Announcements from the Federal Office of Rural Health Policy
CDC: Rural Americans at Higher Risk of Death. On Thursday, the Centers for Disease Control and Prevention (CDC) released a study on the five leading causes of death in rural America, the first in a series of reports on the disparities that create “a striking gap in health between rural and urban Americans, ” according to CDC Director Tom Frieden.
Factors contributing to the decline in rural life expectancy include demographic, environmental, economic, and social factors, many of which CDC will examine as part of a series of rural-focused Morbidity and Mortality Weekly Reports. The MMWR delivers objective, scientific public health data and recommendations each week to state health departments and more than 250,000 electronic subscribers. The rural-focused MMWRs represent a significant focus on rural issues by the CDC and will be a feature in the FORHP Announcements this year. The increasing mortality in rural areas was also a topic of a recent report from the National Advisory Committee on Rural Health and Human Services.
New Rural Health Model in Pennsylvania. Also on Thursday, the CMS Innovation Center announced a new model opened to test the predictability of global budgets for rural hospitals in Pennsylvania and determine if they enable services tailored to the needs of local communities. Under this Model, monthly payments made by Medicare fee-for-service and all other participating payers would be based on a fixed amount for inpatient and outpatient services. In addition, rural hospitals would be allowed to redesign delivery to invest in quality measures and preventive care in a way that meets their patients’ needs. The funding will be used to oversee the Model, collect and analyze data, and provide technical assistance toward several targets, including increasing access to care, reducing rural health disparities and decreasing deaths from substance use.
This model will be important for rural stakeholders to monitor as it offers an opportunity to test whether the predictable nature of the global budgets will enable participating rural hospitals to invest in quality and preventive care, and to tailor the services they deliver to better meet the needs of their local communities.
CMS Innovation Center Report to Congress. The CMS Center for Medicare & Medicaid Innovation recently released its third Report to Congress that focuses on activities of the Innovation Center in Fiscal Years 2015 and 2016 (October 1, 2014-September 30, 2016). During this time period, the CMS Innovation Center announced or tested 39 payment and service delivery models and initiatives. Examples of Innovation Center initiatives of note for rural areas include the ACO Investment Model (AIM), the Transforming Clinical Practice Initiative (TCPI), and the Comprehensive Primary Care Plus (CPC+) initiative. The Innovation Center was created to test “innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care” provided to Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) beneficiaries.
Black Lung Clinics Program (BLCP) & Black Lung Center of Excellence (BLCE) – March 6. As many as 15 public, private, or state entities will receive funding to provide medical, outreach, educational, and benefits counseling services to active and inactive coal miners under the BLCP. Under the BLCE, one entity will be awarded a cooperative agreement to help strengthen the operations of BLCP awardees through improved data collection and analysis. Both the BLCP and BLCE are three-year programs with an anticipated start date of July 1, 2017. See Events section below for assistance with applications.
Radiation Exposure Screening and Education Program – March 6. Up to eight organizations located in high-impact states cited by the Radiation Exposure Compensation Act (Arizona, Colorado, Idaho, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas, Utah, Washington, and Wyoming) will receive total funding of $1.5 million to improve health and quality of life for populations exposed to risk of radiogenic cancers and/or disease resulting from uranium mine industry work or fallout from nuclear arms testing. Awardees will disseminate information and screen individuals for cancer and other radiogenic diseases, provide referrals for medical treatment, and facilitate Radiation Exposure Compensation Act (RECA) claims. See Events section below for assistance with applications.
Area Health Education Centers – March 29. HRSA’s Bureau of Health Workforce will make up to 55 awards to public and nonprofit schools of allopathic or osteopathic medicine to increase diversity and distribution among health professionals and improve health care delivery to rural and underserved areas. A webinar for more information on the AHEC program will be held Wednesday, January 18 from 2:00 to 4:00 pm ET. Dial in ; passcode 5696317.
USDA Invests in Rural Business Development – March 31. The Rural Business Cooperative Service at the U.S. Department of Agriculture (USDA) seeks applications for a program providing assistance to improve rural transportation services and facilities. State agencies, towns, institutions of higher education and other non-profit entities may apply for grants ranging from $10,000 up to $500,000 that can be used to benefit small and emerging businesses through transportation improvement, rural business incubators, land acquisition or development and other projects that boost the local economy of rural communities. In addition, loans up to $1 million and grants of up to $300,000 will be made by the Rural Economic Development Loan and Grant Programs (REDLG) for economic development and job creation. Project activities include advanced telecommunications services for medical, educational, and job training services. Loans and grants may be made to any entity that is identified by USDA Rural Development as an eligible borrower under the Rural Electrification Act of 1936.
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CMS Issues New Guidance for Hospitals. Last month, the Centers for Medicare & Medicaid Services (CMS) issued preliminary guidance clarifying the 21st Century Cures Act provisions that impact hospital outpatient off-campus provider-based departments (PBD) with concrete plans for construction at the passing of the Bipartisan Budget Act of 2015. The Cures law extended the grandfather date for those facilities to qualify for payment under the outpatient prospective payment system, rather than at the lower “site-neutral” rate. On Dec. 28, CMS also issued sub- regulatory guidance on how hospitals can request from their CMS Regional Office a relocation exception for an excepted off-campus provider based department due to an extraordinary circumstance. Please see the fact sheet for more information on the finalized Hospital Outpatient Prospective Final Rule and provisions related to payments for off-campus PBDs.
Report to Congress: Performance Under Value-Based Purchasing Programs. In December, the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) issued the first of two reports to Congress mandated by the IMPACT Act that analyze the effect of social risk factors on Medicare quality measures and quality-based payment programs. In this first report, ASPE considered how the performance of hospitals, health plans, physicians, dialysis facilities, skilled nursing facilities, and home health agencies were affected by the following six social risk factors: (1) dual enrollment in Medicare and Medicaid, (2) residence in a low-income area, (3) Black race, (4) Hispanic ethnicity, (5) residence in a rural area, and (6) disability status. Of the risk factors considered, ASPE found that dual enrollment was the most powerful predictor of poor performance. While beneficiaries’ rural residence was not a significant predictor, rural beneficiaries are more likely to be dually enrolled than their urban counterparts. In its results, ASPE finds that beneficiaries with social risk factors had poorer outcomes on many process, clinical outcome, and patient experience measures, and in every care setting examined, providers that cared for higher proportions of beneficiaries with social risk factors tended to perform worse than their peers, even after adjusting for beneficiary characteristics, leading to financial penalties across all five Medicare quality-based payment programs.
CMS Unveils New Compare Websites and Data Updates. In December, CMS also announced two new websites providing quality data on inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs): IRF Compare and LTCH Compare. The new Compare sites report performance measures from the IRF and LTCH quality reporting programs, such as the percentage of patients with new or worsened pressure ulcers and the rate of unplanned readmissions within 30 days after discharge. Of note for rural residents, the IRF Compare site includes information on inpatient rehabilitation units at both critical access hospitals and other rural hospitals. LTCH Compare also includes rural providers, though these make up only about 5% of all LTCHs. CMS has also provided data updates for the Hospice Quality, Hospital Compare, and Physician Compare websites.
Participate in TOH Quality Measures Pilot – Submit by January 17. Rural-based Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), Long Term Care Hospitals (LTCHs), and Home Health Agencies (HHAs) that have been Medicare-certified for at least one year are eligible to participate in a pilot that allows CMS to test two new efforts to standardize quality measure reporting under the Improving Medicare Post-Acute Care Transformation Act (IMPACT Act) of 2014. Participation in the Transfer of Health Information and Care Preferences (TOH) pilot allows rural agencies and facilities to provide input for the ongoing development of quality measures and to provides a greater understanding of how TOH data collection might impact patient care in rural areas. To participate, see the Pilot Recruitment Form and submit the Interest Form found in the Transfer of Health Pilot zip file by January 17.
Health Workforce Connector – Comment by February 3. To expand the function of the National Health Service Corps Jobs Center, HRSA seeks comments on the information collected to develop a Health Workforce Connector. The Connector would provide a central platform where users can create a profile, search for NHSC and NURSE Corps sites and find job opportunities in underserved communities with facilities in need of providers.
Request for Information: PACE Innovation Act – Comment by February 10. CMS is seeking public input on potential adaptations to the Programs of All-Inclusive Care for the Elderly (PACE), which provides medical and social services to certain frail, community-dwelling elderly individuals most of whom are eligible for Medicare and Medicaid benefits. The changes would implement a new five-year test model for additional beneficiaries, age 21 and older, with disabilities that impair their mobility and who require a nursing home level of care. This is an opportunity for rural providers to provide CMS with input on rural considerations for expanding the program.
CMS Seeks Nominations for Advisory Panel on Hospital Outpatient Payment – Submit by February 21. CMS seeks nominations for the Advisory Panel on Hospital Outpatient Payment. The purpose of the Panel is to advise the Secretary of the Department of Health and Human Services and CMS on the clinical integrity of the Ambulatory Payment Classification groups and their associated weights, and supervision of hospital outpatient therapeutic services. For supervision deliberations, the Panel is interested in members that represent the interests of critical access hospitals.
Resources, Learning Events and Technical Assistance
Reducing Chronic Diseases Through CHW – Tuesday, January 17 at 2:00 pm ET. This webinar will highlight research and tools for engaging community health workers (CHWs) to prevent chronic diseases, including the University of Arizona’s work to create best practices for CHWs in clinical settings.
Black Lung Clinics Program (BLCP) FOA Technical Assistance – Wednesday, January 18 at 12:00 pm ET. Conference line for audio for the Black Lungs Clinic Program: , passcode: 1899090. No pre-registration is necessary, but you must dial into the conference line to hear the audio portion. See Funding Opportunities section above for more information on the Black Lung Clinics Program (BLCP) and the Black Lung Center of Excellence (BLCE). To listen to a recording of the Black Lung Center of Excellence (BLCE) FOA technical assistance webinar, dial / passcode 9819.
Diagnosing Substance Use Disorder – Thursday, January 19 from 1:00 – 2:30 pm ET. Attendees at this 90 minute webinar will learn the diagnostic criteria for substance use disorder, common brain effects of various euphoria-producing drugs and the implications of moderate versus severe disorder for behavioral health and primary care practitioners. Hosted by the Great Lakes Addiction Technology Transfer Center in partnership with HHS Region 5 Offices of SAMSHA and HRSA, the webinar is part of a series of learning events about the integration of addiction and primary care. For more information, contact Anne Huang, Nurse Consultant in HRSA’s Chicago Regional Office at firstname.lastname@example.org.
RESEP Funding Technical Assistance – Thursday, January 19 from 2:30 – 4:00 PM ET. For audio you will need to dial in at (participants must call in to verbally ask questions), passcode: 47535883. See Funding Opportunities section above for more information on the Radiation Exposure Screening and Education Program.
Participate in TOH Quality Measures Pilot – January 17
Advanced Nursing Education Workforce (ANEW) Program – January 25
Pre-Doctoral Pediatric Dentistry Training – January 30
Comment: Health Workforce Connector – Comment by February 3
Comment: PACE Innovation Act – Comment by February 10
Community Facilities Program – Ongoing