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Transcript of Federal Funding Update
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Federal Funding Update
15th Annual Small & Rural Hospital ConferenceCharlotte, North Carolina
Tom MorrisAssociate Administrator for Rural Health Policy
Federal Office of Rural Health PolicyHealth Resources and Services AdministrationU.S. Department of Health and Human Service
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• Today’s Presentation• Driving Policy Issues• Available Funding, Resources and
Technical Assistance
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Key Policy Issues for 2016
• Alignment with Key National Trends
• Medicare Merit-Based Incentive Payments
• Alternative Payment Models• Key Regulations
• Meaningful Use and Interoperability
• Marketplace Issues (Network Adequacy, Essential Community Providers, etc.)
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Key Policy Issues for 2016
• Wrapping Up the Medicare Payment Updates• Inpatient• Outpatient• Physician Fee Schedule• RHCs
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340B Drug Pricing ProgramKey Resource for CAHs and PPS DSH Facilities
• Pricing Close to VA Level
• Contract Pharmacy Option
• Recent Developments
http://www.hrsa.gov/opa/
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Encourage the integration and coordination of clinical care services Improve population health Promote patient engagement through shared decision making
Incentives
Create transparency on cost and quality information Bring electronic health information to the point of care for meaningful
use
Focus Areas Description
Care Delivery
Information
Promote value-based payment systems – Test new alternative payment models– Increase linkage of Medicaid, Medicare FFS, and other payments to
value Bring proven payment models to scale
Delivery System Reform and Rural Implications
Driving Influences
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A Transitioning LandscapeAre the rural payment protections a dividing line?
The Rural Safety Net
CAH Cost-Based
Reimbursement
Rural Health Clinic and
FQHC Payment
Swing Bed Payment
Method II Billing
Traditional Medicare
DRGs
Physician Fee Schedule
Medicare DSH
Medicare GME
Legislation moving
toward value has
emphasized standard payment
Unique rural payment
methodologies not often included
in quality reporting
requirements
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Delivery System Reform Support
• Potential Alignment with Rural Health• Transforming Primary
Care Initiative• Health Learning
Action Network• ACO Investment
Model (AIM)
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NQF Rural Health Project To provide multistakeholder information and guidance on performance measurement issues for rural providers, including:
Critical Access Hospitals Rural Health Clinics Community Health Centers (CHCs) Small rural hospitals, Small rural clinician practices http://www.qualityforum.org/Rural_Health.aspx
http://www.qualityforum.org/Publications/2015/09/Rural_Health_Final_Report.aspx
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http://cph.uiowa.edu/ruralhealthvalue/
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Rural Considerations in the Medicare Access & CHIP
Re-Authorization ActFocus on Chronic Disease Management for Rural Communities …
Technical Assistance for Rural Physicians …
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Key Policy Issues for 2016
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Rural Health and Hospital Research
http://www.ruralhealthresearch.org/
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Another Policy Voice for Rural Health
http://www.hrsa.gov/advisorycommittees/rural/publications/index.html
The National Advisory Committee on Rural Health & Human Services
• Policy Briefs and Recommendations Available online
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FY 2016 Competitive Grant ProgramsSmall Health Care Provider Quality Improvement Grant Program
• 3 years, $200,000 K per year• ~ 20 awards• To deliver quality improvement activities
in rural communities– Evidence-based– Outcomes oriented– Population Health
• Eligibility: rural, non-profit or public entity, partner with 2 other entities
• FOA available: January, 2016• Program start date: August, 2016• Contact: Ann Ferrero, [email protected];
301-443-3999
Rural Health Network Development Planning Program
• 1 year, $100,000 • ~ 24 awards• Help to promote the planning and
development of healthcare networks• Eligibility: rural, non-profit or public entity• FOA available: November, 2015• Program start date: June, 2016• Contact: Amber Berrian,
[email protected], 301-443-0845
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FORHP Grantees in the Carolinas
Greene County Health Care (Snow Hill, NC)
• Provide primary health care services at 41 sites to 118,833 patients each year.
• All sites employ same EHR (MicroMD) with well-organized user group, and are able to share clinic data.
FirstHealth of the Carolinas (Pinehurst, NC)
• In two years, they have seen readmission rates drop from 19.4 percent to 2.7 percent for transition care clinic patients.
• Emergency department utilization has dropped 2 percent for the clinic patients.
Allendale County Hospital Nursing Home (Fairfax,
SC)
• Focus area: telehealth
• Unique in that it is a true statewide effort with all of the major hubs participating in the state, which includes three Medical Schools.
• Program is looking at such issues as standards based platform adoption as well as a statewide provider credentialing program.
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Community Health GatewayToolkits • Resources and best practices
to help you identify and implement public health programs
Sustainability ToolsRural Health Models and Innovations Hub • Find examples of approaches you
can adapt for your program, including models shown to be effective, as well as new and emerging ideas.
Economic Impact Tool• Show how your program’s grant funding
affects your community’s economic well-being
http://www.raconline.org/communityhealth/
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FY 2016 Competitive Grant ProgramsThe Telehealth Network Grant Program
• 3 years• $250,000 per year• To demonstrate the use of telehealth
networks that improve health care for medically underserved people
• Eligibility: nonprofit entities that will provide services to rural communities through a telehealth network
• FOA available: Winter 2016• Start date: September 2016• Contact: Carlos Mena, [email protected],
301-443-3198
Telehealth Resource Center Grant Program
• 3 years• $350,000 per year• To support Telehealth Resource Centers to
provide TA for telehealth implementation • Eligibility: nonprofit entities, including
faith-based, community-based, and tribal nonprofit organizations
• FOA available: Winter 2016• Start date: September 2016
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FY 2016 Competitive Grant ProgramsFlex Veterans Rural Health Access Program
• 3 years• $300,000 per year• To demonstrate the use of telehealth and
health information exchange to enhance care for rural Veterans
• Eligibility: States with hospitals and clinics and the VA as partners
• FOA available: Winter 2016• Start date: September 2016• Contact: Anthony Oliver,
[email protected], 301-443-0835
Telehealth Licensure and Portability Program
• 3 years• Amount to be determined• To identify ways to address strategies to
support safe and effective telehealthservice delivery across state lines
• Eligibility: State licensing boards• FOA available: Winter 2016• Start date: September 2016
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http://www.telehealthresourcecenter.org
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Telehealth, Health Information Exchange & BroadbandTwo Key Federal Programs
• FCC’s Healthcare Connect• Revised program• http://www.fcc.gov/encyclopedia/rural-health-care
• USDA Distance Learning and Telemedicine• http://www.rd.usda.gov/programs-services/distance-
learning-telemedicine-grants
• USDA Broadband• Annual program• http://www.rurdev.usda.gov/RUSTelecomPrograms.html
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Resources for Rural HospitalsState Funding• The Rural Hospital
Flexibility Grant Program• The Small Hospital
Improvement Program
The Flex Monitoring Team• Studies and Data on Critical
Access Hospital Issues and State Flex Programs
http://www.flexmonitoring.org/indicators.shtml
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MBQIP Data Reports
Resources for Rural Hospitals
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New Contract: Rural Quality Improvement Technical Assistance
• Fills an essential need for rural-focused quality TA
• Beneficiaries of TA are FORHP grantees
• Flex Coordinators and MBQIP participating CAHs
• Small Rural Healthcare Provider Quality Improvement program
Resources for Rural Hospitals
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Rural Health ClinicTechnical Assistance Series
• ORHP funded through the National Association of Rural Health Clinics
• Listservo Exchange info, ask questionso Sign up at
http://03672e4.netsolhost.com/?page_id=712
• Conference Callso 6 per year on range of topics
o Sign up and review previous calls at http://www.hrsa.gov/ruralhealth/policy/confcall/index.html
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Health Workforce ResourcesHealth Workforce Training Grants• FY 16 Opportunity: Scholarships for
Disadvantaged Students• Medicine, Dentistry, Behavioral Health, Nursing
• NCCU, WSSU, UNC Charlotte
• Programs to Consider …• Nurse Anesthetist Traineeship Program• Health Career Opportunities Program
• Rural Residency Planning Grants• National Center for Health Workforce Analysis
• National and Regional Projections of Supply & Demand for Primary Care Practitioners: 2013-2025
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National Health Service Corps• www.NHSC.hrsa.gov • Facebook.com/NationalHealthServiceCorps• Twitter.com/NHSCorps
NURSE Corps• www.hrsa.gov/loanscholarships/nursecorps/• Facebook.com/HRSANURSECorps
Health Workforce ResourcesHealth Workforce Placement
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Behavioral Health Resources• New Grant from SAMHSA
• Expand Care Coordination Targeted Capacity Expansion (TCE) through the Use of Technology Assisted Care (TAC) in Targeted Areas of Need
• Guidance Out; Due Date January 4th
• Up to 13 Grants; $280,000 Each(http://www.samhsa.gov/grants/grant-announcements/ti-16-001)
• Center for Integrated Health Solutions
http://www.integration.samhsa.gov
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https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/OpioidMap.html
Behavioral Health
Resources• Continued Focus on Opioid
Abuse and Prevention of Overdose
• New CMS Tool• Rural Grants?
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Declining Rural Life Expectancy
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The Metro Versus Non-Metro Difference in Life Expectancy (Years), United States, 1969-2011
Source: Singh GK, Siahpush M. American Journal of Preventive Medicine. 2014;46(2):e19-e29 (updated data)
0.5
0.7
2.0
0.1
1.8
-0.5
0.0
0.5
1.0
1.5
2.0
2.5
1969-1971
1972-1974
1975-1977
1978-1980
1981-1983
1984-1986
1987-1989
1990-1992
1993-1995
1996-1998
1999-2001
2002-2004
2005-2009
2007-2011
Both Sexes
MalesFemales
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Life Expectancy at BirthMetro vs Nonmetro Counties, South Carolina
74.00
75.00
76.00
77.00
78.00
79.00
80.00
Metro 1985 Nonmetro1985
Metro 2010 Nonmetro2010
Avg. Female LE
62.00
64.00
66.00
68.00
70.00
72.00
74.00
Metro 1985 Nonmetro1985
Metro 2010 Nonmetro2010
Avg. Male LE
Source: Institute for Health Metrics and Evaluation (IHME). United States Life Expectancy Estimates by County 1985-2010. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2013.
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Life Expectancy at BirthMetro vs Nonmetro Counties, North Carolina
Source: Institute for Health Metrics and Evaluation (IHME). United States Life Expectancy Estimates by County 1985-2010. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2013.
66.00
67.00
68.00
69.00
70.00
71.00
72.00
73.00
74.00
75.00
Metro 1985 Nonmetro 1985 Metro 2010 Nonmetro 2010
Avg. Male LE
76.0076.5077.0077.5078.0078.5079.0079.5080.00
Metro 1985 Nonmetro1985
Metro 2010 Nonmetro2010
Avg. Female LE
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HUD 242
USDA Community
Facilities
USDA Revolving Loan Fund
Treasury’s New
Market Tax Credits
Access to Capitalhttp://portal.hud.gov/hudportal/HUD?src=/federal_housing_administration/healthcare_facilities
https://www.cdfifund.gov/programs-training/Programs/new-markets-tax-credit/Pages/default.aspx
http://www.rd.usda.gov/programs-services/rural-economic-development-loan-grant-program
http://www.rd.usda.gov/programs-services/community-facilities-direct-loan-grant-program
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Overview: Veterans Access, Choice and Accountability Act of 2014
• VA officially launched the Veterans Choice Program on November 5, 2014, in accordance with Public Law 113-146 (Veterans Access, Choice, and Accountability Act of 2014)
• The Veterans Choice Act provides $10Billion for community care if • VA cannot appoint within 30 days of the Veteran’s preferred date, or; • The Veteran resides more than 40 miles from their closest VA medical facility, or;• In cases of medical necessity
• The Veterans Choice Act allows VA to expand the availability of community care for Veterans through agreements with non-VA entities and providers
• Veterans Choice Program providers must be approved through a third party administrator• VA signed contracts with Health Net and TriWest to serve as contracted third party administrators and help VA administer the
Veterans Choice Program; for information on how to sign up, visit:• Health Net: http://www.healthnetpc3provider.com/p3c/?register=tru• TriWest: https://joinournetwork.triwest.com/
• This authority sunsets in three years or when Veterans Choice Fund is expended
• For more information on the Veterans Choice Act, visit http://www.va.gov/opa/choiceact/ 35
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VCP Provider Requirements
123
Accept Medicare rates and meet all Medicare conditions of participation and conditions for coverage
Be in full compliance with federal and state regulatory requirements
Have unrestricted license in state where services are delivered
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Third party administrator (TPA) geographic assignments
• Role• Geographic Coverage - Health Net (yellow) and TriWest (blue)
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How to become a VCP provider FORHP
Webinar on the
VeteransChoice
Act
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Key Resources
• Tom Grahek, Chief, Non-VA Purchased Care, Chief Business Office, VHA
– [email protected] or 804-878-2754
• Veterans Choice Program overview• http://www.va.gov/opa/choiceact/factsheets
_and_details.asp• "How to Become a Veterans Choice
Program and/or Patient-Centered Community Provider" fact sheet
– http://www.va.gov/opa/choiceact/documents/FactSheets/VACAA_Provider_Fact_Sheet_Choice_Program_508c_Internet.pdf
• VHA Choice Locator PC3 Provider Map– http://www.va.gov/opa/apps/locator/
• Health Net contact information:• 1-866-606-8198; Email:
• Website: http://www.healthnetpc3provider.com/p3c/?register=tru
• Point of contact: Jim Jones, Health Net Federal Services, [email protected]
• TriWest contact information:• 1-866-284-3743; Email:
• Website: https://joinournetwork.triwest.com/
• Point of contact: Hal Blair, Deputy Program Manager, TriWest Healthcare Alliance, [email protected]
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Key Resources (continued)
Military Culture Training Course Training for community providers on treating the unique Veteran patient communityhttp://deploymentpsych.org/military-culture-course-modules
PTSD Consultation ProgramPost-traumatic stress disorder training offered for health care professionals who treat Veteranswww.ptsd.va.gov/professional/consult/index.asp
Veterans Choice Program ToolkitOutreach materials (e.g., fact sheets, FAQs) designed to make it easy to share information and spread awareness about VCPhttp://www.va.gov/opa/toolkit/index.asp
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Contact Information
www.ruralhealth.hrsa.gov
Want to Get Our Announcements? E-mail Michelle Daniels at [email protected]