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Announcements from the Federal Office of Rural Health Policy

July 22, 2014

Hot Off the Presses

The Department of Veterans Affairs (VA) and the White House Rural Council today announced the award of eight grants, totaling $815,051.50, which will improve access to health care for Veterans living in highly rural areas. The grants will assist over 11,000 Veterans in 7 states and 56 counties by providing up to $50,000 per highly rural area to fund transportation services for Veterans to and from VA medical centers and other facilities that provide VA care.  The grants are part of a program authorized by Congress to help state Veterans Service Agencies and Veterans Service Organizations operate or contract for transportation services to transport Veterans to VA medical centers and other facilities that provide VA care. If you want to reach out to a grantee in your area, the list of grantees is as follows:

  • Virginia Department of Veteran Services
  • American Legion Post 20 in South Dakota
  • Veterans of Foreign Wars Post 8988  in California
  • Nevada Department of Veteran Affairs
  • Veterans of Foreign Wars Post 7202 in far west Texas
  • Washington State Department of Veterans Affairs
  • North Dakota Department of Veterans Affairs

 On May 23, 2014 CMS and Office of the National Coordinator for Health IT (ONC) released the NPRM on the Modifications to the Medicare and Medicaid EHR Incentive Programs for 2014; and Health Information Technology: Revisions to the Certified EHR Technology Definition. This proposed rule would change the meaningful use stage timeline and the definition of certified electronic health record technology (CEHRT). It would also change the requirements for the reporting for clinical quality measures for 2014. Comments are due Monday July 21, 2014. This NPRM pertains to rural providers in particular because many have reported a number of issues with vendors not delivering 2014 CEHRT in a timely manner, also many vendors have required significant licensing or implementation fees for 2014 CEHRT that have impacted rural disproportionately.

HRSA invites you to join the next Health Information Technology and Quality Webinar on Friday, July 25, 2014 from 2pm-3pm ET on the topic of “Financing for Health IT Infrastructure and Broadband.” Under current conditions, rural health care providers face challenges in harnessing the benefits of health information technology (IT) due to limited access to capital and workforce challenges. Rural hospitals tend to have lower financial operating margins and limited capital to make the investments needed to purchase hardware, software, and other equipment. As a result, the United States Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) signed an MOU in August 2011 linking rural health care hospitals and clinics to USDA grants and loans to support the acquisition of health IT infrastructure. The White House Rural Council adopted this initiative and publicly announced its commitment to expanding financing for rural health IT.

Since the signing of the MOU, participating critical access hospital and small rural hospitals have received roughly $38 Million in funding. In-person funding workshops have been launched in Iowa, Kansas, Texas, Illinois, Mississippi, Montana, Georgia, Michigan, Minnesota, Missouri, and Tennessee to share information regarding the available health IT infrastructure funding for rural safety net providers which now includes rural health clinics, long term care facilities, and mental health clinics serving rural veterans.

Presenters for this webinar will speak about current funding opportunities in the states where workshops have taken place and anticipated workshops in additional states. Presenters also will share their experience on how they have been able to leverage the funds to support the health IT infrastructure and rural economic development in their safety net communities. Presenters include Leila Samy from ONC and Jeffrey Schwartz from the Appalachian Regional Commission.

Participants can register at: https://cc.readytalk.com/r/tpp0c92p6dl0&eom

 Rural Research Highlights 

How Does Medicaid Expansion Affect Insurance Coverage of Rural Populations?

This brief from the North Carolina Rural Health Research Program examines how states’ decisions on Medicaid expansion are impacting rural areas in the United States. The study used population estimates, current status of state expansion, and state-level insurance estimates to answer two primary questions:

  • How is Medicaid expansion affecting rural populations, and
  • How would it differ if every state were to expand Medicaid

The Effect of Medicare Payment Policy Changes on Rural Primary Care Practice Revenue

This brief from the RUPRI Center for Rural Health Policy Analysis describes the impact of recent Medicare payment updates to the Geographic Practice Cost Indices (GPCIs) portion of the Medicare Physician Fee Schedule (MPFS) on rural primary care providers’ practice revenue from Medicare. Using rural primary care provider Medicare claims from 2009 linked to the 2013 MPFS relative value units (RVUs), the 2013 GPCIs for non-metropolitan localities, and the GPCI updates from the Pathway for SGR Reform Act of 2013, we developed a revenue model to derive estimates of Medicare-related average revenue in 2013 and change-in-average-revenue percentage due to the GPCI updates for 50 non-metropolitan localities. Holding the conversion factor (CF) and RVUs fixed, we found that changes to the GPCIs made between January 1, 2013 and March 31, 2014 resulted in an average 0.12% (median 0.18%) increase in Medicare-derived revenue to rural primary care practices. Without the GPCI work floor reinstatement, however, primary care practices in rural areas would have been disproportionately negatively impacted through lower Medicare-related revenues.

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

Webinars, Events, and Other Technical Assistance

The Advisory Panel on Hospital Outpatient Payment (HOP Panel) will be meeting August 25-26. Registration to attend the meeting in person closes August 1, and can be completed at https://www.cms.gov/apps/events/upcomingevents.asp?strOrderBy=1&type=3 by clicking the Register button next to the HOP Panel event listing and entering the required information.

The HOP Panel meets three times per year to make recommendations to CMS about the appropriate supervision level (General, Extended Duration, or Direct) for outpatient therapeutic procedures at rural hospitals, based on information presented by hospitals.  CMS changed its rules effective January 1 to require direct supervision for all outpatient therapeutic services provided in CAHs and rural hospitals with less than 100 beds, unless general or extended duration supervision has been specified. Some rural hospital stakeholders have expressed concern that this will affect access because it will limit the hours available to patients to come in for certain procedures, and it could cause some hospitals to drop services altogether. The HOP Panel includes CAH representatives to help address these concerns. Each meeting is an opportunity for rural hospitals to present data on those measures they believe require only general supervision.  Services approved for general supervision are listed on the CMS Hospital Outpatient PPS page.

At the meeting, the HOP Panel will re-deliberate chemotherapy and complex drug delivery, among other topics.  For more information on the meeting, see the Federal Register Notice.  Presentations and comments must be emailed to APCPanel@cms.hhs.gov by 5:00 p.m. ET on July 25.

The Health Policy Institute of Ohio invites you to its Second Annual Telehealth Leadership Summit to discuss federal and state telehealth policy and regulatory issues, learn about promising telehealth programs and strategies, and hear an update on Ohio’s rules and regulations. The summit will take place on Tuesday, August 19, 2014 from 10 a.m. to 2 p.m. Click here for more information or to register.

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.