Sherilyn Pruitt, Director, Office for the Advancement of Telehealth,

1. All Aboard for Rural HealthIndiana Rural Health Association17th Annual Rural Health ConferenceJune 10, 2014 Sherilyn Pruitt, Director, Office for the Advancement of Telehealth, Office of Rural Health Policy DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2. Changing Environment for Rural Health Mid-2000s: First small steps toward pay for reporting 1999: First of a series of IOM Reports on Quality • 2014 & Beyond • Industry Consolidation • Quality Penalties • Heavy Focus on CAHs • Changing Nature of Fee for Service and New Models • Possible Workforce Shortages • Medicaid Decisions • Changing Payer Mix • DSH Reductions 1983-1987: Wave of Rural Hospital Closures

3. Emerging Questions & Challenges What Might This Mean for Rural Health?

4. Our Goal…. Helping Rural Providers Make the Transition

5. How ORHP Programs Support Rural Hospitals • Regulation Review • Flex Monitoring Team • National Advisory Committee on Rural Health & Human Services • Flex • SHIP • Small Health Care Provider QI • State Office of Rural Health • Technical Assistance & Services Center • Rural Assistance Center • RHC TA Series • Outreach • Network • Network Planning • Telehealth Networks • USDA Capital Loans • Workforce

6. HHS and Rural Health • The Office of Rural Health Policy • HRSA • HHS • Other Key Federal Players 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”). Section 711 Of the Social Security Act http://www.hrsa.gov/ruralhealth/index.html

7. Collaboration

8. http://www.whitehouse.gov/administration/eop/rural-council

9. Finance • Variable National Picture • Identifying and Promoting Successful Interventions • Monitoring “At-Risk” Communities • Helping Rural Health Clinics

10. Finance • Where Does Rural Fit In … • ACOs • Medical Homes • Bundling • Value-Based Payment • Deficit Reduction

11. Community Health

12. President’s Budget FY 2015 • Modernizing Graduate Medical Education • Expanding the National Health Service Corps (NHSC) • Extending Enhanced Medicaid Primary Care Payments • Other provisions include $4 million to fund a new Rural Physician Training Grant program

13. Rural Health Quality Special Projects in Critical Access Hospitals and Rural Health Clinics

14. Supporting Rural Health Quality • Small Rural Hospital Improvement Program • The Future of the Flex Grant

15. Health Information Technology and Telehealth • Leveraging Telehealth Technology • Grants as a Test Bed • A New Focus on the Evidence-Base • A Special Focus on Veterans • Connecting Communities with National Experts • Identifying Ongoing and Emerging Policy Challenges

16. Policy and Research • Ensuring a Voice for Rural • Picking Through the Annual Payment Updates • Translating the Larger Policy Context • Evolution of the ORHP Research Role • Informing Policy .

17. Research Processes • Portfolio development • Programs and cooperative agreements • Products – Briefs, peer-reviewed journal articles, used to provide: • advice to HRSA, Department • information to other Federal policymakers, e.g., MedPAC, CMS, GAO • Information to other rural stakeholders

18. FY14 Competitive Grant Programs Competitive Grant Opportunities • Evidence-Based Telehealth Network Program • Guidance Available in Late Spring • September Award Date • 3-5 Awards; @ $400K per year, 4-year project period • Contact: cmena@hrsa.gov

19. FY 2015 Competitive Grant Programs Rural Health Care Services Outreach Program Rural Health Network Development Planning Program 1 year $100,000 help to promote the planning and development of healthcare networks Eligibility: rural, non-profit or public entity FOA available Fall/Winter 2014 Start date: June 2015 Contact: Amber Berrian, aberrian@hrsa.gov, 301-443-0845 • 3 years • $200,000 per year • To deliver health care services in rural communities • Evidence-based • Outcomes oriented • Eligibility: rural, non-profit or public entity, partner with 2 other entities • FOA available Fall/Winter 2014 • Start date: May 2015 • Contact: Linda Kwon, lkwon@hrsa.gov, 301-594-4205

20. FY15 Competitive Grant Programs Ongoing Rural Hospital Grant Funding • The Rural Hospital Flexibility Grant Program • $25 million to 45 States with CAHs • The Small Hospital Improvement Grant Program • $15 million to More Than 1,500 Small Rural Hospitals • Contact: kmartinsen@hrsa.gov

21. The Rural Assistance Center http://www.raconline.org

22. Flex Monitoring Team Studies and Data on Critical Access Hospital Issues and State Flex Programs http://www.flexmonitoring.org/indicators.shtml

23. RHC TA Series • ORHP funded through the National Association of Rural Health Clinics • Listserv • Exchange info, ask questions • Sign up at http://03672e4.netsolhost.com/?page_id=712 • Conference Calls • 6 per year on range of topics • Sign up and review previous calls at http://www.hrsa.gov/ruralhealth/policy/confcall/index.html

24. National Organization of State Offices of Rural Health http://www.nosorh.org

25. Community Health Gateway Toolkits Resources and best practices to help you identify and implement public health programs Rural Health Models and Innovations Hub Find examples of approaches you can adapt for your program, including models shown to be effective, as well as new and emerging ideas. Sustainability Tools The tools provided here are intended to help you consider the sustainability of programs that address community needs and to engage your partners and stakeholders in this planning process. Economic Impact Tool Show how your program’s grant funding affects your community’s economic well-being http://www.raconline.org/communityhealth/

26. Policy and Research Resources http://www.ruralhealthresearch.org/

28. How to be a Grant Reviewer ORHP has multiple grant program reviews each year We need reviewers with rural experience to be a part of our Objective Review Committee panels You must register to be a reviewer: http://www.hrsa.gov/grants/reviewers/ Indicate “rural health” as one of your specialties in the background information

29. Sherilyn Pruitt Office for the Advancement of Telehealth Office of Rural Health Policy, HRSA spruitt@hrsa.gov 301-594-0819