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Critical Access Hospital Advisory Council. Cari Fouts, Program Director Jen Dunn, CAH Program Coordinator. Welcome!. Introductions What’s in your binder? Housekeeping. CAH Advisory Council Agenda. Overview of current CO CAH program Update on current, new and developing CAH programs

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critical access hospital advisory council

Critical Access Hospital Advisory Council

Cari Fouts, Program Director

Jen Dunn, CAH Program Coordinator



What’s in your binder?


CAH Advisory Council Agenda

Overview of current CO CAH program

Update on current, new and developingCAH programs

Explore HIT/ARRA requirements and opportunities

Strategic planning for future programs and project development

Learn about the QHi Benchmarking Tool

What is a CAH?

Balanced Budget Act 1997

Rural area, or special provision

25 acute care beds, additional 10 distinct part rehab or psychiatric allowable

Average length of stay, 96 hours or less

35 miles from nearest hospital or CAH, or more than 15 miles of mountainous terrain, OR necessary provider before 12/05

Why become a CAH?

Enhanced Payment through Medicare

Most inpatient/outpatient services 101% of reasonable and allowable costs

Ambulance services owned/operated receive 101%

Provider-Based rural health clinics receive cost based reimbursement

CAH/Flex Review

Medicare Rural Hospital Flexibility Program (Flex), created in 1997

Funding to support conversion and infrastructure to strengthen rural health care

  • Performance Improvement/Quality Improvement
  • Supporting Hospitals
  • Evaluation
  • Integration of EMS services
  • Networking (optional)
  • Conversion to CAH status (optional)
Proposed New Flex Focus Areas

Quality Improvement (Hospital Compare?)

Financial and Operational Performance Improvement

Community Engagement and Impact (regional and local collaborations)

Health Information Technology

Colorado CAH Partners

Colorado Department of Public Health and Environment

Colorado Foundation for Medical Care

Colorado Hospital Association

Centers for Medicare & Medicaid

New Programs/Resources in 08/09

Board Webinar series

Member only Website access (tools and resources)

RAC resources –

  • CAH self audit tool
  • Group Discounted rates for Milliman or Interqual and EHR Physician Advisor services

QHi Benchmarking Resource

Nurse Leadership Training

Capital Equipment Purchases - RACE Program

Grant Writing Program – GROW

RHC Technical Assistance Services

Programs in Progress

Colorado Credentialing Network

Revenue Cycle Management Services

Peer Review Network Expansion

Swing Bed Online Training

Observation and UM Manual/Training

Community Paramedic Program

health reform
Health Reform - SenateHealth Reform

Senate proposal has combined the Finance Committee and the HELP (Health, Education, Labor, and Pension) Committee.

Proposal being analyzed by the Congressional Budget Office (CBO) to determine costs.

Senate bill content unclear - not publicly released.

Rural amendments that NRHA is working to get included, once a bill is brought to the floor:

  • Allow flexibility in CAH bed count,
  • Raise the RHC cap to $92,
  • Waive the 35-mile rule for CAH designation, and
  • Rural Training Track funding for medical schools.

Still many unknowns and uncertainty if there are enough votes to avoid a filibuster.

Timeframe was set for this week or next, but there is talk that things could get pushed out until 2010.

health reform20
Health Reform - HouseHealth Reform

Combined three bills (current bill almost 2,000 pages) and received an approximate $1 trillion price tag from the CBO.

Hoped to have a floor vote this week; not likely to happen.

There are not enough votes to pass the current bill (need 218).

Points of contention: public plan option, cost, immigration, etc.

Note: House introduced a bill (H.R. 3961) that addresses the Sustainable Growth Rate (SGR) that would fix the current mandated cuts that must be addressed each year concerning Medicare rates to physicians. The Senate voted down a similar bill in October.

SGR not being addressed in any of the health reform proposals due to the price tag ($245 billion over 10 years)

legislative updates
Colorado State BudgetLegislative Updates

FY09-10: ~ $1.4 billion General Fund shortfall addressed during 2009 legislative session

Since then, an additional $589 million shortfall has been addressed

1.5% Medicaid Provider cuts effective September 1st; an additional 1% Medicaid Provider cuts effective December 1st

Delayed Medicaid payments – final two weeks of payment for FY09-10 will be shifted into FY10-11

Cuts and delayed payments will not apply to RHCs

legislative updates22
CAH Noteworthy Legislative UpdatesLegislative Updates

H1N1 Waiver available if bed capacity is reached:

Final CMS OPPS Rule – outpatient therapeutic services supervision

  • Non-physician supervision as long as service is within scope
  • Must be “immediately” available to assist
  • Auditors not allowed to cite hospitals from 2000-2008
capacity building grant
Grant ProgramsCapacity building Grant

Capacity Building Grant to spread funding opportunity across all CAHs.

28 CAHs awarded funding

capacity building grant24
Capacity Building Grant CategoriesCapacity Building Grant

Quality Improvement

HIT and Regulatory Compliance

Outmigration Studies

EMS Budget Tool Training


  • Trauma Designation Consultation
  • Billing and Coding
  • Swing Bed Training
  • Board Training
  • Simulation Training
  • Leadership and Management
capacity building grant25
Funding BreakdownCapacity Building Grant

Quality Improvement - 6 CAHs for Total of $20,691

HIT - 4 CAHs for Total of $28,825

Regulatory Compliance - 4 CAHs for Total of $19,000

Education/Capacity Building - 14 CAHs for Total of $83,425

    • Billing and Coding - 7 CAHs for Total of $39,400
    • Board Training - 4 CAHs for Total of $19,700
    • Swing Bed Training – 2 CAHs for Total of $3,400
    • Leadership Training – 4 CAHs for Total of $15,768

Additional Funding Options (Outmigration Studies)

  • 3 CAHs for Total of $22,500
capacity building grant26
Individual ProjectsCapacity Building Grant

Innovative Programs/Projects

  • 10 CAHs selected for Total CBG of $50,400
  • Examples
    • Health Fair
    • Prenatal Education
    • Customer Service Training Program
    • Cost Reporting
    • CAH Recertification
    • Montrose – feasibility study to build new CAH
capacity building grant27
CBG Cycle 09/10Capacity Building Grant

Grant guidance NOW AVAILABLE!

Each hospital eligible for $8000 for 09/10

Applications due back December 4, 2009

New opportunities:

  • Business Development
  • Employee Satisfaction Survey
  • HIT Consortium
  • Credentialing Network and Services
  • Expanded Outmigration Options
  • EHR Physician Advisor, Milliman/InterQual
ship grant
Small Hospital Improvement Program (SHIP)SHIP Grant

Approximately $9000 available

HIT Consortium Opportunity

16 Hospitals Participating in Consortium



statewide initiatives
Statewide InitiativesStatewide Initiatives

Center for Improving Value in Health Care (CIVHC)

HIT Regional Extension Center

RHC HIT Solutions

Association of Rural Health Clinics of Colorado (ARHCC)

Hospital Quality Incentive Payment

Strategic Planning – Flex 2010

What do you find most beneficial about the Flex grant?

How can we improve what we are currently doing?

In a perfect world ($ no object!), what would the Flex grant provide?

Workshop/Educational Event Structure

CHA Rural Hospital Conference/CAH Workshop Merging in 2010

  • Topics?

Quality Improvement Workshops in conjunction with Annual Conference

Webinar Educational Series

Frequency (Monthly, Bimonthly, Quarterly, TBD)

Potential Topics

  • Board Governance
  • RAC/MIC/MAC, vegetable soup
  • Regulatory Changes
  • Observation Status
  • Others?
Volunteers needed!

HIT Consortium Advisory Committee

Peer Review Network Expansion Pilot