27th Annual HPSA & MUA/MUP Workshop

1. 27th Annual HPSA & MUA/MUP Workshop Department of Health Care Services Primary, Rural, and Indian Health Division California State Office of Rural Health October 3, 2019 Anaheim, CA

2. Objectives • What Is A State Office of Rural Health • What We Do For You • CalSORH Workforce Activities • Programs Requiring Federal Shortage Designation • Primary, Rural, and Indian Health Programs

3. What Is A State Office of Rural Health?

4. What Is AState Office of Rural Health? • Federal legislation established the State Offices of Rural Health Grant Program • State Offices of Rural Health Grant Program is funded by the Federal Health Resources Services Administration’s (HRSA) Federal Office of Rural Health Policy (FORHP) • The purpose of this program is to assist states in strengthening rural health care delivery systems by maintaining a focal point for rural health within each state • Eligibility for this funding is limited to states with State Offices of Rural Health https://nosorh.org/wp-content/uploads/2013/05/SORH-Factsheet.pdf

5. What Is AState Office of Rural Health? • Department of Health Care Services (DHCS), Primary, Rural, and Indian Health Division (PRIHD) administers the California State Office of Rural Health (CalSORH) • PRIHD Mission: Improve the health status of targeted population groups living in medically underserved urban and rural areas of California • PRIHD administers several programs that focus on increasing the capacity of California’s rural healthcare infrastructure under the umbrella of CalSORH (e.g., Emergency Preparedness & Response Program, J-1 Visa Waiver Program, Small Rural Hospital Improvement Program (SHIP), and the Medicare Rural Hospital Flexibility Critical Access Hospital Program (FLEX/CAH))

6. State Office of Rural HealthRequirements • Establish and maintain within the state a clearinghouse for collecting and disseminating information on: • rural health care issues • research findings relating to rural health care • innovative approaches to the delivery of health care in rural communities • Provide technical assistance and training • Conduct activities pertaining to the recruitment and retention of health care professionals to serve in the rural areas of their states • Collaborate with public and non-profit organizations to carry out CalSORH activities

8. What We Do For You • Inform rural health providers and stakeholders about emerging health issues, research, grant opportunities, Medi-Cal policy changes, federal policy changes, training opportunities, and other resources via a listserv • Deliver trainings to rural providers on emerging public health issues, infrastructure development, and other relevant rural issues • Provide grant development assistance to rural providers preparing federal or state funding proposals • Write letters of support for rural providers applying to HRSA, Federal Office of Rural Health Policy grants

9. What We Do For You • Produce a rural health status overview • Support and contribute to workforce projects with the Office of Statewide Health Planning and Development (OSHPD), Area Health Education Centers (AHEC), California Primary Care Association (CPCA), Office of Binational Border Health (OBBH) • Provide technical assistance in the development of emergency preparedness & response to Tribes and Tribal Health Programs • Collaborate with partner organizations and other state programs and associations; including but not limited to, the California State Rural Health Association (CSRHA) and the National Organization of State Offices of Rural Health (NOSORH)

10. What We Do For You • Administer and coordinate the J-1 Visa Waiver Program & other waiver programs for foreign medical graduates • Administer and coordinate the Medicare Rural Hospital Flexibility/Critical Access Hospital Program (FLEX) in collaboration with the California Hospital Association (CHA) • Administer the Small Rural Hospital Improvement Program (SHIP) • Provide technical assistance to DHCS concerning Federally Qualified Health Center and Rural Health Clinic Medi-Cal administrative issues

11. PRIHD Programs Requiring Federal Shortage Designation

12. The State definition utilizes Medical Service Study Area (MSSA) which is a sub-city and sub-county geographical unit used to organize and display population, demographic and physician data. Total MSSAs in California 541 Rural MSSAs have 250 persons or less per square mile and no Township of more than 50,000. Total Rural MSSAs 173 Frontier MSSAs have less than 11 persons per square mile: Total Frontier MSSAs 54 44 out of 58 counties are designated as Rural Rural and Frontier MSSAs represent approximately 80% of the total land mass of 158,706 square miles California’s Rural Areas

13. Diversity in California’s Rural Population Over 1 million farm workers 109 federally recognized Tribes 2nd highest Native American population in the US Highest population of Hmong people in the US; 65,000

14. Small Rural Hospital Improvement Program (SHIP) • SHIP is authorized by Section 1820 (g) (3) of the Social Security Act. Funded by the HRSA, FORHP • CalSORH disburses federal SHIP funds (approximately $10,000 per hospital in fiscal year 18/19) to small rural hospitals to help them: • Improve data collection activities in order to facilitate reporting to Hospital Compare • Improve quality outcomes • Maintain accurate billing and coding and improve the revenue cycle process • There are 38 SHIP participating hospitals in California

15. Medicare Rural Hospital Flexibility Critical Access Hospital Program (FLEX/CAH) • The Medicare Rural Hospital Flexibility Program was established as part of the Balanced Budget Act of 1997, or Public Law 105-33. Funded by the HRSA, FORHP. • Technical assistance and training is provided on Quality Improvement, Financial and Performance Improvement, and Community Health Systems development. • Seeks to preserve access to inpatient and emergency care within the rural community by offering enhanced Medicare reimbursement for health services rendered. • Hospitals seeking Critical Access Hospital designation must meet the following criteria: • Maintain no more than 25 inpatient acute care beds • Provide inpatient care for an average of 96 hours • Participate in a rural health network including patient referral and transfer • Make available 24 hour emergency services • Be located in a rural area and at least 35 miles from another hospital (15 miles in mountainous terrain) California has a total of 34 CAH designated hospitals

16. Physician WorkforceJ-1 Visa Waiver Program • Under the J-1 Visa Program, foreign medical graduates (FMGs) come to the United States to complete a graduate medical education program • Upon completion of the education program, FMGs must return to their home country for a period of not less than two years before reentering the United States • States can recommend that the U.S. Department of State waive the home residency requirement • Each state may recommend waivers for up to 30 physicians per federal fiscal year • Application period begins October 1st of each fiscal year until filled. • Applications for Specialist accepted after July 1st of each fiscal year, if slots remain available

17. J-1 Visa Waiver Program Physician Requirements • Primary care physician that completes a U.S. residency training program in one of the following practice areas: Family Medicine, General Pediatrics, General Obstetrics/Gynecology, General Internal Medicine or General Psychiatry • Practice primary care medicine full-time (minimum 40 hours per week) • Practice primary care for at least three years in a Health Professional Shortage Area (HPSA) or a Medically Underserved Area (MUA) • Possess a California Medical License • Physician will provide services to a caseload that is comprised of at least 30% Medicaid (Medi-Cal) patients or a 30% caseload comprised of a combination of Medi-Cal and uninsured patients throughout the three year contract period

18. Other Visa Waiver Programs CalSORH provides letters of support for physicians that meet the criteria for the following workforce waiver programs. Applicants must agree to work in a shortage designation area. • Federal HHS J-1 Visa Waiver Physician agrees to work 40 hours per week in a clinical practice for a period of 3 years in a MUA/MUP/Mental Health Shortage Area or VA facility. The petitioner files directly to the Health and Human Services agency. It allows the petitioner to apply for the waiver even if astate’s 30 slots are filled. • National Interest Waiver Physician agrees to work 40 hours per week in a clinical practice for a period of 5 years in a MUA/MUP/Mental Health Shortage Area or VA facility. It relieves the petitioner from fulfilling the labor certification requirement as administered by the U.S. Department of Labor.

19. CalSORH Workforce Activities

20. CalSORH Workforce Activities • J-1 Visa Waiver Program • 3 RNET Employment Portal: Partner with OSHPD to Recruitment Federally Qualified Health Centers & Rural Health Clinics to use the portal. Pay dues • Train Community Health Workers/Promotores: Partner with Office of Binational Border Health • Deliver Recruitment and Retention Webinars for Rural Providers: Partner with the Area Educations Health Center (AHEC) • Co-host Annual Rural Health Conference with California State Rural Health Association (CSRHA) and California Hospital Association (CHA)

21. Primary, Rural, and Indian Health Programs

22. Emergency Preparedness & Response Program • The California Department of Public Health and Department of Health Care Services have an interagency agreement whereas DHCS is tasked with providing outreach, education, and technical assistance to American Indian Health Clinics, Tribal leaders, and Tribal communities on all hazard emergency preparedness planning and response. • The DHCS Emergency Preparedness & Response Program provides on-site technical assistance and training and facilitates communication between tribes and clinics.

23. Emergency Preparedness & Response Program • On-Site Assistance • Emergency Operations Plan (EOP) Technical assistance for emergency preparedness activities - Development & Review of Plans • After Action Report (AAR) Development and Review • Table Top Exercise Development and Review • Trainings Communication Plans, Implementing Emergency Preparedness Requirements, Active Shooter, FEMA courses, Behavioral Health and Psychological First Aid • CAHAN Promote Membership • Annual Survey Conduct Needs Assessment All services are offered at no cost to the Indian health programs or tribes

24. Emergency Preparedness & Response Program - CMS Emergency Preparedness Rule - - Implementation Date was November 16, 2017 - • Emergency Plan: Develop an emergency plan focusing on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies specific to location • Policies and Procedures: Develop and implement EP policies and procedures • Communication Plan: Develop and maintain a communication plan that complies with both Federal and State law • Training and Testing Program: Develop and maintain training and testing programs • Develop and maintain training and testing programs, including initial training in policies and procedures • Demonstrate knowledge of emergency procedures and provide training at least annually • Conduct drills and exercises to test the emergency plan

25. Upcoming Events • Emergency Preparedness and Response Program trainings for Indian Health Clinics, Tribes, and County Medical and Health Operational Area Coordination Program (MHOAC Programs) (TBA 2019/2020) • Annual Grant Writing Workshop, September 24, 2019 • CalSORH Training and Technical Assistance Needs Assessment Survey(tentative release December 2019) Janet Coffman, MA, MPP, PhD, University of San Francisco, Professor of Policy and Community Medicine

26. CalSORH Program Contacts Corinne Chavez, CalSORH Program Manager email: Corinne.Chavez@dhcs.ca.gov CalSORH Program Coordinator phone: 916-449-5770 e-mail: CalSORH@dhcs.ca.gov http://www.dhcs.ca.gov/services/rural/Pages/default.aspx Emergency Preparedness and Response Program Coordinator Joshua Standing Horse Email: Joshua.StandingHorse@dhcs.ca.gov J-1 Visa Waiver Coordinator J-1VisaWaiverProgram@dhcs.ca.gov http://www.dhcs.ca.gov/services/rural/Pages/J-1VisaWaiver.aspx

27. Questions