Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 94 - Rural Health Clinic Program › Section 13 CSR 70-94.030 - Transformation of Rural Community Health (ToRCH)

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This emergency rule establishes the
				  Transformation of Rural Community Health (ToRCH) program. The purpose of ToRCH
				  is to direct new resources to rural communities that commit to addressing
				  social conditions that lead to poor health.
PURPOSE: This rule governs the Transformation of
				  Rural Community Health (ToRCH) program. ToRCH provides MO HealthNet coverage of
				  both clinical and health-related social needs through a hub-based model. Care
				  under ToRCH is delivered by a collaboration between participating providers as
				  well as community-based organizations.
EMERGENCY STATEMENT: The Department of Social
				  Services, MO HealthNet Division (MHD) finds that this emergency rule is
				  necessary to preserve a compelling governmental interest as it allows MHD to
				  immediately extend MO HealthNet coverage in rural communities to include
				  services that address health-related social needs in addition to traditional MO
				  HealthNet services. On June 30, 2023, Governor Parson signed CCS SCS HCS HB 11,
				  which, for the first time, appropriates funding for State Fiscal Year (SFY)
				  2024 for the Transformation of Rural Community Health (ToRCH) program. In the
				  time since the appropriation was authorized, MHD worked diligently to develop
				  and submit a section 1915(b) waiver for approval by the Center for Medicare and
				  Medicaid Services (CMS). After working with CMS on the waiver language, and in
				  multiple technical assistance sessions, the waiver for ToRCH was approved on
				  March 25, 2024. This emergency rule is being issued now that MHD has final
				  approval to use the federal funds that were appropriated to it to administer
				  the operation of ToRCH. The ToRCH model of care coordination is urgently needed
				  in Missouri's rural counties, due to the ongoing struggle to maintain an
				  adequate health care system in these regions, as well as address chronic social
				  conditions that lead to bad health outcomes, which can in turn require costly
				  medical care. Through ToRCH, MHD will work with rural providers to create
				  community hubs in eligible rural counties that will both coordinate medical
				  care and address the health-related social needs of MO HealthNet participants
				  in these communities. MHD has already identified providers to launch the
				  program and is implementing the program on the ground in six (6) counties.
				  These providers are poised to hire staff and support the Community-Based
				  Organizations (CBOs) they work with, and they require the resources to complete
				  that work. Promulgating this rule will give MHD the authority to make this
				  happen. In order to timely release this funding to start delivering services as
				  soon as possible, an emergency rule is required. A proposed rule, which covers
				  the same material is published in this issue of the Missouri Register. This
				  emergency rule limits its scope to the circumstances creating the emergency and
				  complies with the protections extended by the Missouri and United States
				  Constitutions. The MHD believes this emergency amendment to be fair to all
				  interested parties under the circumstances. The emergency rule was filed April
				  22, 2024, becomes effective May 6, 2024, and expires November 1,
				  2024.
(1) This rule
				implements the Transformation of Rural Community Health (ToRCH) program. ToRCH
				is a hub-based model that is designed to allow rural communities to have the
				flexibility to address health-related social needs (HRSN) among their MO
				HealthNet populations in a manner that focuses on improving health outcomes.
				ToRCH will integrate social care supports into clinical care, so that clinical
				outcomes are less likely to be compromised by social challenges. ToRCH will
				also create a new role for rural health care providers, and a new path to
				sustainability for these providers.
(2) Definitions. For purposes of this rule,
				the following words and phrases are defined as follows:
(A) "Community" shall mean a county or group
				of counties considered by the ToRCH entity as its core service region, and for
				whose health outcomes the leadership board will be held accountable;
(B) "Community Based Organization (CBO)"
				shall mean a public or private not-for-profit entity that provides specific
				services or resources to the community or targeted population within the
				community;
(C) "Community Health
				Needs Assessment" shall mean a community-wide assessment that identifies key
				health needs and issues through systemic, comprehensive data collection and
				analysis;
(D) "Health-related social
				needs (HRSN)" shall mean an individual's unmet, adverse social conditions that
				contribute to poor health. These needs can include, but are not limited to:
1. Food insecurity;
2. Housing instability;
3. Unemployment or under-employment;
				or
4. A lack of reliable
				transportation;
(E) "Rural
				community health hub" shall mean a partnership among the ToRCH entity, primary
				care, behavioral health, and community-based organizations, to provide
				communitylevel care management services, including but not limited to strategic
				coordination of community-based services; and
(F) "ToRCH entity" shall mean the leader of a
				rural community health hub that will provide community-level care management
				services, i.e. strategic coordination of community-based services that primary
				care partners are then able to utilize in a systematic way to more fully
				achieve the goals of primary care case management on an individual patient
				level. A ToRCH entity shall be located in a county deemed eligible for
				rural-targeted funding by the Federal Office of Rural Health
				Policy.