Rural Community Infrastructure Roundtable Meeting August 28, 2018

1. Rural Community Infrastructure Roundtable MeetingAugust 28, 2018 Kristi Martinsen Hospital State Division Director, Federal Office of Rural Health Policy 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. HRSA’s Regions

4. Office of Regional Operations HRSA’s national network of 10 Regional Offices strive to increase access to quality care, information and resources. • Provide responsive outreach and assistance to HRSA grantees, target populations and stakeholders • Partner with and convene local and regional stakeholders to advance HRSA priorities • Extend the reach of HRSA’s Bureau and Office programs • Represent HRSA at meetings and events to promote HHS/HRSA initiatives • Identify emerging regional/state trends, priorities, and effective strategies • Office of Regional Operations

5. FORHP Programs and Activities Community-Based Division Hospital-State Division • Pilot Programs for Rural Communities • Expanding the Community Health Gateway • Public Health Programs • Black Lung and Radiation Exposure • Grants Focusing on Performance and Quality Improvement for Small Rural Hospitals • State Offices of Rural Health Office for the Advancement of Telehealth Policy Research Division • Policy and Regulatory Analysis • Research • Telehealth Network Grants • Telehealth Resource Centers • Licensure and Portability FY 2018: Addition of Rural Communities Opioid Response Program

6. Rural Safety Net Providers: Rural Hospitals • Critical Access Hospitals (CAHs) – This is a special designation under Medicare for facilities have fewer than 25 beds and a limitation on length of stay of an average of 96 hours. • Medicare Dependent Hospitals (MDHs) – This is a special designation under Medicare for small rural hospitals where Medicare patients comprise at least 60 percent of their patient base. They have the option of receiving a special payment rate under Medicare based on historic costs. • Sole Community Hospitals (SCHs) – This is a special designation under Medicare for small rural hospitals that are 35 miles from another acute-care hospital. They also receive the option of a special payment rate under Medicare in recognition of their geographic isolation and the challenge of serving that population. • Rural Prospective Payment System Hospitals (PPS)– These are regular general acute care hospitals reimbursement by Medicare on the standard pre-determined, fixed amount for services.

7. Rural Safety Net Providers: RHCs and FQHCs • Rural Health Clinics (RHCs) – These are Medicare-certified clinics that were created by The Rural Health Clinic Services Act (RHC Act) of 1977 and receive certification, based in part on their location, from the Centers for Medicare & Medicaid Services (CMS) for participation in the Medicare and Medicaid programs. • The Health Center Program (also known as Federally Qualified Health Centers): This program is administered by HRSA’s Bureau of Primary Health Care and was established in the 1960s as a War on Poverty demonstration program. The aim of the program was to provide access points to health and social services for medically underserved and disenfranchised populations in urban and rural areas.

8. 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 Connect with your SORH: https://nosorh.org/nosorh-members/

9. Telehealth Resource Centers (TRCs)

10. Resources and Tools Regarding Capital Needs

11. Tools & Resources • National Rural Health Resource Center, with Capital Link Are you ready to begin a capital project? Toolkit • Related Webinars • Strategic Capital Planning and Capital Budgeting • Operational Considerations for Facility Planning and Capital Project Management • Laying the Groundwork for a Capital Campaign • Business Planning and Financial Projections for Capital Projects • Rural Health Information Hub - Financing Capital for Rural

12. Tools & Resources • Delta Region Community Health Systems Development Program https://www.ruralcenter.org/drchsd • Vulnerable Hospitals Toolkit (2016) https://nosorh.org/wp-content/uploads/2016/11/Vulnerable-Hospital-Toolkit-Excerpt.pdf • Critical Access Hospital Replacement Process: Blueprint and Roadmap (2010 –oldies but goodies) https://www.ruralcenter.org/sites/default/files/cahreplacementprocess_0.doc

13. 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 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: 1.800.270.1898 • By email: info@ruralhealthinfo.org https://www.ruralhealthinfo.org/

14. Capital Link (www.caplink.org)

15. Kristi MartinsenHospital State Division DirectorFederal Office of Rural Health PolicyHRSA301-594-4438kmartinsen@hrsa.gov

16. To learn more about our agency, visit www.HRSA.gov