Federal Funding Update

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

• Today’s Presentation• Driving Policy Issues• Available Funding, Resources and

Technical Assistance

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.)

Key Policy Issues for 2016

• Wrapping Up the Medicare Payment Updates• Inpatient• Outpatient• Physician Fee Schedule• RHCs

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/

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

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

Delivery System Reform Support

• Potential Alignment with Rural Health• Transforming Primary

Care Initiative• Health Learning

Action Network• ACO Investment

Model (AIM)

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

http://cph.uiowa.edu/ruralhealthvalue/

Rural Considerations in the Medicare Access & CHIP

Re-Authorization ActFocus on Chronic Disease Management for Rural Communities …

Technical Assistance for Rural Physicians …

Key Policy Issues for 2016

Rural Health and Hospital Research

http://www.ruralhealthresearch.org/

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

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

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.

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/

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

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

http://www.telehealthresourcecenter.org

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

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

MBQIP Data Reports

Resources for Rural Hospitals

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

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

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

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

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

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?

Declining Rural Life Expectancy

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

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.

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

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

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

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

Third party administrator (TPA) geographic assignments

• Role• Geographic Coverage - Health Net (yellow) and TriWest (blue)

How to become a VCP provider FORHP

Webinar on the

VeteransChoice

Act

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:

[email protected]

• 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:

[email protected]

• Website: https://joinournetwork.triwest.com/

• Point of contact: Hal Blair, Deputy Program Manager, TriWest Healthcare Alliance, [email protected]

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

Contact Information

[email protected]

www.ruralhealth.hrsa.gov

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