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Results from the Alabama Rural Health Roadshow

The Alabama Rural Health Association, in effort to learn more about the needs of its members, conducted a four-part information gathering roadshow during the month of November, 2022.  Traveling to four locations, Montgomery, Hartselle, Atmore, and Livingston, more than 150 rural constituents and stakeholders participated in a series of listening sessions. 

During these sessions, they were presented with data regarding rural health in Alabama, and then broke into four groups to discuss what their experiences have been and what improvements could be made to policies and strategy to rural health.  Each group wrote their desired policy improvements on tear-away white pages and then all attendees marked their top 10 preferred improvements with a sticky dot.  The results of each roadshow were tabulated by the association and amalgamated into a single tabulation, with similar categories combined for each of viewing.

The results are as follows:

Policy NeedsResults
Medicaid expansion41
Mental health access34
Workforce Improvement (recruitment, retention, compliance, scope of practice)29
Rural transportation29
Healthy literacy / health education issues27
Increase in telehealth utilization, coordination and support20
Social determinants of health (food insecurity, poverty, housing)15
Broadband access11
Increase provider rates with Medicaid9
Coordination of services especially transportation9
NPs/CNM increased scope8
Food insecurities / food deserts8
Standardized credentialing7
Increase provider rates with Medicare7
Expose students to health professions6
Comprehensive sex education in k-126
Not having enough doctors6
Taking tools and skills away from rural/primary physicians (sending everything to specialists)6
Rural residency training6
Apprenticeships w/in health prof- tech schools, shadowing5
Price gouging5
Pharmaceutical cost5
Family Support5
Elder/Disabled services5
Too many people without insurance5
Utilization of community health advocates5
Increase state funding for ARMSA4
Relationship building4
Focus on multidisciplinary approach to PT care4
Hospital vulnerability4
EMS service availability4
Physician fee schedule issues3
High administration cost3
Standardized claims filing3
Safety in Schools3
Community transportation3
Knowing the community that’s being worked in3
Funding3
Awareness of resources3
Health equity3
Maintain Sources of income (post covid)3
Not having docs in the correction locations in the state (incentive issues)3
Delay in seeking services cost3
Encourage physicians to recruit local2
More cohesion w/ reg. agencies2
Substance Abuse (opioid, ETOH)2

One week after the conclusion of the roadshow, the Alabama Rural Health Association board of directors met at a special in-person session in Clanton to discuss these results and the strategy for the association moving forward.  After significant discussion, the following action items will be taken.

  1. The Alabama Rural Health Association will continue its advocacy toward Medicaid expansion, with the most immediate action being a letter sent to Governor Ivey corresponding with National Rural Health Day declaring the need for this expanded coverage for the state’s working poor.
  2. The Alabama Rural Health Association will have a renewed focus on mental and behavioral health services, with a more direct need to providing collaboration with these services and primary care in the state.  This may consist of increased educational sessions, connection for direct partnerships, or grant opportunities.
  3. The Alabama Rural Health Association will establish a new effort to recruit rural constituents into its contact lists in order to directly assist with health literacy and education efforts.  Establishing a list of constituents will provide the association with an outlet to educate the public.  The education may consist of each-to-view flyers, video, and other materials that help the public to navigate the healthcare system and understand the complexities of the system.  The association may pursue grant-funding to produce these videos and other marketing efforts.

The Association is appreciative to its constituents for providing this direct feedback and helping to guide policy in 2023 and beyond.  We know that these efforts to continue to improve rural health will take time, but the end result will be worth the effort.

HRSA Looks to Reduce a Large Number of HPSAs

The US Health Resources and Services Administration (HRSA) has released a list of Health Professional Shortage Areas (HPSAs) slated for removal. Each year HRSA adds and reduces HPSAs based on the result of survey data from providers that determines how many are located in different counties compared to the population of those counties.

HPSAs are designated for shortages of primary care, dental or mental health professionals in certain geographic areas, population groups and/or facilities. The lists of designated HPSAs are reviewed, revised and published annually on the HRSA Data Warehouse shortage area topic web page.

The most recent pull of HPSAs “proposed for withdrawal” is staggering compered to previous years. And this is not just for Alabama. More than 15% of primary care and 8% of mental health HPSAs nationwide are slated for withdrawal

Simply put, the removal of the HPSA designation and the loss of the federal funds that is allows in our state will have a large impact on providers. This will affect not only enhanced 10% bonus to physicians who provide Medicare service in these areas, but it will also affect National Health Service Corps, Nurse Corp program, and J-1 Visa Waiver programs.

Click here to view the full report of HPSAs slated proposed for withdrawal.

We are closely watching this situation and are working with the Alabama Department of Health to see what can be done about this situation.

COVID-19 isolation and quarantine period shortened

The Centers for Disease Control and Prevention (CDC) has announced it has shortened the recommended isolation and quarantine period for people with COVID-19 to five days, if asymptomatic and if persons can wear a mask when around others. 
These updates are recommended as the Omicron variant continues to spread throughout the U.S. and reflect the current science on when and for how long a person is most infectious. Emerging information with the Omicron variant demonstrates that the majority of SARS-CoV-2 transmissions occur early in the course of illness, generally in the one to two days prior to the onset of COVID-19 symptoms and the two to three days afterward. The new CDC recommendations for the general population mean that asymptomatic people who test positive may leave isolation five days after testing if they can continue to consistently and correctly mask for five more days to minimize the risk of infecting others. Infected persons who cannot follow mask guidance after five days, for example, young children, need to remain in isolation for 10 days after testing positive. 
In addition, CDC is updating the recommended quarantine period for those exposed to COVID-19. For people who are unvaccinated or if they are more than six months past their second dose of mRNA vaccine (Pfizer or Moderna) or more than two months after their Johnson and Johnson vaccine and not yet boosted, CDC now recommends quarantine for five days followed by strict mask use for an additional five days. 
If a five-day quarantine for vaccinated, not yet boosted, persons is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but they should wear a mask for 10 days after the exposure. 
For all those exposed, CDC states that best practice would also include a test for SARS-CoV-2 at the fifth day after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms their symptoms are not attributable to COVID-19. 
In the past week, the percent positivity in COVID-19 tests in Alabama has more than doubled to 22.1 percent with new cases doubling, and all but six counties in high level of community transmission. ADPH urges all age-eligible Alabamians to continue to follow recommendations to be vaccinated and those 16 years of age and above to be boosted to reduce severe disease, hospitalization and death. According to CDC, data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against infection for two doses of an mRNA vaccine is approximately 35 percent. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75 percent.
Vaccination remains the best way to protect yourself and others and to reduce the impact of COVID-19 on our communities in light of recent studies showing that the previously widely available monoclonal antibody treatments are not effective against the Omicron variant. 
Definitions of isolation and quarantine are as follows. Isolation relates to behavior after a confirmed infection. Isolation for five days followed by wearing a well-fitting mask will minimize the risk of spreading the virus to others. Quarantine refers to the time following exposure to the virus or close contact with someone known to have COVID-19. 
Visit www.alabamapublichealth.gov for more information on COVID-19.
https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html

CMS Issues Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers

Yesterday, CMS released the interim final regulations requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs. These requirements will apply to approximately 76,000 providers and cover over 17 million health care workers across the country.

Facilities covered by this regulation must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services by December 5, 2021All eligible staff must have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna or one dose of Johnson & Johnson – by January 4, 2022.  

At this time, CMS is not allowing for daily or weekly testing of unvaccinated individuals as an alternative to vaccination.  The regulation provides for exemptions based on recognized disability, medical conditions or religious beliefs, observances, or practices.  With regard to recognized clinical contraindications to receiving a COVID-19 vaccine, facilities should refer to the CDC informational document, Summary Document for Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States, accessed at www.cdc.gov/vaccines/covid-19/downloads/….  CMS directs providers and suppliers to the Equal Employment Opportunity Commission (EEOC) Compliance Manual on Religious Discrimination160 for information on evaluating and responding to requests related to religious beliefs, observances, or practices. While employers have the flexibility to establish their own processes and procedures, including forms, CMS points to The Safer Federal Workforce Task Force’s “request for a religious exception to the COVID-19 vaccination requirement” template as an example.

Facilities must develop a similar process or plan for permitting exemptions in alignment with federal law. CMS will ensure compliance with these requirements through established survey and enforcement processes.  If a provider or supplier does not meet the requirements, it will be cited by a surveyor as being non-compliant and have an opportunity to return to compliance before additional actions occur.

The requirements apply to: Ambulatory Surgical Centers, Hospices, Programs of All-Inclusive Care for the Elderly, Hospitals, Long Term Care facilities, Psychiatric Residential Treatment Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Home Health Agencies, Comprehensive Outpatient Rehabilitation Facilities, Critical Access Hospitals, Clinics (rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services), Community Mental Health Centers, Home Infusion Therapy suppliers, Rural Health Clinics/Federally Qualified Health Centers, and End-Stage Renal Disease Facilities.

NRHA will be reviewing the regulation and submitting comments on behalf of our members expressing concern about the workforce and access implications in rural areas.  Comments on the interim final regulation must be provided within 60 days of November 5th, 2021 to be considered. 

To view the interim final rule with comment period, visit: public-inspection.federalregister.gov/…

To view a list of frequently asked questions, visit: www.cms.gov/files/document/cms-omnibus-staff-vax-requirements-2021.docx

NRHA will be sharing a more detailed summary of the regulation shortly.  In meantime, feel free to contact our government affairs team at ccochran@ruralhealth.us. Thank you.

What to Gift Active Kids for the Holidays to Keep Them Moving

Most kids are always moving, but some are more daring than others. To keep the active child in your life occupied, exploring, and growing, the right gift is crucial. Here are the holiday gifts that active kids will want—and need—to keep them on a roll all through the new year.

The Alabama Rural Health Association is dedicated to promoting and advocating for rural health matters. Learn about membership today.

Indoor Gifts for Active Kids

Depending on the weather and where they live, some more adventurous kids can’t get outside as often as they’d like. No problem—these indoor gifts will have them jumping and moving before you know it.

Balance Boards

Commonly called Spooner boards, indoor (and outdoor) balance boards are an engaging toy. They require the balance and coordination of riding, say, a skateboard, but without wheels that can wreak havoc on the floor and elsewhere in the house.

Children as young as preschool age can begin to balance on such a board, making this an excellent gift for every age and stage of development. Older kids will enjoy doing tricks and taking healthy risks, too.

Basement or Playroom Gym

From the Gorilla Gym to DIY rock walls, there are many ways to build an indoor gym for kids. The Gorilla Gym, for example, hangs in a doorway and offers up attachments like swings, pull-up bars, rope ladders, and more to encourage activity.

If you have the square footage, building a rock wall or installing gym equipment can be an excellent way for kids to keep moving year-round. You can DIY a climbing wall (or gift the materials) for kids using plywood, climbing holds, lag screws, and, of course, floor mats for safety.

And, as REI explains, rock climbing teaches kids decision-making skills and discipline, helps boost their confidence, and enhances focus—necessary for keeping energetic kids safe in their adventures.

Outdoor Gifts for Active Kids

For kids who have access to a vast backyard, neighborhood parks, or wilderness, these outdoor gifts are the perfect fit for year-long play.

A New (and More Challenging) Bike

Riding a bicycle is old hat for most kids. But mountain biking presents new and stimulating challenges. Between the benefits of being in nature (like building confidence, reducing stress, and more) and the physical endurance required to handle a mountain bike, kids will be working off excess energy for years to come. If they’re going to spend more time in nature, consider picking them up a smartwatch as well. Kid-friendly smartwatches allow them to take and share pictures and also include safety features like GPS.

A Swing Set (Even DIY)

If the child in your life has room outside for a swing set, this might be the perfect holiday gift. Studies show that unstructured play enhances kids’ social-emotional development, cultivates imagination, and stimulates their senses, Genius of Play explains.

Plus, it gets them moving as they climb ladders, navigate slides, and pump their legs on the swings.

For older kids, you don’t even have to choose one that’s boxed up and ready to go. What better gift for an active kid than a DIY swing set or fort-building kit? Tweens and teens can put their engineering, critical thinking, and problem-solving skills to good use as they read directions, consult diagrams, and hammer nails—while wearing appropriate safety gear, of course.

Need to level out a part of your yard so your swing set is on level ground? Search for “land leveling near me” and look over reviews and ratings from grading contractors. You may be able to find deals as well so you can save on this service.

Kids who like to move may never slow down. But to make sure they’re pursuing healthy activities, consider one or more of these athletic gifts this holiday season. Even for kids who prefer screen time to sweating, the right type of (physical) outlet could change their minds.