Federal Office of Rural Health Policy RCORP Update Missouri Rural Health Conference August 20, 2019 Marcia Colburn Federal Office of Rural Health Policy (FORHP) Health Resources and Services Administration (HRSA)

The Federal Office of Rural Health Policy Organizational Set-Up Community-Based Division Hospital-State Division Pilot Programs for Rural Communities Expanding the Community Health Gateway Public Health Programs Black Lung and Radiation Exposure Grants Focusing on Performance and Quality Improvement for Small Rural Hospitals State Offices of Rural Health Policy Research Division Office for the Advancement of Telehealth PRD flows from 711 But like much of HRSA also have a heavy program focus C-B vs. state Emerging issues like Opioids But also TH Policy and Regulatory Analysis Research Telehealth Network Grants Telehealth Resource Centers Licensure and Portability FY 2019: The Rural Community Opioids Response Program

FORHP Priority Areas 2019 Address the Rural Opioid Epidemic Lifting Up Rural Community Health Address the Rural Opioid Epidemic Emerging Rural Health Disparities Rural Hospital Viability With that as a backdrop, like to like to talk a little more about some of the work within our Office around some key priority areas I’ll touch on each of these topics; And like to do that by focusing on where the action actually happens; and that is at the community level It’s one of the great aspects of this job and the work we do … Get to see how communities and how leaders at the state and local level take advantage of our funding and come up with creative and innovative ways to have an impact Never ceases to amaze me

FY 2019 Federal Office of Rural Health Policy Budget: $317.8 million FORHP Budget 2019 FY 2019 Federal Office of Rural Health Policy Budget: $317.8 million Rural Health Policy Development $9.4 million Rural Health Outreach Programs $77.5 million Rural Hospital Flexibility Grants $53.6 million State Offices of Rural Health $10 million Radiation Exposure & Screening $1.8 million Black Lung Clinics $11 million Telehealth $24.5 million Rural Communities Opioids Response $130 million Rural Residency Program

Rural Opioid Community Response Program (RCORP) Background Created in FY18 with $130 million appropriation Goal: “To support treatment for and prevention of substance use disorder . . .[in] rural communities at the highest risk for substance use disorder.” $100 million for grants and cooperative agreements $30 million for National Health Service Corps Loan Repayment awards Multiple RCORP initiatives awarded in FY18, FY19 and planned for FY20: https://www.hrsa.gov/rural-health/rcorp Part of HRSA-wide initiative to combat the opioid epidemic among vulnerable and underserved populations https://www.hrsa.gov/opioids -RCORP initiative housed in HRSA, FORHP -We have had great support from our HRSA leadership on this and while our office has been working on opioids for a few years now, last year we received an appropriation of $100M to allocate to rural communities to address OUD. -Then this year, we received a $120M to get out to rural communities. -Now for those of you who know our office, our annual budget is typically around $160M so this is a significant increase in our budget and one that we are working hard to make sure that we are being strategic about how to support rural communities. -We have had many discussions with our rural grantees and stakeholders about this initiative to really get an understanding of what their needs are, what resources are needed and we are taking all of that into consideration as we are designing our programs. 5

New RCORP Investments $80 Million- 80 rural consortium RCORP-Implementation to implement a set of prevention, treatment, and recovery activities. $8.25 Million - 12 recipients received RCORP-Medication-Assisted Treatment (MAT) Expansion awards of up to $725,000 each to establish and/or expand MAT $6.6 Million- 3 recipients to establish Centers of Excellence on Substance Use Disorders (CoEs) to identify, translate, disseminate, and implement evidence-based and SUD promising practices $3 Million- 1 Evaluation team to evaluate the impact of the RCORP initiatives, develop evaluation tools and resources for use in rural communities, and to inform future rural health initiatives $3 Million- (supplemental funding to existing provider) – Technical Assistance to increase for all RCORP awardees, to include site visits and other support to additional awardees.

All services must exclusively target rural areas. RCORP Initiative RCORP-Planning RCORP-Implementation RCORP-MAT Expansion Goal To strengthen the capacity of multi-sector consortiums to address opioid use disorder prevention, treatment, and recovery. To strengthen and expand SUD/OUD prevention, treatment, and recovery service delivery. Learn more: https://www.hrsa.gov/about/news/press-releases/2019 To enhance access to medication-assisted treatment within small rural clinic and hospital settings. Period of performance 1 year 3 years Award amount Up to $200K Up to $1 million Up to $725K # Awards 95 (FY18) 120 (FY19) 80 (FY19) 34 (projected-FY20) 12 (FY19) Eligibility All services must exclusively target rural areas. -To begin with, this slides gives you a sense of what is coming up for this initiative. -This past year, we made 95 Planning awards which are one-year grants designed to support rural communities in identifying what the gaps are in their communities around addressing SUD and strengthening their partnerships and capacity as they plan for this. Are they considering their workforce? Do they know who their partners area? Have they conducted a needs assessment? Do they want to address this from a regional approach which we are learning is working quite well with our currently funded grantees. -The Implementation program is on a larger scale and is one that we will be releasing in the next month or so to allow communities to actually implement their plan of action in addressing SUD. We have aligned it well with the HHS 5-point strategy which touches on prevention, treatment and recovery with a heavy focus on treatment and recovery. It will allow communities to increase the number of providers who are able to identify and treat SUD, increase the number of providers who are willing to provide MAT and train the support staff to complement MAT, recruit providers through NHSC, enhance collaboration with law enforcement and first responders to treat those who have overdosed, enable individuals and families to navigate support services including childcare, housing, transportation, develop recovery coaches etc. -RMATE: recognizing the need to expand access to MAT in small rural hospitals and RHCs by recruiting providers and support staff and training them 7

RCORP Initiative RCORP-Technical Assistance RCORP-Evaluation RCORP-Centers of Excellence Goal To assist rural consortiums with addressing opioid use disorder prevention, treatment, and recovery service and workforce needs. To evaluate the impact of RCORP initiatives through data collection and analysis, and to develop evaluation tools and resources for rural communities. To support the dissemination of best practices related to the treatment for and prevention of SUDs within rural communities, with a focus on the current opioid crisis, and the development of methods to address future SUD epidemics. Period of performance 4 years 3 years Award amount $3 million first year $6 million 3 years $3 million per year $6.7 million Award recipient JBS International Up to 3 awards--TBA -This initiative also has a huge support aspect to it and we awarded a TA cooperative agreement to JBS in September of last year and we are collaborating very closely to ensure that we are able to provide the resources needed for our grantees and for rural communities overall -We will be funding an evaluation initiative later this year to allow us to evaluate the RCORP initiative overall to determine the impact being made with our investments. And also developing resources and tools for rural communities as they are looking to evaluate their efforts -And new this year in the FY 19 report language is the creation of three CoEs to provide TA to state health departments and other rural communities on approaches to addressing SUD; disseminating best practices related to rural communities, helping to build the evidence base in rural. -Three criteria's (Delta/Appalachia; state 60% rural and one on development of best practices around recovery housing to disseminate) 8

Missouri Received $8,000,000 RCORP Implementation Funding-FY2019

Missouri Received $1,200,000 RCORP Planning Funding-FY2019 Missouri received 6 awards, totaling $1,200,000 in funding.  Organization City State Amount About Our Kids, Inc. Lamar MO $200,000 Health Care Coalition of Lafayette County Waverly National Council on Alcoholism and Drug Abuse - St. Louis Area, Inc. St. Louis Northwest Health Services, Inc. St. Joseph Pike County Memorial Hospital Louisiana Powerhouse Community Development Corporation Marshall

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Contact Information Marcia Colburn Federal Office of Rural Health Policy (FORHP) Health Resources and Services Administration (HRSA) Email: mcolburn@hrsa.gov Web: hrsa.gov/ruralhealth/