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The Federal Rural Health Landscape Carrie Cochran Deputy Associate Administrator for Rural Health Policy Health Resources and Services Administration U.S. Department of Health and Human Services South Carolina’s 13 th Annual Rural Health Conference April 29-30, 2009 Today’s Presentation

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the federal rural health landscape

The Federal Rural Health Landscape

Carrie Cochran

Deputy Associate Administrator for Rural Health Policy

Health Resources and Services Administration

U.S. Department of Health and Human Services

South Carolina’s 13th Annual Rural Health Conference

April 29-30, 2009

today s presentation
Today’s Presentation
  • Washington Update
  • Health Care Reform
  • The Stimulus Bill
  • Emerging Challenges
  • Opportunities and Resources
slide3

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
slide4

Tough Times: Thin Margins get Thinner

  • Local job losses
  • State cuts
  • Increase in the uninsured
slide5

Current Health Care Challenges

  • Increases in the Uninsured, Underinsured
  • Decreased Revenues
  • Workforce Recruitment and Retention
  • Increased Focus on Quality and Reporting
  • Resources/Infrastructure
slide6

Health Care Reform

  • Health Care Reform Front & Center
  • President’s 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
slide7

Health Care Reform

  • White House Forum a starting point
  • Opportunities for rural?
  • More information available:

http://www.healthreform.gov/

slide8

Health Care Reform

Current Proposals

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

Some Common Themes

  • Rising Costs
  • Reductions in Access
  • A Need to Improve Quality
  • Linking Workforce
slide9

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
slide10

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/inactionreportprintmarch2009.pdf

the american reinvestment and recovery act arra
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

arra hit
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)
slide13

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
slide14

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
slide15

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
slide16

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

arra community health centers
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

arra prevention wellness
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
slide19

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

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

ARRA: Other Rural Resources
children s 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

Children’s Health Insurance Program Reauthorization (CHIPRA)
emerging trends rural hospitals
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
emerging trends workforce
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
    • Labor’s Workforce Investment Act Programs got a big boost
slide24

ORHP Structure

  • Community-Based Division
    • 9 grant programs
  • Hospital- State Division
    • 4 grant programs
  • Border Health Division
  • Policy-Research Team
    • 3 grant programs
slide25

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)
slide26

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)
slide27

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/

slide28

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@healthworkforceinfo.org

healthworkforceinfo.org

slide29

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

slide30

ORHP Resources: Capital

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

http://portal.hud.gov/portal/page?_pageid=73,1827038&_dad=portal&_schema=PORTAL

(Click on CAH Planning, Design and Construction Guide)

slide31

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

slide32

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/
slide33

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
slide34

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: 1.800.270.1898

E-mail: info@raconline.org

Hours – Monday – Friday 8 AM – 5 PM CT

slide35

Contact Information

  • Carrie Cochran
  • Deputy Associate Administrator
  • for Rural Health
  • 301-443-4701
  • ccochran@hrsa.gov
  • http://ruralhealth.hrsa.gov/