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Hello Everyone!
We hope May has been kind to you! It has only snowed once (thus far) this month in Duluth, so I'd say it's been a good May.
We are super excited about all the different activities happening like the Chronic Obstructive Pulmonary Disease (COPD) Supplemental project and the Emergency Medical Services (EMS) Supplemental project. The Minnesota Rural Health Conference will also be happening in Duluth on June 17th and 18th, and we expect around 600 participants.
I'm looking forward to seeing so many of you in person at the Reverse Site Visit in July, and I hope you enjoy this month's edition of Rural Route. We appreciate you taking the time to read it.
Thank
s,
Andy Naslund
Program Coordinator
Technical Assistance and Services Center (TASC)
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Welcome to:
- Cassie Kennedy, the new Flex Coordinator in Iowa
- Martina Garcia, the new Flex Coordinator in New Mexico
- Michelle Teachout, the new Flex Coordinator in Utah
We are happy to have all of you be a part of Flex!
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FORHP Updates
Updates include:
CAH Regulatory Update
Updates include:
- Comment requests for draft guidance on hospital co-location
- Comment requests for State Empowerment waivers
- The Medicaid IMD Additional INFO Act
- The Primary Cares First Initiative
- Integrating Medicare and Medicaid Beneficiaries opportunities
- Rural Maternity and Obstetrics Management (RMOMS) Funding Extension Deadline
- A new Rural Opioid Funding opportunity
- Proposed changes to the Medicare Hospital Inpatient prospective payment system
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2019 Flex Program Reverse Site Visit
As a reminder, the 2019 Flex Program Reverse Site Visit (RSV) will be held July 10-11, 2019 at the
Washington Marriot Wardman Park in Washington, DC. This in-person Flex meeting is supported by the Federal Office of Rural Health Policy (FORHP).
The purpose of the Flex Program RSV is to highlight the latest information and issues in the Medicare Rural Hospital Flexibility (Flex) Program, as well as offer states an opportunity to share experiences, lessons learned and successes in a collaborative learning environment.
Online registration for the Flex Program RSV is open and a draft agenda is available
on the 2019 RSV page of the TASC website.
You will also find information regarding lodging and room rates.
Please note that the deadline to make hotel reservations at the group rate is Monday, June 10, 2019. Don't hesitate to contact us if you have any questions.
The Reverse Site Visit is targeted to the 45 states that participate in the Medicare Rural Hospital Flexibility (Flex) Program. The intended audience for the Flex Program RSV is State Office of Rural Health Directors, Flex Coordinators/other key Flex personnel (two per state), the Flex Monitoring Team (FMT), Stratis Health's Rural Quality Improvement Technical Assistance (RQITA) team, Technical Assistance and Services Center (TASC) staff and Advisory Committee, and FORHP staff.
If you would like to have more than two attendees, please contact your project officer at FORHP for approval.
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Fiscal Year 2020 MBQIP Eligibility Criteria
Now that Fiscal Year (FY) 2019 waivers are closing, FORHP would like to release the reporting requirements for FY 2020 MBQIP Eligibility. After reviewing the amazing national reporting rates in MBQIP, in order to be eligible for FY 2020 (September 1, 2020 - August 31, 2021) Flex funds, critical access hospitals (CAHs) will be required to meet these 2 conditions:
(1) A signed Memorandum of Understanding (MOU) to submit and
share
MBQIP data
(2)
Reported data on at least one MBQIP Core measure, for
at least two
quarters
, in at least
three of the four quality domains
, within a certain
reporting period.
Note: Measures that are only reported on an annual basis (Antibiotic Stewardship, HCP/IMM-3, and OP-22) count towards the requirement of reporting for at least two quarters.
You can find the full guidance
here.
If you have any questions, please feel free to reach out to
[email protected] or your Flex Project Officer.
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New CMS Payment Model: Primary Care First
On April 22, CMS released information on a set of five NEW voluntary Accountable Care arrangements for Medicare PPS providers, called Primary Care First.
With
Primary Care First, CMS seeks to simplify the process and pay physicians a monthly fee per patient. While this proposed plan is in its infancy, the idea is that physicians could generate as much as 50% more revenue by participating. In theory, the more patients a practice can keep out of the hospital, the higher their CMS payments will be.
For practices that are prepared to take on more accountability - and greater opportunity for reward - Primary Care First focuses on fostering practice independence and rewarding outcomes by reducing administrative burdens and paying for outcomes instead of process requirements.
See the CMS Fact Sheet
.
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Rural Communities Opioid Response Program - Rural Centers of Excellence on Substance Use Disorders
Deadline: June 10
The Health Resources and Service Administration's (HRSA) Federal Office of Rural Health Policy (FORHP) released a Notice of Funding Opportunity (NOFO) on April 25 for the Rural Communities Opioid Response Program-Rural Centers of Excellence on Substance Use Disorders (RCORP-RCOE). HRSA will provide three cooperative agreements totaling about $20 million to establish three Rural Centers of Excellence.
Each Center will adopt one of the following three Focus Areas:
- Focus Area 1: Innovative and effective treatment interventions for substance use disorders (SUD), particularly opioid use disorder (OUD), in rural communities;
- Focus Area 2: Best practices in recovery housing programs for SUD, particularly OUD, intervention among low-income, high-risk individuals in rural communities; and
- Focus Area 3: Addressing synthetic opioid-related overdose mortality in rural communities in the Delta and/or Appalachian regions.
Selected RCORP-RCOE applicants will receive up to $6.7 million each for a three-year period of performance to identify, translate, disseminate, and provide technical assistance to implement evidence-based programs and promising practices related to treatment for and prevention of SUD in rural communities, with a focus on the current opioid crisis.
Eligible applicants include domestic public or private, non-profit or for-profit entities, including, but not limited to,
- Public or private institutions of higher education;
- State, county, or city or township governments;
- Faith-based and community-based organizations; and
- Federally recognized American Indian tribes, tribal organizations, and tribal governments.
See pages 7-8 of the NOFO for more information on eligibility requirements.
Applicant organizations may be located in an urban or rural area but all RCORP-RCOE program activities must exclusively serve populations residing in HRSA-designated rural areas, whether across multiple states, within one or more regions, or throughout the nation. See the HRSA Rural Health Grants Eligibility Analyzer
to identify HRSA-designated rural areas.
to learn more about how HRSA is addressing the opioid epidemic
.
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Rural Communities Opioid Response Program-Medication-Assisted Treatment Expansion
Deadline: June 10
HRSA's FORHP also a Notice of Funding Opportunity (NOFO) last week for the Rural Communities Opioid Response Program-Medication-Assisted Treatment Expansion (RCORP-MAT Expansion). HRSA plans to invest approximately $8 million in rural communities as part of this funding opportunity.
Successful RCORP-MAT Expansion award recipients will receive up to $725,000 for a three-year period of performance to establish or expand medication-assisted treatment (MAT) in eligible hospitals, health clinics, or tribal organizations located in high-risk rural communities.
Eligible applicants include domestic public or private, non-profit or for-profit:
- Rural Health Clinics, as defined by Social Security Act Section 1861(aa) and 42 CFR Parts 405 and 491;
- Critical Access Hospitals, as defined by Section 1820 (e) of the Social Security Act and 42 CFR 485 subpart F;
- Health Center Look-Alikes, defined as entities that meet all Health Center Program statutory, regulatory, and policy requirements but do not receive funding under section 330 of the Public Health Service Act, as amended (see https://bphc.hrsa.gov for more information);
- Other small rural hospitals with 49 available staffed beds or less, as reported on the hospitals' most recently filed Medicare Cost Reports; or
- Tribes or tribal organizations (excluding health centers that receive Health Center Program federal award funding).
All applicants must be located, and all services must be provided, in HRSA-designated rural areas (as defined by the
Rural Health Grants Eligibility Analyzer). Applicants do not need to be RCORP-Planning award recipients to apply for this funding opportunity. Applicants may apply for RCORP-MAT Expansion funding if they have applied for
RCORP-Implementation funding, but they must detail in their applications how they will avoid duplication of effort and services if awarded both grants. Award recipients are strongly encouraged to leverage workforce recruitment and retention programs like the
National Health Service Corps (NHSC)
Before applying for RCORP-MAT Expansion on grants.gov, applicants must register in
grants.gov
,
SAM, and
DUNS. These registration processes can take up to a month to complete.
To learn more about how HRSA is addressing the opioid epidemic, visit
https://www.hrsa.gov/opioids.
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TASC Updates:
Rural Chronic Obstructive Pulmonary Disease (COPD) Podcast Series: Episode #3 Out Now!
The
National Rural Health Resource Center (The Center) has partnered with Dr. Bill Auxier of
Rural Health Leadership Radio
to produce a six-part podcast series about Rural Chronic Obstructive Pulmonary Disease (COPD) and its prevalence in rural America.
This series from The Center provides information about COPD, how
rural
providers are meeting the needs of their communities, and the importance of billing and coding appropriately while ensuring quality of care is being addressed.
Each podcast features a guest with expert knowledge in COPD and rural health.
-
Dr. Dan Doyle is a physician at New River Health Association, a Federally Qualified Community Health Center (FQHC) in West Virginia. He is a physician and consultant at Cabin Creek Health Center, another FQHC in West Virginia, Medical Director of New River Breathing Center, a Black Lung Clinic which is part of the West Virginia and Federal Black Lung Clinics Program. As of 2013, Dr. Doyle has been the Medical Director of the Grace Anne Dorney Pulmonary Rehabilitation project of West Virginia, which is a collaborative effort of Cabin Creek Health System FQHC, New River Health Association FQHC, Southern West Virginia Health System FQHC, West Caldwell County FQHC in North Carolina, Boone Memorial Hospital, and Jackson General Hospital providing community-based pulmonary rehabilitation services.
- Dr. Doyle discusses his medical background and how he got initially got involved at the New River Health Association, the impact of COPD on rural communities, the lack of access to COPD care, diagnosing COPD and pulmonary function testing, the Dorney Koppel Foundation, the COPD National Action Plan, and the future of COPD care.
Coming very soon:
E
pisode 4
featuring Suzan Michelle Collins
- Suzan Michelle Collins is a registered respiratory therapist at Lincoln Health, Franklin Memorial Hospital, and Central Maine Medical Center.
Catch up on older episodes here!
The 2018 FY COPD Supplemental Project
The goal of the COPD Supplemental Project is to address rural disparities in COPD services and to provide resources and technical assistance to rural hospitals and provider-based clinics in order to address these
disparities
. The COPD Supplemental Project will result in the creation of a manual, a podcast series, dissemination of an assessment, and three webinars.
The components of the COPD Supplemental Project will address the following topics: the importance of addressing COPD services in rural America, the current landscape in rural, payment, workforce needs, clinical treatment, and technology. Please contact Caleb Siem at
[email protected] with any questions.
Coming soon: The COPD/Pulmonary Scope of Services Assessment
Flex coordinators, be on the lookout for the COPD/Pulmonary Scope of Services Assessment that we will be sending soon. We ask that you please forward this assessment to hospital staff in your state, which would include CEO's, CFO's, CNO's, and Cardiopulmonary Department Directors. We intend to use the results to help inform the COPD manual.
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The 2018 FY EMS Supplemental Project
The goal of the EMS Supplemental Project is to better position state-wide and community-level EMS agencies to move toward value-based care. The EMS Supplemental Project will result in the creation of three manuals and an online assessment for EMS providers to determine their readiness for value-based payment systems in rural communities. A small group meeting was held in March with rural EMS experts from around the country to develop key strategies to support the transition of rural EMS services to value models and a summary will be disseminated in May. In addition, there will be an RSV pre-event learning session held in Washington, D.C. on July 9, 2019 for Flex Programs to share progress, challenges, successes, and lessons learned. Please contact Nicole Clement at
[email protected] with any questions.
The May TASC 90 Webinar featured an update on Flex supplemental funding EMS on EMS projects and included updates from TASC,
Rural Quality Improvement Technical Assistance (
RQITA
), the Flex Monitoring Team (
FMT
) and
FORHP
, to include both the Flex Program and policies impacting critical access hospitals.
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New from SRHT: Strategy Map and BSC Learning Collaborative Recordings!
The Center and the Small Rural Hospital Transition (SRHT) Project created the Selected Hospital Learning Collaborative (LC) to support selected hospitals with developing and implementing a Strategy Map and Balanced Scorecard (BSC). A series of five Learning Collaborative (LC) webinar recordings with rural hospitals and experts guiding them through a process to use the
downloadable, pre-filled templates
to develop and tailor their own Balanced Scorecard (BSC) & Strategy Map. The recordings also include educational slides from our subject matter experts and facilitated hospital discussion.
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MBQIP Updates
Updated Resources
Please send your MBQIP questio
ns to the TASC email address
. TASC will ensure your question reaches the appropriate person.
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Webinars, Recordings & Events
Save the Dates
June 3, 2019 | 2:00 p.m.
July 9, 2019 | Washington, D.C.
July 10-11, 2019 | Washington, D.C.
August 5, 2019 | 2:00 p.m. Central Time
August 14, 2019 | 2:00 p.m. Central Time
Webinar Playbacks
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New and Updated Resources
A full list of resources is available in the
TASC resource library
Many more resou
rces can be found on the
TASC website
by searching for key words in the search field.
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New Flex Monitoring Team Research
Financial Policy Brief
The Flex Monitoring Team has published a
new brief comparing the characteristics of communities served by critical access hospitals (CAHs) predicted to be at high risk of financial distress to communities served by all other CAHs. Using data from 2017, the Financial Distress Index (FDI) model assigns CAHs to high, mid-high, mid-low, or low predicted risk levels for 2019 using Medicare cost reports and Neilsen-Claritas data summed to market areas.
CAHs predicted to be at high risk of financial distress were found to serve communities with significantly higher percentages of non-White individuals (Black individuals in particular), lower high school graduation rates, higher unemployment rates, and worse health status.
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Rural Interview with CDC
The Centers for Disease Control and Prevention (CDC) is focusing on rural health. Take some time to
read the RHIhub interview with CDC on their work with rural, and the need for storytelling and data collection.
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The most recent interviews are on the topics of agriculture and mental health, various aspects of rural health, PAs and NPs in CAHs, and HIV, immunization, and billing.
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