June 2023 Newsletter

Message from the IARHC Board President

IARHC members, 

It has been a busy and fruitful year for IARHC! From our annual conference to participating in a strategic plan for IARHC, the board is excited for another year of continuing to strengthen the organization and our ability to support RHCs across the state.

IARHC's annual membership drive is coming to a close at the end of the month. We appreciate all of our members that renewed their membership with IARHC and continue to welcome new members. If your clinic still needs to renew membership, please complete the form on the IARHC website.

Thank you to all of the candidates in the annual Board of Directors election. The election closes this week, so be sure to read about the candidates and cast your vote by Friday, June 23rd.

In this newsletter, you will find information about IARHC resources, Lilypad quality improvement programs, policy updates, and rural health clinic updates.

Thank you for being members of IARHC and your commitment to providing quality access to healthcare to rural communities across Iowa!


Ann Wise

Board President

Clinic Director

UnityPoint Clinic Buena Vista, Sac City, and Lake View

IARHC Resources

IARHC's new website contains updated resources for all RHCs as well as exclusive resources for IARHC members. Resources for IARHC members only will be announced in our weekly listserv communications and newsletters. Two resources available to members only are Transitions of Care Process Flow Checklist and a RHC Evidence Binder which includes an evidence binder description and content that should be included in your clinics evidence binder.

Other resources developed by IARHC include: a check list of items requested during a survey, RHC chart reviews, 28 day multi-dose medication calendar, and more. The resource page also includes information from HRSA, CMS, Iowa Medicaid, NARHC, and Iowa HHS. Visit the IARHC Resource page here.

IARHC Resources Webpage

IARHC Spring Workshop Recap and Upcoming Events

Thank you to all that attended the IARHC Spring Workshop in May! We hope you enjoyed the full day workshop focused on billing and coding. Charles James Jr., President and CEO of North American HMS provided presentations on RHC Preventative Services Billing, RHC Behavioral Health Changes, and a RHC Billing Overview. If you attended the workshop and did not save the presentation slides, please email [email protected].

Be on the lookout for information about IARHC's fall conference. Information will be shared in our weekly listserv in the coming weeks.

About Lilypad

Lilypad is a Maine-based analytics firm founded in 2011 to provide mobile and web-based performance improvement applications for healthcare provider organizations and State Offices of Rural Health. Lilypad adheres to a core business principle that accountable leaders require sound data and simple, innovative tools to be successful in their roles within the emerging value-based care delivery environment. More information about Lilypad is available on the IARHC website.

Quality Improvement Programs

Over the last year, Lilypad has worked to develop and implement a formal quality improvement project for provider-based rural health clinics (PB-RHC) in Iowa. The goal of the project is to help PB-RHCs improve the quality of care for their patients, simplify and streamline transitions of care between primary care and inpatient services, and strengthen chronic disease management processes. Lilypad has worked to identify a cohort of provider-based RHCs that are motivated to implement a set of clinical and operational best practices to improve performance in one of the focus areas listed below:

  • Controlling Blood Pressure
  • Preventive Care and Screening: Tobacco Use
  • Childhood Immunization Status
  • Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
  • Documentation of Current Medications

These metrics are the most relevant quality improvement metrics for rural health clinics and are built into Lilypad’s Practice Operations National Database (POND) web application and are available for reporting on a quarterly basis. Participating PB-RHCs selected a metric/focus area and translated those activities into a formal Plan-Do-Study-Act (PDSA) initiative to be implemented during the project year. Lilypad’s PDSA initiative tool is a component part of its Learning and Knowledge Exchange (LAKE), a web-based portal containing quality improvement tools, best practice models and a library of compliance, regulatory, strategy and performance improvement resources for RHCs. While not a prerequisite, the proposed project can serve as a basis for RHCs to earn and/or maintain Patient Centered Medical Home (PCMH) accreditation.

Linking Finance and Quality in Iowa RHCs Webinar

In an era of increased value-based reimbursement, successful small rural clinics and hospitals will integrate quality and financial functions to eliminate operational silos. When properly implemented, the variety of new public and private payer-sponsored chronic care programs have the potential to fund mission-based priorities to increase access to high quality care and fuel service growth. Please pre-register for this free 60-minute webinar on Thursday, August 10th at 10:00 am using this link. This webinar is open to all RHCs.

U.S. Census Rural Tools Webinar | Iowa Rural Development Council

Join the Iowa Rural Development Council on Friday, June 23rd, for a webinar presented by Kira O'Bradovich, a data dissemination specialist with the US Census Bureau. The webinar will give a brief introduction on rural census data and allow for an opportunity to learn about their data tools. O'Bradovich will also include a live demo of one of the Census Bureau's most user friendly and rural-relevant tools as well as a hands-on exercise for those who would like to try it out. In addition, O'Bradovich will discuss changes that have been made to the definition of "rural" and potential impacts. Join the meeting using this link to join the webinar on June 23rd.  

Rural Healthcare Provider Transition Project | Funding Opportunity

Applications are being accepted to receive one year of technical assistance beginning in November 2023. This program is designed to assist small rural hospitals and certified rural health clinics strengthen their foundation in key elements of value-based care including, but not limited to, efficiency, quality, patient experience, and safety of care. Click here for more information. 

New Reports to Congress on Medicare and Medicaid Health Care Delivery System

The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment Advisory Commission (MACPAC) submit annual reports to Congress with analyses and recommendations from Commissioners on Medicare and Medicaid, respectively. In their June report, MedPAC highlights telehealth utilization and examines telehealth services payment implications for rural and urban providers post- public health emergency. Among other topics, the MedPAC report also addresses aligning fee-for-service payment rates across ambulatory settings reforming Medicare’s wage index systems. MACPAC examines Medicaid Disproportionate Share Hospital payments to rural and urban hospitals.

Medicaid Coverage Outreach Information

Please see the linked resources below for information regarding keeping people covered in Medicaid and CHIP as states restart full eligibility reviews.

  • Call to Action for Partners on Medicaid Redeterminations (including community organizations, unions, employers, private sector, etc.)
  • Health Professionals Tool for speaking to patients to help them prepare for Medicaid and CHIP renewals

No Surprises Act Resources for Providers and Patients

CMS recently released a set of tools regarding more information about the No Surprises Act for patients and providers. These tools include an explanation of a good faith estimate, requirements, and other resources. View the CMS webpage here

Telehealth Flexibilities Following the PHE

In preparation for the end of the PHE, Iowa Medicaid examined telehealth flexibilities and changes in clinical practice and regulatory structure, and solicited feedback from stakeholders. From this, Iowa Medicaid identified opportunities to expand access while maintaining or improving quality. More information is included in this informational letter

NARHC News, Policy, & Resources

MACs to Adjust RHC Payment Error

NARHC has confirmed with CMS that the MACs will be adjusting payments and no action will be needed from rural health clinics. NARHC believes that each MAC will issue a notification acknowledging the issue and describing how they will rectify the error.

NARHC believes that most, if not all, of the MACs will be initiating mass adjustments for the improperly processed claims. NARHC will post the links from the MACs regarding this issue as we have them. More information can be found here.

CMS Rescinds COVID-19 Health Care Staff Vaccination Requirements

CMS released a final rule ending the COVID-19 health care staff vaccination requirements. The relevant section reads as follows:

"Therefore, in this rule, we are withdrawing language on COVID-19 health care staff vaccination requirements issued in the staff vaccination IFC. COVID-19 vaccination policies and procedures for health care staff will no longer be required under the CoPs, CfCs, and requirements."

While federal rules typically go into effect 60 days after they've been published, CMS states that:

"Since facilities are no longer operating under PHE circumstances, and considering the lower policy priority of enforcement within the remaining time, we will not be enforcing the staff vaccination provisions between now and [INSERT 60 DAYS AFTER DATE OF PUBLICATION IN THE FEDERAL REGISTER]."

RHC Burden Reduction Act Introduced in the House of Representatives

NARHC announced that the Rural Health Clinic Burden Reduction Act was introduced in the House by Representatives Adrian Smith (NE-03), Earl Blumenauer (OR-03), Jill Tokuda (HI-02), and Kelly Armstrong (ND). As the RHC community is aware, this legislation was introduced in the Senate in February, and updates 5 important provisions of the RHC statute, intended to modernize RHC program policies to make them more reflective of the changing healthcare landscape. NARHC is grateful for the rural champions in Congress for their continued leadership on these important RHC issues. 

The work to pass this legislation, however, is just beginning, and NARHC needs your help! Your Senators and Representatives need to hear from you – the people and clinics that these provisions will directly impact. Making your voice heard is simple – just use the messaging tool on NARHC.org. Please contact [email protected] if NARHC can assist you in contacting your Congressional offices to advocate for this legislation.

NARHC Technical Assistance Webinars

Did you miss the NARHC RHC Billing 101 or End of PHE webinars? Watch the recordings or view the slide presentations below.

NARHC provides technical assistance webinars covering the most current and up-to-date information for RHCs. View more TA webinars here.

RHC COVID-19 Distribution Programs

As a reminder, CMS-certified Rural Health Clinics (RHCs) can receive COVID-19 vaccines, testing supplies, and COVID-19 antivirals directly from HRSA. Please reference the linked websites for additional information and enrollment instructions. Technical assistance resources for these programs are available through the National Association of Rural Health Clinics. Note: The Pfizer-BioNTech COVID-19 bivalent vaccine for people 12 years of age and older is available to order through RHC Vaccine Distribution Program in both single and multi-dose vials. The single-dose option responds to widespread requests to allow greater flexibility for RHCs that may not have the demand or capacity to store multi-dose vials. Contact [email protected] for more information.   

Contact Us


Questions? Ideas you want to share? Concerns or barriers you’re facing? Feel free to reach out to staff at [email protected] - we’ll try to help or get you connected. Or you can reach out to your colleagues by posting a question on the IARHC listserv. Simply send an email to [email protected]. This listserv gives you access to the current IARHC membership – use it as a tool to learn from each other!

IARHC Staff Members

Hannah Toresdahl

[email protected]


Iowa Association of Rural Health Clinics | www.iarhc.org | [email protected]