Announcements from the Federal Office of Rural Health Policy

December 22, 2014

Hot Off the Presses

1.  The Federal Office of Rural Health Policy is pleased to announce several organizational changes.  We have established an Administrative Operations Division and have elevated the Policy Research Team to division status.  In addition, the word “Federal” has been added to the beginning of our name to reinforce the statutory charge in our authorizing language (Section 711 of the Social Security Act) to advise the Secretary and others in the Department on rural health issues.   For more information about the Office, please visit the FORHP website at http://www.hrsa.gov/ruralhealth/. For more information about the organizational changes, the Federal Register Notice can be found here.

2. For the Marketplace’s 2016 benefit year, the Centers for Medicare & Medicaid Services (CMS) is releasing a draft updated list of Essential Community Providers (ECPs) to assist issuers in complying with the requirements in 45 CFR 156.235.  Under that regulation, ECPs are defined as providers who serve predominantly low-income, medically underserved individuals.  They include health care providers defined in section 340B(a)(4) of the Public Health Service Act and described in section 1927(c)(1)(D)(i)(IV) of the Social Security Act.  This draft list of ECPs and a description of the draft list are available at http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/qhp.html under the section titled “Other QHP Application Resources.”

CMS is publishing this draft HHS list of ECPs to provide entities on the list an opportunity to notify CMS of any necessary corrections.  CMS is soliciting public comments until 5 p.m. EST on January 2, 2015 to improve the accuracy of the list.

CMS considers the following to be within the scope of this solicitation:

1. Detailed corrections to the draft ECP list, including documentation that points CMS to a valid source of data that supports the correction; and
2. Additions to the draft ECP list that contain sufficient data for inclusion in the list, as well as documentation that points CMS to a valid source of data that confirms that the added entity is a member of one of the ECP groups listed in the “Description and Purpose of the Draft HHS List of ECPs” document posted at the above link.

Please send corrections or additions to the ECP electronic mailbox at: EssentialCommunityProviders@cms.hhs.gov.  Commenters should write in the subject line of the email the following: “Comments on draft ECP list.” Rural providers should take note of a change to the status of Rural Health Clinics. Under this revision, a Medicare-certified Rural Health Clinic is included in the non-exhaustive ECP list if it meets the following two requirements: 1) Based on attestation, it accepts patients regardless of ability to pay and offers a sliding fee schedule; or is located in a primary care Health Professional Shortage Area (geographic, population, or automatic); and 2) Accepts patients regardless of coverage source (i.e., Medicare, Medicaid, CHIP, Marketplace plan, etc.).

The Affordable Care Act

 

3. Best Practices for Health Insurance Marketplace Outreach and Enrollment in Rural Areas The Affordable Care Act provided coverage through the Health Insurance Marketplace to nearly seven million people during the first open enrollment period. Yet, research suggests that the enrollment rates for eligible individuals living in rural areas were less than enrollment rates for those living in urban areas. That may be due, in part, to specific challenges in rural communities, including lack of internet access, low population density, or travel barriers to obtaining help.

Among rural communities, there was considerable variation in the enrollment rate. Key informant interviews were conducted of navigators, health centers, Certified Application Counselors, and other partner organizations to try to identify best practices for marketing, outreach and education, in-reach (identifying eligible current clients), and enrollment in rural communities. The fact sheet from the North Carolina Rural Health Research Program highlights some of the best practices identified through these interviews.

4.  A new video, featuring Agriculture Secretary Tom Vilsack, highlights the importance of the ACA in rural America: https://www.youtube.com/watch?v=p4An08hn0Js. Rural consumer assistors may have an interest in featuring this video in promotional materials. Assitors may also be interested in new Spanish language tools from the Kaiser Family Foundation to help consumers better understand health insurance as they shop for plans during open enrollment for the Affordable Care Act’s marketplaces and in other venues:

• El seguro de salud, explicado: ¡los YouToons lo tienen cubierto! is a Spanish version of the five-minute cartoon video Health Insurance Explained – The YouToons Have It Covered, a light-hearted treatment of a difficult and important topic.
• La calculadora del Mercado de Seguros Médicos, the Spanish version of the Foundation’s Health Insurance Marketplace Calculator, now includes zip code-specific data on 2015 marketplace plans.

Open Enrollment has started! To learn about the Health Insurance Marketplace and your coverage options, visit Healthcare.Gov. For materials to help consumers enroll in coverage, visit www.marketpace.cms.gov. To learn more about outreach and enrollment in rural America, visit www.hrsa.gov/ruralhealth/affordablecareact/.

Webinars, Events, and Technical Assistance

5.  Attention Current ORHP Grantees: The Office of Rural Health Policy (ORHP) is pleased to announce a Rural Leadership Workshop for grantees to be held February 4^th from 10:30-5 PM ET.  This interactive workshop will focus on ways you, as a rural leader, can strengthen your leadership skills.  The workshop will be led in collaboration by key rural health leaders, including speakers from the Georgia Health Policy Center, National Rural Health Resource Center, and the National Organization of State Offices of Rural Health.  The workshop will be held in conjunction with the National Rural Health Association (NRHA) Policy Institute, and we encourage you to attend the full meeting to gain a better understanding some of the policy issues that face rural communities.  The link to the conference can be found on: http://www.ruralhealthweb.org/pi. To be eligible, participants must be a current ORHP grantee and must be able to pay for all associated costs of the event (hotel, travel, food, etc.)

If you have interest in attending the Rural Leadership Workshop, please submit the following information to Shelia Tibbs at stibbs@hrsa.gov by December 29^th:

• Your Name;
• Grant Program Name and Number;
• City, State; and
• Brief paragraph on how this workshop can benefit you and your community

Other Useful Information and Resources

6.  The National Center for Health Workforce Analysis (NCHWA) recently published a brief, “The Future of the Nursing Workforce: National-and-State Level Projections.” The brief makes projections of the supply and demand for registered nurses and licensed practical nurses (LPNs) nationally and by state, drawing from an analysis of baseline data from 2012 and HRSA’s Health Workforce Simulation Model. Key findings indicate that the change in RN and LPN supply from 2012 to 2025 should supersede demand. However, these overarching national trends mask the substantial variation in projected RN and LPN supply and demand at the state level, with 16 states projected to experience RN shortages by 2025 and 22 states projected to see LPN shortages by 2025. Understanding the supply, demand, and distribution of the nursing workforce is particularly salient to anticipating and improving the health care delivery models in rural, underserved areas that already experience acute shortages of physicians.

7.  On Thursday December 11^th, CMS released a proposed rule that would require all health care facilities, regardless of location, to give equal rights to spouses of gay and straight patients as long as the marriages are legal somewhere in the United States. This proposal is to ensure that certain requirements for conditions of participation (CoPs) for providers, and conditions for coverage (CfCs) for suppliers are consistent with the 2013 Supreme Court decision United States v. Windsor. This Supreme Court decision held that section 3 of the Defense of Marriage Act (DOMA) is unconstitutional because it violates the Fifth Amendment.

In the proposed regulations, CMS identified nine areas where health care policies should be updated to comply with the DOMA ruling. One of the proposed changes would expand the definition of “representative” to include same-sex spouses, thereby giving them the authority to make medical decisions for spouses that are unable to do so for themselves. The new regulations would affect all providers and suppliers that participate in Medicare and Medicaid, including nursing homes, mental health clinics, hospices, surgery centers, and hospitals.

CMS will accept comments on the proposed rule for 60 days after publication in the Dec. 12 Federal Register. This CMS Ruling is available at https://www.federalregister.gov/articles/2014/12/12/2014-28268/medicare-and-medicaid-program-revisions-to-certain-patients-rights-conditions-of-participation-and

8.  Click here for the latest issue of MLN Connects, a weekly newsletter that gives provider news and updates that may affect how rural providers are impacted by CMS rollouts. Previous issues and a link to subscribe to MLN Connects are available in the archive.

9.  On December 8^th, The Centers for Medicare & Medicaid Services (CMS) published the Medicare Shared Savings Program:  Accountable Care Organizations Proposed Rulein the Federal Register.  Comments are due by February 6^th.  The rule includes the following proposals:

• Changes to encourage ACO participation in risk-based models by:
  • Adopting an alternative risk-based model (“Track 3”) that includes proposals for a higher shared savings rate and prospective attribution of beneficiaries.
  • Seeking comment on the waiver of Medicare payment rules and regulations related to telehealth, qualifying hospital stays for skilled nursing facility (SNF) admission, and qualifications for home health services and post-acute care referrals.
  • Revisions to beneficiary assignment* that may be of interest to rural stakeholders include:
    • Including the claims from non-physician ACO professionals (NPs, PAs, and CNSs) in Step 1 of the beneficiary assignment rule.
    •  Clarifying how primary care services furnished in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) will be considered in the assignment process.  CMS proposes that all primary care services furnished by FQHCs and RHCs would be considered in Step 1 of the beneficiary assignment method.
  • Streamlining ACO access to beneficiary claims data while continuing to enable beneficiaries to opt out from having their claims shared with the ACO.
  • Seeking comments on alternative methods for establishing, updating, or resetting ACO financial benchmarks for determining shared savings/losses, including using regional expenditures rather than national expenditures to set the benchmark.

• Enabling existing ACOs under a one‑sided participation agreement (“Track 1” – shared savings, not losses) to continue for an additional 3-year period at a lower sharing rate

*{Note: The existing method assigns beneficiaries to ACOs in 2 steps based on having the plurality of primary care services furnished 1) by primary care physicians; or 2) by specialists, nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs).}

10.  Attention Rural Hospitals: CMS has extended the deadline for eligible hospitals and Critical Access Hospitals (CAHs) to attest to meaningful use for the Medicare Electronic Health Record Inventive Program 2014 reporting year by 30 days to 11:59 PM ET on December 31, 2014. The extension allows more time for hospitals to submit their meaningful use data and receive an incentive payment for the 2014 program year, as well as avoid the 2016 Medicare payment adjustment. In addition, CMS is also extending the deadline for eligible hospitals and CAHs that are electronically submitting clinical quality measures (CQMs) to meet the requirement for meaningful use and the Hospital Inpatient Quality Reporting (IQR) program, and now have until December 31, 2014 to submit their eCQM data. Please note that this extension does not impact the deadlines for the Medicaid EHR Incentive Program. For more information please visit: www.cms.gov/ehrincentiveprograms/ or call the EHR Information Center at 1-888-743-6433.

11.  Attention Rural Providers: In August, Congress enacted the Veterans Choice Act, which enables veterans to see a local, non-VA provider if they reside farther than 40 miles from a VA site of care or if they face an appointment wait time of longer than 30 days. Coverage through the new Choice program began November 5^th. Veterans who live at least 40 miles from a VA facility, those who are currently waiting for an appointment longer than 30 days from their preferred date or the date deemed medically necessary by their referring physician, and those Veterans enrolled in VA health care who may be eligible for the Choice Program in the future have already been mailed a Veterans Choice Program card and may come to you for their care.  However, before providers can be reimbursed for providing care to eligible veterans, they must sign a participation agreement.  More information is forthcoming, but in the meantime, if you have questions please visit the Veterans Choice web site at: www.va.gov/opa/choiceact/ or call the VA at 866-606-8198.

Funding Opportunity Announcements

12.  The Administration for Children and Families (ACF) has announced a new $500 million funding opportunity to expand access to high-quality, comprehensive services for low-income infants and toddlers and their families. This funding will support the creation of Early Head Start-Child Care (EHS-CC) Partnerships and the expansion of Early Head Start services to children and families. Funding for EHS-CC Partnerships will encourage collaboration between new or existing Early Head Start grantees and child care providers to improve the quality of existing child care programs and expand access to high-quality care for infants and toddlers. Rural community-based organizations may be interested in applying to support high-quality childcare and preschool infrastructure in their communities.

13.  The Nurse Anesthetist Traineeship Program is designed to improve access to nurse anesthetist services for underserved populations. Through providing traineeships for licensed registered nurses (RNs) to pursue a nurse anesthesia programs, the NAT program is an important iniative in the development of the rural health workforce. The NAT grant funds traineeships for licensed registered nurses who are enrolled as full-time students beyond the 12^th month of study in a master of doctoral nurse anesthesia program. Funding covers the cost of tuition, books, fees and reasonable living expenses for the student during the traineeship. Eligible applicants include education programs at accredited schools of nursing, academic health centers, and other private of public entities that provide registered nurses with full-time nurse anesthetist education and are accredited. Grant applications are being accepted until February 26^th. To see the official grant opportunity, click here. For more information about eligibility or specifics on the funding, please contact Karen Delia Breeden, kbreeden@hrsa.gov .

The Announcements from the Federal Office of Rural Health Policy are distributed weekly. To be added to the distribution list, please e-mail SShapiro-Baruch@hrsa.gov.