1. Federal Office of Rural Health Policy Update for 3RNet September 14, 2016 Megan Meacham Senior Advisor Federal Office of Rural Health Policy (FORHP) Health Resources and Services Administration (HRSA) U.S. Department of Health and Human Services (DHHS)

2. Today’s Presentation Background on the Federal Office of Rural Health Policy (FORHP) Key Policy Issues FORHP Program Initiatives Resources Available to You 2

3. FORHP: HHS and HRSA 3

4. HRSA Strategic Goals 4 Improve Access to Quality Health Care and Services Strengthen the Health Workforce Build Healthy Communities Improve Health Equity Strengthen HRSA Program Management & Operations

5. The Federal Office of Rural Health Policy Authorizing Legislation Sec. 711. [42 U.S.C. 912] (a) There shall be established in the Department of Health and Human Services (in this section referred to as the “Department”) an Office of Rural Health Policy (in this section referred to as the “Office”). The Office shall be headed by a Director, who shall advise the Secretary on the effects of current policies and proposed statutory, regulatory, administrative, and budgetary changes in the programs established under titles XVIII and XIX on the financial viability of small rural hospitals, the ability of rural areas (and rural hospitals in particular) to attract and retain physicians and other health professionals, and access to (and the quality of) health care in rural areas. 5

6. The Federal Office of Rural Health Policy Building Healthy Rural Communities Mission FORHP collaborates with rural communities and partners to support programs and shape policy that will improve health in rural America. 6 Build Healthy Rural Communities Policy & Research Community Based Programs Telehealth Programs State & Hospital Programs Values AccountableKnowledgeable CollaborativeRespectful InnovativeResponsive

7. The Federal Office of Rural Health Policy Policy Role Review and Comment on on the Major Medicare, Medicaid and ACA Marketplace Regulations Provide a Rural Context on Policy Issues within HHS Monitor Access, Workforce and Quality Issues Staff the National Advisory Committee on Rural Health and Human Services 7

8. The Federal Office of Rural Health Policy Monitoring Workforce Data 8

9. 9 The National Health Service Corps places nearly 5000 providers in rural communities CAHs as NHSC sites 248 CAHs 50 clinicians

10. The Federal Office of Rural Health Policy Key Policy Considerations Ongoing Transition to Value and Delivery System Reform Rural Hospital Closures Opioid Abuse Epidemic Leveraging the Broader Potential of Telehealth Administration Transition 10

11. Rural Considerations MACRA 11 Technical Assistance for Rural Physicians … Focus on Chronic Disease Management for Rural Communities …

12. Rural Considerations Hospital Closures 12

13. Rural Considerations Opioid Epidemic Though opioid abuse and opioid-related death has been on the rise nationally, rural communities are disproportionately affected 13 Drug-related deaths 45% higher in ruralRural communities have a history of substance abuse Rural has greater prevalence of risk factors and fewer options for treatment. Rural residents are most likely to be prescribed opioid painkillers

14. Rural Considerations Rural Health Clinics Proposed CY 2017 Physician Fee Schedule RHCs and chronic care management (CCM) Awaiting further CMS decision 14

15. Rural Considerations Workforce Innovation and Opportunity Act Final Rules published in Federal Register WIOA Resource Page: https://www.doleta.gov/wioa/ https://www.doleta.gov/wioa/ 15

16. The Federal Office of Rural Health Policy Investing in Rural Communities Community Health Supporting Rural Hospitals Leveraging Telehealth 16

17. The Federal Office of Rural Health Policy Workforce Programs Workforce Specific Programs: Rural Health Workforce Development Rural Training Track Technical Assistance Rural Network Allied Health Training Program Rural Health Information Technology Workforce Program Ongoing Programs: Network Planning and Development Outreach 17

18. Workforce Development Program 2010 - 2013 18

19. Workforce Development Program Types of Disciplines and Training Sites 19 Number of Training Site(s) by Type201120122013Average Critical Access Hospital 727480 75 Other Rural Hospital 2133 29 Clinics 113126145 128 Rural Health Clinics 434657 49 Community Health Center 203227 26 Federally Qualified Health Center 293635 33 Health Department 534 4 Indian Health Service (IHS) or Tribal Health Sites 435 4 Other Community Based Site 495468 57 Total356407454 406 Trainee Discipline Type(s)201120122013Average Allied Health Professional 10 Dentist 355 4 Mid-Level Provider 699 8 Nurse 10811 10 Physician (DO) 610 9 Physician (MD) 11 12 11

20. Workforce Development Program Economic Impact $1.63 generated for every HRSA $1 ~$19.4 Million generated for ~$11.9 Million HRSA investment 20

21. Rural Training Track Technical Assistance Part of the President’ Improving Rural Health Care Initiative Objectives: Improving fill rates of RTT programs Improving sustainability of existing programs Helping to get new RTT programs started 21

22. Rural Training Track Technical Assistance 22 Active 1-2 RTTs *1-2 like RTTs *RTT Technical Assistance Program – Updated 6-4-2016, Randall Longenecker, Senior Project Advisor

23. Rural Health IT Workforce 2013 - 2016 One-time funding for 15 grantees to expand the rural health IT workforce 3 year grant program at $300,000 per year per grantee from September 2013 – August 2016 Supported by the White House Rural Council Grantees in 15 states to support formal rural health networks for activities related to recruitment, education, training, and retention of health IT specialists in rural areas Students gained EHR technology certification, apprenticeship training, and opportunity for employment in rural hospitals and clinics Focus was to recruit current healthcare staff, local unemployed workers, rural veterans, and other potential students in rural areas 23

24. Rural Health IT Workforce Grantee Locations 24 CA CO MT SD MN WI IN KY NY PA VA NC TX AL FL

25. Rural Network Allied Health Training 2015 - 2018 3 year pilot program funded in FY 2015 at $200,000 per year For the recruitment, clinical training, and retention of allied health professionals, to include displaced workers and veterans Supports the formal development of mature, rural health networks that focus on activities that achieve efficiencies, expand access to, coordinate and improve the quality of essential health care services, and strengthen the rural health care system Supports the President’s Rural Health Care Initiative by focusing on rural recruitment and retention activities and builds upon accomplishments of the Rural Health Workforce Development pilot program 25

26. Rural Network Allied Health Training Grantee Locations 26 NM (2) LA MT IA MO IN (2) KY AL

27. The Federal Office of Rural Health Policy Community-Based Programs 27 ProgramFY 2017 FY 2018FY 2019 Rural Health Network Development Planning (Network Planning) X *Funding applications available Winter 2016 X *Funding applications available Winter 2017 X *Funding applications available Winter 2018 Rural Health Network Development Program (Network Development) X *Funding applications available Fall 2016 Rural Health Care Services Outreach Program (Outreach Program) X *Funding applications available Fall 2017

28. The Federal Office of Rural Health Policy Support for Rural Hospitals Collaborating with State Offices of Rural Health and State Flex Programs Improving Quality Improving Finances Strengthening Health Systems 28

29. The Federal Office of Rural Health Policy Telehealth Potential to improve physician distribution problems and improve access to care Continuing questions: “Face-to-Face” encounters Integration of services Licensure portability Limits on sites and services 29

30. Telehealth Interstate Medical Licensure Compact 30 Source: http://www.licenseportability.org

31. Telehealth Telehealth Resource Centers 31

32. Innovative Workforce Activities Leveraging FORHP Grant Programs State Innovations Use of Telehealth Use of non-Physician Providers 32

33. Resources Rural Health Research Gateway 33 https://www.ruralhealthresearch.org

34. Resources Rural Health Information Hub Topic Guides Community Health Gateway Evidence-Based Toolkits Rural Health Models and Innovations 34 https://www.ruralhealthinfo.org

35. Resources HRSA GME Eligibility Tool Medicare supports graduate medical education through Direct Medicare Graduate Medical (DGME) and Indirect Medical Education (IME) payments. Rural hospitals that have not previously trained residents may qualify for Medicare GME payments. 35 How it works: Tool located on HRSA Data Warehouse Filter by State, County, Hospital Name to select hospital 1 Report per hospital that indicates whether DGME, IME, or other training costs have been incurred since 1997 Not applicable to CAHs Hospitals must still touch base with MAC to confirm

36. Resources HRSA GME Eligibility Tool – Finding the Tool 36 Direct Link: https://datawarehouse.hrsa.gov/tools/hdwreports/Filters.aspx?id=462https://datawarehouse.hrsa.gov/tools/hdwreports/Filters.aspx?id=462 https://datawarehouse.hrsa.gov/

37. Resources FORHP Weekly Announcements Sign up for our Weekly Announcements Rural-focused Funding opportunities Rural Research findings Policy updates from a Rural Perspective 37 To sign up, email Michelle Daniels at: mdaniels@hrsa.gov

38. Contact Information Megan Meacham, MPH Senior Advisor Federal Office of Rural Health Policy (FORHP) Health Resources and Services Administration (HRSA) Email: mmeacham@hrsa.govmmeacham@hrsa.gov Phone: 301-443-8349 Web: hrsa.gov/ruralhealth/ Twitter: twitter.com/HRSAgov Facebook: facebook.com/HHS.HRSA 38