State Offices of Rural Health Region A Annual Meeting Office of Rural Health Policy Update U.S. Department of Health

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State Offices of Rural Health Region A Annual
MeetingOffice of Rural Health Policy
UpdateU.S. Department of Health Human
ServicesHealth Resources Services
AdministrationOffice of Rural Health PolicyJune
23, 2008Jennifer Chang, MPHJeanene Meyers, MPH
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ORHP Update

• Overview of Presentation
• HHS, HRSA, and ORHP Priorities
• National Advisory Committee on Rural Health and
  Human Services
• Regulatory Issues
• Rural Health Research
• ORHP Grant Programs
• Community-Based Grants
• Hospital-State Based Grants
• Rural Health Resources and Tools

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HHS Priorities

• Every American Insured
• Insurance for Children in Need
• Value-Driven Health Care
• Information Technology
• Personalized Health Care
• Health Diplomacy
• Prevention
• Louisiana Health Care System
• Preparedness
• Ongoing Initiatives

HHS Hubert Humphrey Building Washington, D.C.
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HRSA Goals

• Improve Access to Health Care
• Improve Health Outcomes
• Improve the Quality of Health Care
• Eliminate Health Disparities
• Improve the Public Health and Health Care Systems
• Enhance the Ability of the Health Care System to
  Respond to Public Health Emergencies
• Achieve Excellence in Management Practices

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ORHP Priorities

• 2008 Priorities (3 topics chosen each year)
• Workforce
• Quality Improvement
• Health Information Technology (HIT)

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ORHP Functions

• Roles of the Office of Rural Health Policy
• Serves as a Voice for Rural within HHS
• Supports Rural Health Research
• Supports Rural Health Grant Programs

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NACHRHHS

• National Advisory Committee on Rural Health
  Human Services (NACRRHS)
• External Policy Voice
• Public advisory panel of 21 nationwide rural
  health experts, staffed by ORHP
• Annual Report to the Secretary
• 2008 Report is a 20-Year Retrospective
• http//ruralcommittee.hrsa.gov
• 2009 Report topics
• Workforce Community Development
• Serving At-Risk Children
• Creating Viable Medical Homes in Rural
  Communities
• SORH representative Graham Adams

Chairman David Beasley
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Regulatory Issues

• Emerging Rural Health Policy Issues
• Medicare Part D Rural Community Rx Viability
• Medicare Advantage
• Federal Quality Initiatives
• Medicare Value Based Purchasing
• Patient Safety

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Regulatory Issues

• Key Regulatory Issues Were Tracking

• Inpatient Hospital Payment
• Outpatient Hospital Payment
• Physician Payment
• Rehab Payment
• Psych Payment
• Skilled Nursing Facility and Long Term Care
  Payments

• Ambulance Fee Schedule
• Medicare Advantage
• Medicare Part D
• Rural Health Clinics
• Federally Qualified Health Centers
• Medicaid Waivers
• Medicare GME

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Regulatory Issues

• New Health Professional Shortage Area (HPSA)
  Proposal
• Proposed Designation of Medically Underserved
  Populations/Areas (MUA/MUP) and HPSAs
• 40 Federal programs use these designations as
  criteria, e.g., CHCs, RHCs, National Health
  Service Corps
• Proposed new method increases accuracy for
  targeting resources, better science, simplifies
  process
• Three-step process, includes a safety net
  provision for safety net facilities
• Proposed rule was posted in the Federal Register
  on February 29 Comments due on or before June
  30, 2008.

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Regulatory Issues

• Rural Health Clinic (RHC) Regulation
• Final Rule on hold
• New proposed rule expected in Summer of 2008
• Updated Participation Requirements and Payment
  Provisions
• Shortage area requirements
• De-designation of RHCs
• Quality Assurance/Performance Improvement (QAPI)

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Regulatory Issues

• CAH Interpretive Guidelines
• CAH Observation Services - April 4, 2008
• Use and location of observation beds in CAH
• CAH Conditions of Participation (CoPs) for
  location replacement facility requirements,
  revision released on September 7, 2007
• Explains criteria to determine 75 rule for
  relocation (services, staff, service area)
• Revises geographic definitions of mountainous
  terrain and primary roads

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Rural Health Research

• Rural Health Research Centers (RHRC)
• The only HHS program solely focused on rural
  research
• Supports ORHP policy role with rural specific
  data
• Informs policy makers
• Rural Health Research Gateway New!
• One stop shopping for RHRC information at
  http//www.ruralhealthresearch.org/
• Rural Health Research Listserv at
• www.ruralhealthresearch.org/listserv/
• Targeted Research Grant
• Up to 150,000 for 18 months
• Applications available February 2009 to begin
  September 1, 2009

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Rural Health Research
Recent Research Report Changes in the Rural
Registered Nurse Workforce from 1980 to 2004
Skillman SM, Palazzo L, Hart LG, Butterfield P.
Changes in the Rural Registered Nurse Workforce
Since 1980. October 2007.
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ORHP Budget
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ORHP Grant Awards

• Grants
• Hospital-State Based
• Community-Based
• ORHP awarded 258 million in funding for 450
  grants in 50 States over three years

258 Million
450 Grants
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ORHP Grant Awards
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ORHP Grant Awards

• FY 08 Community-Based Grants

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Community-Based Grants

• Rural Health Care Services Outreach (Outreach)
• Rural Health Network Development (Network
  Development)
• Rural Health Network Development Planning
  (Network Planning)
• Delta States Rural Development Network (Delta)
• Small Heath Care Provider Quality Improvement
  (Quality)
• Radiation, Exposure, Screening and Education
  Program (RESEP)
• Black Lung Clinic Program (BLCP)
• Delta Health Initiative (DHI)
• Frontier Extended Stay Clinic (FESC)

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FY09 Community-Based Grants

• Outreach
• Three year demonstration grant funding up to
  150,000 for year one, 125,000 for year two, and
  100,000 for year three
• Applications available July 2008
• Expect to make up to 90 Awards to begin May 1,
  2009
• Network Planning
• One year demonstration grant funding up to
  85,000
• Applications available July 2008
• Expect to make up to 20 Awards to begin March 1,
  2009
• Quality - next competition FY 2010
• Network Development - next competition FY 2011

http//ruralhealth.hrsa.gov/funding/GrantPrograms.
htmproviders
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ORHP Grants TA

• Targeted Technical Assistance Workshops
• Seven States have not received a Community-Based
  Grant from ORHP over the past 5 years
• Utah, Wyoming, Pennsylvania, Oklahoma, Idaho,
  Colorado Tennessee
• ORHP will provide targeted TA at Grant Workshops
  in each of the States.
• Grant Workshops coordinated through the
  respective SORHs

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Hospital-State Grants

• State Offices of Rural Health (SORH)
• 50 States
• Rural Hospital Flexibility Grant (Flex)
• 45 States
• Small Rural Hospital Improvement Program (SHIP)
• 46 States
• Critical Access Hospital HIT Network Grants
  (CAH-HIT Network)
• 16 States

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CAH-HIT Network Grants

• One-time funding opportunity in FY 2007 for 25
  million
• Focus Use HIT to create networks, so that
  patient data follows the patient across the
  continuum of care
• Networks include a CAH as well as a referral
  hospital and ambulatory and post-acute providers
• Funded grants in 16 States
• Alabama, Hawaii, Illinois, Indiana, Louisiana,
  Michigan, Minnesota, North Dakota, Nebraska,
  Oklahoma, South Carolina, Tennessee, Texas,
  Virginia, Washington, and Wisconsin
• Grants will serve as pilot projects for rural HIT
  implementation

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CAH-HIT Network Grants
CAH HIT Network Grants
CAHHIT States in red More information
at http//ruralhealth.hrsa.gov/funding/flexpurpos
e.htm
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Grant Reviewers

• We Need You!
• ORHP has multiple grant program reviews each year
• Reviewers with rural experience needed to be a
  part of our Objective Review Committee panels
• You must register with HRSA to be a reviewer
• Register at https//grants.hrsa.gov/webReview/
• Indicate rural health as one of your
  specialties in the background information section
• Tell ORHP staff which programs you are familiar
  with

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Tools and Resources

• Grants.gov - one Web site to apply for all
  government funding
• All grant applications must go through Grants.gov
  first
• HRSAs Electronic Handbook (EHB)
• HRSA grants specific
• Update your users
• Performance measures
• https//grants.hrsa.gov/webexternal/login.asp
• Register and Apply EARLY!

http//www.Grants.gov
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Tools and Resources

• Different processes for different grant types
• Competitive (New) Awards
• Application process is entirely in Grants.gov
• External Objective Review Process
• Non-Competitive (Continuation) Awards
• Two-step application process first in
  Grants.gov and then in HRSAs EHBs
• Separate deadlines, cant apply in EHB if you
  miss the Grants.gov deadline
• Internal Staff Review

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Tools and Resources
The Rural Assistance Center

• One-Stop Shopping for Rural
• Funding Information
• Resource Guides
• Best Practices

http//raconline.org
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Tools and Resources
http//www.3rnet.org
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Tools and Resources

• Workforce Programs HRSAs Bureau of Clinician
  Recruitment and Service
• Educational Support
• Nursing Loan Repayment
• http//bhpr.hrsa.gov/nursing/loanrepay.htm
• Nursing Scholarships
• http//bhpr.hrsa.gov/nursing/scholarship/
• National Health Service Corps
• Loan Repayment Scholarships for Physicians,
  Dentists, Psychologists, Nurse Practitioners and
  Physician Assistants
• Recruitment Retention Assistance for
  Communities
• 1-800-221-9393 or E-mail callcenter_at_hrsa.gov
• http//nhsc.bhpr.hrsa.gov/join_us/scholarships.asp

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Tools and Resources

• Workforce Programs - HHS
• J1-Visa Waivers
• Conrad 30 Program (Most Flexibility)
• Work through your States Primary Care Office or
  Office of Rural Health
• HHS Program (Focused on Areas of Greatest Need)
• Limited to RHCs and FQHCs with a HPSA Score of 14
  or higher
• For more information, call 301-594-4154 or go to
  http//www.hhs.gov/ogha/exchange.html

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Tools and Resources

• Technical Assistance for Rural Health Clinics
• Free quarterly TA conference calls provided by
  the National Association of Rural Health Clinics
  (NARHC)
• Past topics include billing, pandemic flu, HIT,
  etc.

A Rural Health Clinic in Michigan
http//www.narhc.org/members/orhp_series.php
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Tools and Resources

• 340B Drug Pricing Program
• Provides outpatient and ER drugs at reduced cost
• Many Disproportionate Share Hospitals (DSH) are
  eligible
• HRSA Pharmacy Services Support Center (PSSC)
  provides free consultative services about program
• HRSA Office of Pharmacy Affairs (OPA) guides
  application process

http//pssc.aphanet.org/http//www.hrsa.gov/opa/
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Tools and Resources

• Health Information Technology Portal
• Developed by the Agency for Health Research and
  Quality (AHRQ)

http//healthit.ahrq.gov
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Tools and Resources

• A New EMS Resource
• Web site with background and updates on Federal
  EMS initiatives and programs
• Developed by the National Highway Traffic Safety
  Administration (NHTSA) at DOT

http//www.ems.gov/
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Tools and Resources

• Mental Health Evidence-Based Practices Web Site
• Developed by the Substance Abuse Mental Health
  Services Administration (SAMHSA)
• Includes filter for rural and/or frontier location

http//www.nrepp.samhsa.gov/find.asp
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Tools and Resources

• USDA offers housing, utilities and business
  programs
• Utilities programs include economic development
  loans and grants for
• Distance Learning and Telecommunications
• Broadband access to underserved rural areas
  (Community Connect Grant)
• New pilot program on using combination grant/loan
  for Electronic Health Records
• http//www.rurdev.usda.gov/

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Tools and Resources

• Access to Capital
• HUD and USDA
• Model Plans available for hospitals
• Capital Replacement Manual under development

HUDs Health Care Facilities Web
site http//www.hud.gov/offices/hsg/hosp/hsghospi
.cfm Critical Access Hospital Prototype http//w
ww.hud.gov/offices/hsg/hosp/prototype.pdf
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Contact Information
Jennifer Chang, MPH Jeanene Meyers, MPH Public
Health Analyst Public Health Analyst HRSA,
ORHP HRSA, ORHP jchang_at_hrsa.gov jmeyers_at_hrsa.g
ov ORHP Web Site http//ruralhealth.hrsa.gov
ORHP Main Phone Number [phone]