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Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
Carrie Cochran Deputy Associate Administrator for Rural ...
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Carrie Cochran Deputy Associate Administrator for Rural ...

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  • HRSA and Departmental Leadership focus on Rural External Groups also showing renewed interest Office of Rural Health Policy 2009 Priorities- A Voice within HHS Regulation review; policy development Created in 1987 to address the problems for rural hospitals that arose from the implementation of the Prospective Payment System (PPS). Serves as the voice for rural within the Department of Health and Human Services Administers grant programs, makes policy recommendations, and facilitates research on rural health.
  • Economic factors hit health care sector particularly hard Job losses; increases in the uninsured; folks putting off elective procedures and end up with higher acuity; tougher cases Support services being cut at the state level (home care aids, transportation, etc.) Always difficult to recruit providers in rural areas; even tougher now And while most agree that the increased focus on quality is a good thing, the rapid ramp up of reporting requirements both at the Federal and State level is a challenge And, doing all this at a time when facilities are aging, capital can be hard to get and there is a need to invest in HIT Typical reaction in tough economic times is to retrench; that’s easy to do in some industries but not always possible in HC; folks still get sick; still need services; and you can’t turn them away
  • Opportunities for Rural?
  • Commonwealth Fund Reports http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2009/Feb/The-Path-to-a-High-Performance-US-Health-System.aspx Senate Finance Committee http://finance.senate.gov/healthreform2009/home.html
  • First Steps The American Recovery and Reinvestment Act The State Children’s Health Insurance America Recovery and Reinvestment Act Passed House 246-183 on February 13 Passed Senate 60-38 on February 13 Signed into law February 17 The final bill is a massive stimulus package containing historic levels of spending for rural America. 
  • Support the implementation Health information Technology in Federally Qualified Health Centers, Critical Access Hospitals, Rural Health Clinics, and providers (physicians, PA, NP, and Behavioral Health). Program is supported by HIT Extension program, HIT Research Centers, HIT Regional Extension Centers to provided Technical Assistance for adoption, implementation, and effective use. Medicare Incentives for PPS Hospitals $2M Base +Discharge Payment x Medicare Share No penalty until 2014 Incentives discontinue after 2015 Medicare Incentives for CAHs Eligible for 4 years of enhanced Medicare Payment with immediate full depreciation of certified EHR Costs Total EHR Costs x (Medicare Share + 20%) Only eligible through 2014, if adoption occurs after 2014 no additional incentives occur
  • Medicaid Incentives Eligible Professionals are eligible for either Medicare or Medicaid Incentives – NOT BOTH Acute Care Hospitals, including CAHs are eligible for both Eligible Professional cannot be Hospital based and must have a patient load of 30% Medicaid Payments cover up to 85% of net allowable costs to adopt and operate EHR Technology Allowable costs for the first year are to be the average costs expended for the implementation or upgrade of an EHR system to not exceed $25 K and cannot occur after 2016 Subsequent years are to be calculated at 85% 0f 10K to not exceed 2016 If provider is ped, then patient volume must be 20% Medicaid and the incentives will be taken at 2/3 the rate If eligible provider practices at a FQHC or RHC then patient volume must be 30% “needy” Individuals Medicaid, sliding fee, uncompensated care, or receiving assistance under Title XXI Eligible Hospitals All Children’s Hospitals, Acute Care Hospitals (including CAHs) with at least 10% Medicaid Patient Volume (EHR Cost + Medicaid Share) x 50% for one year period or (EHR Cost + Medicaid Share) x 90% for 2 year period 4 year transition schedule to be utilized to attain Aggregated Payment Maximum
  • ARRA provides $1,500,000,000 in grants for construction, renovation and equipment, and for the acquisition of Health Information Technology to HRSA ARRA provides $2,000,000,000 to the Office of the National Coordinator to carry out Title XIII until the funds are expended Title XIII – Health Information Technology for Economic and Clinical Health Act (HITECH) – Inserted ARRA is required to direct $300,000,000 of the $2,000,000,000 to support regional or sub-national health information exchanges regional centers for technical assistance. non-profit or group of non-profit institutions or organizations. Regional Centers should give priority to public or non-profit hospitals, critical access HIT Extension Center Program- ONC required to create regional centers to provider TA and direct assistance to rural providers HEALTH INFORMATION TECHNOLOGY REGIONAL EXTENSION CENTERS.”  They must provide assistance to: “Each regional center shall aim to provide assistance and education to all providers in a region, but shall prioritize any direct assistance first to the following: ‘‘ (A) Public or not-for-profit hospitals or critical access hospitals. ‘‘ (B) Federally qualified health centers (as defined in section 1861(aa)(4) of the Social Security Act). ‘‘ (C) Entities that are located in rural and other areas that serve uninsured, underinsured, and medically underserved individuals (regardless of whether such area is urban or rural). ‘‘ (D) Individual or small group practices (or a consortium thereof) that are primarily focused on primary care. Health Care Information Enterprise Integration Research Centers Generation of innovative approaches to health care enterprise integration by confronting current challenges to health care delivery Health Information Technology Research Center To provide Technical Assistance and develop or recognize best practices to support and accelerate efforts to adopt , implement, and effectively utilize HIT Health Information Technology Regional Extension Centers Mission is to promote the adoption and implementation of HIT on a regional basis, while providing best practices and technical assistance
  • The American Recovery and Reinvestment Act of 2009 allotted $7.2 billion in funds to extend broadband service nationally. The National Telecommunications and Information Administration (NTIA), in coordination with the Federal Communications Commission (FCC), established the Broadband Technology Opportunities Program (BTOP) to oversee the distribution of $4.7 billion of the funds. The purposes of the BTOP are to "accelerate broadband deployment in unserved and underserved areas and ensure that strategic institutions that are likely to create jobs or provide significant public benefits have broadband connections." In addition, the Rural Utilities Service (RUS) was given authority over $2.5 billion of the funds to make grants and loans for the deployment and construction of broadband systems. The purpose of RUS is to "improve access to broadband in areas without service or that lack sufficient access to high-speed broadband service to facilitate economic development." Broadband:  A total of $7.2 billion. USDA’s Distance Learning, Telemedicine and Broadband Program will receive $2.5 billion.  The funding is for grants, loans and loan guarantees with 75% required to go to rural areas that lack sufficient broadband speed for economic development.  The bill also provides $4.7 billion to the Commerce Department’s National Telecommunications and Information Administration’s (NTIA) Technology Opportunities Program (TOP) for competitive grants to accelerate broadband deployment in unserved and underserved areas. Implications for Rural: Supports Health Information Technology
  • Topic : Strengthening the Health Workforce Program Purpose: Support programs such as the National Health Services Corps which place providers in underserved communities. Further, it will fund existing workforce programs (Title VII and VIII) which are critical for the education and training of the next generation of doctors, nurses and other providers. Amount of AARA Funding: The act provides $500 million to support these programs $300 million goes towards the National Health Services Corps to assist communities in health professional shortage areas (HPSAs) in the recruitment and retention of clinicians through scholarships and loan repayment contract in return for primary health care services (mental, medical, dental etc) in underserved communities of greatest need. May include both national and state loan repayment programs, SEARCH, etc. The NHSC scholarship application opened early March The NHSC loan repayment program opened in March and is to be open for 18 months. There will be 3-month application cycles over the AARA funding. $200 million for all the disciplines trained through the primary care medicine and dentistry program, public health prevention program, scholarship and loan repayment programs (Nurse training) RPF opened March 19th Submission Date: April 17th Funding Obligation: June 1st, 2009 Impact on Grantees: Inform grantees when funding opportunities are available since there are more available funds Listen to the workforce issues grantees mention (non-compete apps) because there will be more placements available
  • Topic : Health Center Program (Federal Qualified Health Centers) Program Purpose: Health centers provide comprehensive culturally competent, primary health care services to over 16 million medically underserved and uninsured patients. Health centers are community-based and patient-directed organizations that improve the health of their patients and communities by addressing financial, geographic, cultural, linguistic and other barriers to care. Amount of AARA Funding: The act provides $2 billion to support services, investments in HIT, and renovations and repairs. New Access Point grants were awarded to a total of 126 community-based organizations that submitted highly-rated but unfunded applications to become New Access Points in FY 2008.  The new health centers will receive $155 million in FY 2009 and 2010. (April 1, 2009) Those grants mean another 750,000 people in 39 states and two territories will have access to quality health care. Increased Demand for Services (IDS) grants were awarded to 1,128 health center grantees that applied to receive a share a of $337 million, awarded by formula in 2009 and 2010, to help health centers care for an additional 2 million people hit hard by the economic downturn. Half of the new health center patients, it is expected, will have no health insurance. (June 1, 2009) Health Center Modernization, Renovation and Repair grants will provide assistance for construction, renovation and equipment and for HIT. There will be grants for minor capital, major capital and to support HIT systems and networks. The scheduled award date is July 1, but there have not been any RFPs for these opportunities. "We have acted quickly to put Recovery Act dollars to good use in communities across America," said President Obama. "The construction and expansion of health centers will create thousands of new jobs, help provide health care to an estimated 750,000 Americans across the country who wouldn’t have access to care without these centers, and take another step toward an affordable, accessible health care system." Impact on Grantees: FQHCs are partners in the community (many are part of the consortiums for rural health Outreach and Network grants). With the additional funds, CHCs will be able to support the increased demand for health services by uninsured patients. More information: http://bphc.hrsa.gov/recovery/ (includes the organizations funded through the New Access Points and IDS grants)
  • Topic : Prevention and Wellness Funds Program Purpose: To carry out evidence-based clinical and community-based prevention and wellness strategies authorized by the Public Health Service Act (PHS Act), as determined by the Secretary, that deliver specific, measurable health outcomes that address chronic disease rates. Amount of AARA Funding: The Recovery Act provides $1 billion to support Secretarial initiatives and programs authorized by the PHS Act. $650 million for those programs authorized by the PHS act to carry out evidence-based prevention and wellness strategies that focus on improving chronic disease management (e.g., diabetes, obesity, cardiovascular disease, etc.), oral health care, mental health care, etc. $350 million for Secretarial initiatives, which are currently being discussed. The Recovery Act also requires that a portion of the $1 billion is used to provide annual evaluations of programs carried out with ARRA funds to determine the quality and effectiveness of the programs. Impact on Grantees: May be asked to use the 330A PHS Act Outreach Authority to award additional grants with the ARRA Prevention and Wellness Funds Regardless of how the Prevention and Wellness Funds are distributed to agencies from HHS, rural health care will be a primary focus of the grants. Other agencies, may turn to ORHP for guidance on how to include rural partners in their grant program. SORHs, Outreach, Network Development, and Quality grantees may have opportunities to participate in these grants.
  • Rural Business Programs: $150 million to support $3 billion in loans and grants to support income and employment expansion through improved business opportunities in rural areas.  These programs serve as the primary USDA tools for business development in the rural sector and are made available to rural areas with a population of 50,000 or less.  As sources of private credit have become more restrictive the demand for these programs has gone up.  Additionally, the Small Business Administration has reduced its lending, shifting interest to these programs.  It is estimated these funds will create 34,600 private sector jobs. Rural Water and Waste Disposal Program:  $1.38 billion to support $3.8 billion in loans and grants for needed water and waste disposal facilities in rural areas.  A substantial and longstanding backlog exists of approved applications for clean water and waste disposal projects in rural communities.  These funds would help alleviate that backlog and are estimated to create 87,000 private sector jobs.  Not only will the installation of water and waste disposal systems provide long-term economic benefit to rural communities, the short term benefit of construction activity will also benefit those local economies. Rural Community Facilities for hospitals, health clinics, health and safety vehicles and equipment, public buildings, and child and elder care facilities ($130 million in budget authority to support $1.234 billion in loans and grants). Funding for the Rural Community Facilities program is important because it provides affordable capital to rural communities so that they can fund critical services; Rural Drug Enforcement Assistance program, which addresses the special needs of rural communities faced with drug-related crime and can be used to hire additional police officers ($125 million); Rural Housing Programs.   $200 million to support $11.5 billion in loans that will provide an estimated 105,000 very low to moderate-income rural households the opportunity of homeownership or avoid the risk of foreclosure, especially during this period of uncertainty in the housing market. Given the role of housing markets in the current economic downturn, these housing loans will help ease the credit shortfall by allowing current borrowers to refinance existing RHS loans, and to refinance non-RHS loans if the borrower would now be eligible for a RHS direct loan.  These funds will also assist potential borrowers in achieving home ownership, thereby removing existing vacant housing from the market which will help stabilize the overall housing market.  Demand for this program is rising at a substantial rate, especially for guaranteed loans and it is estimated these funds will create 2,800 private sector jobs. Loans for Beginning Farmers:   $20.44 million for Direct Farm Operating Loans, which helps beginning farmers.
  • Topic: Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Overview: On February 4, 2009, President Obama signed the Children’s Health Insurance Program Reauthorization Act of 2009, H.R.2.ENR (now PL 111-3) which amends title XXI of the Social Security Act to extend, improve and expand the State Children’s Health Insurance Program through FY 2013. Rural Specific Provisions: There will be a specific focus on outreach and enrollment to geographic areas with high rates of eligible but un-enrolled children, including children who reside in rural areas. The Act provides $100,000,000 (for the period FY 2009-2013) in grant funds for outreach and enrollment efforts that increase participation of eligible children in both Medicaid and CHIP. Of the $100 million, $10 million will be set aside for a National Enrollment Campaign, $10 million will go to IHS and Tribal outreach, and $80 million will be directed towards States and communities to awareness to efforts targeting un-enrolled children. Efforts will also be made to improve quality of care for pediatric services, both in rural and urban parts of the country.  Health providers that furnish primary health care to children and families who live in urban and rural medically underserved communities will be consulted in the development of these efforts.   In States with distinct CHIP or combination Medicaid/CHIP programs, the legislation requires that the Medicaid Prospective Payment System (established under section 1902(bb)) be used in reimbursing Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) for services provided to CHIP beneficiaries. To help States transition to the new RHC and FQHC PPS reimbursement methodology, approximately $5 million in grant funding will be made available to CHIP programs in affected States.
  • Upcoming WWAMI Study on Aging of the Physician Workforce 32.3 percent of Rural Physicians are 56 or Older Current Pipeline not big enough to fill that void AAMC Calling for a 30% Increase in Med School Enrollment
  • Rural Quality & Network Planning: next competition in FY 2010 Network Development & Network Planning : next competition in FY 2011
  • Transcript

    • 1. The Federal Rural Health Landscape South Carolina’s 13 th 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
    • 2. Today’s Presentation <ul><li>Washington Update </li></ul><ul><li>Health Care Reform </li></ul><ul><li>The Stimulus Bill </li></ul><ul><li>Emerging Challenges </li></ul><ul><li>Opportunities and Resources </li></ul>
    • 3. About Office of Rural Health Policy <ul><li>Role of the Office of Rural Health Policy </li></ul><ul><li>Voice for Rural within HHS </li></ul><ul><li>Administers Rural Health </li></ul><ul><li>Grant Programs </li></ul><ul><li>Makes Policy Recommendations </li></ul><ul><li>Facilitates Rural Health Research </li></ul>
    • 4. <ul><li>Tough Times: Thin Margins get Thinner </li></ul><ul><li>Local job losses </li></ul><ul><li>State cuts </li></ul><ul><li>Increase in the uninsured </li></ul>
    • 5. Current Health Care Challenges <ul><li>Increases in the Uninsured, Underinsured </li></ul><ul><li>Decreased Revenues </li></ul><ul><li>Workforce Recruitment and Retention </li></ul><ul><li>Increased Focus on Quality and Reporting </li></ul><ul><li>Resources/Infrastructure </li></ul>
    • 6. Health Care Reform <ul><li>Health Care Reform Front & Center </li></ul><ul><li>President’s Vision Key Principles </li></ul><ul><ul><li>Protect families’ financial health </li></ul></ul><ul><ul><li>Assure affordable, quality coverage </li></ul></ul><ul><ul><li>Provide portability of coverage </li></ul></ul><ul><ul><li>Guarantee choice of providers </li></ul></ul><ul><ul><li>Invest in prevention and wellness </li></ul></ul><ul><ul><li>Improve patient safety and quality </li></ul></ul><ul><ul><li>End barriers for pre-existing conditions </li></ul></ul><ul><ul><li>Reduce long-term growth of health care costs </li></ul></ul>
    • 7. <ul><li>White House Forum a starting point </li></ul><ul><li>Opportunities for rural? </li></ul><ul><li>More information available: </li></ul><ul><ul><li>http://www.healthreform.gov/ </li></ul></ul>Health Care Reform
    • 8. <ul><li>Some Common Themes </li></ul><ul><li>Rising Costs </li></ul><ul><li>Reductions in Access </li></ul><ul><li>A Need to Improve Quality </li></ul><ul><li>Linking Workforce </li></ul><ul><li>Current Proposals </li></ul><ul><li>Improving Access </li></ul><ul><li>Re-Emphasizing Primary Care </li></ul><ul><li>Improving Outcomes </li></ul><ul><li>Strengthening Medicare, Medicaid and SCHIP </li></ul>Health Care Reform
    • 9. <ul><li>What Does This Means for Rural? </li></ul><ul><li>Long-Standing Access Problems </li></ul><ul><ul><li>Uninsured; Insurance Market Challenges </li></ul></ul><ul><li>Heavier Chronic Disease Burden </li></ul><ul><ul><li>Opportunity to Improve Outcomes and Value </li></ul></ul><ul><li>Workforce </li></ul><ul><ul><li>Already Focused on Primary Care but in dire need of more providers </li></ul></ul>Health Care Reform
    • 10. <ul><li>Viewing Health Care Reform as part of the Recovery … </li></ul><ul><ul><li>New Report from the White House Office of Health Reform </li></ul></ul><ul><ul><li>More information expected </li></ul></ul>http://www.healthreform.gov/reports/inaction/inactionreportprintmarch2009.pdf Health Care Reform
    • 11. The American Reinvestment and Recovery Act (ARRA) <ul><li>$787 billion stimulus package for: </li></ul><ul><li>Health Information Technology (HIT) </li></ul><ul><li>Community Health Centers </li></ul><ul><li>Prevention and Wellness </li></ul><ul><li>Health Workforce </li></ul><ul><ul><li>www.recovery.gov </li></ul></ul>
    • 12. ARRA: HIT <ul><li>Medicare HIT Payments </li></ul><ul><li>Based on “Meaningful” HIT adoption through 2014 </li></ul><ul><li>PPS Facilities: Adjustment to Base Payment relative to Medicare share </li></ul><ul><li>CAHs: Payment based on Medicare Share + 20% of depreciation amount </li></ul><ul><ul><li>Paid via interim payments (not cost-settlement) </li></ul></ul>
    • 13. <ul><li>Medicaid HIT Payments </li></ul><ul><li>Based on “Meaningful” HIT </li></ul><ul><li>adoption through 2014 </li></ul><ul><li>Eligible Professionals, including RHCs and FQHCs, get up to 85% of HIT-related costs </li></ul><ul><ul><li>Tied to meeting a 30% combined Medicaid, SCHIP, </li></ul></ul><ul><ul><li>uncompensated care patient population threshold </li></ul></ul><ul><li>Eligible Hospitals, including PPS and CAH, with at least 10% Medicaid patient volume </li></ul>ARRA: HIT
    • 14. <ul><li>Other HIT Resources </li></ul><ul><li>Construction, renovation and </li></ul><ul><li>equipment, and acquisition of HIT </li></ul><ul><li>HIT workforce training </li></ul><ul><li>Regional health information exchange </li></ul><ul><li>HIT Extension Program- Regional Technical Assistance Centers </li></ul>ARRA: HIT
    • 15. <ul><li>$7.2 billion in funds to extend broadband service nationally through USDA </li></ul><ul><ul><li>$4.7b for Broadband Technology Opportunities Program (BTOP) </li></ul></ul><ul><ul><li>$2.5 b for Rural Utilities Service (RUS) for grants/loans for deployment & construction of broadband systems </li></ul></ul>ARRA: Rural Broadband
    • 16. ARRA: Workforce <ul><li>$500 million to strengthen the health care workforce </li></ul><ul><ul><li>$300m to National Health </li></ul></ul><ul><ul><li>Service Corps </li></ul></ul><ul><ul><li>$200m Title VII- Primary Care, Dentistry, AHECs </li></ul></ul><ul><li>Additional Labor Department Provisions </li></ul>
    • 17. ARRA: Community Health Centers <ul><li>$2 billion to support CHC services, repairs and renovations, and investments in HIT </li></ul><ul><li>$155m New Access Points- awarded to 126 CHC for FY09 and FY10 </li></ul><ul><li>$337m Increased Demand for Services (IDS)- awarded to 1,128 CHC for FY09 and FY10 </li></ul><ul><li>http://bphc.hrsa.gov/recovery </li></ul>
    • 18. <ul><li>$1 billion to support HHS initiatives and programs in Public Health Service Act </li></ul><ul><ul><li>$650m Evidence-based Prevention & Wellness </li></ul></ul><ul><ul><li>$350m Secretarial Initiatives </li></ul></ul><ul><ul><li>Evaluation of quality & effectiveness of program spending </li></ul></ul>ARRA: Prevention & Wellness
    • 19. <ul><li>$130 million for rural community facility development through the USDA Capital Facilities Loan Program </li></ul><ul><ul><li>$67 million in loans </li></ul></ul><ul><ul><li>$63 million in grants </li></ul></ul><ul><ul><li>Translates to well over </li></ul></ul><ul><ul><li>$1 billion in guaranteed loans </li></ul></ul><ul><ul><li>for rural facilities </li></ul></ul>ARRA: Capital
    • 20. <ul><li>Rural Business Programs </li></ul><ul><li>Rural Water and Waste Disposal Programs </li></ul><ul><li>Rural Community Facilities </li></ul><ul><li>Law Enforcement- Rural Drug Enforcement Assistance Program </li></ul><ul><li>Rural Housing Programs </li></ul><ul><li>Loans for Beginning Farmers </li></ul>ARRA: Other Rural Resources
    • 21. Children’s Health Insurance Program Reauthorization (CHIPRA) <ul><li>CHIPRA extends, improves, and expands CHIP through 2013 </li></ul><ul><li>Rural Provisions: </li></ul><ul><ul><li>Focus on outreach and enrollment for un-enrolled rural children </li></ul></ul><ul><ul><li>Improve quality of care for pediatric services </li></ul></ul><ul><ul><li>New PPS reimbursements for RHC & FQHC </li></ul></ul>
    • 22. Emerging Trends: Rural Hospitals <ul><li>Federal Quality Initiatives: </li></ul><ul><ul><li>Value-based Purchasing, Hospital Re-admission Payments, Bundled Episodes of Care, Care Coordination, Implementation of the Medical Home Model, QIO 9th Scope of Work </li></ul></ul><ul><li>Medicare Recovery Audit Contractors </li></ul><ul><li>Changes to the Medicare Advantage Program </li></ul><ul><li>Monitoring Medicare & Medicaid Payments </li></ul>
    • 23. Emerging Trends: Workforce <ul><li>Continued Workforce Shortages- Physicians, Nurses, other Allied Health </li></ul><ul><li>National Attention to Workforce Issues Growing </li></ul><ul><ul><li>Stimulus Package has a significant investment in both NHSC and Title VII and VIII </li></ul></ul><ul><ul><li>Labor’s Workforce Investment Act Programs got a big boost </li></ul></ul>
    • 24. ORHP Structure <ul><li>Community-Based Division </li></ul><ul><ul><li>9 grant programs </li></ul></ul><ul><li>Hospital- State Division </li></ul><ul><ul><li>4 grant programs </li></ul></ul><ul><li>Border Health Division </li></ul><ul><li>Policy-Research Team </li></ul><ul><ul><li>3 grant programs </li></ul></ul>
    • 25. Community-Based Division <ul><li>Rural Health Services Outreach </li></ul><ul><li>Rural Health Network Development </li></ul><ul><li>Rural Network Development Planning </li></ul><ul><li>Delta States Development Network (Delta) </li></ul><ul><li>Small Rural Provider Quality Improvement </li></ul><ul><li>Radiation, Exposure, Screening and Education Program Black Lung Clinic Program (BLCP) </li></ul><ul><li>Delta Health Initiative (DHI) </li></ul><ul><li>Rural AED (RAED) </li></ul><ul><li>Frontier Extended Stay Clinic (FESC) </li></ul>
    • 26. <ul><li>State Offices of Rural Health (SORH) </li></ul><ul><li>Rural Hospital Flexibility Grant (Flex) </li></ul><ul><li>Small Rural Hospital Improvement Program (SHIP) </li></ul><ul><li>Critical Access Hospital HIT Network Grants (CAH-HIT Network) </li></ul>Hospital-State Division
    • 27. <ul><li>Rural Recruitment and Retention Network </li></ul><ul><li>National Rural and Urban Underserved </li></ul><ul><li>Workforce Summit </li></ul><ul><ul><li>Focus on Primary Care Providers </li></ul></ul><ul><ul><li>August 2009, Washington DC </li></ul></ul><ul><li>HRSA BHPR Programs </li></ul><ul><ul><li>NHSC </li></ul></ul><ul><ul><li>Nursing Scholarships and Loans </li></ul></ul><ul><ul><li>Medicare GME </li></ul></ul><ul><ul><li>http://bhpr.hrsa.gov/ </li></ul></ul>ORHP Resources: Workforce
    • 28. <ul><li>Health Workforce Information Center </li></ul><ul><li>Web site - Easy access to key </li></ul><ul><li>information on over 50 workforce </li></ul><ul><li>topics and 80 professions, including: </li></ul><ul><ul><li>Events & training, Organizations, </li></ul></ul><ul><ul><li>Funding, News and Updates, Resources </li></ul></ul><ul><li>HWIC Call Center </li></ul><ul><ul><li>1-888-332-4942 </li></ul></ul><ul><ul><li>info@healthworkforceinfo.org </li></ul></ul>healthworkforceinfo.org ORHP Resources: Workforce
    • 29. <ul><li>Patient Safety Pharmacy Collaborative </li></ul><ul><li>Started in 2008 </li></ul><ul><li>Team-based training </li></ul><ul><ul><li>Institute for Healthcare Improvement “Model for Improvement” </li></ul></ul><ul><ul><li>Open to HRSA Grantees as well as CAHs, RHCs </li></ul></ul><ul><li>New Class to Start in 2009 </li></ul>Pharmacist in Jordan, MT ORHP Resources: Quality
    • 30. <ul><li>Resources for CAHs Capital Planning </li></ul><ul><ul><li>Protype Design </li></ul></ul><ul><ul><li>Capital Planning Manual In Development </li></ul></ul>http://portal.hud.gov/portal/page?_pageid=73,1827038&_dad=portal&_schema=PORTAL (Click on CAH Planning, Design and Construction Guide) ORHP Resources: Capital
    • 31. ORHP Resources: RHC TA Series <ul><li>Help for Rural Health Clinics through free quarterly technical assistance conference calls </li></ul><ul><li>Past topics include billing, pandemic flu, HIT, etc. </li></ul>A Rural Health Clinic in Michigan <ul><ul><li>http://www.narhc.org/members/orhp_series.php </li></ul></ul>
    • 32. ORHP Resources: Research <ul><li>New Manuals </li></ul><ul><ul><li>Mental Health Best Practices </li></ul></ul><ul><ul><li>FQHC-CAH Collaboration </li></ul></ul><ul><ul><li>Rural HIV Best Practices </li></ul></ul><ul><ul><li>CAH Capital Planning </li></ul></ul><ul><li>Rural Health Research Gateway </li></ul><ul><ul><li>Learn more about past and ongoing studies and policy briefs http://www.ruralhealthresearch.org/ </li></ul></ul>
    • 33. <ul><li>2009 Report to the Secretary- The National Advisory Committee on Rural Health and Human Services </li></ul><ul><li>Rural Implications of the Medical Home Model </li></ul><ul><li>Serving At-Risk Children in Rural Areas </li></ul><ul><li>Workforce and Rural Economic Development </li></ul>ORHP Resources
    • 34. Rural Assistance Center <ul><li>One-Stop Shopping </li></ul><ul><ul><li>- Funding Info </li></ul></ul><ul><ul><li>- Resource Guides </li></ul></ul><ul><ul><li>- Best Practices </li></ul></ul><ul><li>Web-Based Services & </li></ul><ul><li>Electronic Updates </li></ul><ul><li>Subscribe on the website </li></ul><ul><li>Customized Assistance </li></ul>http://raconline.org Phone: 1.800.270.1898 E-mail: [email_address] Hours – Monday – Friday 8 AM – 5 PM CT
    • 35. Contact Information Carrie Cochran Deputy Associate Administrator for Rural Health 301-443-4701 [email_address] http://ruralhealth.hrsa.gov/

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