Few and Far Away: Detoxification services in rural areas

Based on Working Paper #41: Availability, Characteristics, and Role of Detoxification Services in Rural Areas. Findings: Few rural detox providers exist; 82% of rural residents live in a county without a detox provider. More than half of all rural detox providers serve a 100 mile radius. Travel distances are a barrier to outpatient detox models. Referral options to substance abuse treatment are limited, especially in isolated rural areas

Mental Health Services in Rural Jails [Policy Brief]

Based on interviews with state and local corrections and mental health informants in four rural states (Minnesota, Montana, Texas, and Vermont), the researchers sought to learn more about hte challenges that rural jails face along with promising practices being used to meet the needs of inmates with mental health concerns

Many Urban and Rural Workers Lose Health Insurance During Job Transitions

Numerous studies have found that rural residents are more likely to be uninsured than urban residents, in part because rural workers are more likely to be employed by a small business or have low wages and thus have more limited access to employer coverage.1-5 Yet, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured,6 and there is some evidence that this risk is even greater for rural workers.7 In the past 20 years, much of the federal-level policy attention related to health insurance coverage (e.g. the Consolidated Omnibus Budget Reconciliation Act and the Health Insurance Portability and Accountability Act) has emphasized ensuring continuity of coverage for individuals that experience an employment transition. However, these key policy interventions do not apply to smaller employers that are the backbone of rural economies. !us, rural workers may be more likely than urban workers to experience disruptions in health insurance coverage following an employment transition. The purpose of this study was to explore the impact of changes in employment status on insurance coverage for rural and urban workers, and the factors behind any differences. !e Affordable Care Act (ACA) provides a new backdrop against which to consider the issues of job change, job loss, health insurance portability and coverage of rural residents. Our findings provide important information about the health insurance coverage challenges that rural workers may face, and may help to identify potential challenges and opportunities for implementing ACA in rural areas

Impact of Employment Transitions on Health Insurance Coverage of Rural Residents

Numerous studies have found that rural residents are more likely to be uninsured than urban residents. This coverage difference is generally due to more limited access for rural workers to employer-sponsored health insurance. Lower wages, and the tendency for rural residents to work for small employers, account for this reduced access. While we have substantial information on static insurance coverage rates for rural residents, our knowledge about how coverage changes with employment transitions is limited. Prior research indicates that loss of a job puts workers at greater risk of becoming uninsured, and there is some evidence that this risk is even greater for rural workers. Other studies suggest that access to health insurance plays an important role in determining whether a worker decides to change. Whether this relationship is any different for urban versus rural workers has not been well-studied. In the past 20 years, much of the federal-level policy attention related to health insurance coverage has emphasized ensuring continuity of coverage for individuals that experience an employment transition. For example, the Consolidated Omnibus Budget Reconciliation Act (COBRA), passed in 1985, ensured that those with employer-sponsored coverage could retain that coverage even if that employment ceased. Similarly, the 1996 Health Insurance Portability and Accountability Act (HIPAA) guaranteed individual coverage for those who leave a group plan. However, both of these key policy interventions are inapplicable to the smaller employers that are the backbone of rural economies. Thus, rural workers may be more likely than urban workers to experience disruptions in health insurance coverage following an employment transition. The Patient Protection and Affordable Care Act (ACA) provides a new background against which to consider the issues of job change, job loss, health insurance portability and coverage of rural residents. Understanding how changes in employment status impact insurance coverage for rural workers can help to identify potential challenges and opportunities for implementing ACA in rural areas

Access to Mental Health Services and Family Impact of Rural Children with Mental Health Problems

Mental health problems have considerable impact on children and their families and some of these impacts are higher in rural than urban areas. Rural children are slightly but significantly more likely to have a mental health problem than urban children, are more likely to have a behavioral difficulty, and are more likely to be usually or always affected by their condition. Compared to urban children, rural children are more likely to go without access to all parent-reported needed mental health services and their families spend more time coordinating their care. This working paper and policy brief provide information on prevalence of children’s mental health needs and associated access to care and family impact across rural and urban areas. Analyses are based on the 2005-06 National Survey of Children with Special Health Care Needs

Monitoring the Community Benefits of CAHs: A Review of the Data (Policy Brief #13)

This publication examines evidence of differences in the community benefits provided by CAHs compared to larger hospitals and discuss the issues for CAHs in complying with IRS community benefit reporting requirements. This policy brief is designed to summarize key findings and identify important trends. For state-level CAH community benefit data, browse the State Profiles. Key Findings CAHs may benefit from technical assistance and other support in collecting and reporting community benefit data using the CAH/IRS framework and managing their charity and uncompensated care activities. CAHs may be unlikely to use community benefit tools that duplicate existing management tools or are not integrated with existing management information systems. CAHs are less likely to participate in medical research and education; two significant areas of community benefit activity in larger hospitals, due to their sizes and limited patient volumes. Development of arbitrary hospital community benefit standards may disadvantage CAHs as they typically provide lower levels of community benefits when measured as a percentage of total revenues.In this brief, we review the background of this project, examine evidence of differences in the community benefits provided by CAHs compared to larger hospitals, and discuss the issues for CAHs in complying with IRS community benefit reporting requirements

Monitoring the Community Benefits of CAHs: A Review of the Data (Briefing Paper #24)

This publication examines evidence of differences in the community benefits provided by CAHs compared to larger hospitals and discuss the issues for CAHs in complying with IRS community benefit reporting requirements. For state-level CAH community benefit data, browse the State Profiles. Key Findings CAHs may benefit from technical assistance and other support in collecting and reporting community benefit data using the CAH/IRS framework and managing their charity and uncompensated care activities. CAHs may be unlikely to use community benefit tools that duplicate existing management tools or are not integrated with existing management information systems. CAHs are less likely to participate in medical research and education; two significant areas of community benefit activity in larger hospitals, due to their sizes and limited patient volumes. Development of arbitrary hospital community benefit standards may disadvantage CAHs as they typically provide lower levels of community benefits when measured as a percentage of total revenues. In this brief, we review the background of this project, examine evidence of differences in the community benefits provided by CAHs compared to larger hospitals, and discuss the issues for CAHs in complying with IRS community benefit reporting requirements

Developing Indicators to Document the Community Impact of CAHs (Policy Brief #7)

The Federal Office of Rural Health Policy has created clear expectations and incentives for CAHs to engage with their communities, develop collaborative delivery systems of care, and undertake efforts with those in their community to address unmet community health and health system needs. Additionally, there has been a growing push in clarifying the “community benefit” provided by not-for-profit hospitals – including the development of community benefit reporting requirements in dozens of states. The Flex Monitoring Team worked to develop a set of community impact and benefit indicators for CAHs, which attempt to provide rural-relevant community impact indicators for CAHs to quantify their benefit to their communities. Through use of these indicators, CAHs can document their community impact activities and CAH progress in meeting community needs can be monitored. The indicators were pilot tested with approximately 25 CAHs across six states before finalization