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SHIP Program: Funding Opportunity Announcement (FOA)

and Frequently Asked Questions (FAQs)

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Agenda

• SHIP Critical Information• SHIP Program Changes for 2013• Key Concepts of the SHIP• Broad Contents of the SHIP• The National Rural Health Resource Center

(The Center) Technical Assistance • SHIP FAQs

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SHIP Critical Information

• FOA release date: 1/16/2013• Application due date: 3/15/2013• Hospital eligibility: 49 or less staffed beds, reported on

the most recent Medicare Cost Report, Line 14– If hospital reports a licensed bed count greater than 49 on

Line 14 but staffs 49 beds or fewer, you may certify eligibility by submitting a written statement to the SORH that includes: 1) the number of staffed beds at the time of the most recent cost report submission, 2) the cost reporting period of the most recently filed cost report, and 3) the “real-ink” signature of the certifying official (CEO or CFO).

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Key Concepts of the SHIP• Program integrity, program integrity, program integrity• Project and investments may, and in many cases should complement

the Flex Program; there is an upcoming TA call on this topic next Thursday

• CAHs can’t duplicate Flex services• Non-CAHs can spend on Flex-type work• SHIP funds can’t be used for direct patient care or facility personnel

costs (consultants aren’t included here)• No “co-mingling” of SHIP/Flex funds – Spending 2 funding streams on

the same project without delineating direct expenditures• Forming “networks” is strongly encouraged (“network” defined as 2 or

more hospitals working together on training/education and/or equipment purchases); MOUs or contracts aren’t required

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Broad Contents of the SHIP

• Why the changes to the program?• What may be purchased and why• Use of networks• Measurement and Performance Information

Measurement Systems (PIMS)• The Center’s FY13 State Spreadsheet of SHIP

Applicants and FY13 SHIP Hospital Applicant Form

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Why Changes to SHIP?

• The national healthcare environment is rapidly changing – SHIP must adjust and enable small hospitals to meet Affordable Care Act (ACA) objectives, as well as future administrative changes

• Ensuring program integrity has become critical • Purchases must be legitimate and quantifiable

(measurable)• SHIP should be used as a tool to complement Flex

activities more than it has in the past

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What may be Purchased and Why• Purchases must fall under several categories identified in the ACA: Value-

Based Purchasing, Accountable Care or Shared Savings and Payment Bundling/PPS

• Or, be identified as specific investments listed on the SHIP Purchasing Menu• Menu selection priority must be given to: 1st, activities relating to MBQIP

registration and data transmission of at a minimum some Phase I data; 2nd, implementation of HCAHPS or ICD-10 activities (1 or the other, in no order)

• If a hospital is participating in all 3 activities (Tiers), that hospital may select an activity on the menu

• If a hospital has implemented all activities on the menu and attests to such, that grantee may receive permission from their PO for another purchase that must meet ACA category objectives (VBP, ACO, Payment Bundling)

• “Real-ink” signatures of CEO and SHIP Project Director must be on the application; grantees must have a plan to collect and maintain receipts of purchases

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Use of Networks

• Not mandated but strongly encouraged• May be quantified through measures and PIMS• Many of you use networks now; Flex networks may

be used for SHIP, and vice-versa• Forming networks and examining their

efficacies/efficiencies is a critical part of future ORHP work

• MOUs or contracts aren’t required by HRSA for network creation or operation

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Measurement and PIMS

• ORHP is working on creating PIMS measures similar to the measures on the SHIP purchasing menu

• Measures on the SHIP purchasing menu must be used in correlation with the activity selected

• Different measures may be used with PO approval

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The Center’s Spreadsheet for Recording Hospital Data and Hospital Applicant Form

• The Center has developed resources for grantee use • Simple and self-explanatory; correlates to

information necessary for the application • Grantees are strongly encouraged to use these

resources• See attachments: FY13 State Spreadsheet of SHIP

Applicants and FY13 SHIP Hospital Applicant Form

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SHIP FAQs

• What are the 3 Tiers of SHIP?– Answer: Tier 1 is MBQIP (having registered for and having

transmitted at a minimum some data from Phase 1 by February 15, 2013); Tiers 2 and 3 are interchangeable: implementation of HCAHPS and implementation of ICD-10

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SHIP FAQs, cont.

• Can SHIP funds be used for HCAHPS if HCAHPS has already been implemented (likewise for ICD-10) – i.e., maintenance fees, or if HCAHPS has been implemented (likewise for ICD-10)must hospitals move onto the next tier, i.e., ICD-10 or an item on the menu?– Answer: The intent of SHIP funds is to “jumpstart”

programs, i.e. HCAHPS or ICD-10, that have not yet been implemented. In this scenario, if HCAHPS has been implemented, and ICD-10 has not yet been implemented, then the funds must be spent on ICD-10. However – if all 3 tiers have been implemented, SHIP funds may be used for maintenance fees.

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SHIP FAQs, cont.

• If a hospital has completed all 3 tiers (MBQIP, HCAHPS, and ICD-10), can that hospital select to fund maintenance on 1 of the tiers (i.e., pay annual HCAHPS vendor fee or update ICD-10 software)?– Answer: Yes; once a hospital has registered/transmitted at

a minimum some Phase I data, and has implemented both HCAHPS and ICD-10 (definition of “implementation” next slide), then that hospital may fund maintenance on any of the 3 tiers rather than select an item on the menu.

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SHIP FAQs, cont.

• How will I know if a hospital has met the definition of “implementation” concerning Tiers 2 and 3 (ICD-10)?– Answer: To meet Tier 2 and 3 completion requirements,

hospitals at the very least must be in a state of implementation. Implementation of ICD-10 is defined as having completed the installation of and currently billing services using ICD-10, or in the direct process of installing ICD-10 hardware/software, i.e., written assurances from vendors that installation will proceed by April 1, 2013. Having participated in webinars, paid consultants to conduct feasibility studies/cost estimates, and putting aside funds for future implementation don’t count.

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SHIP FAQs, cont.

• How will I know if a hospital has met the definition of “implementation” concerning Tiers 2 and 3 (HCAHPS)?– Answer: Implementation of HCAHPS is defined as

having purchased and utilized HCAHPS at least once, or having purchased HCAHPS and planning to use it by April 1, 2013. Having participated in webinars, paid consultants to conduct feasibility studies/cost estimates, and put funds aside for future implementation don’t count.

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SHIP FAQs, cont.

• Would the Tier 1 requirement be considered complete if a hospital is reporting some MBQIP Phase 1 data but not Phase II data? – Answer: At this time, the primary objectives of SHIP FY13-

FY14 are to improve national participation concerning all 3 Tiers. If a hospital has registered for and is transmitting at a minimum some Phase 1 MBQIP data, then Tier 1 is considered complete.

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SHIP FAQs, cont.

• May hospitals still fax/email applications to the state SHIP coordinator?– Answer: Yes, so long as the signatures on the applications

are in ink – no e-signatures, stamps, proxy signatures, or signatures of other hospital representatives.

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SHIP FAQs, cont.

• May a hospital, which has completed Tier 1 (MBQIP registration/some Phase 1 data transmission), split its SHIP funds between Tiers 2 and 3 (HCAHPS and ICD-10) if that hospital has yet to implement either?– Answer: Yes.

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SHIP FAQs, cont.

• How will I know if a hospital has completed Tier 1 (MBQIP)? If a hospital has only N/As on their MBQIP report, does that count as a data transmission?– Answer: That hospital will have registered for MBQIP, as

well as have transmitted at a minimum some Phase I data by February 15, 2013.

– Answer: Yes, N/As do count as a data transmission. However – if a hospital has N/As for 4 consecutive quarters, HRSA may investigate a bit further into the data reporting of that hospital.

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Questions?

CDR David Dietz, MHSA, MSWDdietz@hrsa.gov301-443-4081

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Thank you for participating!

Please take our online evaluation: https://

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Upcoming SHIP TA Webinars:Collaboration: Complementing the State Medicare Rural Hospital Flexibility (Flex) Program and Working with Networks• Thursday, January 31, 2013 - 2:00pm –

3:00pm (Central Time)

Rural Hospital Participation in Accountable Care Organizations (ACOs) and Patient-Centered Medical Care Homes• Tuesday, February 19, 2013 - 2:00pm –

3:00pm (Central Time) ICD-10: What Does it Mean and How Will it Impact Rural Hospitals?• Tuesday, May 21, 2013 - 2:00pm – 3:00pm

(Central Time)