# Presentation: 656899

## Rural Health Resources

- Resources for Rural Health Networks
-  National Cooperative of Health Networks
- 	Tom Morris, Deputy Director
- 	Office of Rural Health Policy
- 	Health Resources and Services Administration
- 	U.S. Department of Health and Human Services

## Rural Health Resources

- Resources for Rural Health Networks
-  National Cooperative of Health Networks
-  Today’s Topics
-  New Opportunities
-  Washington Resources
-  Grant Programs

## Rural Health Resources

- Resources for Rural Health Networks
-  340b: Side Benefit of the Medicare Modernization Act
-  DSH change creates opportunity

## Rural Health Resources

-  Significance of DSH Change
-  Key for Rural Hospitals in the South
-  Opens Door to the 340b Drug Program which lowers the hospitals’ prescription drug costs
-  	- Open to facilities with a DSH % of 11.75 	or greater
- 	- Must also meet certain ownership 	requirements

## Rural Health Resources

## Rural Health Resources

-  340b Program Ownership Requirements
-  Hospitals must also be ...
- 	- Owned or operated by a unit of State or local 	government
- 	- A public or private non-profit corporation which is 	formally granted governmental powers by a unit of 	State or local government
- 	- A private non-profit hospital which has a contract with 	a State or local government to provide health care 	services to low income individuals

## Estimated Prices For Selected Public Purchasers, as Percent AWPvon Oehsen; Pharmaceutical Discounts Under Federal Law: State Program Opportunities

- Stephen Schondelmeyer, PRIME Institute, University of Minnesota (2001)

**100.0%**

**80.0%**

**67.9%**

**60.5%**

**51.7%**

**49.0%**

**47.9%**

**34.6%**

**0%**

**20%**

**40%**

**60%**

**80%**

**100%**

**AWP**

**AMP**

**Medicaid (Min.)**

**Medicaid Net**

**FSS**

** ****340B**

**FCP**

**VA Contract**

- Private Sector Pricing

## Rural Health Resources

- 340B Program

**Provides discounts on outpatient drugs to certain “covered entities.”**
**Manufacture that participate in Medicaid must  sign a Pricing Agreement to participate in the 340B program**

## Rural Health Resources

- Use of 340B Drugs

**Can only be used for “Covered Entity” Patients **** **
**Cannot be used to generate Medicaid rebate on 340B discounted drug**

## Rural Health Resources

-  The 340b Program
-  Key for Rural Hospitals in the South
-  Hospitals apply to HRSA first
-  CMS must then certify the DSH % (although letter from FI certifying eligibility also works)

## Rural Health Resources

- Contacting HRSA’s Office of Pharmacy Affairs

**Telephone:****	****	****800-628-6297**
**Prime Vendor:****	****800-270-8464 x4141**
**TA:****	****	****	****866-PharmTA**
**Web: ****	****	****          http://bphc.hrsa.gov/opa**
**	****	****	****	**_**http://pssc.aphanet.org **_

## Rural Health Resources

- Public Hospital Pharmacy Coalition (PHPC)
**    ****www.phpcrx.org****	****                       ****202-872-6774**
- Pharmacy Services Support Center (PSSC)
-     **http://pssc.aphanet.org                        ****1-800-628-6297**
- 340B Prime Vendor Program
**    ****www.hppi340bpv.com                         972-910-6646**** **

## Rural Health Resources

- The National Advisory Committee on Rural Health and Human Services
-  Another Rural Voice within DHHS
-  National Expert Panel
-  Chaired by Former S.C. Governor David Beasley
-  Annual Reports to the Secretary

## Rural Health Resources

- The Secretary’s Rural Initiative
-   Continues to yield benefits after two years in place
-  Agencies thinking about rural proactively
-  With more than 220 programs that serve rural communities, HHS trying to make it easier to connect the dots

## Rural Health Resources

-  Example of the Culture Change: CMS Open Door Forums
-  Held monthly
-  Includes a rural call, as well as calls for other major provider types (hospitals, docs, nursing homes, etc.)
-  Helps resolve regulatory issues for Medicare and Medicaid providers

## Rural Health Resources

- The Secretary’s Rural Initiative
-   (continued)
-  Meets quarterly
-  All Key Agencies and Operating Divisions Participating
-  Looking at Joint Integrated Technical Assistance

## Rural Health Resources

- The Secretary’s Rural Initiative
-   (continued)
-  Key Ongoing Challenge: Helping rural communities to understand and to take advantage of available resources
-  Showing rural communities how the resources and programs fit together to serve rural communities

## Rural Health Resources

- Key ORHP Programs
-  Outreach Grants
-  Network Grants
-  Rural Health Research
-  Rural AED
-  Flex and SHIP

## Rural Health Resources

- Outreach Grants
- 	Demonstration Grants
- 		- Three Years
- 		-  $200K Annually
- 		- Non-Categorical
- Disclaimer: 15-20 Awards Each Year/ More than 200 applicants

## Rural Health Resources

- Network Development Grants
- Demonstration Grants
- - Three Years
- -  $200K Annually
- - Non-Categorical

## Rural Health Resources

- Network Development Planning Grants Demonstration Grants
- 		- One Year
- 		-  $50-75K Annually
- 		- Non-Categorical
- 		- Focus on Initial Steps 			  Toward Networking

## Rural Health Resources

- Rural Health Research
-  Rural Health Research Center Grant Program
-  Eight centers funded
-  Single Rural Health Research Award Program
- 		- Fund 5-7 single research 			awards a year

## Rural Health Resources

- The Rural Access to Emergency Devices Program
- 	- Supports Placement of 		Automatic External Defibrillators 	(AEDs) in Rural Communities
- 	- Supports Training in Use of AEDs 	by First Responders
- 	- State Grant Program: EMS Office

## Rural Health Resources

- The Rural Hospital Flexibility Grant Program
- 	- Grants to States
- 	- $25 Million a Year (Based on Congressional 	Appropriations)
- 	- Focus on Critical Access Hospital 	conversion; quality, EMS Integration 	and Networking

## Rural Health Resources

- The Small Rural Hospital Improvement Program (SHIP)
- 	- Grants to Hospitals (through State)
- 	- Quality Improvement
- 	- Prospective Payment System  	Transition
- 	- HIPAA Compliance

## Rural Health Resources

- State Offices of Rural Health
- 	- Matching Grant Program
- 	- All 50 States participating
- 	- Line also supports State Rural 	Health Associations

## Rural Health Resources

**Office of Rural Health Policy: Contacts:** (301) 443-0835
- Outreach: Eileen Holloran, Nisha Patel, Lily Smetana,  Jennifer Chang
- Network: Erica Molliver
- Flex: Steve Hirsch
- SHIP: Keith Midberry
- AED: George Brown
- Rural EMS: Blanca Fuertes
- Research: Joan Van Nostrand, Nisha Patel
- Policy: Emily Costich, Blanca Fuertes, Carrie Cochran
- State Offices: Jennifer Riggle, Jennifer Chang

## Rural Health Resources

- Other HRSA/ORHP Supported Rural Services
- Rural Recruitment and Retention Network
- 	(http://www.3rnet.org)
-  Rural EMS Technical Assistance Center (http://www.ruralhealth.hrsa.gov/ruralems/index.html)
-  Rural PACE Assistance (http://www.ruralhealth.hrsa.gov/pace/index.htm)

## Rural Health Resources

- Other Key HHS Grant Programs
- 	- Primary Care
- 	- Quality and Information 	Technology
- 	- Capital
- 	- Workforce

## Rural Health Resources

- Primary Care
- Community Health Center Expansion
- 	- Section 330 Grants
- 	- Federal Tort Claims Act Coverage
- 	- 340(b) Drug Pricing Program
- 	- FTCA Coverage
- 	- Contact (301) 443-4300

**Notes:**
So far, they announced 76 new access points in December and plan to fund 17 more in 2005

## Rural Health Resources

- Primary Care
- Healthy Communities Access Program
- 	- Focus on ...
- 		 coordination of care, safety net, HIT, 		disease prevention, etc.
- 	- Contact (301) 594-4300

## Rural Health Resources

- Information Technology:
- AHRQ Healthcare IT Program
- 	- Focus on Quality Improvement 	through Information Technology
- 	- 2005 applications only open to 2004 planning grant awardees
**http://www.ahrq.gov**

## Rural Health Resources

- Information Technology:
- National Library of Medicine
- - Information Systems Grants
- www.nlm.nih.gov/pubs/factsheets/infosystem.html
- Internet Access to Digital Libraries
- www.nlm.nih.gov/ep/iadl-rfa.html
- - Integrated Advanced Information Systems Grants
- www.nlm.nih.gov/pubs/factsheets/iams.html

## Rural Health Resources

- Capital:
- USDA Community Facilities Program
- 	- State Administered
- 	- Grants, Loans and Loan Guarantees
- 	- Web Site:
- _[www.rurdev.usda.gov/rhs/cf/brief_cp_grant.htm](http://www.rurdev.usda.gov/rhs/cf/brief_cp_grant.htm)_

## Rural Health Resources

- Capital:
- HUD 242 Program
- 	- Hospital Focused
- 	- Mortgage Insurance
- 	- Special Rules for CAHs
- 	- Three Approved
- 	- Web site:
- _[www.hud.gov/offices/hsg/hosp/hsghospi.cfm](http://www.hud.gov/offices/hsg/hosp/hsghospi.cfm)_

## Rural Health Resources

- Workforce:
- J1 Visa Waiver Requests
- 	- USDA Out; HHS Steps In
- 	- Limited to RHCs and FQHCs with 	a HPSA Score of 14 or higher
- 	- For more information, call 301-	594-4154
- http://www.hhs.gov/ogha/exchange.html

## Rural Health Resources

- Workforce:
- Health Careers Opportunity Program
- 	- Funds for Schools of Medicine, Dentistry, 	Pharmacy and Other Allied Health
- 	- Assistance for Students from 	Disadvantaged Backgrounds
- 	- Contact (301) 443-1348

## Rural Health Resources

- Workforce:
- Nursing Education Loan Repayment Program
- 	- Repayment of Educational Loans for 	Registered Nurses
- 	- Must Serve at Least 2 years in Critical 	Shortage Facility (CSF)
- 	- Contact (301) 443-3232

## Rural Health Resources

- Workforce:
- National Health Service Corps
- 	- Recruit Health Professionals to Deliver Primary Care Services in Underserved Communities
- 	- Loan Repayment and Scholarship Programs
- 	- 1-800-221-9393/Email callcenter@hrsa.gov
- 	- Web site: http://nhsc.bhpr.hrsa.gov/

## Rural Health Resources

- Nurse Managed Centers Grants (part of the Basic Nurse Education Practice Grants)
- - Support projects that provide an access point for the underserved while also serving as a training ground fornursing students.
- - Application materials are available on the web site throughout the year. Applications are typically due in late January with awards made by no later than mid-summer.
- - **Contact: **Madeline Turkeltaub, PhD, CRNP, RN, 301-443-6193

## Rural Health Resources

- The HRSA Preview
- - Includes information about all the HRSA Grant Opportunities for FY 2005
- - This is available on the Internet at:
-  http://www.hrsa.gov/grants.htm

## Rural Health Resources

- Workforce:
- Workforce Investment Boards
- 	- Workforce Investment Act of 1998 	- State and Local Boards
-  	- Workforce Issues
-  	- Health Care Workforce Shortages

## Rural Health Resources

- Mental Health: Healthy Schools, Healthy Students
- 	- DoJ, DoE, HHS Program
- 	- Designed to prevent violence and substance 	abuse among our Nation’s youth, schools, and 	communities
- 	- $1 million over 3 years
**http://www.sshs.samhsa.gov/initiative/default.aspx**

**Notes:**
30 Rural grants in 2004; that represents 1/3 of the total grantees
Expect 40 in 2005

## Rural Health Resources

**Tom Morris**
**Deputy Director**
**Office of Rural Health Policy**
**HRSA, DHHS**
**(301) 443-4269**
**Tmorris@hrsa.gov**