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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

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

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Today’s 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

  • 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

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Health Care Reform

  • White House Forum a starting point

  • Opportunities for rural?

  • More information available:

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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

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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

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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

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  • 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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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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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

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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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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

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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)

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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

    • Labor’s 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

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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


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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,1827038&_dad=portal&_schema=PORTAL

(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

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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

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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

    Phone: 1.800.270.1898


    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