Policy Guidance and Updates

Flu season is here. Use these messages to share with your patients the importance of getting a flu shot. Click here.

• STATE OFFICE OF RURAL HEALTH
• Emergency Preparedness
• Hospital Support Programs
• New Clinic Development
• Policy Guidance and Updates
• Practice Management
• Project ECHO®
• Rural Health Scholars Program
• Telehealth

As information in healthcare continues to evolve, Well-Ahead Louisiana works to provide you with the most accurate and up-to-date changes in policy guidance, healthcare, notices and deadlines.

State and Federal COVID-19 Information and Resources

These are links to state and federal information and resources related to the COVID-19 pandemic. Check these resources regularly as they are updated frequently as new information is made available.

Louisiana Information and Resources

• To ensure you are staying alert on the status of COVID-19 in Louisiana, please see the Louisiana Department of Health’s COVID-19 website.
• For additional vaccine information and resources, LDH has a dedicated COVID-19 Vaccine page for providers.
• If your patients have questions about COVID-19, please direct them to contact the Louisiana 211 Network by dialing 211. Or, they can text the keyword LACOVID to 898-211 for the most current information about the outbreak as it becomes available. They can also get answers on the Louisiana 211 website.
• For COVID-19 Vaccination provider trainings, visit LDH’s website.

COVID-19 Vaccine Locations

Connect patients to their nearest vaccination site.

National Information and Resources

• For the latest information about COVID-19, including signs and symptoms, how to prepare and resources for the community, please visit the Centers for Disease Control and Prevention’s (CDC) website.
  • FAQs from the CDC
  • Information on the variants
  • Communication toolkits to help share information with your community
  • FAQs from CMS
  • Telehealth Services Guide from CMS

  Rural COVID-19 Support Webinar

  Review four COVID-19 support programs currently available to rural providers:

  • American Rescue Plan (ARP) COVID-19 Testing and Mitigation
  • Rural Health Clinic COVID-19 Testing and Mitigation (RHCCTM) Program
  • Rural Health Clinic COVID-19 Vaccine Distribution (RHCVD) Program
  • Rural Health Clinic Vaccine Confidence (RHCVC) Program
  • Presentation Slides
  • 2021 RHC Vaccine Confidence Program FAQs
  • American Rescue Plan Funding for SHIP COVID-19 Testing and Mitigation Example Activities

  Guidance and Updates

  COVID-19 Vaccine Booster Dose Interval Shortened Update
  Updated: January 10, 2022
  On January 8, the Louisiana Department of Health (LDH) announced that, effective immediately, the six-month interval between completing the Moderna COVID-19 vaccine series and receiving a booster dose has been shortened to five months. The COVID-19 vaccine booster interval was shortened for the PfizerBioNTech vaccine to five months.

  Rural Health Clinic COVID-19 Testing Supply Distribution Program Resource Distribution
  Updated: January 10, 2022
  The Department of Health and Human Services announced that all Medicare-certified Rural Health Clinics are invited to order free, FDA-approved COVID-19 self-testing supplies for distribution in their communities through the Health Resources and Services Administration’s (HRSA) COVID-19 Testing Supply Program. Apply here. For questions, email RHCTestKit.HRSA@hrsa.gov.
  For more information on the COVID-19 Testing Supply Program, visit HRSA’s website.

  Medicaid Reimbursement for COVID-19 Vaccine Administration Reimbursement
  Updated: November 30, 2021
  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can now receive reimbursement for COVID-19 vaccine administration outside of full medical encounter for dates of service on and after December 23, 2020, and throughout the COVID-19 public health emergency. The relevant procedure codes for vaccine and vaccine administration are listed on the COVID-19 Vaccine/Treatment Fee Schedule which will be updated as new information becomes available.
  Administration of COVID-19 vaccines as part of an otherwise billable FQHC/RHC encounter will be reimbursed as a part of the all-inclusive encounter rate and no separate reimbursement will be made. See Informational Bulletin 21-27 for more information.

  The Delta Region Community Health Systems Development (DRCHSD) Program Technical Assistance
  No deadline to apply
  The DRCHSD assists leaders and providers in identifying and addressing health care needs while strengthening the local health care system. Selected health care organizations, and their communities receive technical assistance to make in-depth health system enhancements over multiple years. Eligible applicants include small rural hospitals (critical access hospitals and prospective payment system acute care facilities up to approximately 100 beds), rural health clinics, and other healthcare organizations.
  Apply here: https://www.ruralcenter.org/content/eligibility-and-application

  • Improve financial position and increase operational efficiencies
  • Implement quality improvements that support an evidenced-based culture for improved health outcomes
  • Address workforce recruitment and retention needs
  • Increase use of telemedicine to fill service gaps and access to care
  • Ensure access to and availability of Emergency Medical Services
  • Integrate social services to address socio-economic challenges
  • Enhance coordination of care and develop a community care coordination plan
  • Strengthen the local health care delivery system to position for population health

  For more information, contact Bethany Adams at 859-806-2940 or drchsd-program@ruralcenter.org.

  Rural Health Clinic COVID-19 Testing Supply Distribution Program Resource Distribution
  Updated: June 10, 2021
  No deadline to apply
  The Rural Health Clinic Vaccine Distribution (RHCVD) Program, through a partnership between HRSA and the CDC, distributes COVID-19 vaccines directly to RHCs to increase the availability of COVID-19 vaccines in rural communities. This program is currently ongoing.

  1. Complete the Rural Health Clinic COVID-19 Vaccine Distribution Program Readiness Assessment
     1. Will be required to attest to/provide information about ability to meet storage requirements, current vaccine data reporting, staffing and processes, and contact information
     2. MUST KNOW YOUR VTrcKS PIN
     3. If you don’t know your VTrcKS PIN, contact State Immunization Manager
        1. Stacy Hall, 504-568-2600, stacy.hall@la.gov, dhh.louisiana.gov
        1. Will receive email from VPoP with instructions within about 1 week after submitting Conditions of Participation Agreement and the Readiness Assessment
        1. HRSA places shipment orders on Thursdays to be delivered to clinics the following week (Monday/Tuesday)
        2. Minimum dosage orders
           1. Pfizer: 450 (decreased from 1,170)
           2. Moderna: 100
           3. Johnson & Johnson: 100
           1. Only vaccines supplied through HRSA’s federally allocated vaccine program should be managed in VPoP

           CDC has advised that concerns about wasting unused doses in a small-volume environment is secondary to the imperative to get “shots in the arms.”

           Eligible facilities include Rural Health Clinics (RHCs) that are active, certified by CMS, have CMS Certification Numbers (CCNs), and are listed in the CMS Survey and Certification’s Quality, Certification and Oversight Reports (QCOR); and organizations that own and operate RHCs meeting the qualifications above. Verify your eligibility through Quality Certification and Oversight Reports (QCOR).

           Webinar Archive:

           Rural COVID-19 Support Webinar

           Monday, June 16, 2021

           • Presentation Recording
           • Presentation Slides

           Additional resources:

           • HRSA RHCVD Program Website
           • CDC COVID-19 Vaccine Quick Reference Guide for Healthcare Professionals
           • CDC Identification, Disposal, and Reporting of COVID-19 Vaccine Wastage
           • NRHA COVID-19 Vaccine Talking Points
           • NRHA COVID-19 Vaccine Resources
           • HRSA RHCVD Questions: RHCVaxDistribution@hrsa.gov
           • Allowable Expenses Health Resources and Services Administration Rural Health Clinic (RHC) COVID-19 Program Infographic

           Rural Health Clinic COVID-19 Testing and Mitigation Program (RHCCTM) Funding Distribution
           Updated: June 10, 2021
           Applications not required
           The Rural Health Clinic COVID-19 Testing and Mitigation (RHCCTM) Program distributes to each eligible CMS-certified RHC a “flat” one-time payment of up to $100,000 designed to increase testing and expand mitigation based on community need.

           Rural Health Clinics (RHCs) that met the requirements for the RHC COVID-19 Testing Program should have received a one-time allocation of up to $100,000 per clinic site automatically deposited in the bank account of the corresponding Tax Identification Number (TIN) organization around June 10, 2021 (some payments, including those issued via paper check, may have a longer processing time) with the payment description COVID*ARPAct*RHCCTMPmt*HHS.GOV. RHCs do not have to apply for payments for this program. However, RHCs that received the RHC COVID-19 Testing and Mitigation funds and are not current with reporting of testing data on rhccovidreporting.com will not have received automatic payments and may have the opportunity to catch up for future program consideration, dependent on the availability of funds. RHCs can utilize this funding for a variety of COVID-19 testing and mitigation activities. See more information on allowable expenses. RHCs receiving COVID-19 Testing and Mitigation funds are required to submit monthly reports by the last day of each month during the duration of this initiative (January 1, 2021-December 31, 2022) is to be entered in the reporting portal, rhccovidreporting.com. RHCs receiving funds in June 2021 will begin reporting July 31, 2021. Information to be submitted for reporting include the number of tests conducted, the number of positive tests, and data related to COVID-19 mitigation activities. If you have additional RHC COVID-19 Testing Program data reporting questions, please contact the National Association of Rural Health Clinics (NARHC) or the National Organization of State Offices of Rural Health (NOSORH). For additional questions: RHCCOVID-19Testing@hrsa.gov.

           Technical assistance webinars:

           • Presentation Recording
           • Presentation Transcript
           • Presentation Slides

           Please contact RHCcovidreporting@narhc.org for additional information.

           Webinar Archive:

           Rural COVID-19 Support Webinar

           Monday, June 16, 2021

           • Presentation Recording
           • Presentation Slides

           Additional Resources:

           National Association of Rural Health Clinics Mid-Build RHC Survey Survey
           Updated: June 10, 2021
           The National Association of Rural Health Clinics (NARHC) is asking RHCs that were mid-build as of December 31, 2020 to complete this survey. This information will assist NARHC in their work with Congress on legislation that would allow mid-build or mid-construction RHCs to qualify for grandfathering status for the purposes of RHC Medicare upper payment limits.

           • Had a binding written agreement with an outside unrelated party for the construction or establishment of a Provider-Based Rural Health Clinic by December 31, 2020; and
           • Did not have an 855a or PECOS application submitted to CMS by December 31, 2020

           Guidance and Updates Archive

           Rural Healthy People 2030: Challenges and Opportunities for the New Decade Survey
           The National Association of Rural Health Clinics is requesting your input. Rural health clinics (RHCs) have an unprecedented opportunity to help influence the future direction of health policy in this country via the Rural Healthy People 2030 initiative.

           The RHC community has been invited to work with researchers at the Southwest Rural Health Research Center to ensure that the voices of the rural health community are included in this information gathering process. The responses you and others provide will be incorporated into a report that will be shared with policy makers as they seek to identify the rural health agenda for the next 10 years. The survey should take no longer than 15 minutes to complete. We encourage you to share this link with your patients or others you may know who have an opinion about rural health care. If you have any questions about this study, please feel free to reach out to Timothy Callaghan from the Southwest Rural Health Research Center at callaghan@tamu.edu.

           • Phase 1: Within30 days after the regulation is published (December 5, 2021), staff at all health care facilities included within the regulation must have received, at a minimum, the first dose of a primary series or a single dose COVID-19 vaccine prior to staff providing any care, treatment, or other services for the facility and/or its patients.
           • Phase 2: Within 60 days (January 4, 2022), staff must complete the primary vaccination series (except for those who have been granted exemptions from the COVID-19 vaccine or those staff for whom COVID-19 vaccination must be temporarily delayed, as recommended by CDC).

           CMS believes that exemptions could be appropriate in certain limited circumstances, but no exemption should be provided to any staff for whom it is not legally required (under the ADA or Title VII of the Civil Rights Act of 1964) or who requests an exemption solely to evade vaccination.

           Facilities are required to allow for exemptions to staff with recognized medical conditions for which vaccines are contraindicated or religious beliefs, observances, or practices (See the Safer Federal Workforce Task Force Request for Religious Exemption Template or Request for Medical Exemption Template). CMS encourages facilities to review the Equal Employment Opportunity Commission’s Compliance Manual on Religious Discrimination for more information on religious exemptions. At this time, CMS is not allowing for daily or weekly testing of unvaccinated individuals as an alternative to vaccination.

           CMS will ensure compliance with these requirements through the survey processes conducted by state survey agencies and accrediting organizations. Facilities that fail to comply with requirements will be cited by the surveyor as non-compliant and will be required to submit an action plan to return to compliance in accordance with the established survey and enforcement processes.

           For more information, please review the CMS Frequently Asked Questions. Additional questions can be sent to Nicole Coarsey, State Office of Rural Health Manager, at nicole.coarsey@la.gov.

           The comment period for the Interim Final Rule is open through January 4, 2022.

           Sample COVID-19 Vaccination Policy and Procedures

           The National Association of Rural Health Clinics (NARHC) developed a template for Rural Health Clinics to use to develop Policy and Procedure in response to the Medicare and Medicaid Programs; Omnibus COVID–19 Health Care Staff Vaccination Interim Final Rule (November 5, 2021). This should be incorporated into your existing policies and procedure per the Staffing and Staff Responsibilities section at 42 CFR 491.8(d) utilizing their existing numerical system.

           For questions, contact Nathan Baugh, NARHC Director of Government Affairs at Nathan.Baugh@narhc.org or Sarah Hohman, NARHC Deputy Director of Government Affairs at Sarah.Hohman@narhc.org.

           Vaccine Confidence Resources

           The National Rural Health Association has created a number of resources as part of their Rural Vaccine Confidence Initiative to help rural health stakeholders build vaccine confidence at the local level.

           The vaccine confidence communication toolkits are free and easy to use communication tools developed around three specific audiences:

           • Hospitals
           • Business/community partners
           • Community as a whole
           • Feature rural-specific messaging, based on current research
           • Focus on “caring for our community” and getting the real facts to promote confidence in the vaccine
           • Are customizable to allow for localized messaging and branding by hospitals and community partners

           Additional Resources

           • Centers for Medicare & Medicaid Services Healthcare COVID-19 Health Care Staff Vaccination IFC-6 National Stakeholder Call: CMS hosted a webinar with information on the vaccine mandate. View the recording here and the presentation slides here.
           • Qualified providers of healthcare, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenues due to coronavirus.
           • Based on providers’ changes in operating revenues and expenses from July 1, 2020 to March 31, 2021.
           • To promote equity and to support providers with the most need, HRSA will:
             • Reimburse smaller providers for changes in operating revenues and expenditures at a higher percentage compared to larger providers.
             • Provide “bonus” payments based on the amount of services they provide to Medicaid, CHIP, and Medicare patients, priced at the generally higher Medicare rates.

             American Rescue Plan (ARP) Rural

             • ARP Rural is intended to help address the disproportionate impact that COVID-19 has had on rural communities and rural healthcare providers, and funding will be available to providers who serve patients in these communities.
             • Payments based on the amount of services providers furnish to Medicaid/CHIP and Medicare beneficiaries living in Federal Office of Rural Health Policy (FORHP)-defined rural areas.
               • To promote equity, HRSA will price payments at the generally higher Medicare rates for Medicaid/CHIP patients.

               Providers can apply for both programs through a single application in the Provider Relief Fund Application and Attestation Portal. Applications must be completed by October 26, 2021 at 11:59 p.m. ET. Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal HRSA Exit Disclaimer and have not logged in for more than 90 days will need to first reset their password before starting a new application.

               • To guide SRHs and certified RHCs not currently participating in VBC to prepare for and position their organizations to be effective participants in a health system focused on value

               For more information, please contact Rhonda Barcus at 904-321-7607 or rhptp@ruralcenter.org.

               • Provide educational outreach on the framework, capabilities, and capacity of critical utility systems
               • Allow the healthcare industry to ascertain a vulnerability assessment of their utility infrastructure and its potential impacts to their facility when a failure/disaster occurs
               • Provide an opportunity for the healthcare industry to engage with information that would inform decisions and proposals related to possible future Biden funding for strengthening healthcare infrastructure
               • Samantha Ebersold, Public Health Analyst, Communications Branch, HRSA Office of Provider Support
               • Lindsey Nienstedt, Public Health Analyst, Policy Research Division, Federal Office of Rural Health Policy

               To watch the recording of this (and other webinars) visit the TA Webinars page under the Resources tab on narhc.org.

               If you have any questions about the webinar, please email asst@narhc.org.

               • Are facilities that convert from either a Critical Access Hospital or a rural hospital with less than 50 beds and do not provide acute care inpatient services
               • Must furnish emergency department services and observation care and may provide other outpatient medical and health services as specified by the Secretary through rulemaking.
               • Medicare payment shall apply to items and services furnished on or after January 1, 2023.

               CMS is asking for stakeholder feedback on:

               • The extent to which the existing health and safety standards for hospitals, critical access hospitals (CAHs), and skilled nursing facilities (SNFs) should also apply to REHs;
               • Additional health and safety standards that should apply to REHs;
               • Quality measurement and reporting;
               • Payment policies;
               • Addressing health equity; and
               • Data sources, additional considerations, and unintended consequences that CMS should consider in the development of policies for REHs.

               Providers are encouraged to submit comments to CMS. Public comments are due no later than September 17, 2021.

               Vulnerable Rural Hospital Assistance Program Funding Opportunity Updated: August 3, 2021 Deadline closed: Saturday, July 31, 2021 Applications are open to all Louisiana Critical Access Hospitals (CAHs) for the 2021-2022 cohort of the Vulnerable Rural Hospital Assistance Program (VRHAP). The Center for Optimizing Rural Health (CORH) works with up to 30 hospitals per year through the year-long VRHAP program. Selected hospitals receive free technical assistance—guidance, resources and recommendations—from a team of rural hospital experts, interactive sessions with peer hospitals and learning opportunities tailored to topics that can benefit their hospital. Apply here: optimizingruralhealth.org/portal-application For more information, watch the presentation recording An Overview of the Year 4 Application Process for the Rural Hospitals Assistance Program from the Center for Optimizing Rural Health (CORH). Questions can be sent to CORH@tamu.edu or call 855-234-0712.

               • Medicare-certified Rural Health Clinics and organizations that own and operate Medicare-certified Rural Health Clinics.
               • All RHCs must have active CMS Certification Numbers (CCNs) and be listed in the CMS Survey and Certification’s Quality, Certification and Oversight Reports (QCOR).
               • To verify your eligibility, visit the CMS Quality, Certification and Oversight Reports (QCOR) website. On the site, you can verify that your provider type is listed as an RHC.
               • HRSA will fund all eligible RHCs and organizations that own and operate eligible RHCs that apply and have a complete and acceptable RHCVC Program application.
               • The RHCVC program DOES NOT have any rural area location requirements.

               Funding:

               HRSA will award grants to all eligible RHCs that submit an acceptable application. Final award amounts will depend on the number of acceptable applicants, but it is estimated that there will be 2,000 awards for $50,000 per RHC site.

               Funding may be used for a broad range of efforts to improve healthcare in rural areas and reinforce basic messages about prevention and treatment of COVID-19 and other infectious diseases.

               Activities may include, but are not limited to:

               • Vaccine promotion
               • Information dissemination to rural residents about how and where to get vaccinated
               • Coordinating with existing vaccination sites and public health partners to identify isolated and/or vaccine hesitate populations
               • Increasing rural community and individual patient literacy on the benefits of broad vaccination and the safety of vaccines

               Use the National Institute of Health COVID-19 Vaccination Communication Guide for ideas on effective health communication tactics to educate about the vaccine.

               Payments:

               HRSA will make payments under this award through the HHS Payment Management System (PMS). PMS is a tool to help you draw down funds and file the Federal Financial Report (FFR). The Division of Payment Management, Financial Management Services, Program Support Center, manages the PMS. They will forward instructions for obtaining payments. The Awards Management Tutorial has information that will assist you in the successful administration and fiscal management of your award.

               Technical assistance webinars:

               NOSORH RHC Vaccine Confidence Grants Webinar

               Monday, June 14, 2021

               • Presentation Recording
               • Presentation Slides
               • The National Organization of State Offices of Rural Health (NOSORH) has provided sample grant applications that clinics can mirror.

               Grants.gov Applicant Overview Webinar Technical Assistance

               Friday, June 4, 2021

               Please contact support@grants.gov or 1-800-518-4726 for additional Grants.gov questions.

               Rural Health Clinic Vaccine Confidence Program Webinar (HRSA)
               How to Respond to the Notice of Funding Opportunity (NOFO) Wednesday, June 2, 2021

               • Presentation Recording
               • Presentation Slides

               Rural COVID-19 Support Webinar

               Monday, June 16, 2021

               • Presentation Recording
               • Presentation Slides
               • 2021 RHC Vaccine Confidence Program FAQs

               Please contact RHCVaxConfidence@hrsa.gov for additional information.

               Additional resources:

               Additional RHC Vaccine Confidence Program information and updates, are available here.

               • HRSA Application Guide
               • Registration for System Management System (SAM)
               • For assistance from Grants.gov, call 1-800-518-4726 (U.S.) or e-mail support@grants.gov.
               • Allowable Expenses Health Resources and Services Administration Rural Health Clinic (RHC) COVID-19 Program Infographic

               Technical assistance may also be obtained regarding the grant and its application process through National Office of State Offices of Rural Health (NOSORH) by emailing rhcvaxconfidenceinfo@nosorh.org.

               For grants management or budget questions, contact Nancy Gaines at (301) 443-5382 or RHCVaxConfidence@hrsa.gov.

               • Purchase and administration of COVID-19 tests
               • Development and implementation of strategies to address patient concerns regarding testing
               • Ensure access to COVID-19 testing by addressing long-standing systemic health and social inequities that put some rural residents at increased risk for COVID-19 or other severe illness
               • Install temporary structures, leasing of properties, retrofitting facilities
               • Education, rehabilitation, prevention, treatment, and support services for symptoms occurring after recovery from acute COVID-19 infection
               • Planning for implementation of a COVID-19 testing program, hiring staff, procuring supplies to provide testing, training providers and staff on COVID-19 testing procedures, and reporting data to HHS on COVID-19 testing activities

               COVID-19 Mitigation

               • Promote behaviors that prevent spread of infectious diseases
               • Ensure Ventilation Systems operate properly
               • Educate the community, including education on vaccines
               • Maintain health operations for staff, including building measures to cope with employee stress and burnout
               • Conduct contact tracing
               • Use digital technologies to strengthen the hospital’s core capacity to support the public-health response to COVID-19
                 Support and referrals to testing, clinical services, and other essential support services

               For additional information or questions, please contact Kandi Smith, Rural Hospital Sustainability Manager at Kandi.Smith@la.gov.

               Webinar Archive:

               Rural COVID-19 Support Webinar

               Monday, June 16, 2021

               • Presentation Recording
               • Presentation Slides
               • American Rescue Plan Funding for SHIP COVID-19 Testing and Mitigation Example Activities