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Carrie CochranDeputy Associate Administrator for Rural Health Policy
Health Resources and Services AdministrationU.S. Department of Health and Human Services
The Federal Rural Health Landscape
South Carolina’s 13th Annual Rural Health Conference
April 29-30, 2009
Today’s Presentation
Washington Update
Health Care Reform
The Stimulus Bill
Emerging Challenges
Opportunities and Resources
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
Tough Times: Thin Margins get Thinner Local job losses State cuts Increase in the uninsured
Current Health Care Challenges
Increases in the Uninsured, Underinsured
Decreased Revenues Workforce Recruitment and Retention Increased Focus on Quality and
Reporting Resources/Infrastructure
Health Care Reform Health Care Reform Front & CenterPresident’s Vision Key Principles
Protect families’ financial healthAssure affordable, quality coverageProvide portability of coverage Guarantee choice of providersInvest in prevention and wellnessImprove patient safety and qualityEnd barriers for pre-existing conditionsReduce long-term growth of health care costs
White House Forum a starting point
Opportunities for rural?
More information available: http://www.healthreform.gov/
Health Care Reform
Some Common Themes
• Rising Costs• Reductions in
Access• A Need to Improve
Quality• Linking Workforce
Current Proposals• Improving Access• Re-Emphasizing
Primary Care• Improving Outcomes• Strengthening
Medicare, Medicaid and SCHIP
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
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
http://www.healthreform.gov/reports/inaction/inactionreportprintmarch2009.pdf
Health Care Reform
The American Reinvestment and Recovery Act (ARRA)
$787 billion stimulus package for: Health Information Technology (HIT) Community Health Centers Prevention and Wellness Health Workforce
www.recovery.gov
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)
ARRA: HIT
Medicaid HIT Payments Based on “Meaningful” HIT adoption through 2014Eligible 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
ARRA: HIT
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
ARRA: HIT
$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
ARRA: Rural Broadband
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
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
http://bphc.hrsa.gov/recovery
$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
ARRA: Prevention & Wellness
$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
ARRA: Capital
• 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
Children’s Health Insurance Program Reauthorization
(CHIPRA) • 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
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 ContractorsChanges to the Medicare Advantage ProgramMonitoring Medicare & Medicaid Payments
Emerging Trends: Rural Hospitals
Continued Workforce Shortages- Physicians, Nurses, other Allied HealthNational 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
Emerging Trends: Workforce
ORHP Structure• Community-Based
Division– 9 grant programs
• Hospital- State Division– 4 grant programs
• Border Health Division
• Policy-Research Team– 3 grant programs
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)
• 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)
Hospital-State Division
•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 GMEhttp://bhpr.hrsa.gov/
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– [email protected]
healthworkforceinfo.org
ORHP Resources: Workforce
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
ORHP Resources: Quality
Resources for CAHs Capital Planning
Protype Design Capital Planning Manual In Development
http://portal.hud.gov/portal/page?_pageid=73,1827038&_dad=portal&_schema=PORTAL(Click on CAH Planning, Design and Construction Guide)
ORHP Resources: Capital
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.
• 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
http://www.narhc.org/members/orhp_series.php
ORHP Resources: Research New Manuals
Mental Health Best Practices FQHC-CAH Collaboration Rural HIV Best PracticesCAH Capital Planning
Rural Health Research Gateway
Learn more about past and ongoing studies and policy briefs http://www.ruralhealthresearch.org/
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
ORHP Resources
Rural Assistance Center• One-Stop Shopping
- Funding Info- Resource Guides- Best Practices
• Web-Based Services &
Electronic UpdatesSubscribe on the website
• Customized Assistance
http://raconline.org
Phone: 1.800.270.1898E-mail: [email protected]
Hours – Monday – Friday 8 AM – 5 PM CT
Contact InformationCarrie Cochran
Deputy Associate Administrator for Rural Health 301-443-4701
http://ruralhealth.hrsa.gov/
