Federal Office of Rural Health Policy March 23, 2016 Release of NCC: March 15, 2016 Due Date of NCC: May 16, 2016 FY 16 Flex Non-Competing Continuation HRSA: 5-H Technical Assistance Call

What is a Non Competing Continuation? Where do I access the NCC? Components of the NCC Budget Reporting Requirements Reminders A Closer Look at MBQIP and Next Steps Reminders V2 Questions Summary

A Progress Report/Performance Narrative that provides HRSA with: – 1) a summary of grant activities and progress for the current budget year, – 2) expected progress for the remainder of the current budget year, and – 3) project plans for continuation of funds next budget year (FY2016) The NCC is an opportunity to ‘re-adjust’ and ‘refine’! What is a Non-Competing Continuation (NCC) ?

HRSA Electronic Handbooks – HRSA EHB Generated should let you know it was made available on 3/15. – You NEED to be a registered user in EHB to access If you’re a new Flex Coordinator, ensure you have access Where is the NCC Located?

ContentTitleTypeRequiredMax. Pages SF-PPR FormYesN/A SF-PPR-2FormYesN/A Performance Narrative AttachmentYes 15 Appendices FY 15 Work PlanAttachmentYesN/A FY 16 Work PlanAttachmentYesN/A FY 16 Budget Justification NarrativeAttachmentYesN/A Position Descriptions of New StaffAttachmentYesN/A Curriculum Vitaes of New Staff AttachmentYesN/A MBQIP Waiver AttachmentIf ApplicableN/A NCC Components

SF –PPR & SF-PPR2 which is pre-populated in EHB but can be edited; The Performance Narrative, uploaded as an attachment, (15 page limit) FY 15 Work Plan (updated) – uploaded as an attachment (no page limit) FY 16 Work Plan (09/01/ /31/2017) – uploaded as an attachment (no page limit) FY 16 Budget Justification Narrative – uploaded as an attachment (no page limit) – Base total budget on the ‘Recommended Future Support’ amount on your NOA (Box 13) – This is the same funding as the award Position Descriptions of New Staff – uploaded as an attachment (no page limit) Curriculum Vitae of New Staff – uploaded as an attachment (no page limit) MBQIP WAIVER NCC Components

SF-PPR Form page contains basic information about your grantee organization and is the cover page for the progress report. By default, the information will be pre-populated from the information in the application which started the last budget period This is a component of EHB – PPR Please refer to pages of the NCC Progress Report User Guide for Grantees; – PPR2 Please refer to pages of the NCC Progress Report User Guide for Grantees SF-PPR and SF-PPR2

Performance Narrative – 12-point, Times New Roman Font, 1-inch margins, and it may be single spaced – The Performance Narrative/Progress Summary will be uploaded in EHB as an attachment, 15 Page Limit for this section. – Please refer to pages of the NCC Progress Report User Guide for Grantees Performance Narrative

The Performance Narrative should include the following information: – Grant activities and progress for the current budget year (09/01/2015 – 03/15/2016), – Expected progress for the remainder of the budget year (03/16/2016 – 08/31/2016), and – Project plans for continuation of funds next budget year (09/01/2016) Performance Narrative, Cont.

Clearly and concisely describe the progress of the goals, objectives, and activities as broken out by Program Area: – QI – Medicare Beneficiary Quality Improvement Project (MBQIP) – Financial and Operational Improvement – Population Health Management and EMS Integration – CAH Conversion – Integration of Innovative Care Models Discuss associated measures for which data were/are/will be collected Performance Narrative, Cont.

Correlates with your Work Plan and Budget! – Therefore, it is important to utilize these harmoniously! – A strong work plan can help refine and balance the narrative for those worried about 15 page limit. Performance Narrative, Cont.

Discussion of any significant changes, challenges and barriers faced and/or anticipated in the remainder of the year and how to address them; Lessons Learned and/or Best Practices from FY 15 Flex Program; Other Information: such as networks, new linkages that have been established with other programs What are your technical assistance needs; Any adjustments to your evaluation plan; Summary of FY 16 Flex Program (Beginning September 1, 2016) and any potential adjustments or expansions of program activities; – Refer back to the Flex Grant Guidance as necessary: Performance Narrative, Cont.

All activities must fit within one of the program areas: – Quality Improvement - MBQIP – Financial/Operational Improvement – Population Health Management and EMS Integration – CAH Conversion – Integration of Innovative Care Models If you are uncertain of where/if an activity may fit into a program area, please consult the Flex Grant Guidance: – medicare-rural-hospital-flexibility-flex-grant-guidance medicare-rural-hospital-flexibility-flex-grant-guidance Reminder

Attachments – Please refer to pages of the NCC Progress Report User Guide for Grantees – Each attachment must contain the Grant Number, Project Title, Organization Name, and Primary Contact Name – Grantees are allowed to attach only the components listed within the NCC Progress Report submission; Please ensure that each attachment is correctly labeled and attached in the appropriate section in the appropriate order If grantees do not comply, submissions will be returned/ – Submissions will be returned if they’re insufficient or missing information. Attachments

Attachment 1: FY 15 Work Plan - Updated Attachment 2: FY 16 Work Plan Attachment 3: FY 16 Budget Justification/Narrative Attachment 4: Position Description of New Staff Attachment 5: Curriculum Vitae for New Staff Attachment 6: MBQIP Waivers Attachments

The same Work Plan submitted with last year’s Competing package, including – Program Area Goal Objective Activity Timeline Responsible Party Baseline and Outcomes Should correlate to Performance Narrative/Progress summary Update as necessary to reflect changes/reality FY 15 Work Plan - Updated

FY 16 Work Plan (Sept 1, 2016 – Aug 31, 2017) : Should follow the same format as the FY 15 work plan; It should be clear to the reader of the NCC – through the Performance Narrative/Progress Summary – why a grantee has elected to continue specific activities or have adjusted activities as necessary FY 16 Work Plan

Please provide a Budget Justification Narrative that is detailed and covers use of federal funds for each object class category. Travel and contractual costs must be itemized. Discuss any significant changes to your FY16 budget relative to FY15. Budget Justification Narrative

Flex Requires at least 1.0 FTE budgeted Reminder: – FORHP expects all grantees to participate in the 2017 Flex National Meeting and one Regional or National meeting each year related to the administration of the Flex Grant, as a part of ensuring program maintenance and integrity. The budget should include necessary travel funds;. – A Flex representative is encouraged to attend the NRHA CAH Conference in Kansas City, MO. – Whenever staff turnover occurs by personnel directly responsible for executing the duties of the Flex grant, the replacement personnel are required to attend a Flex Workshop in Duluth, MN within one year of start date. Budget Justification

Attachment 4: Position Descriptions for all new positions for which grant support is requested. Please indicate if new positions are filled or currently vacant. Attachment 5: Curriculum vitae or resume for any staff hired since submission of the 2015 Competing Continuation Application. New Position / Staff CV

Reminder Performance Improvement System (PIMS) must be reported no later than 60 days after the end of the budget year – Fall 2016 for FY 15 data – Fall 2017 for FY 16 data Prior budget period Federal Financial Report (FFR) submitted through HRSA EHBs no later than January 30, 2017 NCC for FY 2016 will be available sometime Spring 2017 General Reporting Requirements

Please refer to the NCC Progress Report User Guide for detailed instructions on how to submit this report in EHB: Other sources of information include: Your Project Officer TASC Flex Grant Guidance: Encouraged Work Plan Template: program-work-plan-template program-work-plan-template NCC Important Reminders

1) FORHP is maintaining its stance that in order for a CAH to participate in ANY Flex funded activities, they must be participating in MBQIP. – Hence this emphasis, FORHP is releasing resources and information to keep Flex Coordinators apprised of our minimal requirements for MBQIP participation; which CAHs are at risk; and paths to move forward. 2) FORHP in introducing some minor additions to MBQIP. – For those with CAHs not yet reporting on these additions, we expect changes related to planning/implementation of MBQIP Flex activities. Flex Participation, MBQIP and YOU

So, Where are we now?

MBQIP Goal: 100% CAH reporting on ALL MBQIP core measures Current Status: – 98% of CAHs have signed MOUs with FORHP – 96% of CAHs are reporting data for at least one quarter in at least one domain between 2 nd Quarter 2014 – 2 nd Quarter 2015 (props to you all!) Flex participation: MBQIP Criteria Overview

Phased approach to give flexibility to CAHs to report on all MBQIP core measures Criteria for Eligibility for Flex funds and participation in Flex-funded activities – FY 2015 (September 2015 – August 2016): Capacity building – FY 2016 (September 2016 – August 2017): (1) a signed Memorandum of Understanding with FORHP (2) submitted data on MBQIP measures for at least one quarter for at least one measure in at least one of the four quality domains within a certain reporting period – FY 2017 (September 2017 – August 2018): more details will be provided in September 2016 MBQIP Criteria Overview (cont.)

Patient Engagement (HCAHPS): 2Q14 - 2Q15 Care Transitions (EDTC): 2Q14 – 4Q15 Outpatient (OP-1, 2, 3, and 5): 2Q14 – 2Q15 – OP- 4, 18, 20, 21, and 22 - these measures do not apply for this year’s eligibility requirements Patient Safety – Inpatient (HF-1, 2, 3 and PN-3b, 6): 2Q14 – 2Q15. These measures are included in this year’s eligibility requirements (Sept 2016 – Aug 2017), but will be excluded in next year’s eligibility requirements since CMS retired these inpatient measures – OP-27 and Imm-2 – these two measures do not apply for this year’s eligibility requirements Criteria: Reporting Period

Hospitals that have been building capacity/assessing readiness for MBQIP for the past year and are preparing to start submitting data in September 2016 Hospitals that signed the Memorandum of Understanding between September 2015 thru August 2016 and is building capacity Hospitals who just received CAH designation Hospitals with extenuating circumstances Questions on any exceptions not outlined above should be directed to your FORHP Project Officer Criteria: Exceptions to waive penalty for CAHs not eligible for Flex funds

Waiver request must be submitted with Non- competing continuation application as an attachment Elements required in waiver: – Hospital’s CCN and Hospital Name – Reason and situations each hospital faces for not being able to submit data on each MBQIP Quality Domain as well as other reasons/situations Patient Engagement (HCAHPS) Care Transitions (EDTC) Outpatient (OP-1, OP-2, OP-3, OP-5) – Any documents that are relevant to your hospital’s case A sample waiver will be posted on the TASC website Criteria: Sample Waiver

Due to CART technical issues, OP-4 and OP-18 will be required MBQIP measures Flex programs/CAHs will not be penalized from participating in Flex if data for these two metrics is not reported between September 2016 – August 2017 September 2016 – August 2017: Capacity building for these two outpatient measures September 2017: CAHs will be required to report on these two measures Two Additional MBQIP Required Outpatient Measures

Some hospitals have had their cases for the AMI (OP 1-5) and ED Throughput (OP- 18, 20, 22*) rejected from the data warehouse because OP-4 and OP-18 data elements were not part of the submission process Occurs when CAHs change their measure preferences in CART to only collect certain measures in a measure set Situation

FORHP is not certain how many CAHs have changed their measure preferences in CART Requiring submission of OP-4 and OP-18 will have a limited impact on CAH data collection burden – Additional data elements needed to submit OP-4 and OP-18 OP-4: Aspirin on Arrival and Reason for no aspirin on arrival OP-18: ED departure date and ED departure time – No additional cases need to be abstracted Cases for measures OP-1, 2, 3, 5, and 20 will be rejected from the data warehouse if OP-4 and OP-18 are not included. Hospitals not submitting on required MBQIP core measures will be on the non- submission list and possibly deemed not eligible to receive Flex funds or participate in Flex-funded activities. Assessment

Flex Coordinators: – Add these two measures to non-competing continuation application workplan – Update documentation and any lists of required MBQIP measures to include OP-4 and OP-18 – Inform CAHs of the inclusion of these two additional measures in the required MBQIP measure set CAHs are highly encouraged to NOT adjust the measure setting preferences on CART after downloading the updated version of the tool prior to abstracting any cases – Updated CART version for Q is anticipated in April 2016 – Next CMS Outpatient data submission deadline (Q discharges) is June 1, 2016 CAHs using vendor tools: We are not aware of instances where CAHs using a vendor tool have had cases rejected from QualityNet warehouse for this reason TASC and RQITA are updating all documents relevant to these changes FORHP Recommendations

If you have questions/comments related to the measure submission process, please reach out to If you have questions/comments related to this policy change, please reach out to MBQIP Questions

Be mindful that EHB times-out after 30 minutes of inactivity. Users should ensure that they save their work at frequent intervals. For assistance with HRSA’s EHBs, contact the HRSA Call Center, 8 a.m. to 8 p.m. ET, weekdays (except Federal holidays): – Phone: (877) Go4-HRSA or (877) Quarterly Reports Still Due this month! Have others in your office read your NCC – does it make sense? Is there enough detail ? Lastly, PO’s will send back your NCC if it lacks detail or omits required information. Important Reminder V2:

Questions Spokane River