The Federal Rural Health Landscape

1
The Federal Rural Health Landscape

• South Carolinas 13th Annual Rural Health
  Conference
• April 29-30, 2009

Carrie Cochran Deputy Associate
Administrator for Rural Health Policy Health
Resources and Services Administration U.S.
Department of Health and Human Services
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Todays Presentation

• Washington Update
• Health Care Reform
• The Stimulus Bill
• Emerging Challenges
• Opportunities and Resources

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About Office of Rural Health Policy

• Role of the Office of Rural Health Policy
• Voice for Rural within HHS
• Administers Rural Health
• Grant Programs
• Makes Policy Recommendations
• Facilitates Rural Health Research

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• Tough Times Thin Margins get Thinner
• Local job losses
• State cuts
• Increase in the uninsured

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Current Health Care Challenges

• Increases in the Uninsured, Underinsured
• Decreased Revenues
• Workforce Recruitment and Retention
• Increased Focus on Quality and Reporting
• Resources/Infrastructure

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Health Care Reform

• Health Care Reform Front Center
• Presidents Vision Key Principles
• Protect families financial health
• Assure affordable, quality coverage
• Provide portability of coverage
• Guarantee choice of providers
• Invest in prevention and wellness
• Improve patient safety and quality
• End barriers for pre-existing conditions
• Reduce long-term growth of health care costs

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Health Care Reform

• White House Forum a starting point
• Opportunities for rural?
• More information available
• http//www.healthreform.gov/

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Health Care Reform

• Some Common Themes
• Rising Costs
• Reductions in Access
• A Need to Improve Quality
• Linking Workforce

• Current Proposals
• Improving Access
• Re-Emphasizing Primary Care
• Improving Outcomes
• Strengthening Medicare, Medicaid and SCHIP

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Health Care Reform

• What Does This Means for Rural?
• Long-Standing Access Problems
• Uninsured Insurance Market Challenges
• Heavier Chronic Disease Burden
• Opportunity to Improve Outcomes and Value
• Workforce
• Already Focused on Primary Care but in dire need
  of more providers

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Health Care Reform

• Viewing Health Care Reform as part of the
  Recovery
• New Report from the White House Office of Health
  Reform
• More information expected

http//www.healthreform.gov/reports/inaction/inact
ionreportprintmarch2009.pdf
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The American Reinvestment and Recovery Act (ARRA)

• 787 billion stimulus package for
• Health Information Technology (HIT)
• Community Health Centers
• Prevention and Wellness
• Health Workforce
• www.recovery.gov

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ARRA HIT

• Medicare HIT Payments
• Based on Meaningful HIT adoption through 2014
• PPS Facilities Adjustment to Base Payment
  relative to Medicare share

• CAHs Payment based on Medicare Share 20 of
  depreciation amount
• Paid via interim payments (not cost-settlement)

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ARRA HIT

• Medicaid HIT Payments
• Based on Meaningful HIT
• adoption through 2014
• Eligible Professionals, including RHCs and FQHCs,
  get up to 85 of HIT-related costs
• Tied to meeting a 30 combined Medicaid, SCHIP,
• uncompensated care patient population
  threshold
• Eligible Hospitals, including PPS and CAH, with
  at least 10 Medicaid patient volume

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ARRA HIT

• Other HIT Resources
• Construction, renovation and
• equipment, and acquisition of HIT
• HIT workforce training
• Regional health information exchange
• HIT Extension Program- Regional Technical
  Assistance Centers

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ARRA Rural Broadband

• 7.2 billion in funds to extend broadband service
  nationally through USDA
• 4.7b for Broadband Technology Opportunities
  Program (BTOP)
• 2.5 b for Rural Utilities Service (RUS) for
  grants/loans for deployment construction of
  broadband systems

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ARRA Workforce

• 500 million to strengthen the health care
  workforce
• 300m to National Health
• Service Corps
• 200m Title VII- Primary Care, Dentistry, AHECs
• Additional Labor Department Provisions

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ARRA Community Health Centers

• 2 billion to support CHC services, repairs and
  renovations, and investments in HIT
• 155m New Access Points- awarded to 126 CHC for
  FY09 and FY10
• 337m Increased Demand for Services (IDS)-
  awarded to 1,128 CHC for FY09 and FY10
• http//bphc.hrsa.gov/recovery

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ARRA Prevention Wellness

• 1 billion to support HHS initiatives and
  programs in Public Health Service Act
• 650m Evidence-based Prevention Wellness
• 350m Secretarial Initiatives
• Evaluation of quality effectiveness of program
  spending

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ARRA Capital

• 130 million for rural community facility
  development through the USDA Capital Facilities
  Loan Program
• 67 million in loans
• 63 million in grants
• Translates to well over
• 1 billion in guaranteed loans
• for rural facilities

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ARRA Other Rural Resources

• Rural Business Programs
• Rural Water and Waste Disposal Programs
• Rural Community Facilities
• Law Enforcement- Rural Drug Enforcement
  Assistance Program
• Rural Housing Programs
• Loans for Beginning Farmers

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Childrens Health Insurance Program
Reauthorization (CHIPRA)

• CHIPRA extends, improves, and expands CHIP
  through 2013
• Rural Provisions
• Focus on outreach and enrollment for un-enrolled
  rural children
• Improve quality of care for pediatric services
• New PPS reimbursements for RHC FQHC

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Emerging Trends Rural Hospitals

• Federal Quality Initiatives
• Value-based Purchasing, Hospital Re-admission
  Payments, Bundled Episodes of Care, Care
  Coordination, Implementation of the Medical Home
  Model, QIO 9th Scope of Work
• Medicare Recovery Audit Contractors
• Changes to the Medicare Advantage Program
• Monitoring Medicare Medicaid Payments

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Emerging Trends Workforce

• Continued Workforce Shortages- Physicians,
  Nurses, other Allied Health
• National Attention to Workforce Issues Growing
• Stimulus Package has a significant investment in
  both NHSC and Title VII and VIII
• Labors Workforce Investment Act Programs got a
  big boost

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ORHP Structure

• Community-Based Division
• 9 grant programs
• Hospital- State Division
• 4 grant programs
• Border Health Division
• Policy-Research Team
• 3 grant programs

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Community-Based Division

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

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Hospital-State Division

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

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ORHP Resources Workforce

• Rural Recruitment and Retention Network
• National Rural and Urban Underserved
• Workforce Summit
• Focus on Primary Care Providers
• August 2009, Washington DC
• HRSA BHPR Programs
• NHSC
• Nursing Scholarships and Loans
• Medicare GME
• http//bhpr.hrsa.gov/

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ORHP Resources Workforce

• Health Workforce Information Center
• Web site - Easy access to key
• information on over 50 workforce
• topics and 80 professions, including
• Events training, Organizations,
• Funding, News and Updates, Resources
• HWIC Call Center
• 1-888-332-4942
• info_at_healthworkforceinfo.org

healthworkforceinfo.org
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ORHP Resources Quality

• Patient Safety Pharmacy Collaborative
• Started in 2008
• Team-based training
• Institute for Healthcare Improvement Model for
  Improvement
• Open to HRSA Grantees as well as CAHs, RHCs
• New Class to Start in 2009

Pharmacist in Jordan, MT
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ORHP Resources Capital

• Resources for CAHs Capital Planning
• Protype Design
• Capital Planning Manual In Development

http//portal.hud.gov/portal/page?_pageid73,18270
38_dadportal_schemaPORTAL (Click on CAH
Planning, Design and Construction Guide)
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ORHP Resources RHC TA Series

• Help for Rural Health Clinics through free
  quarterly technical assistance conference calls
• 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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ORHP Resources Research

• New Manuals
• Mental Health Best Practices
• FQHC-CAH Collaboration
• Rural HIV Best Practices
• CAH Capital Planning
• Rural Health Research Gateway
• Learn more about past and ongoing studies and
  policy briefs http//www.ruralhealthresearch.org
  /

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ORHP Resources

• 2009 Report to the Secretary- The National
  Advisory Committee on Rural Health and Human
  Services
• Rural Implications of the Medical Home Model
• Serving At-Risk Children in Rural Areas
• Workforce and Rural Economic Development

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Rural Assistance Center

• One-Stop Shopping
• - Funding Info
• - Resource Guides
• - Best Practices
• Web-Based Services
• Electronic Updates
• Subscribe on the website
• Customized Assistance

http//raconline.org Phone [phone] E-mail
info_at_raconline.org Hours Monday Friday 8 AM
5 PM CT
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• Contact Information
• Carrie Cochran
• Deputy Associate Administrator
• for Rural Health
• 301-443-4701
• ccochran_at_hrsa.gov
• http//ruralhealth.hrsa.gov/