1. 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)

2. 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

3. 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

4. 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

5. HRSA’s Regions

6. 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.

7. 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:

8. 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:

9. 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.

10. 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:
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)

11. 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

12. 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!
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
• Alerts
• Experts
• Dissemination Toolkit
Source:

13. Rural Health Grants
FYs 18 and 19 Rural Health Grants

14. 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)
Tip: Register early with grants.gov, DUNS, and SAM
Learn how HRSA is addressing the opioid crisis 14

15. 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

16. Resources and Tools Regarding Capital Needs

17. 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

18. 2/21/2019
Tools & Resources
Delta Region Community Health Systems Development Program
Vulnerable Hospitals Toolkit (2016)
Toolkit-Excerpt.pdf
Critical Access Hospital Replacement Process: Blueprint and Roadmap (2010)
0.doc

19. More Tools & Resources

20. 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: By
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 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:

21. RHIhub – RHCs Models and Innovations
Featured model programs and successful rural projects that can serve as a source of ideas and provide lessons learned

22. Capital Link (www.caplink.org)

23. Nick Zucconi Regional Administrator HRSA Office of Regional Operations - Denver

24. To learn more about our agency, visit
2/21/2019
To learn more about our agency, visit