NARHC-News | Summer 2019
RHC Articles in This Newsletter

• The Fight to Modernize the RHC Program
• TN to Reconsider RHC Medicaid Changes
• NARHC Board of Director Candidates
• Notice of Funding Opportunity
• Stay Informed. Like Our FB Page.
• Certified RHC Professional Course (CRHCP)
• 2019 NARHC Fall Institute
• Rural Hospitals Support Wage Reform
• Free Webinars & Breaking Legislative News
• New Data on HIV Diagnoses
• The Importance of Patient Surveys
• Why Rural Communities Need CAHS
• 6 Things You Need to Know About ROI
• Did You Have a Championship Season?
• A Continued HPSA Designation
The Fight to Modernize the Rural Health Clinics Program

As I hope you are all aware of, we are working extremely hard to pass the Rural Health Clinic Modernization Act through Congress. This legislation will modernize outdated RHC rules and raise the cap or upper payment limit on Medicare reimbursement for rural health clinics .

When the Rural Health Clinic Services Act was signed into law by President Jimmy Carter in 1977, the world was a dramatically different place.

In 1977, Star Wars first premiered, the average house cost $49,300, and Apple Computers launched the Apple II.

In 1977, hospitals still received “cost-plus” reimbursement from Medicare while the Physician Assistant and Nurse Practitioner professions were still in their infancy not yet recognized by Medicare.

In 1977, the average page length of a Congressional bill was 8.5 pages. The Rural Health Clinic Services Act itself, is only 7 pages long. 

I can go on, but you get the point. While the world has changed, the laws governing the rural health clinic program have not kept up.     Read More
Tennessee to Reconsider RHC Medicaid Changes

In late 2017, the Tennessee Medicaid program (aka TennCARE) sought and obtained from CMS a moratorium on enrollment of newly Certified RHCs in the TennCARE program. 
 
Existing RHCs would remain in the program and continue to see Medicaid patients and continue to receive the previously approved PPS payments. Newly certified RHCs would be able to see TennCARE enrollees but only as “traditional” Medicaid providers. They would not receive RHC PPS payments.
 
The stated reason for this moratorium was concerns the state had that there were loopholes in the methodology TennCARE was using to determine the initial RHC payment rates and these loopholes were resulting in TennCARE payments to RHCs higher than the state thought appropriate. Read More
NARHC Board of Director Candidates

There are six highly-qualified candidates running for four openings on the NARHC Board of Directors. These positions will be voted into office by NARHC Membership at the Annual Meeting held in St. Louis during the NARHC Fall Institute on Monday, Oct. 7, 2019. Absentee ballots will also be accepted in advance. Only RHC member-types may vote. All primary contacts will be emailed ballots about a month before the Annual Meeting. The top 4 candidates with the most votes will serve out three-year terms: January 1, 2020 — December 31, 2022. The candidates’ biographies follow.  Read More
Notice of Funding Opportunity:
(SUPPORT) ACT, SECTION 1003

Last week, the Centers for Medicare & Medicaid Services (CMS) released a Notice of Funding Opportunity for State Medicaid Agencies to apply for planning grant funding to increase the capacity of Medicaid providers to deliver substance use disorder (SUD) treatment and recovery services. Up to $50 million dollars is available to at least ten states for 18 months. This funding opportunity is authorized by the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, Section 1003. Up to 5 states that receive planning grants will be selected to implement 36-month demonstration projects and receive enhanced federal reimbursement for increases expenditures for SUD treatment and recovery services.

To apply for a planning grant, visit  grants.gov To view the CMS press release, visit   cms.gov
Stay Informed.
Like Our Facebook Page!

Connecting with the National Association of Rural Health Clinics on Facebook is a great way to keep in touch with like-minded people! Help support NARHC while also staying connected all year round through the latest national news specific to rural health clinics.  Click Here to be taken to the FB page.

Next Session of NARHC's...
 Certified RHC Professional Course (CRHCP)
Registration Opens: August 1st
In-Person Final Exam in St. Louis on Oct. 9

ONLINE TRAINING* will prepare you to successfully manage and run an RHC. Learn the latest information on RHC rules, regulations, and laws. Study nights, weekends, or whenever your schedule permits! Course takes approximately 30 hours. No prerequisite! Coursework is broken into 4 modules with video presentations & a series of short knowledge-based tests for each module. This course is designed to give you a well-rounded, ground level knowledge base of the major facets of RHC management. Read More

  • Module 1: Administration & Finance
  • Module 2: Billing & Coding
  • Module 3: Human Resources
  • Module 4: Regulatory Compliance & Quality
Register Now...
2019 NARHC Fall Institute
Hyatt Regency at the Arch, St. Louis, MO
Oct. 7-9, 2019  (M-W noon)  
The conference "for & about" RHCs
17 Speakers, 18 Sessions, 8 Breakouts

BEGINNER PRE-CONFERENCE:
RHC & Billing Basics
Cost Report Basics
How to Assure a Successful RHC Survey

CONFERENCE:
•Washington Update •Advocacy for RHCs
•Medicare Bad Debt •Advanced RHC Billing
•NARHC Annual Meeting •Is It A HIPAA Breach?
•Emergency Preparedness
•Incorporate Quality in Your RHC
•Provider Based Rules & Compliance
•How to Maintain Compliance & Pass Survey 4
•What Does the Future Hold for E & M Services?
•Create an Opioid Treatment Program in Your RHC
•Hardwire a 5-Star Patient-Centered Clinic Experience
•Conduct the Annual RHC Eval + Policy & Procedure Manual
•RHC Management: Developing a Practice Management Toolbox
•Think Outside of the Box (Telehealth, Dentistry, Diabetes, Pharmacy, etc.) Read more
Rural Hospitals Support Wage Reform

Hospital and health system executives and practitioners were largely supportive of the CMS'  proposed changes  to the wage index that they say has disproportionately impacted rural providers.

Hospital presidents and concerned employees, predominantly from rural areas, claim in some of more than  2,000 public comments  that the "fundamentally flawed" system the CMS uses to set hospital payments has led to hospital closures. They hope that the agency's plan in October to raise the index for low-wage hospitals at the expense of decreasing it for high-wage hospitals will close a  wide payment disparity .

"Without the relief CMS has proposed, Tennessee hospitals will continue to suffer and more may be forced to close their doors to the many Tennesseans who need care," wrote Bruce Hartmann, senior vice president and chief community relations officer for the University of Tennessee Medical Center, describing the proposal as a "lifeline." Read More
FREE Webinars & Breaking Legislative News & Updates
Sign Up for the Technical Assistance Forum

NARHC and the Federal Office of Rural Health Policy periodically offer free Technical Assistance Webinars on various Rural Health Clinic topics (RHC Billing, Best Practices, Most Common Claim Errors, Creating an Opioid Treatment Program, Emergency Preparedness, etc.). Webinars are just one hour. A list of past webinars can be found on the NARHC.org website. You can also be automatically notified of every upcoming T.A. webinar via your email!

TO SIGN UP: Please go to the NARHC.org website, click on the Discussion Forums tab. You will be asked to log in after which you may choose to subscribe to the Technical Assistance and other forums. This is also the Forum where breaking RHC Legislative News & Updates is announced.

The next webinar will be on Medicare Cost Reporting and will be held on Tuesday, July 30th, at 2:00 p.m. Eastern time. If you are unable to attend, a transcript will be created and can be accessed about 2 weeks later. But do get yourself on the email list to receive those notifications which will also give you the call in number & directions for accessing each webinar. To see past T.A. webinars, Click Here

The Centers for Disease Control and Prevention (CDC) recently released a new Morbidity and Mortality Weekly Report (MMWR) on HIV testing. The CDC data show that less than 40% of people in the U.S. have ever been tested for HIV; in the seven states with rural areas that are particularly affected by HIV, just 26% of people recommended for annual HIV testing were tested in the past year. 

The proposed HHS-wide initiative, “ Ending the HIV Epidemic – A Plan for America ,” is multiyear initiative designed to end the HIV epidemic over 10 years by significantly increasing public health resources, technology, and expertise on the ground in the hardest-impacted areas. The plan, if funded, will focus first on the geographic areas with the greatest HIV burden, including the 50 local jurisdictions and seven states highlighted in the MMWR report, before expanding to reach all areas of the nation affected by HIV. Read More
CONSULTANTS' CORNER

The Importance of Patient Surveys

Within any healthcare organization, patient satisfaction surveys are critical for measuring quality and for obtaining meaningful feedback to help identify areas in need of improvement and to recognize gaps in your system. Patient satisfaction surveys can improve your services and help you meet your goals as a healthcare organization at the highest level.

CMS has been moving toward quality-based and patient-centered care for years and there is no indication that it will stop. Patient satisfaction surveys are key to your business as part of a continuous quality improvement process. Tracking and reporting on patient experience helps you show patients, the public, employees, and third-party payors that your clients and patients are receiving the care they need and deserve   Read More


Why Rural Communities Need Critical Access Hospitals
AND WHY CAHS NEED RHCS TO SURVIVE

There are a handful of terms that come to mind when one says “rural communities”… camaraderie, community, family, simple way of life. In the world of healthcare, we also tend to think of “healthcare deserts.” These rural areas house nearly 20 percent of American populations , and 60 percent of rural areas are designated Health Professional Shortage Areas . More grounding, there have been more than 100 rural hospital closures since 2010.

That being said, more than 4,300 rural health clinics and more than 1,300 critical access hospitals remain. What is at stake for those that are facing negative operating margins or struggling to keep their doors open? And, perhaps more importantly, why is it so crucial we keep these doors open? Read More


6 Things You Need to Know About ROI in an RHC
RELEASING AND REQUESTING PROTECTED HEALTH INFORMATION

Making sure that you have been correctly authorized to request and release Protected Health Information (PHI) in the RHC can be challenging whether or not you are an independent RHC winging it on your own, a provider-based RHC that is a part of a bigger healthcare system or an RHC somewhere in between. The six must-know things about release of information or ROI are:

1.        Make sure your Authorization / Release Form is correct. 
Often, we see clinics using authorization forms which are not HIPAA compliant. According to HHS.gov, an authorization must specify a number of elements, including a description of the protected health information to be used and disclosed, the person authorized to make the use or disclosure, the person to whom the covered entity may make the disclosure, an expiration date, and, in some cases, the purpose for which the information may be used or disclosed. With limited exceptions, covered entities may not condition treatment or coverage on the individual providing an authorization. Most states have copies of valid release of information authorization forms available for providers. Make sure that your form contains all the HIPAA-required elements as well as any state-required elements. When was your form updated or reviewed? Read More


Did You Have a Championship Season?
HOW TO USE THIS TIME TO PREPARE A BETTER COST REPORT

Did your team have a championship season this year? Sports team typically have a season where the performance of the team can be measured in wins and losses or even a championship in their given field. The end of the season provides an opportunity to evaluate their results and plan for ways to improve their performance next year. Some teams seem to be excellent year after year. The New England Patriots, Alabama’s football team, and the Golden State Warriors come to mind. What most of these great teams have in common besides extremely skilled athletes is they work harder in the off-season than other teams and improve their skills every year. For most rural health clinics your cost report season just finished with cost reports being filed by May 31 st making this a great opportunity to evaluate your results and plan to do better.
 
Thankfully, summer in most clinics is a slower time of year. The kids are not in school, the weather is better, and the number of patients treated for illnesses tends to be at a low point during these hot summer months. This provides a perfect opportunity to look back at what could have been done better and how to become more compliant during this year. As far as the cost report is concerned here are some of the questions to ask: Read More


A Continued HPSA Designation

HPSA’s generally renew every three years and must be re-assessed and re-designated every three-four years. However, we have seen some HPSAs being updated at an annual rate due to a regulation mandated by HRSA in Chapter 1:3 of the HEHS-95-200 report to congress “HHS must by law review annually each designated HPSA to decide if it is still experiencing a shortage of health care providers.” Though this is not an enforced requirement, this appears to be the direction HRSA is heading towards. If you are thinking of moving or building a new RHC, make sure your HPSA has been recently updated. 

In 2017 80% of all primary care HPSA’s were designated due to a large delayed national update. This means that in 2020 these shortages will again have to be documented in order to continue being a Health Professional Shortage Area. Keep this in mind when moving or building a new RHC. Your HPSA status must be ‘designated’ or ‘proposed for withdrawal’ at the time the survey is completed by the state, AAAA, or The Compliance Team in order to receive approval. Read More
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