Federal Office of Rural Health Policy

Policy Research Team Overview

• Tom Morris – Associate Administrator

• Sahira Rafiullah – Deputy Associate Administrator

• Aaron Fischbach – Policy Coordinator• Alicia Swenson O’Brien, Sarah Young, Helen Newton, Suzanne Stack,

Craig Caplan, Marty Rice, Natassja Manzanero, & Anthony Oliver – Policy Analysts

• Paul Moore & Dan Mareck – Clinical and Quality Advisors

• Steve Hirsch – Executive Secretary, National Advisory Committee

• Curt Mueller – Research and Evaluation Director

• Sarah Bryce – Research and Evaluation Associate

Policy Research Team

• Serve as HHS-wide resource on rural health services and data issues

• Review and comment on all HHS regulations

• Review legislation and reports to Congress

• Conduct rural health services research

• Staff the National Advisory Committee on Rural Health and Human Services

• Staff the White House Rural Council

ORHP Policy Research Activities

PRT Grants and Cooperative Agreements

Policy/Research:

Rural Policy Analysis

Rapid Response to Quick Data Turnaround

Rural Health Research Centers

Rural Training Track Technical AssistanceRural Health System Analysis and Technical Assistance

Demonstrations with CMS:

Frontier Extended Stay Clinic

Frontier Community Health Integration

Rural Health Research

Research from ORHP-funded rural health research centers past and present

http://www.ruralhealthresearch.org

HOSPITAL• Critical Access Hospital (CAH)• Sole Community Hospital (SCH)• Disproportionate Share Hospital

(DSH)• Rural Referral Center (RRC)• Medicare Dependent Hospital (MDH)• Rural Prospective Payment Hospital

PHYSICAN• Bonus Payments

– Shortage Areas– Primary Care

• Graduate Medical Education (GME)

AMBULATORY• Rural Health Clinics (RHC)• Federally Qualified Health Centers

(FQHC)• Community Health Centers (CHCs)

POST-ACUTE• Skilled Nursing Facility (SNF)• Home Health Agency (HHA)• Hospice• Swing Beds• Long Term Care Facilities

Rural Provider Types

• Inpatient Hospital Payment• Outpatient Hospital Payment• Physician Payment• Inpatient Rehab Payment• Inpatient Psych Hospital Payment• Skilled Nursing Facility and Long

Term Care Payments• End Stage Renal Dialysis

Payments• Home Health Payments• Hospice Payments

• Ambulance Fee Schedule• Medicare Advantage• Medicare Part D• Rural Health Clinics• Federally Qualified Health

Centers• Medicaid Waivers/SPAs• Medicare GME• EHR/Meaningful Use• Telehealth• ACA related insurance

provisions

Key Rural Regulatory Issues

Regulation Proposed Pub. Date Eff. Date

Inpatient Prospective Payment System April August October

Outpatient Prospective Payment System July November January

Skilled Nursing Facility Prospective Payment System

April July October

Home Health Prospective Payment System

May September October

Inpatient Rehabilitation Facilities April August October

Inpatient Psychiatric Facility Prospective Payment System

January March July

Physician Fee-Schedule July November January

RHCs & FQHCs N/A N/A N/A

Hospice N/A N/A N/A

Rural-Relevant Medicare Regulations

This is not an official calendar endorsed by CMS.

ORHP Policy Focus for 2014-2015

Health Insurance Marketplaces and State Medicaid expansionsACA Outreach, Education, and EnrollmentQuality

Rural hospitals – Partnership for Patients, VBP, etc. CAHs - MBQIP RHCs – quality measures cohort

Outpatient Supervision at rural PPS and CAHsStage 2 MU implementation and Stage 3 planningPrimary care accessRural and Frontier DemonstrationsRHSATAWhite House Rural Council activities

The White House Rural Council

Created by Executive Order June 9, 2011

HHS Policy Ideas• Expand NHSC to CAHs

• Expand Health IT Funding

• Reduce Regulatory Burden

National Advisory Committee on Rural Health and Human Services

• Advises the HHS Secretary on Rural Issues

• Policy Briefs on Current Issues

• Rural Site Visits

http://www.hrsa.gov/advisorycommittees/rural/

Affordable Care Act Update

ACA Outreach and Enrollment

CMS Outreach and Education Websitehttp://www.cms.gov/Outreach-and-Education/Outreach-and-Education.html

ORHP ACA Office HoursWednesdays, 3-4 pm EasternCall-in Number: (800) 857-3749 Passcode: ORHPACAAdobe Connect Session: https://hrsa.connectsolutions.com/orh1/ 

E-mail name and organization to orhp-acaquestions@hrsa.gov to join the listserv

Archive of prior calls: http://www.hrsa.gov/ruralhealth/affordablecareact/index.html

ACA rural fact sheet: http://www.hhs.gov/healthcare/facts/factsheets/2013/09/rural09202013.html

2014-2015 Enrollment

Special enrollment opportunities: https://www.healthcare.gov/how-can-i-get-coverage-outside-of-open-

enrollment/special-enrollment-period/

2015 Open Enrollment begins November 15 Shorter, 3-month period CMS recently issued regulations about continuation coverage and eligibility

redeterminations

ACA Coverage to Care

If you’re a provider, staff, or someone helping people who are new to insurance, there are a few resources to address topics such as: What it means to have health insurance How to find a provider When and where to seek health services Why prevention is important

Resources: http://marketplace.cms.gov/help-us/c2c.html A Roadmap to Better Care and Healthier You

http://marketplace.cms.gov/help-us/c2c-roadmap.pdf

Discussion Guides for Community Partners Your Roadmap to Health (poster) Provider Newsletter

Resources

Policy Resources

Rural Assistance Center• One stop shopping for all rural health and human services• www.raconline.org

Rural Health Research Gateway Access to all RHRC products on a range of rural health topics

www.ruralhealthresearch.org

Medicare www.cms.gov/Medicare/Medicare.html Rural Providers Resource Guide:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Rural-Health-Suite-ICN908465.pdf

Policy Resources

Legislation and statutes http://thomas.loc.gov/

Social Security Act compilation (Medicare and Medicaid are Titles XVIII and XIX) http://www.ssa.gov/OP_Home/ssact/comp-ssa.htm

Code of Federal Regulations -- Public Health (HHS) -- Title 42• http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?

sid=1ea2f8fcbc9a2ec1c2b44ef1c2374ab0&c=ecfr&tpl=/ecfrbrowse/Title42/42tab_02.tpl

 

Federal Register https://www.federalregister.gov/

CMS interpretive guidelines (or state operations manuals) http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/index.html?

redirect=/Manuals/

CMS Rural Resources

• CMS Regional Office Rural Liaisonshttps://www.cms.gov/ProspMedicareFeeSvcPmtGen/downloads/RO-RH-Coordinators.pdf

• CMS Rural Open Door Forum- Sign up at:http://www.cms.hhs.gov/OpenDoorForums

• CMS National Provider Callshttp://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events.html

• CMS Rural Health Clinics Centerhttp://www.cms.hhs.gov/center/rural.asp

Key CMS Rural Resources

A Few Key Websites

www.healthcare.govwww.cms.gov

http://aspe.hhs.gov www.kff.org

www.nashp.orgwww.commonwealthfund.org

Questions?