Do clinicians still need a waiver to prescribe buprenorphine?

No. As of January 2023, the federal waiver requirement was eliminated. Clinicians still register with the DEA to prescribe controlled medications, and applicants must affirm they completed a one-time, eight-hour training, with some exceptions for board-certified and recently graduated practitioners. -

Why does broadband access matter for rural healthcare?

Broadband lets rural facilities send electronic files, support patient portals, and complete telehealth visits. Rural broadband access is also linked to job and population growth, more new business formation, higher home values, and lower unemployment. -

How does Medicaid and CHIP coverage compare in rural areas?

A greater share of rural adults and children are covered by Medicaid and CHIP than in urban areas, in every state and nationwide, making these programs important sources of rural health insurance.

Recent Announcements from the FORHP

HHS Fact Sheet: A Focus on Rural Health. Last week the U.S. Department of Health & Human Services released a compendium of details about actions taken over the last three years to support rural health. In addition to familiar federal programs such as the Rural Communities Opioid Response Program and the National Health Service Corps, new and ongoing efforts include lowering the cost of coverage for Medicare beneficiaries, a new federal designation to keep rural hospitals open, and support for new mothers through continuous Medicaid and CHIP coverage for 12 months postpartum.

Webinar: Improving Rural Access to Medicaid and CHIP Coverage – TODAY, Thursday, November 9 at 2:00 pm Eastern. In this webinar, Centers for Medicare & Medicaid Services staff and partners will discuss important strategies, provide actionable tools, and share materials to support rural community outreach and enrollment in Medicaid and the Children’s Health Insurance Program (CHIP). Medicaid provides health care coverage for eligible low-income adults, children, pregnant women, older adults, and people with disabilities, while CHIP provides low-cost health coverage to children for families that earn too much money to qualify for Medicaid.  These programs are important sources of health insurance in rural areas, and a greater share of rural adults and children are covered by Medicaid and CHIP compared to urban areas in all states and nationwide. This event is the first part of HRSA’s celebration of National Rural Health Day 2023.

Places and People served by Three USDA Rural Broadband Programs. The Economic Research Service at the U.S. Department of Agriculture (USDA) published a new report analyzing the areas and populations served by three USDA rural broadband programs: 10 the Broadband Initiatives Program (BIP), 2) the Community Connect grant program, and 3) the ReConnect program. The study reported the populations served by all three programs were found to be more rural, less educated, poorer, and older than those in areas not served or ineligible. In 2021, 41 percent of households in nonmetropolitan (nonmetro) areas lacked wired high-speed internet service in their homes, compared to 27 percent of metropolitan (metro) households. In addition, a 2020 study published by the Federal Bank entitled Bringing Broadband to Rural, demonstrated broadband access and adoption in rural areas is linked to increased job and population growth, higher rates of new business formation and home values, and lower unemployment rates. For rural healthcare facilities, broadband assists in increasing access and quality services through creating infrastructure to send electronic files, support patient portals, and complete telehealth visits.

FCC Hosts Maternal Health Roundtable on November 17. The Federal Communications Commission (FCC) will host a hybrid event – in person and online – to discuss a new focus on maternal health for its project, Mapping Broadband Health in America. The FCC is seeking comments from the public until November 20 on the interactive map that provides a cross-section of broadband availability with county-level data on factors that contribute to maternal mortality. University of Minnesota research from 2019 found that, when controlling for sociodemographic factors and clinical conditions, “rural residents had a 9 percent greater probability of severe maternal morbidity and mortality, compared with urban residents.”

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 are still required to register with the federal Drug Enforcement Agency (DEA) to prescribe controlled medications. On June 27, the DEA began to require that registration applicants – both new and renewing – 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. Watch this 11-minute video that explains the changes. 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 December 29, 2022 (when Congress eliminated the waiver requirement). Approximately $889,000 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

Learning About Long COVID & Fatiguing Illness – Thursday, November 9 at 3:00 pm Eastern. The Centers for Disease Control and Prevention fund this monthly webinar-style ECHO learning session to rapidly disseminate Post-COVID Conditions (PCC) and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) findings and emerging best practices. The series offers didactic presentations by subject matter experts, examples of emerging best practices and models of care, and a facilitated Q&A. This program is intended primarily for providers who care for patients with PCC and ME/CFS but is open to all healthcare professionals and all Long COVID and ME/CFS patient-lived experience experts interested in learning more about the treatment of Long COVID and ME/CFS.

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

CDC Community Health Worker Services for HIV in Rural Communities – January 5. The Centers for Disease Control and Prevention (CDC) will provide grants to state and local health departments to partner with HIV clinical providers in rural areas. The program will utilize community health workers to engage people with HIV who are not virally suppressed.

USDA Technical Assistance/Training for Rural Water and Waste Disposal Systems – January 2. The U.S. Department of Agriculture (USDA) will invest $37.5 million for grants to nonprofit organizations. Funds may be used to identify and evaluate solutions to water problems and/or to improve the management, operation, and maintenance of water and waste disposal facilities.

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.

Medicare Advantage Enrollment Update 2023. Among key findings in the RUPRI Center’s tracking of Medicare Advantage (MA) enrollment: overall MA enrollment grew from 2022 to 2023 by 7.7 percent; at the current rate of growth, MA plans are projected to enroll a majority of nonmetropolitan beneficiaries in two years.

Policy Updates

Send questions to ruralpolicy@hrsa.gov.

Medicare Finalizes Outpatient Payment and Policy Updates for 2024. Last week, the Centers for Medicare & Medicaid Services (CMS) finalized calendar year 2024 payment rates and policy changes for hospital outpatient facilities and Ambulatory Surgical Centers. In addition to increasing pay rates by 3.1 percent, this rule establishes an intensive outpatient program to serve beneficiaries who require more intense mental and behavioral services than traditional outpatient therapy but less than inpatient-level care. Hospital outpatient departments, as well as federally designated Community Mental Health Centers, Federally Qualified Health Centers, Rural Health Clinics, or Opioid Treatment Programs may provide these services. The rule also finalized the adoption of four measures for the Rural Emergency Hospital (REH) Quality Reporting program and a policy that Indian Health Service and Tribal facilities that become REHs will be paid for hospital outpatient services using their current all-inclusive rate. These facilities will also receive the REH monthly facility payment. Finally, this rule updates Hospital Price Transparency requirements to increase standardization of the data files, clarify how to find the files online, and add provisions on how compliance will be enforced. The final rule is effective January 1, 2024.

Medicare Finalizes 340B-Acquired Drug Program Remedy. To comply with the United States Supreme Court’s decision that the decrease in Medicare payment rates for drugs acquired under the 340B Program from January 1, 2018 through September 27, 2022 was unlawful, the Centers for Medicare & Medicaid Services (CMS) the finalized policy to pay affected 340B providers lump sum payments and to reduce future outpatient non-drug item and service payments to all hospitals starting in January 2026. Released November 2, 2023, CMS will continue to adjust the Outpatient Prospective Payment System payments until the full amount is offset, estimated to be 16 years. This final rule affects all hospitals and is effective January 1, 2024.

Medicare Finalizes 2024 Physician Fee Schedule Updates for 2024. On November 2, the Centers for Medicare & Medicaid Services (CMS) finalized calendar year 2024 (CY 2024) policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues. Under CY 2024 PFS, pay rates will be reduced by 1.25 percent and the PFS conversion factor will decrease by 3.4 percent to $32.74. CMS is also finalizing significant increases in payment for primary care and other kinds of direct patient care. Marriage and family therapists (MFTs) along with mental health counselors are eligible to receive payment for mental health services and substance abuse treatment, including services furnished in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). Payment for telehealth services furnished in RHCs and FQHCs is extended until December 31, 2024. In addition, CMS has created two new billing codes to describe services performed by auxiliary personnel including community health workers (CHWs) under the general supervision of the billing practitioner. The final rule is effective January 1, 2024.

Approaching Deadlines

IHS Small Ambulatory Program for American Indians and Alaska Natives – November 10
EPA Funding One Entity Providing Technical Assistance for Tribal Nations and Entities Addressing Brownfields – November 13
NIH Build UP Trust Challenge – November 14
DOT Assistance for Communities through the Thriving Communities Program – Letters of Interest November 15
NIH Extramural Loan Repayment Program – November 16
Advisory Committee Seeks Input on Rural Participation in Alternative Payment Models – Comment Period Extended to November 17
Johns Hopkins Center for American Indian Health Scholarship – November 17
Veterans Health Administration Rural Scholars Fellowship – November 17
FCC Seeks Feedback on Mapping Broadband for Maternal Health – November 20
USDA Community Facilities Technical Assistance/2022 Disaster Areas – November 24
CDC Rape Prevention and Education – November 30
CMS Making Care Primary Model – November 30
HUD Fair Housing Initiatives Program – November 30
CDC Rigorous Evaluation of Policy-Level Interventions to Prevent Overdose – December 1
Commonwealth Fund/Harvard Fellowship in Minority Health Policy – December 1
HRSA National Health Service Corps Students to Service Loan Repayment Program – December 7
HRSA Healthy Start: Eliminating Disparities in Perinatal Health – December 15
DOJ/CDC Reaching Rural: Collaborative Solutions for Substance Misuse – December 15
ACL Small Business Innovation Research Program – December 18
NIH Research Centers in Minority Institutions – December 18
National Board for Certified Counselors Foundation Rural Scholarships – December 31
USDA Rural Economic Development Loan and Grant Program – December 31
Comments Requested: Disincentives for Health Care Providers that Commit Information Blocking – Comment by January 2
Comments Request: No Surprises Act Federal Independent Dispute Resolution Operations for FY 2024 – Comment by January 2
USDA Technical Assistance/Training for Rural Water and Waste Disposal Systems – January 2
AmeriCorps State and National Grants – January 4
CDC Community Health Worker Services for HIV in Rural Communities – January 5
NARHC Bill Finerfrock Health Policy Fellowship – January 5
NIDA Seeking Telemedicine/Remote-Based Platforms for SUD Treatment – January 8
Request for Information: Upcoming ICD-11 – Comment by January 12
NTIA Tribal Broadband Connectivity Program – January 23
Udall Foundation Native American Congressional Internship – January 24
Rural Health Network Development Planning Program – January 26
HHS Environmental Justice Community Innovator Challenge, Phase 1 – January 30
EPA Small Communities, Big Challenges Competition – January 31
HHS Innovation Challenge: Preventing Human Trafficking/Women and Girls – February 1

Ongoing Opportunities

HRSA Needs Rural Reviewers for Grant Applications