Frontier Community Health Integration Project
(FCHIP) Technical Assistance, Tracking and
Analysis Program
Guidance Overview
Sarah Bryce
July 2, 2014
Department of Health and Human Services
Health Resources and Services Administration
Federal Office of Rural Health Policy
What is FCHIP?
• Section 123 of the Medicare Improvements for Patients
and Providers Act (MIPPA) as amended by Section 3126
of ACA authorized a three-year demonstration project
on community health integration models in certain
rural counties with low population density
• Administered by the Centers for Medicare and Medicaid
Services (CMS) Innovation Center
• HRSA/ORHP responsible for providing TA
• Critical Access Hospitals (CAHs) in 5 states were
eligible to apply for the FCHIP Demonstration
What is FCHIP?
CMS in conjunction with HRSA identified four service areas, or “prongs,” where
payment policies and/or restrictions could be waived
• Telemedicine
• Reimbursing at cost for CAHs that serve as the originating site.
• Reimbursing the distant site provider for asynchronous “store and forward” technology.
• Home Health
• A mileage add-on in addition to the Home Health PPS payment for up to 1600 miles.
• Ambulance
• Waiving the 35 mile rule
• Hospital-Based Nursing Facility Services
• Increasing the bed limits from 25 to 35 beds. The 10 extra beds can only be used for skilled
nursing care
What is FCHIP?
• CAHs could apply to CMS for a waiver in 1 to 4 service areas
• Mandated to be budget neutral
• Basically meaning that payments the secretary makes under the
demonstration cannot exceed payments the secretary would have
made if the demonstration were not implemented
CMS Responsibilities
HRSA Responsibilities
• Reviewing and approving
applications for waivers
from CAHs
• Providing TA to the CAHs
approved by CMS to
participate in the FCHIP
• Implementation of the
FCHIP Demonstration
• Evaluation of FCHIP
• Provide interim and final
Report to Congress (in
coordination with CMS)
• Provide TA, site implementation assistance, and other
tracking and analytical activities to support providers
participating in FCHIP Demonstration
• Provide individual and collective support to
participating CAHs and to ensure that their activities
align with requirements and objectives of the
• Page 3 of the FOA lists 7 specific tasks
1. Provide TA, tracking and analytic support to develop &
implement a strategic performance management plan
2. Complete individual needs assessments
3. Assist in developing appropriate metrics
4. Coordinate participants’ relationships with other entities
(Medicaid, CMS/CMS contractors, local & distant
providers, etc.)
5. Support regular opportunities for peer-based
learning/information sharing
6. Collect information on key policy challenges, identify
strategies/best practices
7. Assist participants in developing cost savings estimates
Funding Specifics
• FY2014 – FY2016
• Cooperative Agreement
• Substantial involvement anticipated between
HRSA and the recipient during performance of
• 1 Awardee
• Up to $500,000 annual funding anticipated
• Information located on page 5 of FOA
Review Criteria
Criterion 1: Need (10 points)
• Demonstrates understanding of unique challenges related to provision and
integration of health care services in rural areas
• Shows familiarity with purpose and requirements of FCHIP Demonstration,
including budget neutrality and maintenance of clinical quality and patient safety
• Describes potential of shared savings and person-centered integrated care
models to be applied in FCHIP Demonstration and Demonstration’s potential to
inform national health care policy
• Demonstrates understanding of staffing, infrastructural, and reimbursement
challenges for CAHs, especially as they relate to four health care services
areas in the FCHIP Demonstration
Located on Page 14 of the FOA
Criterion 2: Response (25 points)
Sub-Criterion 1: Response to Purpose (5 points)
• Appropriately responds to “Purpose” statement
• Demonstrates awareness of how low population density, low patient volumes,
and other challenges impact methodology & work plan
Sub-Criterion 2: Methodology/Work Plan Flexibility (5 points)
• Accounts for providing individual and collective TA, tracking, and analytic
support in up to four different states to CAHs with limited staffing and
infrastructure resources
• Describes how methodology and work plan can be adapted to different
numbers of participating providers in the FCHIP Demonstration
Criterion 2: Response (25 points)
Sub-Criterion 3: Promotion of Participant and Project Goals (10 points)
• Methodology & work plan that support development and implementation of a
performance measurement plan that is consistent with participating providers’
applications to the FCHIP Demonstration and clearly defines individual
expectations and responsibilities
• Methodology & work plan that account for FCHIP Demonstration requirements
and objectives (including budget neutrality, quality of care, patient safety)
• Capacity to facilitate regular information sharing across participants
• Ability to collect and analyze project data & disseminate results
Criterion 2: Response (25 points)
Sub-Criterion 4: Prior Experience (5 points)
• Prior experience in analyzing rural health issues, particularly in identifying and
addressing emerging policy issues for health care delivery systems in isolated
and sparsely populated areas
• Expertise related to hospital finance and quality measurement, specifically in
areas of home health care, hospital-based nursing facility care, telemedicine,
and ambulance services
• Experience with challenges related to effective quality improvement, cost
efficiency, clinical process, and patient outcomes reporting in rural/frontier areas
• Prior experience in communicating complex policy & payment issues technical
and general audiences in ways that highlight key rural/frontier concerns
• Principal investigator demonstrates at least 5 years work experience specific to
rural/frontier health systems research & policy analysis
Located on Pages 14-15 of the FOA
Criterion 3: Evaluative Measures (15 points)
• Proposes feasible and effective method to track and analyze FCHIP
Demonstration results across different groups of providers in different health care
service area categories
• Substantial knowledge of key process and outcome measures & potential
participant needs particular to each health care services area category in the
• Identifies potential strategies to promote regular information sharing, make
connections across participating providers & report common issues and lessons
• Proposes an evaluation plan that is logical, technically sound, and practical & can
yield meaningful findings about areas of project process and outcome that can
inform national health care policy and align with FCHIP Demonstration
requirements and objectives
Located on Page 15 of the FOA
Criterion 4: Impact (20 points)
Sub-Criterion 1: Effectiveness Across All Service Areas (7 points)
• Capacity to provide individual and collective TA across all four areas included in
FCHIP Demonstration, including development and implementation of
performance management plans
• Capacity to provide tracking and analytic support to develop metrics appropriate
for each service area category that align with FCHIP objectives
Sub-Criterion 2: Responsiveness to Participants’ Needs (8 points)
• Capacity to assess participants’ needs related to service delivery, relationships
with outside providers, and measurement and documentation of outcomes
• Describes strategies to identify and address individual and shared needs as
they arise promptly and effectively
Criterion 4: Impact (20 points)
Sub-Criterion 3: Connections Outside Project (5 points)
• Capacity to coordinate interactions with all outside resources and entities,
including local and distant providers and state Medicaid agencies
• Capacity to analyze project data and disseminate findings along with lessons
learned and promising practices that could inform nation health care policy
Located on Pages 15-16 of the FOA
Criterion 5: Resources/Capabilities (25 points)
Sub-Criterion 1: Appropriate Training, Experience, and Knowledge (9 points)
• Evidence of training and experience that qualify personnel to implement
individual and collective TA, tracking, and analytical support in all four services
areas included in FCHIP Demonstration
• Project personnel are sufficiently knowledgeable about policy issues and
reimbursement regarding four services areas
• Describes previous research or practical experience related to assisting
rural/frontier hospitals implement new payment methodologies, new or
expanded services, quality improvement and patient safety initiatives, or costcontainment strategies
Criterion 5: Resources/Capabilities (25 points)
Sub-Criterion 2: Data Collection and Analysis (8 points)
• Demonstrates that project personnel are qualified to develop appropriate
metrics based on participants’ performance management plans and FCHIP
Demonstration objectives and requirements
• Previous experience with interpreting and understanding Medicaid and
Medicare claims data
• Demonstrates how project personnel are qualified by training and/or experience
to collect data, conduct analyses, and report findings and implications for
national health care policy
Sub-Criterion 3: Organizational Structure (8 points)
• Organizational structure capable of providing direct TA to individual participants
pursuing a range of different approaches, as well as measuring and analyzing
collective project data and outcomes
• Shows evidence of formal agreements to form a consortium (where
Located on Page 16 of the FOA
Criterion 6: Support Requested (5 points)
• Extent to which costs, as outlined in the budget, and required resources
sections, are reasonable given the scope of work
• Flexibility to support various numbers of FCHIP Demonstration
• Reasonable distribution of funding for individual TA and site
implementation support as well as collective tracking, analysis, and
reporting activities
• Key personnel and outside entities recruited to provide TA and
implementation support have adequate time devoted to the project to
achieve project objectives
Located on Page 17 of the FOA

HRSA-14-137 PowerPoint for Reviewers