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Dale Quinney, former ARHA Executive Director, won the National Rural Health Association’s President’s Award in 2022. Below is the announcement from NRHA in recognition of Dale’s achievements:

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As the Executive Director of the Alabama Rural Health Association for 16 years, Dale Quinney has made a difference by using data to deliver powerful messages promoting rural health. His special talent is knowing how to present data to generate the reaction that is needed to enact change.

In 2009 and again in 2013, Dale produced the Selected Health Status Indicator Reports for each of Alabama’s 67 counties. These reports presented measures on more than 90 health status indicators, comparing the county to the state and the nation on each indicator. These reports were used to identify local health issues and obtain additional information for writing more competitive grant applications. He shared the report with local papers, elected officials, and other stakeholders to showcase healthcare as an economic factor.

Dale served as the leader of a team of data specialists to develop the first Community Health Assessment for Alabama, working with the Alabama Department of Public Health and over 300 other organizations. The team determined the ten leading health issues through large surveys, and compiled them into a detailed report which had special emphasis on Alabama’s rural areas.

Dale leveraged data to save the Wedowee Hospital. Randolph County had already lost its largest hospital and the hospital in Wedowee was old and in bad condition. A large medical center in Georgia agreed to staff and furnish a new hospital in Wedowee if the county could provide 20 million to build the facility.

Dale was contacted by a member of the county commission and asked to speak at a public forum which promised to be heated. Polls indicated that the people were not going to pass a 1 cent sales tax to build the hospital since they were already paying a property tax for healthcare. At the public forum, Dale pointed out that Randolph County had the 2nd highest motor vehicle accident death rate, the 3rd highest accidental firearm death rate, and the 2nd highest stroke death rate among all 67 Alabama counties. He noted that these were situations where the victims needed to get to a hospital emergency department as soon as possible.

His remarks, along with additional information he provided to the local newspaper, were given credit for changing public opinion on the proposed tax. It was approved, receiving 84% of the vote.

His colleagues at other state rural health associations have wonderful comments about his work:

Ryan Kelly from Mississippi says, “From the first time that I met Dale Quinney, I could instantly tell that his passion for improving rural health was deeper than just a career. He lived in rural Alabama, dedicated his free time toward improving rural healthcare, and he sincerely wanted the best for all people. It is determination and dedication like this that makes a true difference in the lives and hearts of others. He has inspired me through my journey in rural health, and no doubt has done the same with so many others.”

Tina Elliot from Indiana remarked, “I’ve enjoyed meeting Dale at various National Rural Health Association events, and learn about how he is meeting the needs of rural communities through Operation Save Rural Alabama, an organization he founded. Dale speaks about materials produced in rural areas that are critical to the survival of rural communities that produce economic impacts for everyone. He shares about the lack of healthy population growth and how to meet the healthcare needs in rural Alabama. Dale talks about his involvement with establishing an Area Health Education Center program in Alabama to expand the healthcare workforce and to create opportunities for interprofessional education.”

Beth O’Connor, who as 2022 NRHA President selected Dale, added, “Concerning the state I represent, Virginia, Dale impressed on me the need to convey information to our elected officials regarding everything rural communities do to support the United States as a whole. He helped me understand how rural communities need to stop begging for resources that came from our land and start communicating how rural supports urban.”

Dale has received many accolades for his work, including the D.G. Gill Award for making an exceptional contribution to public health in Alabama, and the Ira Myers Award. This is the most prestigious public health award in Alabama and is presented to those making a significant impact on public health in Alabama. Dale is one of only two non-physicians to ever receive the Ira Myers Award.

Dale insists that his most important recognition is his family. He and his wife, Susan, have been married for 46 years. Their children Brent and Leigh, along with their spouses, are carrying on Dale’s legacy by making their own contributions to healthcare in Alabama. Dale and Susan have six grandchildren, including two sets of twins.

Addressing the rural crisis in many states and local communities requires leadership, commitment, and coordination, and Dale Quinney has offered those to rural Alabama, and rural America.2

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 Needs	Results
Medicaid expansion	41
Mental health access	34
Workforce Improvement (recruitment, retention, compliance, scope of practice)	29
Rural transportation	29
Healthy literacy / health education issues	27
Increase in telehealth utilization, coordination and support	20
Social determinants of health (food insecurity, poverty, housing)	15
Broadband access	11
Increase provider rates with Medicaid	9
Coordination of services especially transportation	9
NPs/CNM increased scope	8
Food insecurities / food deserts	8
Standardized credentialing	7
Increase provider rates with Medicare	7
Expose students to health professions	6
Comprehensive sex education in k-12	6
Not having enough doctors	6
Taking tools and skills away from rural/primary physicians (sending everything to specialists)	6
Rural residency training	6
Apprenticeships w/in health prof- tech schools, shadowing	5
Price gouging	5
Pharmaceutical cost	5
Family Support	5
Elder/Disabled services	5
Too many people without insurance	5
Utilization of community health advocates	5
Increase state funding for ARMSA	4
Relationship building	4
Focus on multidisciplinary approach to PT care	4
Hospital vulnerability	4
EMS service availability	4
Physician fee schedule issues	3
High administration cost	3
Standardized claims filing	3
Safety in Schools	3
Community transportation	3
Knowing the community that’s being worked in	3
Funding	3
Awareness of resources	3
Health equity	3
Maintain Sources of income (post covid)	3
Not having docs in the correction locations in the state (incentive issues)	3
Delay in seeking services cost	3
Encourage physicians to recruit local	2
More cohesion w/ reg. agencies	2
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.

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.

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

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, 2021. All 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 5^th, 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.