Federal Office of Rural Health Policy

Tom Morris Associate Administrator

Small and Rural Hospital Meeting November 10th, 2011

Department of Health and Human Services

Health Resources and Services Administration Office of Rural Health Policy

Department of Health & Human Services (HHS)

• Broad Investment in the Carolinas

• Key Focus in 2011 and 2012: Implementation of the Affordable Care Act (ACA)

HHS Headquarters

Office of Rural Health Policy (ORHP) 2012 President’s Budget

Office of Rural Health Policy (FY12) Rural Health Policy Development $10 million

Rural Health Outreach $57 million

Rural Hospital Flexibility $26 million

State Offices of Rural Health $10 million

Telehealth $12 million

Radiogenic Diseases $2 million

Black Lung $7 million

Office of Rural Health Policy (ORHP) Activities Improving Rural Health Initiative

• “Within the total amount requested for Rural Health Activities, the Budget includes $79 million to continue the President’s initiative to improve rural health. The goal of this initiative is to improve the access to and quality of health care in rural areas.”

Improving Rural Health Care Initiative Upcoming Funding Opportunities

FY 2012: Network Planning

• Available: application released on 8/31/2012

• Application deadline: 10/31/2012 • # of New Awards: 15 • Funding: $85K /yr (1yr) • Start Date: 03/2013 • Contact: Eileen Holloran,

eholloran@hrsa.gov

FY 2012: Small Health Care Provider Quality Improvement Program

• Available: 09/2012 • # of New Awards: 30-40 • Funding: $150K (Yr 1), $100k • Start Date: 05/2013 • Contact: Ann Ferrero,

aferrero@hrsa.gov

http://www.grants.gov http://www.hrsa.gov/ruralhealth/about/community/index.html

Improving Rural Health Care Initiative Building a Rural Community Health Evidence Base

Community Health Workers Toolkit

Obesity Toolkit in Final Review

http://www.raconline.org/collaborate/pr_chwtoolkit.php

Improving Rural Health Care Initiative Technical Assistance: Sustainability

• Economic Multiplier Calculator for Community-Based Programs • Available on the Rural Assistance Center Website • (http://www.raconline.org/econtool/)

Improving Rural Health Care Initiative Workforce: Linking Rural Health Care Providers to the Federal Workforce Programs

• HRSA Programs such as... • National Health Service Corps • Nursing Loan Repayment • Primary Care Training • Nursing Education

• Key Challenge: Linking Providers & Educational Institutions

http://www.hrsa.gov/ruralhealth/pdf/ruralhealthfundingguidance.pdf

Improving Rural Health Care Initiative

• Technical Assistance Grant with the National Rural Health Association • Sustaining & Expanding the “1+2” Family Medicine Residences • Helping Communities Start New RTTs • Increasing Resident Interest in RTTs • www.raconline.org/rtt_new

Workforce: Rural Training Tracks

Improving Rural Health Care Initiative Telehealth Programs: Offering a Continuum of Program Resources

• Programs • Telehealth Network Grant

• Including Tele-Home Care • Telehealth Resource Centers

• Free Technical Assistance Nationally • Telehealth Technology Assessment Center

• Guidance in Matching Technology to Need and Resources

• Licensure and Portability Program • Information and Collaboration on Cross-

State Telehealth Practice • http://www.hrsa.gov/ruralhealth/about/teleheal

th/telehealth.html

Improving Rural Health Care Initiative Upcoming Telehealth Funding Opportunities

Telehealth Network Grant Program

• Target Audience: Networks Serving Rural

• Available: 01/2012 • # of new awards: up to 17 • Funding: $250K / yr (3yrs) • Start Date: 09/2012 • Contact: Carlos Mena,

cmena@hrsa.gov

Telehealth Resource Center Program

• Target Audience: Centers of Excellence to provide TA to new or expanding tele-health programs

• Available: 01/2012 • # of new awards: up to 4 • Funding: $325K / yr (3yrs) • Start Date: 09/2012 • Contact: Monica Cowan,

mcowan@hrsa.gov

Improving Rural Health Care Initiative Overview: Building a Rural Hospital Evidence Base

• Measuring Outcomes • Sharing Best Practices • Providing Resources • Aligning Programs to the Health Care

Environment

• Grants • Small Hospital Improvement

Program (SHIP) • State Offices of Rural Health

(SORH) • Medicare Rural Hospital

Flexibility Program (FLEX) • Initiatives

• Flex Medicare Beneficiary Quality Improvement Project (MBQIP)

• Technical Assistance • Workforce Programs

Focus Programs

Hospital State Division (HSD)

• Pilot Project under Quality Improvement • Common Metrics • Measuring Outcomes and Demonstrating

Improvements • Sharing Best Practices • Official Start: Sept 2011; Waivers: July 1, 2011

• http://www.hrsa.gov/ruralhealth/about/video/index.html

Medicare Beneficiary Quality Improvement Project (MBQIP)

Hospital State Division (HSD) Medicare Beneficiary Quality Improvement Project (MBQIP)

Report Data

Measure Improvements

Begin Intervention

Define Baseline & Targets

Identify Intervention

Identify Problem

Office of Rural Health Policy (ORHP) Activities

• Created by HHS Secretary in 2010 • Co-Chaired by the HRSA Administrator and the

Director of the Office of the National Coordinator for Health Information Technology (ONC)

• Charge: • Identifying Challenges and Policy Issues • Enhancing Collaboration Across HHS and Other

Federal Programs

• Focus for 2011 • HIT Workforce • HIT’s Role in Promoting Patient Safety

The HHS Rural Health Information Technology Task Force

The White House Rural Council

August Report from the Council Executive Order Establishing the Council

Created by Executive Order June 9th Key Activities

Rural Economic Summit held in August HHS Policy Ideas Expand NHSC to CAHs Expand Health Information Technology Use in Rural Health

White House Rural Council Health Proposals Announced

Expand the NHSC to CAHs

• Pilot Program Begins in 2012

• Guidance available in November, 2011

• Placements in 2012 • Sites Must Apply

Promote HIT in Rural Areas

• Access to Capital • Collaboration with USDA

• Rural HIT Workforce Training • Collaboration with Labor,

Education and VA

Office of Rural Health Policy (ORHP)

• Direct Supervision Regulation • Hospital and CAH Changes • Partnership for Patients • Health Access Exchanges • Center for Innovation Work

• ACOs/Shared Savings • Bundling Options

Hospital Issues We Are Tracking Office of Rural Health Policy

Office of Rural Health Policy (ORHP) Activities

• Advises the Secretary of HHS on Rural Issues

• 2011 Report & Five ACA Policy Briefs Online

National Advisory Committee on Rural Health & Human Services

http://www.hrsa.gov/advisorycommittees/rural/publications/index.html

The Patient Protection & Affordable Care Act (ACA)

• Rural Coverage Realities • Initial Steps Toward Improving

Coverage • Pre-Existing Condition Plan • Coverage for Young Adults

• Why CHIP and Medicaid are Key • Exchanges and Cooperatives

Rural Considerations on the Affordable Care Act (ACA)

The Patient Protection & Affordable Care Act (ACA) 2011 Plan Options & Out-of Pocket Costs

Beneficiary Responsibilities

Federal Plans State Plans

Standard Option

Extended Option

HSA-eligible Option

Monthly premium $116 - $626 $156 - $842 $121 - $650 $69 - $1,806

Medical deductible $2,000 $1,000 $2,500 $0 - $5,000

Drug deductible $500 $250 Incl. in medical

$100 - $500 or incl.

Out-of-pocket limit $5,950 $5,950 $5,950 $5,950

• As in commercial coverage, PCIP enrollees pay monthly premiums and deductibles for coverage

Resources Other Programs to Consider

• Public Health: CDC’s Community Transformation Grants • Funding via State Health Department with a 20-percent rural set-

aside • http://www.cdc.gov/communitytransformation/funds/index.htm

• USDA’s Distance Learning and Telemedicine Grants • http://www.rurdev.usda.gov/UTP_DLT.html

• Federal Communications Commission Rural Health Program • Rulemaking in early 2012

23 http://www.raconline.org

Resources Data & Information

Information on ACA • http://www.healthcare.gov

Health Data • http://www.data.gov/communities/health

Definition of Rural • http://www.ers.usda.gov/data/ruralatlas/

Mapping Tools • http://www.udsmapper.org/index.cfm

Rankings • http://www.countyhealthrankings.org

Community Health • http://www.communityhealth.hhs.gov

Resources Key Partners & Resources

National Rural Health Association • Annual Policy Brainstorming Sessions • State Rural Health Association Support • Rural Medical Educators • Partner in Rural Hospital Issues Group

American Hospital Association • Partner in Rural Hospital Issues Group • Collaboration with Small and Rural Hospital Section

Contact Information

Tom Morris Associate Administrator

301-443-4269 tmorris@hrsa.gov http:www.hrsa.gov