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Rural Route
June 18, 2015
In this Issue
Welcome & Farewell
Notes from FORHP
Regulatory Updates
Reverse Site Visit Registration
MBQIP Guides
New TASC Resources
Rural Research
Rural Healthy People 2020
Flex Program Forum
ICD-10 End-to-End Testing
New Network Grantees
DLT Grant
Rural Relevant Measures Webinar
Value-Based Models Webinar
Partnerships Webinars
Webinar Playbacks and Event Materials
Network Leadership Resources
The Center Blog
Save the Dates
Social Media
TASC Website Quick Links



Flex Coordinator Manual

Flex Program Forum

Resource Library


State Flex Profiles

On Center Blog

Dear Colleagues,


The Flex Program Reverse Site Visit is right around the corner. We are really looking forward to seeing many of you in person next week. The agenda is packed full of great content focusing on this year's theme of Pathways to Value. We are also really pleased to provide a great skill building workshop on facilitation the day before the Reverse Site Visit. We think it will be really valuable and fun.


This edition of Rural Route highlights some new resources and webinars on topics like rural healthy people, ICD-10 testing, telemedicine grants, and partnership development. Just a reminder to take a peek at the MBQIP Quality Guide before you attend the Reverse Site Visit. 


I hope your summer is off to a great start. We are busy here starting to think about resource development for next year to support the new Flex program areas. Conversation next week at the Reverse Site Visit will help TASC continue to tailor its services to best meet the needs of the state Flex Programs and critical access hospitals (CAHs). We look forward to spending time together, hearing your needs and learning from your successes.


Take care,


Tracy Morton, MPH
Senior Program Manager
Technical Assistance and Services Center (TASC)
Quick Links



Rural Health Value

Welcome & Farewell


We extend a fond farewell to Aaron Fischbach who is no longer working with the Federal Office of Rural Health Policy. Aaron has joined the US Department of Health and Human Services Office of the Secretary, Executive Secretariat where he is a Policy Coordinator. Aaron provided much knowledge and information to the Flex Program, including regulatory and policy updates for this monthly newsletter and the quarterly TASC 90 webinars. We wish Aaron the very best!



Do you have staff updates?

We encourage you to keep your Flex staff contact information current by completing the new contacts form as soon as possible whenever there are changes in your office. Please review your contacts as listed in your State Flex Profile and complete the form as necessary for any additions or changes. 

Notes from FORHP

Greetings from the Federal Office of Rural Health Policy (FORHP),

We're less than a week away from the Flex Reverse Site Visit and we're all excited to see so many familiar faces and a few new ones too. I might be biased, but I think we have a terrific agenda put together with a fabulous group of speakers. Our office is also putting the finishing touches on the Flex reviews and hope to share more information with you in the coming weeks.

I know this is short (and sweet?) but I have a lot of work left to do before next week, when many of you will get to hear more.

Until next time,


Kevin Chaney

Flex Coordinator

Federal Office of Rural Health Policy 

Regulatory Updates

Medicare Shared Savings Program Final Rule

On June 9, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Shared Savings Program: Accountable Care Organizations (ACO) Final Rule in the Federal Register. The rule includes the following proposals:
  • Encourages greater ACO participation in risk-based models by:
    • Permitting ACOs under a one sided participation agreement ("Track 1" - shared savings, not losses) to continue participating for one additional 3-year agreement period with the same 50 percent sharing rate.
    • Creating an alternative risk-based model ("Track 3") that includes a higher sharing rate (75 percent), prospective attribution of beneficiaries, and the ability to use new care coordination tools.
    • Establishing a waiver of Medicare payment rules and regulations related to 3-day qualifying hospital stays for skilled nursing facility (SNF) admissions for beneficiaries in ACOs under Track 3.
  • Revises the beneficiary assignment process:
    • {Note: The method assigns beneficiaries to ACOs in two steps, after having first identified those who received at least one primary care service by a physician in the ACO. Previously, assignment was based on having the plurality of primary care services furnished by 1) primary care physicians; 2) specialists, nurse practitioners (NP), physician assistants (PA), and clinical nurse specialists (CNS).}:
      • Including the claims from non-physician ACO professionals (NP, PA, and CNS) in Step 1.
      • Clarifying how primary care services furnished in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will be considered. All primary care services furnished by FQHCs and RHCs will be considered in Step 1.
  • Streamlining the process for data sharing between CMS and ACOs on patient claims data necessary for health care operations.
  • Modifications to encourage ACOs to take on 2-sided risk that CMS intends to propose in future rulemaking: 
    • Waiving the geographic requirement for telehealth services.
    • Including regional costs in the methodology for resetting benchmarks.
    • Modifying the beneficiary attribution rule to hold ACOs accountable for beneficiaries who have designated that an ACO practitioner is responsible for their care. 
2015 Flex Program Reverse Site Visit

Arrow indicating pathways to value
Pathways to Value
We are so excited to see you next week at the 2015 Flex Program Reverse Site Visit & Facilitation Skill-Building Workshop. This event is supported by the Federal Office of Rural Health Policy (FORHP) and will take place June 22-24, 2015 in Bethesda, Maryland. The theme for this year's event is Pathways to Value.

The 2015 Flex Program Reverse Site Visit is scheduled for Tuesday, June 23, 2015 8:30 a.m. Eastern Time to Wednesday, June 24, 2015 3:30 p.m. Eastern Time. 
FORHP Regional Project Officer Meetings with attendees will take place from 2:00 p.m. - 3:30 p.m. on Wednesday, June 24, 2015. The Facilitation Skill-Building Workshop is scheduled from 1:00 p.m. - 5:00 p.m. on Monday, June 22, 2015.

Dates and Times
The pre-event Facilitation Skill Building Workshop is on Monday, June 22, 2015 from 1:00 p.m. - 5:00 p.m. Eastern Time in Ballroom AB at the DoubleTree by Hilton Bethesda in Bethesda, Maryland. Registration for this optional event was required. Onsite registration to pick up your materials and name tag will be open at 11:30 a.m. on June 22 outside of Ballroom AB on the second floor of the hotel.

The Flex Program Reverse Site Visit begins on Tuesday, June 23, 2015 at 8:30 a.m. Eastern Time in Ballroom AB at the DoubleTree by Hilton Bethesda in Bethesda, Maryland. Registration was required. Onsite registration to pick up your agenda, participant list and name tag will be open on Monday, June 22 from 11:30 a.m. - 5:00 p.m. and on Tuesday, June 23 beginning at 7:30 a.m. Eastern Time outside of Ballroom AB on the second floor of the hotel.

The Flex Program Reverse Site Visit will adjourn on Wednesday, June 24, 2015 at 3:30 p.m. Eastern Time.

The Facilitation Skill Building Workshop and Flex Program reverse Site Visit will be held at the DoubleTree by Hilton Bethesda located at 8120 Wisconsin Avenue, Bethesda, MD 20814
(301) 652-2000

Agenda and Presentation Materials
In an effort to reduce our carbon footprint, presentation materials will not be provided onsite at the Reverse Site Visit. Presentation materials are available on the event webpage at: Please note that not all sessions have presentation materials. A print agenda will be provided to you onsite at the Reverse Site Visit.

The DoubleTree by Hilton Bethesda is about a 40-45 minute cab ride costing approximately $50 from Washington National Airport (Ronald Regan DCA), Baltimore/Washington International Airport (BWI) and Washington Dulles International Airport (IAD). The hotel is located 1/2 mile from the Bethesda Metro Station, which is on the Red Line towards Shady Grove. Metro fare is approximately $5.

Meals will not be provided as part of attendance at the Flex Program Reverse Site Visit. Ample time will be allowed during the event to allow for participants to have lunch. The hotel offers a full service restaurant serving lunch and breakfast beginning at 6:00 a.m. Eastern Time. The hotel also offers a lobby grab and go outlet for quick breakfast items or salads and sandwiches in the afternoon and evening. Within walking distance of the hotel is a number of restaurants. A list of these restaurants will be available at the registration table onsite.

Meetings with Project Officers
Regional Project Officer meetings will be held on Wednesday, June 24 from 2:00 p.m. - 3:30 p.m. Eastern Time as part of the Reverse Site Visit agenda. If you indicated during the registration process that you would like to meet one-on-one with your Project Officer, they have been notified and should have been in contact with you to make separate arrangements. This is intended to be separate time aside from the regional meetings. If you would like to still request a one-on-one meeting, please contact your Project Officer directly.

Please don't hesitate to contact us if you have any questions about the 2015 Flex Program Reverse Site Visit & Facilitation Skill-Building Workshop (optional). We look forward to seeing all of you next week!  
New MBQIP Guides

Two guides were released last month to support the FORHP Medicare Beneficiary Quality Improvement Project (MBQIP), a quality initiative for all state Flex Programs and CAHs. There will be MBQIP sessions at the Reverse Site Visit next week. Familiarity with the MBQIP Quality Guide is beneficial!

The purpose of the MBQIP Quality Guide is to help CAH staff and state Flex Program personnel analyze and make good use of MBQIP Hospital Data Reports in order to support quality improvement efforts and improve patient care. This guide includes:
  • Examples of how to interpret data from sample MBQIP Hospital Data Reports 
  • Summary tables for each of the four MBQIP domains, including detailed information about each measure as well as suggested best practices for improvement
  • Recommendations for how to prioritize opportunities for improvement
  • Links to quality improvement resources
  • A chart detailing how reported data flows through the Quality Improvement Organization (QIO) Clinical Warehouse
  • An MBQIP acronym guide and a glossary of terms
The MBQIP Excel Data User Guide was developed for use by state Flex Program personnel. It includes instructions for how to manipulate the MBQIP Excel data files provided by FORHP in order to:
  • Calculate hospital rates, state averages and benchmarks
  • Sort and/or group hospitals by rates or medians on individual measures
  • Create comparison graphs to help visualize improvement opportunities at a state or hospital level
A webinar was held on April 13, 2015, to launch the guides and describe their use. A link to the webinar recording can be found on the TASC website.

If you have questions about the guides, please contact Sarah Brinkman.

New TASC Resources


The following resources on the TASC website are new or recently updated:


Community Paramedicine Topic Guide

Author: Rural Assistance Center

This topic guide defines community paramedics, highlights models and existing examples of community paramedicine, explains how to start a community paramedic program, and outlines issues and challenges community paramedics face.

Social Determinants of Health for Rural People Topic Guide

Author: Rural Assistance Center

This guide describes how income-level, educational attainment, race and where you reside impact health. The guide includes statistics and FAQs on the health inequities that rural residents experience. 


New MBQIP Resources


MBQIP EDTC and Pharmacist CPOE Reporting Instructions

Author: Federal Office of Rural Health Policy

Instructions for state Flex Programs regarding use of Federal Office of Rural Health Policy (FORHP) provided templates for submission of data for the Emergency Department Transfer Communication (EDTC) and Pharmacist Computerized Provider Order Entry (CPOE) measures. Includes submission deadlines for both measures through the 3rd quarter of calendar year 2015. 


MBQIP Program Background, Expectations and Measures  -  updated

Author: Federal Office of Rural Health Policy

This document provides information about the Medicare Beneficiary Quality Improvement Program (MBQIP), its background, expectations and measures.

New Rural Research

Charity Care and Bad Debt Activities of CAHs
In response to concerns about hospital billing and charity care policies, the Affordable Care Act (ACA) requires tax-exempt hospitals to develop and promote written financial assistance and emergency care policies, limit charges to financial assistance patients to the amounts charged to insured patients, implement reasonable billing and collection practices, and refrain from extraordinary collection practices prior to undertaking reasonable efforts to determine eligibility for financial assistance. The final rules implementing these changes to the tax code were released on December 31, 2014.

The Flex Monitoring Team has produced two publications examining charity care and bad debt activities of critical access hospitals (CAHs), other rural and urban hospitals immediately prior to these ACA-mandated financial provisions. They also discuss strategies that CAHs and other hospitals can use to identify and manage charity care and bad debt performance issues. For summarized findings and discussion, please visit the policy brief. For detailed findings and analysis, please visit the briefing paper.
Rural Healthy People 2020

Nearly 20% of the U.S. population resides in non-metropolitan areas where they experience many of the same health challenges as their urban counterparts. In fact, some of the distinctive cultural, social, economic and geographic characteristics which define rural America place rural populations at greater risk for a myriad of diseases and health disorders.

It is this recognition of the unique health challenges faced by rural America that serves as the impetus for the Rural Healthy People 2020 project. The primary goal of this research effort, completed by the Texas A & M Health Science Center, is to identify and address the priority health concerns of rural America.

For each rural health priority identified, a brief review of literature on this disease or condition in rural America is provided and illustrative solutions summarized. For each rural health priority, researchers contacted select rural communities across the nation to find innovative programs and practices which address these concerns. These Models for Practice illustrate promising approaches by rural communities to address their health priorities. 
Learn from your Colleagues: Flex Program Forum
Don't miss the ongoing discussions on the Flex Program Forum. This is your chance to learn from each other. Do you have a question, idea, success or challenge to share? While you are there, upload your photo if you haven't already.
Please note, you will need to login to read recent postings, which include:

Tele ER by Kim Kelley, Jill Bullock and Melissa Turner

Necessary Provider Example Letters by Tracy Morton, Curtis Metzger, Callen Vorpi, Susan Triggs and John Eich

If you have questions about the Flex Program Forum, please contact TASC.
CMS Conducts 2nd Successful Medicare FFS ICD-10 End-to-End Testing Week in April

From April 27 through May 1, 2015, Medicare Fee-For-Service (FFS) health care providers, clearinghouses and billing agencies participated in a second successful ICD-10 end-to-end testing week with all Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor. CMS was able to accommodate most volunteers, representing a broad cross-section of provider, claim and submitter types.

This second end-to-end testing week demonstrated that CMS systems are ready to accept ICD-10 claims. Approximately 875 providers and billing companies participated, and testers submitted over 23,000 test claims. View the results.
Overall, participants in the April end-to-end testing week were able to successfully submit ICD-10 test claims and have them processed through Medicare billing systems. The acceptance rate for April was higher than January, with an increase in test claims submitted and a decrease in the percentage of errors related to diagnosis codes. Most of the claim rejections that occurred were due to errors unrelated to ICD-9 or ICD-10.

In addition to acknowledgement testing, which may be completed at any time, a final end-to-end testing week will be held on July 20 through 24, 2015. The opportunity to volunteer for this testing week has closed. Testers who participated in the January and April end-to-end testing weeks are automatically eligible to test again in July.

Prepare Now for ICD-10 Implementation

Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code. The Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015; or accept claims that contain both ICD-9 and ICD-10 codes.

There is still time to get ready!

Even though the October 1, 2015, mandatory implementation date is quickly approaching, providers still have time to prepare for ICD-10, and CMS has created a number of tools and resources to help you succeed. One tool is the "Road to 10," aimed specifically at smaller physician practices with primers for clinical documentation, clinical scenarios, and other specialty-specific resources to help you with implementation.

For more information
MLN Matters Article #MM8867, "ICD-10 Limited End-to-End Testing"
MLN Matters Special Edition Article #SE1435
, "FAQs - ICD-10 End-to-End Testing"
MLN Matters Special Edition Article #SE1409, "Medicare FFS ICD-10 Testing Approach"
New Network Development Planning Grantees Announced

Earlier this month, FORHP announced new Rural Health Network Development Planning grantees covering 24 rural communities in 20 states. These grants provide up to $100,000 to support a range of projects including health workforce, mental and behavioral health, implementing health information technology and more. Please check to see if you have a new grantee in your state and connect to see how you can work together to create synergy.

Questions on the Rural Health Network Development Planning program can be directed to Amber Berrian. 
Distance Learning & Telemedicine Grant Program

The US Department of Agriculture (USDA) Rural Development is now accepting
applications for the Distance Learning and Telemedicine (DLT) program. The DLT program provides grant funds to help schools and medical facilities purchase equipment to develop and expand distance learning and telemedicine opportunities. Grant awards from from $50,000 to $500,000. Applicants are required to provide at least a 15 percent match. Applications are due by July 6, 2015.
Rural Relevant Measures: Next Steps for the Future

Paul Moore, DPh, Federal Office of Rural Health Policy
Paul Moore, DPh, Federal Office of Rural Health Policy
Increasingly we are seeing a movement toward a "value-based" method of payinfor healthcare in the quality driven incentives, penalties and payment modifiers some rural providers are already experiencing. While many rural providers currently remain outside of value-based reimbursement, we may ignore this movement at our own peril. Measuring and reporting the quality of care provided in rural facilities is not only an opportunity to tell our own "value" story, but may be key to remaining "relevant" in the healthcare system of the future. During this presentation, Paul Moore, DPh, Senior Health Policy Advisor to the Federal Office of Rural Health Policy, speaks to the challenges and principles informing quality measurement and reporting in a low-volume, resource restricted environment while encouraging rural provider participation.
Value-Based Models Webinar Available

TASC held an informative webinar on May 13, 2015 on the use of value-based models in rural health care. Featuring a discussion from rural individuals working with value-based models, the learning objectives for this webinar include:
  • Learn definitions of terms related to value-based models and establish a common foundation for discussion
  • Expand awareness of what is happening among early rural adopters of value-based models and why they moved in their current direction
  • Discover lessons learned and outcomes from early adopters and identify potential strategies for engaging in value-based models in your state
The webinar recording and supportive materials can be found on the TASC website.
Partnerships: Positioning Hospitals For the Future

Historically, "affiliating" with a larger health system meant losing all control over the services that would be maintained in rural communities. Today, the market has changed and in many ways, the changes favor rural providers. Affiliations no longer have to follow the "hub and spoke" approach dominated by systems when rural providers understand their value and position in an industry that is moving toward population health and a system that is affordable and efficient for delivering care, that maintains access to medical care, and produces health for the community. Rural providers can't do this all under their own roof and need to create interdependence with other providers in creating a system of care. This two-part webinar series, presented by Brian Haapala, Director, Stroudwater Associates, provides practice tools, advice and case studies for how to accomplish these goals.

Webinar Playbacks and Event Materials

Are you looking for resources in the topics of: strategies for the new health care era, quality improvement, contract negotiation, data analytics or population health? Look no further!

Leadership Resources for Networks

The Network Technical Assistance Center, funded by FORHP, worked with a leadership consultant to develop a Leadership Learning Community. The primary goal of the Learning Community was to build leadership capacity within newly forming rural health networks. The Learning Community met for four virtual sessions and completed a network self-assessment tool. Playbacks from these sessions, relevant to your newly forming rural health networks can be accessed at the following links:
More information on the Network Technical Assistance Center is available on its website at Rural Health Innovations, a subsidiary of the National Rural Health Resource Center.

National Rural Health Resource Center Blog   

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Stay in the loop by following the National Rural Health Resource Center blog

Recent postings

The Center's Growing Team by Leslie Quinn, featuring new staff members: Sarah Brinkman, Bridget Hart, Deb Laine, Paul Luciano and Cassy Rockers

Rural Network Leadership abstracted article from Tim Size, Executive Director, Rural Wisconsin Health Cooperative

Grow your Career: Save the Dates 


Below is a list of upcoming events relevant to rural health:



Facilitation Skill-Building Workshop

June 22, 2015 in Bethesda, Maryland, held in conjunction with the 2015 Flex Program Reverse Site Visit


2015 Flex Program Reverse Site Visit

June 23-24, 2015 in Bethesda, Maryland


TASC 90 Webinar - Topic to be Determined

August 12, 2015 2:00 p.m. - 3:30 p.m. Central Time


Check the TASC Events page for upcoming events.


More Resources


Rural Health Virtual Training Gateway

View upcoming rural health webinars and other virtual training events sorted by date and category.


Rural Assistance Center (RAC) Calendar

View upcoming rural events by month, state or keyword search.


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