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Announcements from the Federal Office of Rural Health Policy

August 18, 2014

Hot Off the Presses

1. On Friday, September 19th, 2014 from 2-3 PM ET, Mark Holmes, PhD and George H. Pink, PhD from the North Carolina Rural Health Research Center will host a webinar entitled “Change in Profitability and Financial Distress of Critical Access Hospitals (CAHs) from Loss of Cost-Based Reimbursement.” Information and registration for the webinar is available at: http://www.ruralhealthresearch.org/webinars/critical-access-hospitals. The webinar will focus on the financial distress of Critical Access Hospitals, and will present summaries of three recent reports:

2. Eligibility in the 340B Drug Pricing program, a federal program established in 1992 that provides significant savings on drug purchases for certain eligible health care providers,  is reviewed annually by the Office of Pharmacy Affairs (OPA) and Covered Entities are required to recertify as a part of this process. Covered Entities for 340B fall into one of three categories: hospitals and other safety-net providers, HRSA grantees, and family planning centers.  Each category of provider recertifies during a different quarter. Hospitals and safety-net providers are currently up for recertification, and they must complete the process by September 10, 2014. OPA recently sent email notifications about the recertification process to the Primary Contact and Authorizing Official for each Covered Entity.  If you are a 340B participating hospital or safety-net provider, please look for the email and begin the recertification process. For more information about recertification, including a recertification guide, please visit the OPA recertification Web page.

Affordable Care Act Updates

3. If you are interested in participating in the “ORHP, ACA, and You” rural outreach and enrollment office hours hosted by the Office of Rural Health Policy and did not participate last year, please e-mail orhp-acaquestions@hrsa.gov with your name and organization to be added to the office hours listserv.

Webinars, Events, and Other Technical Assistance

4. SAMSHA invites you to attend the first webinar in their 2014 Rural Behavioral Health Webinar Series:  Building the Case for Addressing the Social Determinants of Health for Children in Rural Communities. The webinar will be held on August 20th, 2014 from 3:00-4:30 PM Eastern Time. The behavioral health and well-being of any community and its members is significantly connected to the social and physical contexts in which the community exists and its members’ function. In essence, these contexts refer to social determinants or social factors that impact behavioral health outcomes and well-being either positively or negatively. This webinar will discuss the impact of social determinants and provide strategies for addressing the negative impact of certain social determinants on children, youth and families in rural communities with a special focus on infants, toddlers and preschool age children and their families. Additionally, the webinar will engage participants in discussion about how to effectively use available tools and strategies to reduce disparities and improve outcomes. For additional information and to register for the webinar, please visit: http://ruralbehavioralhealth.org/webinars/building-case-addressing-social-determinants-health-children-rural-communities.

5. In the wake of recent financially crippling catastrophic disasters like Superstorm Sandy and Hurricane Irene, pre-incident financial sustainability planning to help reduce the overall financial impact to hospitals and other healthcare organizations post disaster are at the forefront of healthcare disaster recovery concerns. You are invited to join the HHS Office of the Assistant Secretary for Planning and Response on Thursday, August 21, 2014 from 2:00 PM – 3:30 PM EDT for a discussion on the essential elements necessary to ensure your healthcare system is prepared to mitigate the financial burden associated with post-recovery operations. Hospital and healthcare system leadership, risk management personnel, finance personnel, and community and state response coordinators may find this call especially beneficial. The following topics will be addressed:

  • What conditions are necessary for the Secretary to waive or modify certain Medicare, Medicaid, CHIP, and HIPAA requirements under Section 1135 of the Social Security Act?
  • Does my Acute Care Hospital qualify for FEMA Reimbursement?
  • How can I recoup costs related to providing medical care and medical evacuation for patients my hospital treats during a disaster?
  • Is my healthcare organization eligible to receive low-cost Disaster Loans from the Small Business Administration?
  • How can I implement “Best Practices” from Superstorm Sandy testimonies into my organization’s disaster recovery planning efforts?

Meeting Information:

6. The Advisory Panel on Hospital Outpatient Payment will be meeting August 25th, 2014. CMS permits hospitals to participate by providing information on appropriate levels of supervision. The Panel will make recommendations to CMS about the appropriate supervision level (General, Extended Duration, or Direct) for outpatient therapeutic procedures presented for consideration. At this meeting, the panel will deliberate chemotherapy and complex drug delivery, among other topics. For more information on the HOP Panel Summer Meeting, see the Federal Register Notice and the HOP Panel website.

Other Useful Information and Resources

7. The Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking comments on its FY 2015 – 2018 Strategic Plan “Leading Change 2.0: Advancing the Behavioral Health of the Nation” (Leading Change 2.0). The deadline for commenting is August 18th, 2014.   The strategic plan outlines how SAMHSA will efficiently focus its work to increase the awareness and understanding of mental and substance use disorders, promote emotional health and wellness, address the prevention of substance abuse and mental illness, increase access to effective treatment, and support recovery.  The strategic plan does not, at this time, include specific strategies for addressing disparities in rural behavioral health care. For those interested in the evidence base on rural behavioral health disparities, the Maine Rural Health Research Center has a list of recent reports and studies on their website.

8. For those interested in Veteran’s Health care issues, a recently updated online resource provides facility-level patient access data. The information may be of interest to rural providers thanks to the recently passed HR 3230, which focuses on increasing access to care for Veterans and includes $10 billion in mandatory appropriations to pay for care at non-VA facilities.

9. The Federation of State Medical Boards (FSMB), a national nonprofit representing the 70 medical and osteopathic boards of the U.S. and its territories, is nearing completion on a draft interstate compact for physician licensure. For states that have interest in using an interstate compact, sample language is available from FSMB. The Compact, which offers a streamlined alternative pathway for state-based licensure, would create a new process for faster licensing for physicians interested in practicing in multiple states, including those who practice telemedicine, and reaffirms the location of a patient as the jurisdiction for oversight and patient protections.

10. On Monday, August 4, the Centers for Medicare and Medicaid Services (CMS) put on display the fiscal year (FY) 2015 Hospital Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital Prospective Payment System (LTCH PPS) final rule, updating Medicare’s payment rates for care in acute inpatient and long term care hospitals. The final rule is scheduled to publish on August 22, 2014 and has an effective date of October 1, 2014.

The final rule also addresses quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and the Electronic Health Record (EHR) Incentive Program.

Listed below are highlights from the final rule that are relevant for rural stakeholders:

  • FY 2015 Payment Updates: CMS projects that the payment rate update to general acute care hospitals will be 1.4 percent in FY 2015. However, IPPS operating payments overall are expected to decrease by 0.6 percent after adjustments for documentation and coding, the Hospital Readmissions Reduction Program, the Hospital Acquired Conditions Reduction Program, Medicare disproportionate share hospitals changes, and other changes to IPPS payment policies finalized in this rule. For rural hospitals, IPPS operating payments are expected to decrease by 0.7 percent overall after making the aforementioned adjustments. CMS projects that total Medicare spending on inpatient hospital services will decrease by about $756 million in FY 2015.
  • Changes to Graduate Medical Education (GME) Payments: The final rule also makes certain adjustments to GME. Effective October 1, 2014, a rural hospital that has been redesignated as urban (as a result of the implementation of new OMB delineations), can receive a permanent cap adjustment for a new program, if it received a letter of accreditation for the new program, and/or started training residents in the new program, prior to being redesignated as urban. In addition, CMS finalized changes to the participation of redesignated hospitals in rural training tracks. CMS is also updating its policies to make the FTE resident caps, rolling average, and IRB ratio cap effective simultaneously. In response to public comment, CMS is finalizing a modified version of its proposal so that these policies will be effective beginning with the applicable hospital’s cost reporting period that coincides with or follows the start of the 6th program year of the first new program started.
  • Extension of Rural Payment Adjustments: In accordance with the Protecting Access to Medicare Act of 2014, the final rule extends the Medicare Dependent Hospital (MDH) program and the expansion of the Medicare inpatient hospital payment adjustment for low-volume hospitals for an additional year (through March 31, 2015).
  • Change to Requirements for Physician Certification of CAH Inpatient Services: CMS finalized its proposal to amend the regulations for FY 2015 and subsequent years to allow CAHs until no later than 1 day before the date on which the claim for payment for the inpatient CAH service is submitted, to complete all certification requirements except the admission order.
  • Update to Medicare Disproportionate Share Hospital (DSH) Payment Calculation: In the FY 2015 rule, CMS will distribute $7.65 billion in uncompensated care payments, a decrease from the $8.56 billion estimate in the proposed rule. This decrease is due to changes in the Office of the Actuary’s estimate of payments that would otherwise be made for Medicare DSH in FY 2015 (due to lower projected hospital inpatient spending) and also the change in the percentage of individuals that are uninsured as estimated by the CBO. The rule also proposes to adopt a process to identify hospitals that have merged so that data from all hospitals involved in the merger may factor into the calculation of the remaining provider’s uncompensated care payment.

The final rule is on display now in the Federal Register. CMS has also posted a press release, a policy and payment fact sheet, and a quality fact sheet on the final rule.

11. 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.

12. The University of Washington MS Center and the National MS Society are proud to launce the first ever “Project ECHO” for multiple sclerosis, a rural outreach program funded by a grant from the Medtronic Foundation Patient Link Program. This Project ECHO (Extension for Community Health Care Options) is designed for rural healthcare providers from underserved areas throughout Washington, Alaska, Montana, and Idaho. Project ECHO will provide real-time clinic consultation between community providers and a multidisciplinary team of MS experts. Using this model, Project ECHO fosters mentoring relationships between the MS expert panel and the participating health care providers, as well as developing a peer learning and support network in the region. This project, if successful, could serve as a model for providing support and education to primary care providers in rural communities who either have patients with MS or want to be prepared for patients who may present with MS symptoms. If you know someone who might be a good fit for this program and lives in the states listed above, please contact Kurt Johnston at kjohnson@uw.edu.