Health Resources and Services Administration Rural Community Infrastructure P3 Roundtable Meeting July 24, 2018 Nick Zucconi Regional Administrator, Office of Regional Operations - Denver Health Resources and Services Administration (HRSA)

Health Resources and Services Administration (HRSA) Overview Supports more than 90 programs that provide health care to people who are geographically isolated, economically or medically challenged HRSA does this through grants and cooperative agreements to more than 3,000 awardees, including community and faith- based organizations, colleges and universities, hospitals, state, local, and tribal governments, and private entities Every year, HRSA programs serve tens of millions of people, including people living with HIV/AIDS, pregnant women, mothers and their families, and those otherwise unable to access quality health care

Health Center Program 1 in 3 people living in poverty Roughly 1,400 HRSA-supported health centers operate more than 10,400 service delivery sites across all U.S. states and territories Nearly 26 million people, or 1 in 12 nationwide, rely on a HRSA-funded health center for affordable, accessible primary health care, including: 1 in 3 people living in poverty 1 in 6 rural residents 1 in 10 children 330,000+ veterans 300,000 American Indian/Alaska Natives Primary Care Associations

National Health Service Corps and NURSE Corps Supports 12,000+ scholarships and loan repayments in exchange for service in high-need areas National Health Service Corps (NHSC) currently supports primary care physicians, dentists, physician assistants, nurse practitioners, behavioral health providers, and other primary care providers and health professions students NURSE Corps currently supports licensed registered nurses and nurse faculty members NHSC and NURSE Corps clinicians provide care to more than 12 million people nationwide, including over 3.5 million rural residents

HRSA’s Regions

Federal Office of Rural Health Policy 2/21/2019 Federal Office of Rural Health Policy The Federal Office of Rural Health Policy provides policy support to the Office of Secretary and supports a number of rural health programs, including state offices of rural health, hospital programs, community-based grants, and telehealth grants and technical assistance. https://www.hrsa.gov/rural-health/index.html

State Offices of Rural Health Share information, resources and innovative projects with other rural health stakeholders Coordinate with other state partners on rural health issues Link rural health stakeholders to Federal and state resources Rural recruitment and retention The State Office of Rural Health (SORH) is a federal-state partnership to help rural communities and organizations identify and resolve issues and build rural health infrastructure. Depending on the needs in each state, SORHs may help keep providers aware of new health care initiatives, collect and disseminate data and resources, offer technical assistance for funding and quality improvement, and support workforce recruitment and retention. Connect with your SORH: https://nosorh.org/nosorh-members/

Federal Office of Rural Health Policy Rural Hospital Programs 2/21/2019 Federal Office of Rural Health Policy Rural Hospital Programs Technical assistance and support to address the unique needs of rural hospitals through programs such as: Small Rural Hospital Improvement Program Medicare Rural Hospital Flex Grant (Flex) 96% of Critical Access Hospitals (CAH) reported at least one Medicare Beneficiary Quality Improvement measure and 65% of CAHs showed improvement in at least one quality measure Small Rural Hospital Improvement Program funds state governments to support rural hospitals with 49 beds or fewer. Funding helps small hospitals: Purchase equipment and/or training to attain value-based purchasing provision under the ACA; Join or become accountable care organizations, or create shared savings programs through the ACA; and Purchase health information technology, equipment, and/or training to comply with meaningful use, ICD-10 standards, and payment bundling. The Flex Program supports Critical Access Hospitals (CAHs) to promote quality and performance improvement including: Stabilizing finances; Integrating emergency medical services into health care systems; Incorporating population health; and Fostering innovative models of health care. Under the Flex Program, the Medicare Beneficiary Quality Improvement Project seeks to improve the quality of care provided in CAHs by voluntarily reporting measures not required by CMS. States coordinate technical assistance based on the needs of hospitals in their state. Source: https://www.hrsa.gov/rural-health/rural-hospitals/index.html

Rural Community Programs 2/21/2019 Rural Community Programs Provide funding to increase access to care in rural communities and to address their unique health care challenges Rural Health Network Development Planning Program Rural Health Network Development Program Small Health Care Provider Quality Improvement Rural Health Opioid Program Rural Health Care Services Outreach Grant Program Most programs require community organizations to share resources and expertise using evidence-based models of care in networks of two or more health care services providers. Rural Health Network Development Planning Program support to rural communities for the implementation of activities needed to plan and develop formal and integrated health care networks Rural Health Network Development Program support to mature networks of rural health care providers and community health partners to integrate administrative, clinical, technological and financial functions to improve access and quality of health care in rural areas. Small Health Care Provider Quality Improvement Program support to mature networks of rural health care providers engaged in quality improvement initiatives to improve patient care and chronic disease outcomes using evidence-based quality improvement models, tests of change focused on improvement and the use of health information technology to collect and report data. Rural Health Opioid support to community consortiums in rural communities to prepare individuals with opioid-use disorder to start treatment, implement care coordination practices to organize patient care activities, and support individuals in recovery by establishing new or enhancing existing behavioral counseling, peer support, and alternative pain management activities. Rural Health Care Services Outreach support to promote rural health care services outreach projects utilizing evidence-based or promising practice models in order to address community-specific health concerns.

2/21/2019 Telehealth Programs The Office for the Advancement of Telehealth (OAT) promotes the use of telehealth technologies for health care delivery, education, and health information services. Provides funds to promote and improve telehealth services in rural areas, including: Telehealth Network Grant Program: Since 2005, supported 3,100 new or expanded telehealth sites; nearly a 10% increase from 2015 to 2016 Rural Child Poverty Telehealth Network Grant Program Rural Veterans Health Access Program Evidence-Based Tele-Emergency Network Grant Program Licensure Portability Grant Program Telehealth Network Grant Program: help communities build the human, technical, and financial capacity to develop sustainable telehealth programs and networks Rural Child Poverty Telehealth Network Grant Program: supports established telehealth networks in the delivery of social services Rural Veterans Health Access Program: enhances mental health services for veterans Evidence-Based Tele-Emergency Network Grant Program: telehealth networks to deliver 24-hour emergency department consultation services via telehealth to rural providers that lack emergency care specialists Licensure Portability Grant Program: grants to state professional licensing boards to develop and implement state policies that will reduce statutory and regulatory barriers to telemedicine Source: https://www.hrsa.gov/rural-health/telehealth/index.html Background Note: RHCs cannot bill for telehealth as a distant site provider. RHCs can only bill the originating site fee (about $25). So a patient can come to the RHC (if they have the equipment) to receive consultation from a clinician at another facility or site. HRSA has been trying to raise this issue as a Federal office (that RHCs cannot bill for telehealth) for some time now and hopefully future legislation may actually allow for RHCs to bill for telehealth services as a distant site provider. (per Wakina Scott)

Telehealth Resource Centers (TRCs) OAT also provides support through the Telehealth Resource Center Grant Program. TRCs provide assistance, education, and information on telehealth to expand delivery of health care to rural and underserved populations. There are 12 Regional TRCs and two National TRCs, one focusing on policy and the other on technology. Assistance is generally free of charge (up to 10 hours of free technical consulting). Types of assistance include: How To Get Started/Strategic Planning Program/Protocol Development Business Model Development/Reimbursement Program Evaluation/Quality Assessment Best Practices/Networking Guidance on selecting appropriate technology Guidance on legal, regulatory and other policy issues

Rural Health Research Gateway Free online library with access to research from all eleven federally-funded Rural Health Research Centers Use the library to find: rural health research products and journal articles information about the research centers information about individual researchers current research center projects much more! https://www.ruralhealthresearch.org The Rural Health Research Gateway provides easy and timely access to research conducted by the Rural Health Research Centers. The Centers study critical issues facing rural communities in an effort to secure adequate, affordable, high-quality health services for rural residents. Puts new findings and information in the hands of policymakers, educators, public health employees, hospital staff, and more. This online resource of research connects you to: • Research and Policy Centers • Reports & Journal Publications • Fact Sheets • Policy Briefs • Research Projects • Email Alerts • Experts • Dissemination Toolkit Source: https://www.ruralhealthresearch.org/

Rural Health Grants FYs 18 and 19 Rural Health Grants

Rural Communities Opioid Response-Planning Funding Opportunity Focus Eligibility $200,000 for one year Approximately 75 grants will be awarded Awardees are encouraged to leverage other federal, state, and local opioid use disorder funding and initiatives Awardees will develop plans for implementing opioid use disorder prevention, treatment, and recovery interventions in their communities All high risk rural communities All domestic public and private entities, non-profit and for-profit Lead applicant must be part of consortium of at least four entities All services must be provided in rural areas In FY 2019 and beyond, there will be additional funds available to provide continued support, including additional grants and National Health Service Corps (NHSC) Loan Repayment Program awards. RCORP-Planning awardees are encouraged . . . to incorporate workforce recruitment and retention needs and efforts into planning and capacity building activities throughout the period of performance. For example, RCORP-Planning awardees can use funds to ensure that health care organizations obtain eligibility for placement of rural NHSC clinicians in future years. More about this funding opportunity (applications due July 30) https://apply07.grants.gov/apply/opportunities/instructions/oppHRSA-18-116-cfda93.912-cidHRSA-18-116-instructions.pdf Tip: Register early with grants.gov, DUNS, and SAM https://www.hrsa.gov/grants/apply/register/index.html Learn how HRSA is addressing the opioid crisis https://www.hrsa.gov/opioids 14

FY19 Rural Health Grants *These programs will be competitive in 2019 2/21/2019 Small Health Care Provider Quality Improvement Program The purpose of this grant program is to improve patient care and chronic disease outcomes by assisting rural primary care providers with the implementation of quality improvement (QI) initiatives. Rural Health Network Development Planning Program The purpose of this one-year, annual grant program is to promote the planning and development of healthcare networks in order to: achieve efficiencies; expand access to, coordinate, and improve the quality of essential health care services; and strengthen the rural health care system as a whole. Small Health Care Provider Quality Improvement Program Eligibility: Must be a rural public or rural nonprofit private health care provider or provider of health care services, such as a critical access hospital or a rural health clinic; or another rural provider or network of small rural providers; and Must not previously have received a grant under this subsection for the same or similar project. Project period: 3 years Rural Health Network Development Planning Program Eligibility: The Rural Health Network Development Planning Program requires the establishment of a network. A rural health network is defined as an organizational arrangement among at least three separately owned regional or local health care providers that come together to develop strategies for improving health services delivery systems in a community. For example, a critical access hospital, a community health center, and a public health department may collaborate to form a network around a shared purpose. Other examples of health care providers could be hospitals, public health agencies, home health providers, mental health centers, substance abuse service providers, rural health clinics, primary care providers, oral health providers, social service agencies, health profession schools, local school districts, emergency services providers, community and migrant health centers, federally-qualified health centers, tribal health programs, churches, and civic organizations that are/will be providing health related services. Project period: 1 year

Resources and Tools Regarding Capital Needs

Tools & Resources National Rural Health Resource Center 2/21/2019 Tools & Resources National Rural Health Resource Center ARE YOU READY TO BEGIN A CAPITAL PROJECT? Rural Health Information Hub Financing Capital Investments in Rural Health Care Rural Health Clinics and Critical Access Hospitals Capital Needs Assessment

2/21/2019 Tools & Resources Delta Region Community Health Systems Development Program https://www.ruralcenter.org/drchsd Vulnerable Hospitals Toolkit (2016) https://nosorh.org/wp-content/uploads/2016/11/Vulnerable-Hospital- Toolkit-Excerpt.pdf Critical Access Hospital Replacement Process: Blueprint and Roadmap (2010) https://www.ruralcenter.org/sites/default/files/cahreplacementprocess_ 0.doc

More Tools & Resources

Rural Health Information Hub (RHIhub) Capital Funding Capital Funding for Rural Healthcare major federal grant or loan programs that support capital projects for rural healthcare facilities foundations that support capital projects for rural healthcare facilities low-interest loans available to rural facilities other funding available to finance capital projects Provides customized assistance By phone: 1.800.270.1898 By email: info@ruralhealthinfo.org https://www.ruralhealthinfo.org/ Funded by HRSA’s Federal Office of Rural Health Policy. The RHIhub can help you: Plan—find toolkits and program models that show what works in rural communities so that you can build effective community health programs. Locate statistics, maps, and more to help you demonstrate need in your area. Develop—get the information you need to build, maintain, and improve services in your community. The RHIhub online library offers access to thousands of resources from organizations across the U.S. Learn—gain insight and understanding of the issues affecting rural America through topic guides, timely news, and updates. Every morning you can get the latest news and regulations relevant to rural health. Hear right away about the newest key reports and opportunities from federal agencies and national organizations via the website, social media, or our regular email updates. Connect—find others who have passion and expertise in rural health issues. The hub’s resources can help you identify organizations and experts on a variety of topics, as well as in your state. Source: https://www.hrsa.gov/ruralhealth/resources/

RHIhub – RHCs Models and Innovations Featured model programs and successful rural projects that can serve as a source of ideas and provide lessons learned https://www.ruralhealthinfo.org/topics/rural-health-clinics/project-examples

Capital Link (www.caplink.org)

Nick Zucconi Regional Administrator HRSA Office of Regional Operations - Denver 303-844-7879 nzucconi@hrsa.gov

To learn more about our agency, visit 2/21/2019 To learn more about our agency, visit www.HRSA.gov