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Announcements from the Federal Office of Rural Health Policy

June 12, 2014

Hot Off the Presses

  1. The Centers for Medicare & Medicaid Services (CMS) today announced the availability of funding, totaling $60 million, to support Navigators in Federally-facilitated and State Partnership Marketplaces in 2014-2015. Navigators provide unbiased information to consumers about health insurance, the Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.

“Navigators have been an important resource for the millions of Americans who enrolled in coverage in 2014. This funding ensures this work will continue next year, including during the open enrollment period for the Marketplaces,” said CMS Administrator Marilyn Tavenner.

This is an important opportunity for rural communities, as recent research by the Rural Policy Research Institute has noted that rural America has more per capita uninsured individuals than urban communities. The ACA represents an important opportunity to get previously uninsured individuals and families medical care, and it also helps providers in rural communities by reducing the amount of charity care and bad debt as more of their patients are insured.

The funding opportunity announcement is open to eligible individuals, as well as private and public entities, applying to serve as Navigators in states with a Federally-facilitated or State Partnership Marketplace. It is open to new and returning Navigator applicants, and applications are due by July 10, 2014.

Last month, CMS finalized regulations that update the requirements applicable to Navigators. To access the final rule, visit: https://www.federalregister.gov/articles/2014/05/27/2014-11657/patient-protection-and-affordable-care-act-exchange-and-insurance-market-standards-for-2015-and

Navigators will now be required to maintain a physical presence in the Marketplace service area, so that face-to-face assistance can be provided to consumers. Navigator grant applicants will also be encouraged to perform background checks for all Navigator staff that will be handling sensitive or personally identifiable information (PII). In addition to quarterly and annual reporting, Navigators will be required to submit to CMS weekly and monthly progress reports detailing their progress and activities in their target communities.

To access the funding opportunity announcement, visit: http://www.grants.gov, and search for CFDA # 93.332.

For more information about Navigators, visit: http://cciio.cms.gov/programs/exchanges/assistance.html

  1. Rural communities have long benefitted from many of the HRSA workforce programs in the Bureau of Health Professions and the Bureau of Clinician Recruitment Services.  Those Bureaus are now being combined to create the new HRSA Bureau of Health Workforce.  This change, which was announced recently in the Federal Register, seeks to help HRSA better achieve its mission of improving health and achieving health equity through access to quality services, a skilled health workforce and innovative programs.  Integrating HRSA’s workforce programs that were previously housed in the Bureau of Health Professions and the Bureau of Clinician Recruitment and Service will help us better respond to the needs for a well-trained, well-distributed 21st century workforce. If you aren’t familiar with HRSA workforce programs, check out the website to find out more information about the programs: http://bhpr.hrsa.gov/. For more information specific to the health professions programs, here’s a guide specific to how these programs impact rural America: http://www.hrsa.gov/ruralhealth/pdf/ruralhealthprofessionsguidance.pdf.
  1. The next CMS Low Income Health Access Open Door Forum is scheduled for Wednesday, June 11, 2014. Please see below for call-in details:
    • Start Time: 2:00-3:00 PM Eastern Standard Time (EST);
    • Please dial-in at least 15 minutes prior to call start time.
    • To participate by phone, dial: 1-800-837-1935 & reference conference ID: 71074920.

HRSA works with CMS to coordinate the agendas of LIODFs.  This call includes the following topics, as well as an open Q&A session and covers many important policy issues for rural communities such as:

  1. HRSA invites you to join the next Health Information and Quality Webinar on Friday, June 20, 2014 from 2PM – 3PM ET on the topic of health IT tools for veterans. Veterans have access to a variety of health information technology tools that empower them to be    active participants in their healthcare. The Veterans Health Administration (VA) is America’s largest integrated health care system with over 1,700 sites of care, serving 8.76 million Veterans each year. Under the U.S. Census Bureau definition of rural utilized by  the Veterans Administration (VA), 3.2 million (36%) of Veterans who receive care through the VA live in rural America.  The VA has created a web-based tool called “My HealtheVet” which is a suite of online tools for Veterans to access their health information  electronically. When used collaboratively with the health care team, these tools can be used to: increase process efficiency, help patients become more engaged and active, enhance communication, increase patient and provider satisfaction, and lead to improved health outcomes.

HRSA provides funding for community-based programs, which are programs that are funded at the local and community level. Listeners will be able to learn through this webinar how a rural provider was and former ORHP Rural Health Outreach grantee was able to successfully link electronic patient information with the VA to enhance care coordination. Community Health IT, a non-profit entity and HRSA grantee in Gainesville, Florida designed to improve the health of their local communities through activated health information exchange (HIE), has created a web-based tool called “My HealthStory”. This tool enables Veterans to share their health information from the VA health system to their civilian doctors and hospitals.

Presenters for this webinar will provide an overview of both My HealtheVet and My HealthStory and highlight examples of how their programs are currently being used to support safety net providers and Veterans.

Rural Research Highlights

  1. Profile of Rural Residential Care Facilities: A Chartbook

As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging-in-place.

  1. A Guide to Understanding the Variation in Premiums in Rural Health Insurance Marketplaces

This guide provides a framework for assessing variations in the premiums of plans offered in the Health Insurance Marketplaces (HIMs) across geography. Comparisons of premiums must include adjustments for several factors: plan type (metal level), enrollee age and family status, overall cost of living in the area, and the design of marketplace rating areas (state policy choices). What might appear to be differences showing plans in rural places to be more or less expensive than in urban places could shrink or even reverse after appropriate adjustments.

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

Other Useful Information and Resources

  1. The United States Department of Agriculture Economic Research Service (USDA ERS) State Fact Sheets provide information on population, income, poverty, food security, education, employment, organic agriculture, farm characteristics, farm financial indicators, top commodities, and exports. Updated items in this version include 2012 Census of Agriculture data and unemployment for 2013.
  1. As noted in a prior announcement, the comment period for the Medicare Inpatient Prospective Payment System 2015 payment update is open for public comment with comments being accepted through June 30th.  Several provisions of the rule have, or may have, a rural impact.  Specifically, the proposed rule:
    • Implements revised labor market areas based on OMB-updated metropolitan statistical areas (MSAs) using 2010 Census data.  Some counties changed MSA status and others moved to different MSAs.  Critical Access Hospitals (CAHs) located in formerly rural areas that are now designated urban would have two years to apply for rural re-designation in order to keep their CAH status.
    • Modifies a policy adopted in last year’s IPPS final rule regarding the CAH 96-hour payment condition.  CAHs will have until one day prior to submission of a claim to certify that a patient was expected to be discharged or transferred within 96 hours of admission to the CAH.
    • Requests comments on what would be a reasonable timeline for adopting Worksheet S-10 as the new data source for determining the amount of uncompensated care provided by hospitals for determining Medicare DSH payment.  The ACA requires that 75% of the DSH amount be allocated based on hospitals’ uncompensated care. For FY2015, CMS would continue using the number of Medicaid and Medicare SSI discharges as a proxy for uncompensated care.
    • Those interested in more information about the potential implications of the Worksheet S-10 for rural hospitals can refer to a recently released study from the University of North Carolina, Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10.
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