1. ORC TA: Medicare Rural Hospital Flexibility Grant Program HRSA-15-038 U.S. Department of Health & Human Services Health Resources & Services Administration Federal Office of Rural Health Policy Kevin Chaney April 23, 2015

2. 1)Statutory Authority 2)Purpose of the Flex Program 3)Goals of the Flex Program 4)Flex Program Overview 5)Application Format 6)Evaluation Criteria 7)Key Criteria 8)General Reminder 9)Questions Agenda

3. Medicare Rural Hospital Flexibility Grant Program Established by Title XVIII (1&2) of the Social Security Act (42 U.S.C. 1395i-4), as amended; Continuing Appropriations Act, 2015 (P.L. 113-235).

4. Purpose Ensure residents in rural communities have access to high quality health care services

5. Medicare Rural Hospital Flexibility Grant Program This is accomplished by providing funding to state designated entities whom assist Critical Access Hospitals (CAHs). These entities create programs focused on: QUALITY and PERFORMANCE IMPROVEMENT activities; stabilizing rural hospital finance; integrating emergency medical services (EMS) into their health care systems; incorporating population health; and fostering innovative models of health care.

6. Flex Program Goals Improve the quality of care provided by CAHs. Improve the financial and operational outcomes of CAHs Understand the Community Health and EMS Needs of CAHs.

7. Flex Program Goals Enhance the health of rural communities through community/population health improvement. Improve identification and management of Time Critical Diagnoses and engage EMS capacity and performance in Rural Communities. Support the financial and operational transition to value based models and health care transformation models in the health care system.

8. Program Overview Flex is a three year project, composed of Five Program Areas (Appendix A): 1)Quality Improvement - MBQIP (required) Cross Reference MBQIP Table (Appendix B) 2) Financial and Operational Improvement (required) 3) Population Health Management and Emergency Medical Services* Integration (optional) 4) Designation of CAHs in the State (required if requested) 5) Integration of Innovative Health Care Models (optional)** *Capped at 25% total budget ** Intended for states with limited needs in other program areas the capacity

9. Layout Abstract Project Narrative Intro Needs Assessment Methodology / Approach Work Plan Resolution of Challenges Evaluation and Technical Support; Organizational Information Budget Budget Justification – Line Item* Attachments

10. Evaluation Criteria The Medicare Rural Hospital Flexibility Grant Program has six (6) review areas: Need (20 PTS) Introduction (5) Needs Assessment (3 areas – 5pts/area - 15) RESPONSE (30 points) Methodology (15) Work Plan (10) Resolution of Challenges (5) EVALUATIVE MEASURES (10 points) Evaluation and Technical Support Capacity

11. Evaluation Criteria, CNT IMPACT (10 points) Work Plan (5), Project Narrative(5) RESOURCES/CAPABILITIES (20 points) Organizational Information and Organizational Chart (5), Evaluation and Technical Support Capacity (5), and Accomplishment Summary (10) SUPPORT REQUESTED (10 points) Budget (5) and Budget Narrative (5)

12. Key Criteria Intro: Clearly describes the purpose for the proposed project. Clearly articulates which program areas will be addressed Needs Assessment: Quality Improvement Needs Assessment; Financial and Operations Needs Assessment; & Pop. Health Management Needs Assessment. States should utilize data from FMT and TASC Reports to inform their proposal and all assessments.

13. Key Criteria Needs Assessment: Thoroughly identifies and describes the collective needs of CAHs, the needs of rural communities, and partners who can help address these needs. Uses appropriate data to support the discussion of need. (FMT / MBQIP data) Clearly describes the vision of the proposed Flex program, as informed by the needs assessment(s) and expected outcomes Identifies Information gaps

14. Key Criteria Methodology: The proposed goals and objectives are well described and directly address the applicant’s chosen program areas of the Flex Program, as detailed in Appendix A. Activities are well-described and demonstrate a clear link and response to the needs identified in the Needs Assessment section. Baseline and target goal(s) for improvement are clearly described and logical for each measure.

15. Key Criteria Work Plan: Includes and clearly provides specific timelines and completion dates for each major activity. Incorporates the required activities detailed in Appendix A. Incorporates optional activities that are reasonable and address identified state specific needs.

16. Key Criteria Resolution of Challenges: Identifies and discusses current and potential challenges that may be encountered in implementing the program activities as well as the approaches that would be used to address such challenges

17. Key Criteria Evaluation and Technical Support Capacity Proposes feasible and effective method(s) to monitor and evaluate the project results. Proposes evaluative measures that will be able to assess 1) to what extent the program objectives have been met and 2) to what extent these can be attributed to the project.

18. General Reminders States are of various size (geographic) and can have a large discrepancy in the number of CAHs served. States use Flex resources to address identified needs for CAHs within the state and to achieve improved and measurable outcomes in each selected program area. State will have varied resources to address those needs; therefore, applicants can determine the best activity or group of activities to improve on key outcomes within each selected program area.

19. Questions?