the Centers for Medicare & Medicaid Services (CMS) issued an Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers by January 4, 2022. This rule applies to providers who participate in and are certified by the Medicare and Medicaid programs, including, but not limited to, Hospitals, Critical Access Hospitals, Rural Health Clinics, and Federally Qualified Health Centers.

The rule requires that health care providers establish a process or policy to fulfill the staff vaccination requirements over two phases.

• Phase 1: Within 30 days after the regulation is published (December 5, 2021), staff at all health care facilities included within the regulation must have received, at a minimum, the first dose of a primary series or a single dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the facility and/or its patients.
• Phase 2: Within 60 days (January 4, 2022), staff must complete the primary vaccination series (except for those who have been granted exemptions from the COVID-19 vaccine or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by CDC).

CMS believes that exemptions could be appropriate in certain limited circumstances, but no exemption should be provided to any staff for whom it is not legally required (under the ADA or Title VII of the Civil Rights Act of 1964) or who requests an exemption solely to evade vaccination.

Facilities are required to allow for exemptions to staff with recognized medical conditions for which vaccines are contraindicated or religious beliefs, observances, or practices (See the Safer Federal Workforce Task Force Request for Religious Exemption Template or Request for Medical Exemption Template). CMS encourages facilities to review the Equal Employment Opportunity Commission’s Compliance Manual on Religious Discrimination for more information on religious exemptions. At this time, CMS is not allowing for daily or weekly testing of unvaccinated individuals as an alternative to vaccination.  

CMS will ensure compliance with these requirements through the survey processes conducted by state survey agencies and accrediting organizations. Facilities that fail to comply with requirements will be cited by the surveyor as non-compliant and will be required to submit an action plan to return to compliance in accordance with the established survey and enforcement processes.

For more information, please review the CMS Frequently Asked Questions. Additional questions can be sent to Nicole Coarsey, State Office of Rural Health Manager, at nicole.coarsey@la.gov.

The comment period for the Interim Final Rule is open through January 4, 2022.

Sample COVID-19 Vaccination Policy and Procedures

The National Association of Rural Health Clinics (NARHC) developed a template for Rural Health Clinics to use to develop Policy and Procedure in response to the Medicare and Medicaid Programs; Omnibus COVID–19 Health Care Staff Vaccination Interim Final Rule (November 5, 2021). This should be incorporated into your existing policies and procedure per the Staffing and Staff Responsibilities section at 42 CFR 491.8(d) utilizing their existing numerical system.

For questions, contact Nathan Baugh, NARHC Director of Government Affairs at Nathan.Baugh@narhc.org or Sarah Hohman, NARHC Deputy Director of Government Affairs at Sarah.Hohman@narhc.org.

Vaccine Confidence Resources

The National Rural Health Association has created a number of resources as part of their Rural Vaccine Confidence Initiative to help rural health stakeholders build vaccine confidence at the local level.

The vaccine confidence communication toolkits are free and easy to use communication tools developed around three specific audiences:

• Hospitals
• Business/community partners
• Community as a whole

These materials:

• Feature rural-specific messaging, based on current research
• Focus on “caring for our community” and getting the real facts to promote confidence in the vaccine
• Are customizable to allow for localized messaging and branding by hospitals and community partners

Additional Resources

• Centers for Medicare & Medicaid Services Healthcare COVID-19 Health Care Staff Vaccination IFC-6 National Stakeholder Call: CMS hosted a webinar with information on the vaccine mandate. View the recording here and the presentation slides here.

New Provider Relief and American Rescue Plan Funding Funding Opportunity

Deadline closed: October 26, 2021 10:59 p.m. CST

Beginning on September 29, 2021, healthcare providers will be able to apply for two funding distributions related to COVID-19 response: American Rescue Plan (ARP) Rural funding and Phase 4 of the Provider Relief Fund (PRF).

ARP resources are available for providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). The Provider Relief Fund (PRF) Phase 4 funding is available for a broad range of providers with changes in operating revenues and expenses.

Provide Relief Funds Phase 4 General Distribution

• Qualified providers of healthcare, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenues due to coronavirus.
• Based on providers’ changes in operating revenues and expenses from July 1, 2020 to March 31, 2021.
• To promote equity and to support providers with the most need, HRSA will:
  • Reimburse smaller providers for changes in operating revenues and expenditures at a higher percentage compared to larger providers.
  • Provide “bonus” payments based on the amount of services they provide to Medicaid, CHIP, and Medicare patients, priced at the generally higher Medicare rates.

American Rescue Plan (ARP) Rural

• ARP Rural is intended to help address the disproportionate impact that COVID-19 has had on rural communities and rural healthcare providers, and funding will be available to providers who serve patients in these communities.

• Payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare beneficiaries living in Federal Office of Rural Health Policy (FORHP)-defined rural areas.
  • To promote equity, HRSA will price payments at the generally higher Medicare rates for Medicaid/CHIP patients.
• ARP Rural payments will be determined based on the location of the patients, not the provider. Applicants do not need to verify whether their patients live in an area that meets the definition of rural, and can select whether their organization (including any included subsidiaries) would like to be considered for ARP rural payments during the application process.
• HRSA will base payments on data already available to it on the amount and type of Medicare, Medicaid, and CHIP services provided to rural patients. HRSA will use the Federal Office of Rural Health Policy definition of rural.

Providers can apply for both programs through a single application in the Provider Relief Fund Application and Attestation Portal.  Applications must be completed by October 26, 2021 at 11:59 p.m. ET. Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal HRSA Exit Disclaimer and have not logged in for more than 90 days will need to first reset their password before starting a new application.

For more information, please visit the HRSA Provider Relief Future Payments website.

Rural Healthcare Provider Transition Project (RHPTP) Technical Assistance

Updated: September 24, 2021

Deadline closed: Friday, October 1, 2021 at 11:59 p.m. CST

The RHPTP helps strengthen the foundation in key elements of value-based care (VBC) including, but not limited to, efficiency, quality, patient experience, and safety of care. Small rural hospitals (SRH) and certified rural health clinics (RHC) are eligible to apply.

Apply here: https://www.ruralcenter.org/rhptp/application

Informational Video: https://www.youtube.com/watch?v=S5FMMPGDsO4

Application Guidance: https://www.ruralcenter.org/sites/default/files/Application%20Guide_FINAL.pdf

Support Provided: Five applicants will be chosen each year to receive direct technical assistance. Twenty additional organizations will be selected to participate in peer-to-peer education through a Learning Collaborative to promote knowledge base, and support readiness for the more in-depth and comprehensive

Program Duration: 1 Year (November 21, 2021-August 2022)

Program Goals:

• To guide SRHs and certified RHCs not currently participating in VBC to prepare for and position their organizations to be effective participants in a health system focused on value

For more information, please contact Rhonda Barcus at 904-321-7607 or rhptp@ruralcenter.org.

Join the Senate Resolution 59 (SR59) Lunch and Learn Webinar Series

Timeline: August-September 2021

SR59 was passed in the 2021 Legislative Session in response to the unprecedented challenges of the COVID-19 pandemic, coupled with multiple hurricanes and other severe weather events. The past 16 months have highlighted the importance of not only fortifying Louisiana’s utility infrastructure, but also taking the time to ‘kick the tires’ for gaps and fortifications that may be needed to build and sustain a robust healthcare infrastructure. This webinar series has been organized to discuss critical infrastructure capability and capacity needed by medical facilities.

The lunch and learn webinars will be recorded and posted on the Louisiana Department of Health website. The webinars are open to any/all health care organizations.  The webinars are intended to:

• Provide educational outreach on the framework, capabilities, and capacity of critical utility systems
• Allow the healthcare industry to ascertain a vulnerability assessment of their utility infrastructure and its potential impacts to their facility when a failure/disaster occurs
• Provide an opportunity for the healthcare industry to engage with information that would inform decisions and proposals related to possible future Biden funding for strengthening healthcare infrastructure

Provider Relief Fund Reporting Deadline

Deadline closed: September 30, 2021

Providers who received $10,000 or more between April 10, 2020, to June 30, 2020 (most RHCs) are required to submit reporting by September 30, 2021.

RHCs should understand that the PRF reporting portal is similar to, but very distinct from, the reporting on www.RHCcovidreporting.com. With some rare exceptions, RHCs or their parent organizations need to report on both portals. Learn more below.

On Thursday, September 2, 2021 the National Association of Rural Health Clinics hosted a webinar delivered by HRSA staff on the Provider Relief Fund Portal (PRF) and reporting requirements. This webinar covered some of the basics and frequently asked questions regarding the PRF portal.
If you have not yet registered in the Provider Relief Fund Reporting Portal and reviewed the PRF reporting resources, please do so prior to viewing the recording. New resources include a Lost Revenues Guide, Allowable Personnel Expenses, and Reporting Resource Guide.

Webinar: Navigating the Provider Relief Fund Reporting Portal

Speakers:

• Samantha Ebersold, Public Health Analyst, Communications Branch, HRSA Office of Provider Support
• Lindsey Nienstedt, Public Health Analyst, Policy Research Division, Federal Office of Rural Health Policy

To watch the recording of this (and other webinars) visit the TA Webinars page under the Resources tab on narhc.org.

If you have any questions about the webinar, please email asst@narhc.org.

CMS Request for Information Regarding the New Rural Emergency Hospitals (REH) Provider Type Comments Requested

Deadline closed: Friday, September 17, 2021

On August 4, 2021, the Center for Medicare and Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment System Proposed Rule for CY 2022 (CMS-1753-P) in the Federal Register Notice. Within the OPPS proposed rule there is a request for information (RFI) for the new provider type, the Rural Emergency Hospitals (REH).

Providers are encouraged to submit comments to CMS. Public comments are due no later than September 17, 2021.

Statute specifies that REHs:

• Are facilities that convert from either a Critical Access Hospital or a rural hospital with less than 50 beds and do not provide acute care inpatient services
• Must furnish emergency department services and observation care and may provide other outpatient medical and health services as specified by the Secretary through rulemaking.
• Medicare payment shall apply to items and services furnished on or after January 1, 2023.

CMS is asking for stakeholder feedback on:

• The extent to which the existing health and safety standards for hospitals, critical access hospitals (CAHs), and skilled nursing facilities (SNFs) should also apply to REHs;
• Additional health and safety standards that should apply to REHs;
• Quality measurement and reporting;
• Payment policies;
• Addressing health equity; and
• Data sources, additional considerations, and unintended consequences that CMS should consider in the development of policies for REHs.

Providers are encouraged to submit comments to CMS. Public comments are due no later than September 17, 2021.

Vulnerable Rural Hospital Assistance Program Funding Opportunity

Updated: August 3, 2021

Deadline closed: Saturday, July 31, 2021

Applications are open to all Louisiana Critical Access Hospitals (CAHs) for the 2021-2022 cohort of the Vulnerable Rural Hospital Assistance Program (VRHAP). The Center for Optimizing Rural Health (CORH) works with up to 30 hospitals per year through the year-long VRHAP program. Selected hospitals receive free technical assistance—guidance, resources and recommendations—from a team of rural hospital experts, interactive sessions with peer hospitals and learning opportunities tailored to topics that can benefit their hospital.

Apply here: optimizingruralhealth.org/portal-application

For more information, watch the presentation recording An Overview of the Year 4 Application Process for the Rural Hospitals Assistance Program from the Center for Optimizing Rural Health (CORH). Questions can be sent to CORH@tamu.edu or call 855-234-0712.

Rural Health Clinic Vaccine Confidence Program (COVID-19) Funding Opportunity

Updated: August 3, 2021

Deadline closed: Thursday, June 24 at 10:59 p.m. CST

The Rural Health Clinic Vaccine Confidence (RHCVC) Program is a Health Resources and Services Administration (HRSA) initiative to improve vaccine confidence and counter vaccine hesitancy in rural communities where COVID-19 vaccine uptake lags in comparison to more populated areas.

This RHCVC Program will support outreach in rural communities to improve vaccine confidence and counter vaccine hesitancy in rural areas where vaccine uptake lags in comparison to more populated areas. Program will also address health equity gaps by offering support and resources to medically underserved areas.

The program will also address health equity gaps by offering support and resources to medically underserved rural communities.

RHCs meeting the following criteria are eligible to apply for up to $50,000 in grant funds (no match is required):

• Medicare-certified Rural Health Clinics and organizations that own and operate Medicare-certified Rural Health Clinics.
• All RHCs must have active CMS Certification Numbers (CCNs) and be listed in the CMS Survey and Certification’s Quality, Certification and Oversight Reports (QCOR).
• To verify your eligibility, visit the CMS Quality, Certification and Oversight Reports (QCOR) website. On the site, you can verify that your provider type is listed as an RHC.
• HRSA will fund all eligible RHCs and organizations that own and operate eligible RHCs that apply and have a complete and acceptable RHCVC Program application.
• The RHCVC program DOES NOT have any rural area location requirements.

Funding:

HRSA will award grants to all eligible RHCs that submit an acceptable application. Final award amounts will depend on the number of acceptable applicants, but it is estimated that there will be 2,000 awards for $50,000 per RHC site.

Funding may be used for a broad range of efforts to improve healthcare in rural areas and reinforce basic messages about prevention and treatment of COVID-19 and other infectious diseases.

Activities may include, but are not limited to:

• Vaccine promotion
• Information dissemination to rural residents about how and where to get vaccinated
• Coordinating with existing vaccination sites and public health partners to identify isolated and/or vaccine hesitate populations
• Increasing rural community and individual patient literacy on the benefits of broad vaccination and the safety of vaccines

Use the National Institute of Health COVID-19 Vaccination Communication Guide for ideas on effective health communication tactics to educate about the vaccine.

Payments:

HRSA will make payments under this award through the HHS Payment Management System (PMS). PMS is a tool to help you draw down funds and file the Federal Financial Report (FFR). The Division of Payment Management, Financial Management Services, Program Support Center, manages the PMS. They will forward instructions for obtaining payments. The Awards Management Tutorial has information that will assist you in the successful administration and fiscal management of your award.

Technical assistance webinars:

NOSORH RHC Vaccine Confidence Grants Webinar

Monday, June 14, 2021

• Presentation Recording
• Presentation Slides
• The National Organization of State Offices of Rural Health (NOSORH) has provided sample grant applications that clinics can mirror.

Grants.gov Applicant Overview Webinar Technical Assistance

Friday, June 4, 2021

• Presentation Recording

Please contact support@grants.gov or 1-800-518-4726 for additional Grants.gov questions.

Rural Health Clinic Vaccine Confidence Program Webinar (HRSA)
How to Respond to the Notice of Funding Opportunity (NOFO) Wednesday, June 2, 2021

• Presentation Recording
• Presentation Slides

Rural COVID-19 Support Webinar

Monday, June 16, 2021

• Presentation Recording
• Presentation Slides
• 2021 RHC Vaccine Confidence Program FAQs

Please contact RHCVaxConfidence@hrsa.gov for additional information.

Additional resources:

Additional RHC Vaccine Confidence Program information and updates, are available here.

• HRSA Application Guide
• Registration for System Management System (SAM)
• For assistance from Grants.gov, call 1-800-518-4726 (U.S.) or e-mail support@grants.gov.
• Allowable Expenses Health Resources and Services Administration Rural Health Clinic (RHC) COVID-19 Program Infographic

Technical assistance may also be obtained regarding the grant and its application process through National Office of State Offices of Rural Health (NOSORH) by emailing rhcvaxconfidenceinfo@nosorh.org.

For grants management or budget questions, contact Nancy Gaines at (301) 443-5382 or RHCVaxConfidence@hrsa.gov.

American Rescue Plan (ARP) COVID-19 Testing and Mitigation Program Funding Opportunity

Updated: June 21, 2021

Deadline closed: Sunday, June 6, 2021

The American Rescue Plan (ARP) COVID-19 Testing and Mitigation Program provides funding for Critical Access Hospitals (CAHs) and rural hospitals with 50 beds or fewer hospitals to increase COVID-19 testing efforts, expand access to testing in rural communities, and expand the range of mitigation activities to meet community need.

This program is managed and funding will be administered through the state Small Hospital Improvement Program (SHIP).  Applications to participate in this program closed June 6, 2021. Notice of Award is expected July 1, 2021.
Qualifying hospitals who completed an application to participate in the program will be contacted by and enter into agreements with the Louisiana SHIP program to receive funding for allowed expenditures. Allowed expenditures for this program are COVID-19 Testing and COVID-19 Mitigation activities. Some examples of allowed expenditures include:

COVID-19 Testing

• Purchase and administration of COVID-19 tests
• Development and implementation of strategies to address patient concerns regarding testing
• Ensure access to COVID-19 testing by addressing long-standing systemic health and social inequities that put some rural residents at increased risk for COVID-19 or other severe illness
• Install temporary structures, leasing of properties, retrofitting facilities
• Education, rehabilitation, prevention, treatment, and support services for symptoms occurring after recovery from acute COVID-19 infection
• Planning for implementation of a COVID-19 testing program, hiring staff, procuring supplies to provide testing, training providers and staff on COVID-19 testing procedures, and reporting data to HHS on COVID-19 testing activities

COVID-19 Mitigation

• Promote behaviors that prevent spread of infectious diseases
• Ensure Ventilation Systems operate properly
• Educate the community, including education on vaccines
• Maintain health operations for staff, including building measures to cope with employee stress and burnout
• Conduct contact tracing
• Use digital technologies to strengthen the hospital’s core capacity to support the public-health response to COVID-19
  Support and referrals to testing, clinical services, and other essential support services

For additional information or questions, please contact Kandi Smith, Rural Hospital Sustainability Manager at Kandi.Smith@la.gov.

Webinar Archive:

Rural COVID-19 Support Webinar

Monday, June 16, 2021

• Presentation Recording
• Presentation Slides
• American Rescue Plan Funding for SHIP COVID-19 Testing and Mitigation Example Activities