Rural Route
 
November 29, 2017  
In this Issue
Welcome and Farewell
Notes from FORHP
CAH Regulatory Update
MBQIP Highlights
TASC Tasks
Rural Leadership Radio
New & Updated Resources
Flex Forum
Webinar Playbacks and Event Materials
The Center Blog
Save the Dates
Social Media
TASC Website Quick Links

TASC Home

Events

Flex Program Forum

MBQIP

Resource Library

Staff

State Flex Profiles

On Center Blog

Hello Everyone! 

I hope everyone had a good thanksgiving. I for one am in full holiday mode. I've tuned my radio to 'Classical Holiday' and am looking forward to spending time with friends and family in the upcoming season.

I was fortunate enough to spend National Rural Health Day with a group of dedicated professionals at the New England Round Table Conference. 

Please enjoy this month's edition of Rural Route, sorry it was a little late. Thanks for reading.

As always please send any pictures you happen to take along your travels. We enjoy highlighting the beauty found in the places we serve. 

Until next time,

Caleb Siem, MH
Program Specialist
Technical Assistance and Services Center (TASC)
Quick Links
FMT
Welcome and Farewell 

Welcome to:
  • Cynthia Snyder, State Office Director, Kansas
  • Shane Ford, Interim State Office of Rural Health Director, Ohio

Farewell to:
  • Kathy Lubke, Program Support Supervisor, Montana
  • Susan Triggs, Flex Coordinator, Virginia (Retiring December 1)
  • Shellie Smith, Flex Coordinator, Alaska (Retiring December 1)
We encourage you to keep your Flex staff contact information current by completing the new contacts form as soon as possible whenever there are changes in your office. Please review your contacts as listed in your State Flex Profile  and complete the form as necessary for any additions or changes. 
Notes from FORHP 
Sarah Young, FORHP

Happy November,
Happy (belated) National Rural Health Day! I hope you proudly celebrated the Power of Rural on November 16. Here in Rockville, we hosted a series of events for our Health and Human Services colleagues in the building and engaged on social media and webcasts. Check out the HRSA infographic! #OurRural 

You made it through November and you've submitted your Performance Improvement and Measurement System (PIMS) report. Congratulations! Please reach out to your project officer (PO) if you have any lingering questions since the report is due November 30. We will review your PIMS submissions and let you know if we have any questions. Once all of the reports have been approved by your POs, I will be analyzing the data and then share my findings with you in a PIMS webinar in January 2018.

Do you have any questions or comments about PIMS while you are fresh from completing your annual report? Please let me know! I would like to keep making PIMS clearer and easier to use and the only way I can practice continuous improvement is with your help and feedback. 

The next quarterly HRSA Grants Conference call will be January 17 and 18, 2018. The October call included discussion of prior approval requests, the Grants.gov federal grants forecast and electronic handbook (EHB) enhancements including new EHB Interactive Videos.

Thank you for your hard work on behalf of critical access hospitals (CAHs) and rural communities. 

Flex Program Coordinator
CAH Regulatory Update 

Calendar Year (CY) 2018 Final Rule for Quality Payment Program
On November 16, 2017, the Centers for Medicare & Medicaid Services (CMS) published the final rule for the second year of the Medicare Quality Payment Program (QPP). The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established QPP for Medicare clinician payment. Under the QPP, eligible clinicians can participate via one of two tracks: Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS).

New Medicare Physician Payment Model Proposals
MACRA creates the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to make comments and recommendations to the Secretary of the Department of Health and Human Services on proposals for physician-focused payment models (PFPMs) submitted by individuals and stakeholder entities. PTAC has posted four new proposals from provider groups with new ways that Medicare could pay physicians. The proposals include: wound care in private outpatient clinics, delivering acute care in the home, improving transitions from ERs and bundling payments for headache care. Each addresses how these approaches could benefit Medicare beneficiaries in rural areas. Comments for wound care and acute care in the home are due November 30.

For more information on the PTAC and the proposals, please visit the website.  

2019 Proposed Notice of Benefit and Payment Parameters for Health Insurance Marketplace
On November 2, CMS published a proposed rule to update the 2019 Benefit and Payment Parameters for the Federally-Facilitated Exchange (FFE) and the State-Based Exchanges that use the federal platform (SBE-FP) Healthcare.gov. The rule includes proposals that would provide states with more flexibilities.

State Medicaid Directors' (SMD) Letter on Strategies to Address the Opioid Epidemic
On November 1, 2017, CMS issued an SMD letter describing a streamlined approach to working with states on Medicaid 1115 waivers that increase states' ability to respond to the opioid crisis. CMS would like to use the 1115 waiver demonstration process as the vehicle for improving access to treatment for opioid use disorder and other substance use disorders because of the flexibility it gives states to implement best practices over a 5-year period while incorporating outcome metrics, conducting rigorous evaluations, and reporting progress in a timely manner on the Medicaid.gov website. CMS indicates that this cycle of evaluation and reporting will be critical to informing the response to the national opioid crisis.

A key aspect of these waivers is that states will be able to receive federal matching for services to treat addiction, including services provided to Medicaid enrollees residing in residential treatment facilities. Ordinarily, such residential treatment services are not eligible for federal Medicaid reimbursement due to the exclusion in the Medicaid statute that bans states from using federal Medicaid dollars to fund patients' stays in institutions for mental diseases (IMDs) with more than 16 beds.

CMS also announced the approval of demonstrations in New Jersey and Utah under this new policy. For more information, please see the press release.

For more details on any of the above updates and the complete regulatory update please visit the Regulatory Updates Webpage .
Basic Best Practices in Cybersecurity Training 

The National Health Information Sharing and Analysis Center (NH-ISAC), through funding from the Office of the National Coordinator for Health IT (ONC), offers Basic Best Practices in Cybersecurity events and covers the cost of the meeting space, including audio visual needs. The content is customizable based on the audience and need.

Please contact Kitty Castings at NH-ISAC by email  or phone (386-847-5641) for more information. 
MBQIP Highlights & Resources 
MBQIP highlighted

As a reminder, please send your MBQIP questions to the TASC email address. TASC will ensure your question reaches the best person to answer your question.

MBQIP Data Reporting Reminders


Upcoming Data Submission Deadlines:

January 31, 2018
Emergency Department Transfer Communication (EDTC):
  • Patients seen Q4 2017 (October, November, December)
  • Submission process directed by state Flex Program
February 1, 2018
CMS Population and Sampling (optional)*
  • Patients seen Q3 2017 (July, August, September)
  • Inpatient and Outpatient
  • Entered via the Secure Portal on QualityNet
February 1, 2018
CMS Outpatient Measures:
  • Patients seen Q3 2017 (July, August, September)
  • CMS Hospital Inpatient Reporting Specifications Manual version 10.0a
  • Submitted to the QualityNet warehouse via CART or by vendor
  • CART version - 1.16
February 15, 2018
CMS Inpatient Measures:
  • Patients seen Q3 2017 (July, August, September)
  • CMS Hospital Inpatient Reporting Specifications Manual version  5.2b
  • Submitted to the QualityNet warehouse via CART or by vendor
  • CART version -  4.20
*Population and Sampling refers to the recording of the number of cases the hospital is submitting to the QualityNet warehouse this is done directly through the QualityNet Secure Portal.

Note: The entry of Outpatient Population and Sampling data directly into the grid in the QualityNet Secure Portal is again functional.


Input Needed!
Stratis Health is facilitating a Technical Expert Panel (TEP) to review the EDTC measure. Recommendations from the TEP will be used to inform potential updates to the measure structure and/or measure specifications, which would be submitted to the National Quality Forum.

As part of this process, Stratis Health is seeking input from CAHs and other stakeholders regarding the utility of the measure, and feedback on suggested changes or improvements to the measure structure and/or specifications. This input will be shared with the TEP to inform their deliberations. Please provide feedback by responding to this four-question questionnaire by December 15, 2017.

* Please share this request for information with your CAHs as appropriate. Flex Programs and CAHs are encouraged to provide feedback by December 15, 2017.


Resources

Author: Stratis Health
For use by Flex Programs in helping CAHs with quality data reporting by reminding them of upcoming data submission deadlines, corresponding collection time periods and submission tools.

Author: Stratis Health
This recorded training series is for CAH staff with responsibility for data collection of the Centers for Medicare & Medicaid Services (CMS) inpatient and Outpatient Quality measures. These short videos provide a comprehensive overview of the process to identify each measure population and abstract the required data elements.


Ask Robyn - Quarterly Open Office Hour Calls for Data Abstractors  
Scheduled approximately one month before data submission deadlines each quarter, RQITA Quality Data Specialist Robyn Carlson will be offering open office hour calls to respond to MBQIP data abstraction questions .

2018 dates:
  • January 10, 2:00 - 3:00 p.m. Central Time
  • April 11, 2:00 - 3:00 p.m. Central Time
  • June 20, 2:00 - 3:00 p.m. Central Time
Note: registration is required, please follow this  link for details.

MBQIP Monthly
MBQIP Monthly is a monthly e-newsletter that provides CAHs with information and support for quality reporting and improvement and highlights current information about MBQIP. State Flex Programs are encouraged to distribute MBQIP Monthly to their CAHs as an additional resource to supplement state level MBQIP support. The most current version always available on the  MBQIP Monthly webpage.

MBQIP Virtual Knowledge Groups
Rural Quality Improvement Technical Assistance (RQITA) and TASC have teamed up to host MBQIP virtual knowledge group (VKG) calls/webinars to give you the opportunity to share MBQIP successes, challenges, barriers and brainstorm strategies to assist hospitals towards reporting, participating, improving and excelling in the four MBQIP quality domains. 

These calls/webinars are intended for state Flex Program personnel and designated contractors. The next MBQIP VKG call is scheduled for  December 21, 2017, from 2:00 p.m. - 3:30 p.m. Central Time and the topic is ED-1 and ED-2: Incorporating Inpatient ED Measures into MBQIP.  More information will be sent to the appropriate email lists prior to the call. Contact Jodi Winters at Stratis Health with any questions or for access to the recordings of previous VKG webinars.

Contact  TASC with your inquiries, questions and comments related to MBQIP and/or resources.
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TASC Tasks 

This month, TASC has been reviewing measures submitted by the state Flex Programs on behalf of their hospitals participating in the Flex Supplemental funding. We look forward to supporting those states and hospitals to demonstrate excellent improvement outcomes. For those states participating, there is a webinar on December 7 on how to use the Recommendation Adoption Progress (RAP) Interview, a required part of the project. Other items TASC has been working on include:
  • Finalizing the content for a cybersecurity guide for small rural hospitals and clinics, to be released later this winter
  • Virtual Knowledge Group (VKG) webinar on December 4 on how a state Flex Program can prepare for an impactful CAH site visit
  • Working with the Planning Committee to develop the agenda structure and speaker ideas fro the 2108 Flex Program Reverse Site Visit (RSV)
  • Preparing to support all state Flex Programs in updating their online State Flex Profile in December
  • Updating the Fundamentals of Flex Guide, to be released in January
If you have any questions on any of the above work under development, or an idea for TASC to consider, please let us know by emailing Tracy Morton.
Webinar: New Medicare Card Project 

The New Medicare Card project team will host a webinar to allow CAHs an opportunity to learn more about and ask questions regarding the Centers for Medicare and Medicaid's (CMS) approach to changing the social security number-based health insurance claim numbers (HICN) to the new Medicare beneficiary identifier (MBI). During this webinar, they will cover the background of the New Medicare Card Project, the implementation of new Medicare numbers, the format of the new number, timeline & milestones, the transition period, outreach & education and what you need to know to get ready for the new number.

Visit the New Medicare Card Project website for more information.

Please send feedback and questions to NewMedicareCardSSNRemoval@cms.hhs.gov

Topic: New Medicare Card Project - CAHs
Date: Tuesday, December 12, 2017
Time: 1:00 pm - 2:00 p.m. Central Time

To Join the session
  1. Go to the online event page
  2. Enter your name and email address or registration ID. You can register in advance for faster login.
  3. Enter the session password: This session does not require a password
  4. Click "Join Now"
  5. Follow the instructions that appear on your screen to listen by phone or computer
  
Thank you Nicole Breton and the New England Rural Health Roundtable for a great conference. What better way to spend National Rural Health Day than with a group of people dedicated to improving the health and well-being of communities throughout rural New England!
New Substance Use/Abuse Resources 

With the additional efforts and projects relating to substance use, TASC worked with John Gale from the Flex Monitoring Team to identify resources that might be useful to  you and your hospitals as you work to meet the challenges of substance use/abuse. 

Resources available in the  TASC resource library focus on prevention, tools for providers, examples of other programs and other topics as well. Please take a look at a sample of the resources below. Please share with those who can benefit from these resources and suggest any others to TASC you have found helpful.

Prevention
Tools for Providers
Miscellaneous
Many more resources can be found on the TASC website simply by searching for "substance use" or other key words in the search field. 
Weekly Rural Health Leadership Radio Program 
 
A weekly radio program, Rural Health Leadership Radio , was launched a year ago to support rural health leaders to share stories and information about what is working, and what is not. To read the story of the program's development please visit an article promoting the resource from the National Organization of State Offices of Rural Health. Here are a few recent speakers:
  • Allan Jenkins, University of Nebraska at Kearney
  • Steve Tenhouse, Kirby Medical Center
  • Karen Madden, New York State Department of Health
  • Dale Gibbs & Tom Klobucar, veterans who have served our country
  • Davis Patterson, University of Washinton
Podcast recordings are available through Google Play and iTunes as well as through the Rural Health Leadership Radio website.
  
Thank you Cora Morton for sharing the beautiful turkey she created to help us get in the holiday spirit_
Thank you Cora Morton for sharing the beautiful turkey she created to help us get in the holiday spirit.
Critical Access Hospital (CAH) Recognition One Page Summaries now available 

Developing collaborative and innovative ways of managing the health of communities is an important component in transitioning to value-based care. The CAH Recognition Certificate was established by the National Rural Health Resource Center (The Center) and the Federal Office of Rural Health Policy (FORHP) to recognize the excellent work in CAHs throughout the country. The recognition, nominated by the state Flex Programs, promotes excellence and innovation and honors the achievements and results of CAHs through Flex-supported activities and their impact.

In an effort to provide easy access to the resources and publications TASC produced a one page summary for each facility which has been recognized since 2013. Please take a moment to review the great work of the CAHs and partners as we prepare for our next round of recognition!

New & Updated Resources 

The following resources on the TASC website are new or recently updated:

Author: Rural Health Value (RHV)
Read a profile of a health care network that integrated a medical-legal partnership into the evidence-based chronic care model used in its new transitional care clinics as a means of addressing social determinants of health. Learn more about how legal aid advocates can address insurance coverage, food stamps, unemployment benefits, unsafe housing, housing subsidies, protective orders for domestic violence, as well as mortgage and loans issues as a way of contributing to the reduction of preventable hospital readmissions and emergency department use, and controlling overall health care costs.

Author: Center for Connected Health Policy (CCHP)
The Center for Connected Health Policy's (CCHP) annual State Telehealth Laws and Reimbursement Policies report offers the nation's most current summary guide of Medicaid provider manuals, applicable state laws and telehealth-related regulations for all 50 states and the District of Columbia. This report serves as a vital resource for policymakers, health care professionals and health advocates on how each state defines, governs and regulates technology-enabled health care, noting policy trends across eleven key categories. This report is updated at least annually.

Author: TASC
Developing collaborative and innovative ways of managing the health of communities is an important component in transitioning to value-based care. The Critical Access Hospital (CAH) Recognition certificate was established by the National Rural Health Resource Center and the Federal Office of Rural Health Policy (FORHP) to recognize the excellent work in CAHs throughout the country. The recognition, nominated by the state Flex Programs, promotes excellence and innovation and honors the achievements and results of CAHs through Flex-supported activities and impact.

Author: Centers for Medicare and Medicaid Services (CMS)
The Centers for Medicare and Medicaid Services offer support to promote successful participation in the Quality Payment Program (QPP), in either the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Model (APM) track. This support is from on-the-ground organizations and resources.

Author: Catholic Health Association of the United States (CHA)
Community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. They are not provided for marketing purposes. These resources can help you determine what program or activities count as community benefit.

New/Updated MBQIP Resources - are now in the 'MBQIP Highlights' section above.
Connect Peer to Peer in Flex Program Forum 
mailboxes

Do you have a question, idea, success or challenge to share with your Flex Program peers? Don't miss the ongoing discussions on the Flex Program Forum
Please note, you need to log in to read recent postings, which include:
If you have questions about the Flex Program Forum, please contact TASC.  
Webinar Playbacks and Event Materials 

Are you looking for resources in the topics of: TASC, SHIP, SRHT or Networks? Look no further!

TASC
Learn the performance observations and evidence of rural accountable care organization (ACO) involvement. Discover opportunities for state Flex Program involvement in supporting value-based models of care and understand the successes and challenges of rural ACOs and how the state Flex Program can play a supportive role.
Review the purpose of the Core Competencies for Flex Program Excellence and how they relate to Flex grant requirements. Hear about the self-assessment and learn about technical assistance available from TASC to support development of the Core Competencies. Discover how Flex Programs are using them to improve their program performance.

Network
Within today's health care landscape where collaboration and information sharing are key for engaging communities and improving access to care, rural health networks are one of the answers for successfully shifting toward value-based care models. In this National Rural Health Day 2017 webinar, Kap Wilkes discusses the five common characteristics of a sustained rural health network, how to focus efforts to support those key attributes and what it takes to plan for the future.

 

Other

Since 2005, 122 rural hospitals have closed - 80 since 2010. George Pink, PhD, from the North Carolina Rural Health Research and Policy Analysis Center presented updated and new data about closed rural hospitals and their post-closure disposition. A model predicting financial distress and closure in rural hospitals was also described. Characteristics of hospitals at high risk of financial distress were identified and trends in risk of financial distress among rural hospitals analyzed.
National Rural Health Resource Center Blog 

Stay in the loop by following the National Rural Health Resource Center blog
Recent postings:
Grow your Career: Save the Dates 

Below is a list of upcoming events relevant to rural health:

View upcoming rural events by month, s tate or keyword search.

December 4, 2017 11:30 - 12:30 p.m. Central Time
How a State Flex Program Can Prepare for an Impactful CAH Site Visit

December 13,  2017 1:00 - 2:00 p.m. Central Time
Review national data on burnout and share how healthcare systems across the state of Minnesota are working together to combat this crisis

December 14, 2017 2:00 - 3:30 p.m. Central Time
In this webinar, the presenters will walk through an evaluation planning toolkit to support networks in developing evaluation plans

MBQIP VKG
December 21, 2017 2:00 - 3:30 p.m. Central Time 
ED-1 and ED-2: Incorporating Inpatient ED Measures into MBQIP
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