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t PAGE 07 October 2020 PAGE 06 October 2020 challenge even more serious and has complicated health care providers' efforts to serve rural Americans. The USDA is also working to do its part with its Rural Broadband ReConnect program that delivers nearly $650 million in loans, grants, and loan-grant combinations to deploy high-speed broadband to rural communities without access. As for the MOU, the agencies plan to establish an interagency Rural Telehealth Initiative Task Force, comprised of representatives from each department, to meet regularly and establish future guidelines to exchange expertise, scientific and technical information, data, and publications. Bridging gaps through partnerships HHS's Rural Action Plan is also comprised of key partnerships to tackle everything from increasing funding for school-based mental health services to expanding telehealth options for rural beneficiaries of Medicare Advantage. Key partners include USDA, the U.S. Department of Veterans Affairs (VA), FCC, and the Appalachian Regional Commission (ARC), and Delta Regional Authority (DRA). ARC and DRA primarily serve rural regions and hold federal-state partnerships with HHS. Additional partners will include the U.S. Department of Housing and Urban Development, the U.S. Department of Education, and the U.S. Department of Labor. Leveraging these partnerships, HHS has set forth numerous initiatives in its Plan. Although too numerous to mention in this article, notable initiatives include: ● Elevating the role of the Office for the Advancement of Telehealth (OAT) to address key regulatory and program investments due to COVID-19 to expand the use of telehealth nationally. ● Revisiting the definition of "rural" to help nonprofits, community health centers, and other organizations to compete for grant funding more effectively. The Health Resources & Services Administration (HRSA) Federal Office of Rural Health Policy (FORHP) will issue a Request for Information to seek public comment on ways to revise its definition of rural, as some stakeholders are denied access to needed funding because their area is misclassified as urban. ● The Administration for Children and Families will produce a Human Services Program in Rural Contexts report to better understand the intricacies of rural human service needs, determine unmet needs in rural contexts, and identify opportunities for strengthening capacity for economic and social well-being of rural individuals, families, and communities. Among the programs that will be examined under a rural prism are Health Profession Opportunity Grants, Healthy Marriage and Responsible Fatherhood, Maternal, Infant, and Early Childhood Home Visiting, and Temporary Assistance for Needy Families. This effort, which began in October 2019, will continue through September 2022. ● HRSA's FY 2020 budget included $30 million in funding to support 62 awardees to advance the use of telehealth to meet the needs of rural and medically underserved areas with a focus on tele-emergency and tele- behavioral health. ● Expanding Medicare Fee-for-Service's telehealth benefit by removing existing barriers for telehealth services for participating providers. In another move, the Plan looks to expand Medicare Advantage options for rural beneficiaries enrolled in the program. This provision would allow patients to receive telehealth care from their home without being required to travel to a health care facility, among other reduced CMS regulations. ● The FY 2020 budget included an additional $110 million dollars in the Rural Community Opioid Response Program to reduce morbidity and mortality from substance use disorder and opioid use disorder. This includes prevention, treatment, and recovery services in rural underserved areas. ● The Rural HIV/AIDS Planning program targets seven states, including Missouri, with a disproportionate number of HIV diagnoses in rural communities. The purpose of the program is to assist with planning and development an integrated rural HIV health network for HIV care and treatment. The program offers rural health care providers the opportunity to address community HIV needs, gaps, and challenges. This includes barriers to early diagnosis, comprehensive care that encompasses transportation, substance use treatment, stigma, innovative care models aimed at improving health outcomes, and reducing the number of new HIV infections. ● The FY 2021 budget proposes $12.4 million to expand funding for healthy pregnancies and births by improving the quality of care in rural areas. This includes improved coordination of maternal and OB care, leveraging regional partnerships, and expanded use of telehealth. ● To address health care professional shortages in rural areas, HRSA is injecting $178 million to enhance support training programs and incentives to clinicians who work in rural underserved communities. "Six Missouri rural counties lack a primary care provider and 71 counties lack obstetrics," said Missouri Rural Health Association (MRHA) Executive Director Melissa VanDyne. "These health disparities persist in rural communities due to health care workforce deficits, distance to care, little or no transportation options, and socioeconomic factors. Rural residents are poorer and must overcome practically insurmountable barriers to access quality care. As a result, emergency departments become their entry to care in hospitals that are workforce and cash strapped." Although this article barely scratches the surface of the current and planned initiatives detailed in the Rural Action Plan, it is important to note that this emphasis on rural population health is welcomed and grossly overdue. "Anytime the needs of rural people are being considered and addressed, and the challenges of rural health is closely examined, it is a win," said Toniann Richard, CEO of Health Care Collaborative (HCC) of Rural Missouri. "The collaborative approach the federal government is taking to address everything from broadband connectivity to rural maternity and infant mortality is very hopeful. We will be watching as these proposed initiatives unfurl, and while current programs play out. We also welcome opportunities to have a seat at the table to convey our shared experience as rural health policy is revisited." HCC owns and operates five federally qualified health centers and two school-based clinics in rural communities.

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