Federal Office of Rural Health Policy

August 15, 2016

What’s New

HHS invests more than $26 million in FORHP programs.  On August 11, the U.S. Department of Health & Human Services (HHS) announced new awards for five rural health programs administered by the Federal Office of Rural Health Policy (FORHP).  Of those funds, more than $10 million will go to the Delta States Rural Development Network Program, targeting chronic disease in the eight states of the Delta region (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Missouri, Mississippi, and Tennessee).  Four additional programs received funds that will expand use of telehealth technology for rural veterans and other patients, assist providers with quality improvement activities, and support policy-oriented research to better understand the challenges faced by rural communities.

Surgeon General: Turn the Tide on Opioid Epidemic.  A significant factor in the opioid epidemic is legally written prescriptions from doctors, dentists, nurse practitioners and physician assistants. On August 8, U.S. Surgeon General Vivek Murthy launched a new campaign, called Turn the Tide Rx, to educate and mobilize prescribers in stemming the supply of misused opioids.  The effort aims to educate prescribers about the opioid epidemic, mobilize health care professionals to improve prescribing practices, provide the public with information about opioid misuse, and change the cultural perceptions around addiction so that it is not seen as a moral failing but a chronic illness that must be treated with skill, urgency and compassion.

Policy Updates

**New: FORHP’s Policy Team is ready to answer any questions you may have about these updates at RuralPolicy@hrsa.gov.

Help Wanted: Technical Experts for Quality Measures – Nominate by August 21.  CMS is currently accepting nominations to participate on a technical expert panel (TEP) to assess the quality of post-acute care, as required by the IMPACT Act. Specifically, the panel seeks to include patients and caregivers with personal experience in skilled nursing facilities, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies, as well as health care professionals with setting-specific knowledge of care transitions, care coordination, and admission and discharge planning. For rural stakeholders, serving on the TEP may be an opportunity to influence how new quality measures will accommodate unique factors affecting post-acute care in rural areas, including lower patient volumes and greater travel distance between patients and providers. Those interested in nominating themselves or others should email a completed nomination form, letter of interest, and summary of relevant experience to Lindsey Free by August 21.

Bundled Payments for Cardiac Care and Hip Fractures – Comment by October 3.  On August 2, CMS published a proposed rule for bundled payment models for high-quality, coordinated cardiac and hip fracture care similar to the Comprehensive Care for Joint Replacement (CJR) model which began in April 2016.  Under the proposed episode payment models (EPM), a hospital in which a patient is admitted for care for a heart attack, bypass surgery, or surgical hip/femur fracture treatment would be accountable for the cost and quality of care provided to Medicare fee-for-service beneficiaries during the inpatient stay and for 90 days after discharge. For the new cardiac bundles, hospitals in 98 randomly-selected metropolitan statistical areas would be required to participate in the bundled care model.  Although rural counties are excluded from the models, providers and suppliers such as physicians, non-physician practitioners, skilled nursing facilities, critical access hospitals, and accountable care organizations can be EPM collaborators in providing post discharge care.  Through this proposed rule, rural providers also have the opportunity to propose future condition-specific EPMs and event-based EPMs for procedures and medical conditions that may be more applicable to rural areas. For more information on the proposed rule visit: https://innovation.cms.gov/initiatives/epm/.

Final Rule for Skilled Nursing Facilities – Effective on October 1.  On August 5, CMS published its final rule updating payment and policy for skilled nursing facilities (SNFs) for fiscal year 2017. Total payment for SNFs will increase by 2.4%, or $920 million, compared to FY 2016, with rural SNFs experiencing slightly larger payment increases than urban SNFs: 2.6% vs. 2.4%. In addition to annual payment revisions, the rule contains changes to the quality measures and administrative procedures under the SNF value-based purchasing (VBP) program, which begins FY 2019, and SNF quality reporting program (QRP), including four new measures required by the IMPACT Act. Of note, CMS has clarified that both the SNF VBP and SNF QRP apply to swing beds at rural PPS hospitals, but not swing beds at critical access hospitals.

Final Rule for Medicare Hospice Benefit – Effective on October 1.  On August 5, CMS published its final rule updating hospice payment and policy for fiscal year (FY) 2017. Total payments to hospices will increase by 2.1%, or $350 million, compared to FY 2016, with similar payment increases for both rural and urban hospices: 2.0% vs. 2.1%, respectively. The rule also updates the hospice quality reporting program (HQRP) to add two new measures to begin FY 2019, including one measure set assessing hospice visits in the last week of life and one composite measure of comprehensive patient care at admission. Of note, CMS announced plans to consider a new hospice patient assessment instrument to expand upon and replace the current hospice item set chart abstraction tool. These regulations are effective October 1, 2016. For more information, please see the CMS fact sheet.

Resources, Learning Events and Technical Assistance

Tools to Support Breastfeeding for Young Parents – Monday, August 15 from 2:00 – 3:30 pm ET.  Rural  providers serving parenting and pregnant teenagers can join this live webcast hosted by HRSA’s Chicago Regional Office.  Participants will get training on effective counseling and interventions to help new mothers overcome common misperceptions and barriers to breastfeeding. The session will focus on the prenatal, perinatal (labor and delivery), and postnatal periods and will also feature ways to provide effective referrals to support young parents in breastfeeding.  For more information, contact Lesley.Craig@hhs.gov.

Rural Health Clinics Technical Assistance Webinar – Tuesday, August 16 at 2:00 pm ET.   This session will feature the AgriSafe Network, a national nonprofit promoting health and safety for farm workers.  Participants will learn how to:  1) recognize issues that impact the health of farm families, 2) access free webinars and clinical resources related to farm safety and health, 3) collaborate with wellness champions in your region who can assist.  Participate through the web-based connection at https://hrsaseminar.adobeconnect.com/rhc-ta-webinar/ and by phone at 1-800-779-1416  , using conference passcode 4343459. (Please call-in about 10 minutes prior to the webinar.)  As with all other technical assistance for Rural Health Clinics (RHCs), this session will be recorded and archived on FORHP’s RHC TA page.

3RNet Annual Conference, Nashville TN – September 13-15.  The National Rural Recruitment and Retention Network opens its annual conference to anyone interested in learning more about topics surrounding the recruitment and retention of health care professionals in rural & underserved areas.  Registration is now open for the event that will feature presentations by the Federal Office of Rural Health Policy and the National Health Service Corps, a review of the new 3RNet website and current issues impacting recruitment of health professionals in rural areas.

Approaching Deadlines

Comment: Conditions of Participation for Hospitals – August 15
Health Center Program Service Area Competition – August 16
Early Head Start and EHS-Child Care Partnership Grants – August 24
Early Head Start for Migrant and Seasonal Worker families – August 24
Early Head Start for American Indian/Alaska Natives – August 24
Comment:  Changes to Home Health Payment Rates – August 26
HIV/AIDS Prevention and Engagement in Care – August 28
Rural Health Fellows Program – September 1
Comment: Hospital Outpatient Prospective Payment System – September 6
Comment: Physician Fee Schedule Updates – September 6
Rural Capacity Building for Community Development – September 13
Addressing Homelessness – September 14