Rural Health Policy Update SORH New Directors Orientation

1
Rural Health Policy UpdateSORH New Directors
Orientation

• Carrie Cochran
• U.S. Department of Health and Human Services
• Health Resources and Services Administration
• Office of Rural Health Policy
• November 5, 2008

2
Why is rural special?

• Payment systems and other federal policies are
  designed for maximum efficiency
• In most cases, efficiencyvolume
• System incentivizes provision of services in
  large, urban facilities
• Without adjustments, rural providers could not
  survive
• Federal government recognizes that rural
  residents need access to health care services

3
Why are there still problems?

• Resources are limited
• Competing interests- teaching hospitals, urban
  safety net providers, managed care, many more are
  also priorities
• Within rural health there are competing groups-
  CAH vs. PPS, DSH vs. non-DSH, RHC vs. non-RHC,
  primary care vs. specialty care
• Environment is constantly changing

4
ORHP Staff Policy Role

• Comments on Draft Regulations through HHS
  Regulation Clearance Process
• Participation in Public Meetings and Conference
  Calls
• Monitoring of Rural Policy Related Documents
• Funding to ORHP Research Centers to Analyze Rural
  Policy Issues
• Staff-level Interaction with CMS

5
Key Rural Regulatory Issues

• Inpatient PPS
• Outpatient PPS
• Physician Fee Schedule
• Skilled Nursing Facility PPS
• Rehab PPS
• Psych PPS
• Long Term Care PPS

• Ambulance Fee Schedule
• Medicare Advantage
• Medicare Part D
• Rural Health Clinics
• Medicaid Waivers
• Medicare GME

6
Inpatient Hospital Payments

• FY09 Final IPPS Regulation
• Published 7/31/08 Effective 10/1/08
• 4.7 Market Basket Update w/quality data
• Payments to rural hospitals increase 3.9
• Key Proposed Changes
• Transition to Medicare-Severity DRGs
• Minor wage index changes
• Expanded quality measures 30 FY09, 42 FY10

7
Outpatient Hospital Payments

• CY 2009 Proposed Regulation Effective 1/1/09
• 3.6 Overall payment increase
• Payments to rural hospitals increase 3.6
• 7.1 add-on for rural SCH
• Hold-harmless Payments for Small Rural Hospitals
• New OPPS Quality Reporting starting CY2009
• Includes 5 transfer measures relevant for rural
  
• Includes CAH on a voluntary basis!

8
Rural Regulatory Activity

• Rural Health Clinic (RHC) Regulation
• Updated Participation Requirements and Payment
  Provisions
• Shortage area and non-urban requirements
• Allow RHC to contract with mid-level
  practitioners
• Clarify commingling provisions
• Quality Assurance/Performance Improvement
• Proposed Designation of Medically Underserved
  Populations/Areas (MUA/MUP) and Health
  Professional Shortage Areas Health (HPSA)

9
Medicare Payment Advisory Commission (MedPAC)

• 17 national experts- 2 rural representatives
• Make recommendations to the Congress and the
  Secretary of HHS
• Make recommendations to Congress concerning
  Medicare payment policies
• Review factors affecting expenditures for the
  efficient provider of services
• Two standing reports to Congress also various
  mandated reports

10
Medicare Improvements for Patients and Providers
Act of 2008

• Staves off Medicare physician pay cut
• Extends a number of physician provisions
• Physician Quality Reporting Initiative
• Scarcity area bonus payment
• Floor on the work geographic adjuster
• Rebases Sole Community Hospitals
• Extends Section 508 Wage Index Reclass
• Minor changes to Medicare Advantage
• Moves toward Mental Health Parity

11
Emerging Rural Health Issues

• Medicare Advantage
• Rural Community Rx Viability
• Federal Quality Initiatives- Medicare Value Based
  Purchasing
• CMS Recovery Audit Contractors

12
National Advisory Committee on Rural Health
Human Services (NACRHHS)

• Provides recommendations on rural issues to HHS
  Secretary
• Composed of 21-member citizen panel of nationally
  recognized rural health experts
• Committee meets three times a year once in DC
  and twice in the field
• Report topics are important, timely health
  human services issues affecting rural
  communities.
• http//ruralcommittee.hrsa.gov

13
NACRHHS Report Topics

• 2009 Report Topics
• Medical Home, Workforce, At-risk Kids
• Completed FY 2008
• 20 Years in Rural Health
• Complete FY 2007 Report
• Medicare Advantage Substance Abuse Head Start
• Completed FY 2006 Report
• Access to pharmaceuticals and pharmacy services
  Health information technology in rural areas
  Family caregiver support of the rural elderly

14
HHS Rural Task Force

• Department wide Rural Task Force with
  representatives from each of the HHS agencies and
  staff Divisions
• Established on July 25, 2001
• One Department Serving Rural America on July
  26, 2003
• Provides key recommendations to improve rural
  health and social services coordination

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HHS Rural Task Force

• Last meeting March 21st, 2008
• Shared Agency activities
• Methamphetamine Workgroup
• SAMHSA rural mental health action plan
• AHRQ HIT grants, quality efforts
• Recent Task Force Agenda Items
• Health Information Technology
• Value Driven Healthcare
• Rural Human Services

16
CMS Rural Resources

• CMS Rural Health Council
• CMS Regional Office Rural Liaisons
• http//www.cms.hhs.gov/ProspMedicareFeeSvcPmtGen/d
  ownloads/RO-RH-Coordinators.pdf
• CMS Rural Open Door Forum- Sign up at
• http//www.cms.hhs.gov/OpenDoorForums
• CMS Website Rural Health Center
• http//www.cms.hhs.gov/center/rural.asp

17
ORHP Resources

• Rural Assistance Center
• One stop shopping for all rural health and human
  services
• http//raconline.org
• Rural Health Research Gateway
• Learn more about past and ongoing studies
  http//www.ruralhealthresearch.org/
• Rural Health Clinic TA Series
• Quarterly Conference Call Series for all RHCs
  http//www.narhc.org

18
Questions? Ask the Policy Team!

• Carrie Cochran- Policy Coordinator
• Erica Molliver Michelle Goodman-Policy
  Research Analysts
• Joan Van Nostrand- Research Director
• Jennifer Chang, Meghana Desale Jenna Kennedy-
  NACRHHS Staff
• Kathryn Umali Karen Beckham- IGA Leads
• Nancy Egbert Heather Dimeris-
• Quality Advisors