Federal Office of Rural
Health Policy
Policy Research Team Overview
Policy Research Team
• Tom Morris – Associate Administrator
• Sahira Rafiullah – Deputy Associate Administrator
• Aaron Fischbach – Policy Coordinator
• Alicia Swenson O’Brien, Sarah Young, Helen Newton, Suzanne Stack,
Craig Caplan, Marty Rice, Natassja Manzanero, & Anthony Oliver – Policy
Analysts
• Paul Moore & Dan Mareck – Clinical and Quality Advisors
• Steve Hirsch – Executive Secretary, National Advisory Committee
• Curt Mueller – Research and Evaluation Director
• Sarah Bryce – Research and Evaluation Associate
ORHP Policy Research Activities
• Serve as HHS-wide resource on rural health
services and data issues
• Review and comment on all HHS regulations
• Review legislation and reports to Congress
• Conduct rural health services research
• Staff the National Advisory Committee on
Rural Health and Human Services
• Staff the White House Rural Council
PRT Grants and Cooperative Agreements
Policy/Research:
 Rural Policy Analysis
 Rapid Response to Quick Data Turnaround
 Rural Health Research Centers
 Rural Training Track Technical Assistance
 Rural Health System Analysis and Technical Assistance
Demonstrations with CMS:
 Frontier Extended Stay Clinic
 Frontier Community Health Integration
Rural Health Research
Research from ORHPfunded rural health
research centers past
and present
http://www.ruralhealthresearch.org
Rural Provider Types
HOSPITAL
AMBULATORY
• Critical Access Hospital (CAH)
• Sole Community Hospital (SCH)
• Disproportionate Share Hospital
(DSH)
• Rural Referral Center (RRC)
• Medicare Dependent Hospital (MDH)
• Rural Prospective Payment Hospital
• Rural Health Clinics (RHC)
• Federally Qualified Health Centers
(FQHC)
• Community Health Centers (CHCs)
PHYSICAN
• Bonus Payments
– Shortage Areas
– Primary Care
• Graduate Medical Education (GME)
POST-ACUTE
•
•
•
•
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Skilled Nursing Facility (SNF)
Home Health Agency (HHA)
Hospice
Swing Beds
Long Term Care Facilities
Key Rural Regulatory Issues
Inpatient Hospital Payment
Outpatient Hospital Payment
Physician Payment
Inpatient Rehab Payment
Inpatient Psych Hospital Payment
Skilled Nursing Facility and Long
Term Care Payments
• End Stage Renal Dialysis
Payments
• Home Health Payments
• Hospice Payments
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Ambulance Fee Schedule
Medicare Advantage
Medicare Part D
Rural Health Clinics
Federally Qualified Health
Centers
Medicaid Waivers/SPAs
Medicare GME
EHR/Meaningful Use
Telehealth
ACA related insurance
provisions
Rural-Relevant Medicare Regulations
Regulation
Proposed
Pub. Date
Eff. Date
Inpatient Prospective Payment System
April
August
October
Outpatient Prospective Payment System
July
November
January
Skilled Nursing Facility Prospective
Payment System
April
July
October
Home Health Prospective Payment
System
May
September
October
Inpatient Rehabilitation Facilities
April
August
October
January
March
July
Physician Fee-Schedule
July
November
January
RHCs & FQHCs
N/A
N/A
N/A
Hospice
N/A
N/A
N/A
Inpatient Psychiatric Facility Prospective
Payment System
This is not an official calendar endorsed by CMS.
ORHP Policy Focus for 2014-2015
 Health Insurance Marketplaces and State Medicaid expansions
 ACA Outreach, Education, and Enrollment
 Quality



Rural hospitals – Partnership for Patients, VBP, etc.
CAHs - MBQIP
RHCs – quality measures cohort
 Outpatient Supervision at rural PPS and CAHs
 Stage 2 MU implementation and Stage 3 planning
 Primary care access
 Rural and Frontier Demonstrations
 RHSATA
 White House Rural Council activities
The White House Rural Council
Created by Executive Order June 9, 2011
HHS Policy Ideas
• Expand NHSC to CAHs
• Expand Health IT Funding
• Reduce Regulatory Burden
National Advisory Committee on Rural Health and Human Services
• Advises the HHS Secretary
on Rural Issues
• Policy Briefs on Current
Issues
• Rural Site Visits
http://www.hrsa.gov/advisorycommittees/rural/
Affordable Care Act
Update
ACA Outreach and Enrollment
CMS Outreach and Education Website
http://www.cms.gov/Outreach-and-Education/Outreach-and-Education.html
ORHP ACA Office Hours
Wednesdays, 3-4 pm Eastern
Call-in Number: (800) 857-3749
Passcode: ORHPACA
Adobe Connect Session: https://hrsa.connectsolutions.com/orh1/
E-mail name and organization to orhp-acaquestions@hrsa.gov to join the
listserv
Archive of prior calls:
http://www.hrsa.gov/ruralhealth/affordablecareact/index.html
ACA rural fact sheet:
http://www.hhs.gov/healthcare/facts/factsheets/2013/09/rural09202013.html
2014-2015 Enrollment
Special enrollment opportunities:

https://www.healthcare.gov/how-can-i-get-coverage-outside-of-openenrollment/special-enrollment-period/
2015 Open Enrollment begins November 15


Shorter, 3-month period
CMS recently issued regulations about continuation coverage and eligibility
redeterminations
ACA Coverage to Care
 If you’re a provider, staff, or someone helping people who are new to
insurance, there are a few resources to address topics such as:





What it means to have health insurance
How to find a provider
When and where to seek health services
Why prevention is important
Resources:

A Roadmap to Better Care and Healthier You




http://marketplace.cms.gov/help-us/c2c.html
http://marketplace.cms.gov/help-us/c2c-roadmap.pdf
Discussion Guides for Community Partners
Your Roadmap to Health (poster)
Provider Newsletter
Resources
Policy Resources
Rural Assistance Center
• One stop shopping for all rural health and human services
• www.raconline.org
Rural Health Research Gateway

Access to all RHRC products on a range of rural health topics
www.ruralhealthresearch.org
Medicare

www.cms.gov/Medicare/Medicare.html

Rural Providers Resource Guide:
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/Downloads/Rural-Health-Suite-ICN908465.pdf
Policy Resources
Legislation and statutes

http://thomas.loc.gov/
Social Security Act compilation (Medicare and Medicaid are Titles XVIII and XIX)

http://www.ssa.gov/OP_Home/ssact/comp-ssa.htm
Code of Federal Regulations -- Public Health (HHS) -- Title 42
•
http://ecfr.gpoaccess.gov/cgi/t/text/textidx?sid=1ea2f8fcbc9a2ec1c2b44ef1c2374ab0&c=ecfr&tpl=/ecfrbrowse/Title42/42tab_
02.tpl
Federal Register

https://www.federalregister.gov/
CMS interpretive guidelines (or state operations manuals)

http://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/index.html?redirect=/Manuals/
CMSCMS
Rural
Resources
Key
Rural
Resources
• CMS Regional Office Rural Liaisons
https://www.cms.gov/ProspMedicareFeeSvcPmtGen/downloads/RO
-RH-Coordinators.pdf
• CMS Rural Open Door Forum- Sign up at:
http://www.cms.hhs.gov/OpenDoorForums
• CMS National Provider Calls
http://www.cms.gov/Outreach-and-Education/Outreach/NPC/NationalProvider-Calls-and-Events.html
• CMS Rural Health Clinics Center
http://www.cms.hhs.gov/center/rural.asp
A Few Key Websites
www.healthcare.gov
www.cms.gov
http://aspe.hhs.gov
www.kff.org
www.nashp.org
www.commonwealthfund.org
Questions?