HRSA 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

Background 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

Background Critical Access Hospitals (CAHs) in 5 states were eligible to apply for the FCHIP Demonstration MT WY AK NV ND

Background 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

Background 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

Background CMS Responsibilities Reviewing and approving applications for waivers from CAHs Implementation of the FCHIP Demonstration Evaluation of FCHIP Demonstration HRSA Responsibilities Providing TA to the CAHs approved by CMS to participate in the FCHIP Demonstration Provide interim and final Report to Congress (in coordination with CMS)

Purpose 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 demonstration Page 3 of the FOA lists 7 specific tasks

Purpose 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 project 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 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 demonstration Identifies potential strategies to promote regular information sharing, make connections across participating providers & report common issues and lessons learned 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 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 cost- containment 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 appropriate) 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 participants 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

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