NEBRASKA RURAL HEALTH ASSOCIATION







Nebraska Rural Health Association 
July 2008

In This Issue

•    FEDERAL LEGISLATION

•    CMS PROPOSED RULE RELEASED

•    BREAKING NEWS

•     GRANT OPPORTUNITIES
 
•    RURAL HEALTH AWARDS

 





Register Now!

for the 2008 Nebraska Rural Health Conference,
September 11-12, 2008 in Kearney, NE



FEDERAL LEGISLATION
CMS PROPOSED RULE RELEASED
RURAL HEALTH CLINICS
The major changes are:

RHCs must be located in rural, underserved areas to obtain their designation. In the past, once an RHC was designated, they were allowed to keep their RHC status permanently. CMS is changing this, requiring an RHC to renew their designation every three years provided their service area still is in a rural area and meets the shortage designation requirements. 

In addition, CMS is changing the way it defines rural, now using the Rural Urban Community Areas (RUCA) designations. 

CMS is proposing a change to the way it calculates reasonable cost in their cost-based reimbursement rates for these providers. Currently the law says payments cannot exceed 80 percent of reasonable cost. However, in many instances RHCs and FQHCs can receive more than 100 percent of reasonable costs if they also receive co-pays or Medicaid supplements. This will no longer be allowed.

CMS is proposing changes to those hospitals that qualify to waive the payment cap for provider-based RHCs. These facilities will need to be located in an area with a RUCA score of 9 or 10 and be under 50 beds for their average daily census. This may allow more provider-based facilities to waive the payment cap.

CMS is proposing that RHCs have to implement the following quality programs to remain an RHC:

•Quality Assessment and Performance Improvement Program 
•Infection Control plan
•Emergency services and training

The rule has a number of other payment and participation requirements.  We will continue to update NeRHA members on how this proposed rule will impact the health of rural Americans.  
For now, more information is available from CMS by clicking here for the proposed rule.

BREAKING NEWS
New Report Shows CMS Pilot Program Saving Nearly $700 Million in Improper Medicare Payments

The Centers for Medicare & Medicaid Services (CMS) released a new report offering fresh evidence that the recovery audit contractors (RACs) pilot program is successfully identifying improper payments. The findings will also help the agency improve the program as it is expanded nationwide within two years, officials say.

The evaluation report shows that $693.6 million in improper Medicare payments was returned to the Medicare Trust Funds between 2005 and March 2008. The funds returned to the Medicare Trust Funds occurred after taking into account the dollars repaid to health care providers, the money overturned on appeal and the costs of operating the RAC demonstration program.

Of the overpayments, 85 percent were collected from inpatient hospital providers, and the other principal collections were 6 percent from inpatient rehabilitation facilities, and 4 percent from outpatient hospital providers.

The program, designed to protect the Medicare Trust Funds and beneficiaries from improper payments, began in California, Florida and New York in 2005 and in July 2007 expanded to Arizona, Massachusetts and South Carolina.

For more information on the RAC program and to view the evaluation report, visit: http://www.cms.hhs.gov/RAC.

GRANT OPPORTUNITIES
2009 Guidance is Now Available for the Rural Health Network Development Planning Grant Program
The federal Office of Rural Health Policy has announced that the 2009 Guidance is now available for the Rural Health Network Development Planning Grant Program, a grant program that provides one year of funding to rural communities that seek to develop a formal integrated health care network and that do not have a significant history of collaboration.

The due date for this opportunity is September 15, 2008. The applicant must be a rural, non-profit or public entity that is or represents a consortium of three or more entities that need assistance to plan, organize and develop a health care network. Applications from profit-making organizations will not be accepted. For-profit organizations may, however, participate in the network. Faith-based and community-based organizations requesting health related projects are eligible to apply for these grants.

Tribal Governments and Tribal Organizations are also eligible to apply. The Network Planning Grant funding cycle is from March 1, 2009 through February 28, 2010 and will be funded from the Federal Fiscal Year 2009 appropriation, pending availability of funds. The approximate amount of funding anticipated is $1,150,000. It is anticipated that 20 awards will be made. Individual awards are limited to between $25,000 and $85,000. Applicants can request budget and project periods for one year only.

The legislation for this program states that applications should be prepared in consultation with your State Office of Rural Health (SORH) or other appropriate State government entity. They recommend you contact your SORH early in the application process to advise them of your intent to apply.  The SORH can often provide technical assistance to applicants.

A list of the SORHs can be accessed here.

The application is available through Grants.gov

RURAL HEALTH AWARDS
Integrated Rural Healthcare Award

The Integrated Rural Healthcare Award is open to any provider giving primary care, mental health, and substance abuse collaborative care in rural areas of our state (outside of Douglas, Lancaster and Sarpy counties).   The distinction of this award is the collaborative model, the methodology, the types of providers, the issues they are having problems with and the successes they have seen. The provider can be an individual, a team, a system or partnership. Integration can be with two or all three of the components (primary care, mental health, and substance abuse.) Nominations are accepted from patients, fellow providers, or employees of the provider.


Outstanding Rural Health Practitioner Award

The Outstanding Rural Health Practitioner Award recognizes an individual that is a direct service provider who provides direct patient care such as physicians, nurses, physician assistants, nurse practitioners and others. This individual must exhibit outstanding leadership in bringing and/or improving health services in rural Nebraska. Factors taken into consideration include providing outstanding care; collaboration and multi-disciplinary teamwork; involvement in the community; involvement in education; and lasting contribution to the rural health care system.

Rural Health Achievement Excellence Award

The Achievement Excellence award recognizes an individual in the health care industry for leadership and noteworthy initiative in promoting the development of community oriented rural health care delivery. Factors for selection should include: distinctive efforts to promote and/or improve rural healthcare and provide lasting contributions to health care. This award recognizes noteworthy initiatives in the development of community-oriented rural healthcare delivery.

Rural Health Distinctive Consumer Advocate Award

It is important to recognize that rural health care delivery systems will survive only with the involvement of rural consumers. This award honors an individual consumer, who is not an employee in the health care or health insurance industry, for active participation within his or her community and/or region regarding rural health service delivery issues. For example, the award winner may have testified to the state or national legislature on rural consumers' health care needs or made lasting contributions to rural health care in their community, region, or state. The nominee should be current on rural consumer health care issues and must have shown leadership in community and education regarding health care changes, needs, or improvements.

Click Here for a Awards Nomination Form
On July 9, the Senate overwhelmingly voted to clear a procedural hurdle on critical legislation to protect access to health care in rural America by a vote of 69 to 30. H.R. 6331, the Medicare Improvements for Patients and Providers Act, provides $2 billion in necessary rural health care dollars and temporarily eliminates the cuts to Medicare reimbursement rates to physicians. 



Rural Medicare Victory!
The legislation earlier passed the House, 355 to 59. Both votes were sufficient to override a threatened presidential veto; however, we need NeRHA members to continue to remind their legislators of the importance of the bill and urge them to support the bill in the event of a veto. The legislation's success in the Senate is in part due to NRHA and NeRHA's members' profound efforts in the form of e-mails and phone calls.  

For more information on H.R. 6331,click here.
CMS is revising location requirements and designation exceptions. It also appears to
be adding a requirement for RHCs to obtain or renew their designation every three years. In addition, the proposed rule would require new conditions of participation for clinics in the RHC program and change the calculation of payment rates for RHCs and FQHCs. 
Each year at its annual conference, the Nebraska Rural Health Association honors people who have contributed to rural healthcare through leadership. These awards recognize individuals and organizations who take on leadership roles in healthcare and their communities.  Awards will be presented at the annual Nebraska Rural Health Conference in September 11, 2008.