Federal Office of Rural Health Policy Update. Small and Rural Hospital Conference

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1 Federal Office of Rural Health Policy Update Small and Rural Hospital Conference Tom Morris U.S. Department of Health & Human Services (HHS) Health Resources & Services Administration (HRSA) Federal Office of Rural Health Policy (ORHP) November 13 th, 2013

2 This Presentation ACA Insurance Expansion and Rural Hospitals White House Rural Council Final Actions on 2014 Regulations Federal Programs for Rural Hospitals

3 The ACA & Rural America

4 What Providers Can Do Community Health Needs Assessments For example, a hospital facility's CHNA may identify as significant health needs financial or other barriers to care in the community, such as high rates of financial need or large numbers of uninsured individuals and families. Its implementation strategy could describe a program to decrease the impact of these barriers, such as by expanding its financial assistance program or helping uninsured individuals and families learn about and enroll in sources of insurance such as Medicare, Medicaid, Children's Health Insurance Program (CHIP), and the new Health Insurance Marketplaces (also known as the Exchanges). Source: Community Health Needs Assessments for Charitable Hospitals. 78 Federal Register April Pp Retrieved 12 September 2013 from:

5 Get the latest resources to help people apply, enroll, and get coverage in 2014 Marketplace.cms.gov

6 HRSA Resources HRSA Affordable Care Act Website Provider Marketplace Toolkit t.html ORHP Weekly Office Hours on Outreach, Enrollment and Education (TTY ) Assistance available 24/7 English, Spanish, and 150 languages

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8 White House Rural Council HIT Projects Workforce: Rural-Focused Training Pilots Telehealth Pilots Health Information Exchange Pilots New Rural Health Information Technology Training Network Grants 15 New Awards Community-College Focused (AL, CA, CO; FL, IN; KY, MN; MT, NC, NY; PA, SD; TX, VA; WI)

9 IPPS OPPS Regulation and Policy Updates Observation Status GME DSH MDH Expiration Supervision Moratorium Lifted Code Consolidation Physician Fee Schedule Telehealth Issue

10 Questions on the Future for Rural Hospitals 1999: First of a series of IOM Reports on Quality Mid-2000s: First small steps toward pay for reporting Emerging Factors - Industry Consolidation - Quality Penalties : Hundreds of small rural hospitals close 1983 Inpatient PPS begins Swing Beds, SCH, MDH, MAF and EACH/RPCH Demos Physician fee schedule spurs growth of RHCs BBA (CAH designation created) BBRA, BIPA, MMA refinements, etc. Expansion of CHCs 2010 ARRA EHRs and MU Growth of CHCs and NHSC 2013 ACA Coverage Expansion Real PfP - Heavy Focus on CAHs - Changing Nature of Fee for Service and New Models - Possible Workforce Shortages - Medicaid Decisions - Changing Payer Mix - DSH Reductions

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12 A New Resource

13 ORHP Policy Response Research and Analysis Evaluation Technical Assistance and Tools Fulfilling the 711 Role

14 Rural Health Research Research Informs Policy Effort Seven Rural Health Research Centers Rapid Response Data Analysis Rural Policy Analysis Rural Health and Economic Impact The Rural Health Research Gateway Providers access to all RHRC products at: ruralhealthresearch.org. Publications instantly available in full-text or PDF Contact information provided for more than 150 health researchers

15 Office of Rural Health Policy (ORHP) Activities National Advisory Committee on Rural Health & Human Services Advises the Secretary of HHS on Rural Issues Eight Affordable Care Act Policy Briefs Available Online New Briefs Examine Impact of Budget Deficit Proposals on Small Rural Hospitals

16 Providing the Rural Context Federal Partners Medicare Payment Advisory Commission, GAO, others Recent Example Office of the Inspector General Report on CAHs Key Takeaways

17 How ORHP Programs Support Rural Hospitals Flex SHIP Small Health Care Provider QI Special Projects Finance & Quality Policy Regulation Review Flex Monitoring Team National Advisory Committee on Rural Health & Human Services Outreach Network Network Planning Telehealth Networks USDA Capital Loans Workforce Technical Assistance State Office of Rural Health Technical Assistance & Services Center Rural Assistance Center RHC TA Series

18 Office of Rural Health Policy (ORHP) Program Opportunities for Community-Based Division Network Development Due Dec. 6th Network Planning Nov. 14th Start Planning for QI or OR? Expanding the Community Health Gateway Hospital-State Division Flex Focus Areas SHIP Options Office for the Advancement of Telehealth Telehealth Resource Centers

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21 The Rural Community Health Gateway Building a Rural Community Health Evidence Base Available Now! Community Health Worker Toolkit Obesity Toolkit Coming This Summer! Oral Health Toolkit Mental Health Toolkit Coming Next Year! Care Coordination Toolkit Health Promotion Toolkit

22 Hospital State Division (HSD) Improving Quality and Enhancing Financial Performance Key Elements Medicare Beneficiary Quality Improvement Program QIO Special Project on Transfer Measure Using Annual Financial Data Reports Determining What Interventions Work Charge Master Update Revenue Cycle Management Coding and Billing Training

23 Rural Residency Opportunities Rural Training Tracks Technical Assistance Grant with the National Rural Health Association Student Interest Growing New RTTs qualify for Medicare GME support under the cap Five New RTTs starting Flexibility for New Programs under the GME Cap Teaching Health Centers

24 HRSA Workforce Programs Bureau of Clinician Recruitment Services National Health Service Corps FY 14 Loan Repayment Cycle Opens January 7 th FY 14 Scholarship Program Opens March 18 th Nurse Corps FY 14 Nursing Loan Repayment Opens January 7 th FY Nursing Scholarship Program Opens March 20th

25 Healthcare Connect Fund Goals The Healthcare Connect Fund (HCF) provides support for high-capacity broadband connectivity to eligible health care providers, especially in rural areas Broadband connectivity expands access to healthcare services through higher-speed data transmissions The HCF fosters network/consortium model to maximize cost effectiveness Key Features Applications are now available for funding that begins January 1, 2014 For existing pilot projects, funding begins July 1, % discounts on broadband services and equipment Requires 35% health care provider contribution Applicants can apply either as an individual or through a consortium.

26 Technologies Supported & Funding Technologies Supported Broadband services Reasonable and customary installation charges Connections to off-site administrative offices and data centers Connections to research & education networks Equipment necessary for network Upfront charges for deployment of new or upgraded facilities including dark fiber health care provider constructed and owned facilities Funding Cap on total funding for HCF is $400 million annually Cap for upfront payments in HCF is $150 million annually

27 Eligibility for HCF Eligibility The following entities are eligible to participate: Public and not-for-profit hospitals Rural health clinics Community health centers Local health departments and agencies Post-secondary education institutions Teaching hospitals Medical Schools - Non-rural health care providers may participate if they belong to a consortium that has majority rural - The largest health care providers (400+ patient beds) are eligible but support is capped if non-rural

28 How to Apply to HCF The Universal Service Administrative Company (USAC) administers the Healthcare Connect Fund and other FCC rural health care programs, and processes the applications. The Form 460 is the first step to participate in the HCF and will determine eligibility for the program. To download forms and apply, go to: Frequently Asked Questions Contact USAC

29 Federal Capital Programs USDA Community Facilities Loan Program Business and Industry HUD 242 Program Hospital Mortgage Insurance Other Resources:

30 USDA s Distance Learning and Telemedicine Program Funds Equipment 2014 Cycle Not Yet Announced

31 Contact Information Tom Morris