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Announcements from the Federal Office of Rural Health Policy

April 10, 2014

Rural Research Highlights

  1. Widening Rural–Urban Disparities in Life Expectancy, U.S., 1969–2009
    This study by HRSA’s Maternal and Child Health Bureau examines the trends in life expectancy disparities between rural and urban areas in the United States between 1969 and 2009. The article finds that the disparity has increased since 1990, because life expectancy has grown more rapidly in urban than in rural areas. The disparity in life expectancy of urban over rural areas stood at 2.4 years during 2005-2009. Furthermore, the study’s findings indicate that mortality from cardiovascular diseases, injuries, lung cancer, and COPD is much higher in rural than in urban areas.
  2. Nursing in 3D: Workforce Diversity, Health Disparities, and Social Determinants of HealthThis special report explores the intersecting goals of increased workforce diversity, fair and equal access to quality health care and health care resources, elimination of health disparities, and achieving health equity. In August 2012, HRSA hosted a summit titled, “Nursing in 3D: Workforce Diversity, Health Disparities, and Social Determinants of Health.” This resulting special supplement includes 11 articles authored by 3D Summit speakers who are content experts in the fields of nursing workforce diversity, health disparities, and the social determinants of health. 

More recent rural research can be found on http://www.ruralhealthresearch.org/.

The Affordable Care Act

  1. The Marketplace open enrollment widgets at http://marketplace.cms.gov/getofficialresources/widgets-and-badges/mp-badges-english.html are now deactivated. If you have these embedded in your e-mail or your website, thank you for using them to get the word out for outreach and enrollment, but please note that they are no longer active.
  2. Office Hours Updates – We had our last ORHP, ACA, and You Office Hours call on March 26, 2014 and had a great turn out! Thanks to all of those who were able to join. If you missed it, the link to that call and our past calls can be found here. Moving forward, we will take a break from the weekly calls and continue with the newsletter. We will be sending you a monthly newsletter regarding any updates. Of course, if something major happens, we will send you that information right away. Feel free to continue contacting us at ORHP-ACAQuestions@hrsa.gov with your questions, comments and stories. 
  3. Payment is Required to Complete Plan Enrollment – With open enrollment over, it’s important to remind consumers to make their first premium payment—this is the final step of enrollment. Consumers must pay their premiums in order to have health insurance coverage. 
  • Consumers who selected a plan should be reminded to pay their contribution to the first month’s premium (and every premium when it is due) to their plan directly – not to the Marketplace.
  • After the consumer selects a plan they will either see a link to the insurance company’s website or instructions on how to pay their premium payments to their insurance company. Consumers should check with their insurance company to find out when their first premium is due.
  • Note: The plan’s payment deadline cannot be any earlier than the day before coverage begins. For example, for coverage beginning May 1st, the earliest permissible payment deadline is April 30th. Issuers may be able to give a consumer more time to make their first payment. Consumers should definitely check with their insurance company to find out when their first month’s premium payment is due.
  1.  Post-Enrollment Assistance – Now that millions more Americans have health insurance, there is an even greater need for providers, staff, and any other individual helping people who are new to insurance better understand a variety of topics, including what it means to have health insurance, how to find a provider, when and where to seek health services, and why prevention is important. CMS has created a page, located at http://marketplace.cms.gov/help-us/c2c.html for resources that can help lead consumers down the road from coverage to care.

Other Useful Information and Resources

  1. On April 1st, the President signed the Protecting Access to Medicare Act of 2014 that eliminates for one year scheduled cuts to the Medicare Physician Fee Schedule (PFS) associated with the sustainable growth rate (SGR). The formula known as the SGR determines how much physicians and other providers are paid when they see Medicare patients. Without this law, the SGR cut would have taken effect and reduced the payment for services paid under the PFS by approximately 24% for all services after April 1, 2014.In addition, the bill extends a number of special Medicare payment provisions for hospitals, ambulance services, and others that were set to expire. It also makes other changes to Medicare payments and policies. The changes most important to rural health care providers are listed below. A complete summary along with the text of the law is available online.Key provisions that affect rural stakeholders:
  •  Two-Midnights: Requires that CMS continue to educate hospitals on complying with the new policy on inpatient admissions, which requires that patients who are expected to be in the hospital for less than two midnights should be treated and billed as outpatients. Many hospitals have expressed confusion and concern about this rule, which took effect in October 2013. With this change, the training period will be extended, and CMS and its contractors cannot do post-payment reviews (where they retrospectively audit claims after they have been paid) or reclaim payments for violations until April 1, 2015. This impacts all hospitals, including rural hospitals.
  • ICD-10: This provision delays until October 1, 2015 the transition from ICD-9 to ICD-10. The International Statistical Classification of Diseases (ICD) is used to code services in order to bill for patient treatment. ICD-10 is a major revision and expansion of the code set. This change was previously scheduled to happen October 1, 2014. This delay will change the training and testing schedule for hospitals, clinics, and other providers. This may help providers who weren’t ready for the change, but could increase costs for the ones already gearing up for the transition. CMS will be issuing further guidance on ICD-10 implementation. When it is finally implemented, all providers will have to use ICD-10 in order to be paid by Medicare (and most other insurance companies).
  • GPCI: Extends the geographic practice cost index (GPCI) floor through April 1, 2015. This index is part of the formula used to set Medicare payments under the PFS. The GPCI floor, in effect, increases payments in areas with costs that are below average, and disproportionately benefits rural areas.
  • Therapy caps: Extends the current Medicare therapy cap exemption process until March 15, 2015. Under current law, Medicare beneficiaries may only receive $1,920 per year in physical therapy and speech-language pathology services, or occupational therapy services. However, the exemption process allows medical practitioners to document that a person needs additional rehabilitation and continue services and treatment after the cap is reached. Without the exemption, Medicare would not have paid for any services above the cap.
  • Ambulance add-on payments: Extends add-on payments for ground ambulance and super rural ground ambulance services through April 1, 2015. This provides extra payment for remote rural ambulance services, which struggle financially because they have high overhead due to relatively few patients and long travel distances.
  • LVH: This provision extends the current Low-Volume Hospitals program until April 1, 2015. It provides additional Medicare payment to hospitals in rural areas with fewer than 1,600 Medicare discharges per year.
  • MDH: This provision extends the Medicare-Dependent Hospital (MDH) program through March 31, 2015. This provides additional Medicare payments to rural hospitals that don’t participate in any other alternate payment system, have fewer than 100 beds, and a high proportion (at least 60%) of Medicare patients.

Funding Opportunities

Open funding opportunities through HRSA programs include:

  1. In support of the White House Now is the Time initiative, the Behavioral Health Workforce Education and Training (BHWET) program for Paraprofessionals is supported by HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA). 
  •  This program places special emphasis on treating children and adolescents aged 16 to 25 years old who are at risk for mental illness, substance abuse, and suicide, and among the least likely to seek continuous help.
  • Given the shortage of mental health clinicians in rural areas, rural health professional education and training programs may be interested in applying for funding, and can learn more at http://apply07.grants.gov/apply/opportunities/instructions/oppHRSA-14-126-cfda93.243-cidHRSA-14-126-instructions.pdf.
  • The deadline for final application submission is June 3, 2014.
  • The following TA call is scheduled for applicants:
    Wednesday, April 23 at 3:00 pm (ET)
    Call-in Number: 1-888-628-9526
    Participant Code: 2193070
    Adobe Connect Link: https://hrsa.connectsolutions.com/bhwta042314
    For replay information (The recording will be available until 11:59 pm (ET) June 24, 2014): 866-415-2343; Passcode: 6314
  • For more information and to submit an application, go to www.grants.gov. To learn more about HRSA and SAMHSA programs, visit www.hrsa.gov and www.samhsa.gov.
  1.  The Department of Veterans Affairs Grants for Transportation of Veterans in Highly Rural Areas (HRTG) Program has opened up the grant application process again beginning March 26th. This grant application period is from March 26, 2014 to midnight May 27, 2014. This program’s purpose is to provide grants to eligible recipients to assist veterans in highly rural areas through innovative transportation services to travel to VA medical centers and to other VA and non-VA facilities to assist in providing transportation services in connection with the provision of VA medical care.
  •  Eligible organizations that can apply are Veteran Service Organizations and State Veteran Service Agencies recognized by the Secretary of Veterans Affairs.
  • Non-eligible organizations such as a local transportation providers would have to partner with the above organizations and provide the services as sub recipient.
  • Services will have to be provided in those counties that are considered “highly rural” (see attached document of highly rural areas).
  • Highly Rural is defined by the population density of less than 7 persons per square mile in county. Twenty-five states have counties with highly rural areas.
  • Grantees can receive $50,000 for each highly rural area that they provide transportation services. One grant may be awarded to a grantee per fiscal year for each highly rural area in which the grantee provides transportation services. Transportation services may not be simultaneously provided by more than one grantee in any single highly rural area.
  • A grantee will not be required to provide matching funds as a condition of receiving such grant.
  • Additional information and how to apply can be found on grants.gov. For a copy of the Application Package: Download directly from http://www.grants.gov/web/grants/home.html. Click on search for grants and on the left side type in 64.035 in the box that says CFDA Number or click on this link http://www.grants.gov/web/grants/view-opportunity.html?oppId=253011
  1. The National Health Service Corps Scholarship (NHSC) Program: HRSA is pleased to announce that applications for the NHSC Scholarship Program are now being accepted. Candidates interested in serving in the health professions in rural communities may be interested in applying.
  • Eligibility is open to all students who are U.S. citizens or nationals and are enrolled in a fully accredited training program for Physicians (MD or DO), Dentists, Nurse Practitioners, Certified Nurse-Midwives or Physician Assistants at a U.S. accredited school. The NHSC Scholarship Program is expected to be competitive. If there are more qualified applicants than available funding, the Program will continue to prioritize applicants who are from a disadvantaged background and applicants who demonstrate a commitment to continuing to serve high-need communities after their service to the NHSC is complete.
  • Apply by: Thursday, May 15, 2014
  • Application and Program Guidance
  1.  The State Loan Repayment Program (SLRP) deadline is April 29th, 2014. States interested in applying for SLRP funds to support providers practicing medicine in qualifying rural areas will want to note this deadline. For more information, visit: http://www.grants.gov/view-opportunity.html?oppId=251810
  2. The Agency for Healthcare Research and Quality has issued two funding opportunity announcements (FOAs) aimed at increasing the use of patient-centered outcomes research (PCOR) in primary care practices. Applications are due by July 3rd, 2014. The funding opportunity for up to eight regional cooperatives to help primary care practices build capacity for the implementation of patient-centered outcomes research in clinical care can be found here.
  3. The 2014 NURSE Corps Scholarship Program application cycle is now open. Candidates interested in serving as nurses in rural or frontier communities may be interested in this scholarship. All completed applications must be submitted by May 22, 2014, at 7:30 pm, ET to be considered for an award. Please refer to the Application and Program Guidance for all of the program requirements. 
  • Scholarship support includes tuition, required fees, other reasonable educational costs, and a monthly living stipend (all support is taxable) for up to four years. For each year of financial support, a NURSE Corps scholarship recipient serves one year at a NURSE Corps -approved facility in one of many high-need urban, rural, or frontier communities. The Program requires a minimum 2-year full-time service commitment (or part-time equivalent).