The Flex Program

This is a draft and will require insertion of your own data The Flex Program Medicare Rural Hospital Flexibility Program Goal  Support rural communities in preserving access to primary and emergency health care services. Participation  45 States receive annual federal grant funding to administer the program  CT, DE, MD, NJ, & RI not eligible Each state has developed a state rural health plan approved by CMS  States maintain ongoing planning and program development activities  Administration State Offices of Rural Health  Nonprofit Organizations  Universities  Key Components Critical Access Hospitals  Emergency Medical Services  Quality Improvement  Network Development & Enhancement  Rural Health Planning & Evaluation  Critical Access Hospitals  CAH Designation Criteria Located in a Rural Area  Provide 24-hour Emergency Care  96-hour Average Length of Stay  25 Bed Maximum (including swing and observation beds)  Critical Access Hospitals Currently 1060 CAHs (January, 2005)  Over XX pending in [state name]  Another wave of conversions occurring as legislation implementation dates arrive  “Necessary Provider” sunsets 1/1/2006  Critical Access Hospitals  Benefits      Medicare cost-based reimbursement - currently at 101 percent of reasonable costs Exempt from inpatient and outpatient prospective payment systems Capital improvement and equipment costs may be included in the Medicare cost report May establish psych and rehab distinct part units up to 10 beds each DPU beds are paid under prospective payment system Critical Access Hospitals  Issues Community development  EMS integration  Workforce  Evaluation  Access to capital  Critical Access Hospitals  Trends     Shift to outpatient and long-term care Enhanced access to capital Integration of EMS Improved profitability Note: CAH-owned ambulance services must meet the 35-mile rule (35 miles from another service to be eligible for cost-based reimbursement)  Critical Access Hospitals Data as of 11/9/2004 Emergency Medical Services  Training initiatives -Clinical training -Management -Equipment -Billing -Data entry Needs assessments  Encouraging local collaboration  Enhancing data collection and reporting  Workforce projects  Quality Improvement Improve QI through technical assistance and financial support  Development of networks and affiliations  Connecting hospitals and providers with resources for QI  CAHs required to have agreement with network hospital, QIO or other qualified entity for QA and credentialing  Quality Improvement  CAH and EMS initiatives        Training & education Medical error reporting Data feedback Staffing Use of protocols Error prevention systems Link with state hospital association, Medicare Quality Improvement Organization, Network hospital Networks Patient referral and transfer agreements  Use of communications systems for sharing patient data and telemetry  QI and QA activities  Specialty services  Transportation  Credentialing  Planning and Evaluation  Rural Plan Requirements: Improve access to hospital and other health services for rural residents  Promote regionalization of rural health services  Create one or more rural health networks with CAHs and acute care hospitals   Program Evaluation at State Level Evaluation  Flex Program Monitoring Team University of Minnesota  University of North Carolina  University of Southern Maine  TASC - assists with dissemination   www.flexmonitoring.org Flex Monitoring Team  Findings CAH conversion associated with improved financial condition  Long-term effects not yet known  Economic impact on community is important  Data sharing and collection will become increasingly important  Flex Monitoring Team  Findings, continued  Formidable barriers remain • Life safety costs • Medicaid • Fiscal Intermediaries and IHS Reimbursement policies not well-aligned with long-term care  Quality is getting more attention than expected  [Name of State]  Flex program office Contact  Web site  [State] Flex Program  [State] Flex plan  Goals [State] Flex Program  CAHs Current number, number pending  Network  Quality Improvement  [State] Flex Program CAH Success Story[ies] (year of conversion, condition prior to conversion, changes/activities with CAH status such as financial condition, service line changes/additions, impact on community such as jobs retained/added)  [State] Flex Program  Networks [State] Flex Program  Quality Improvement [State] Flex Program  Emergency Medical Systems [State] Flex Program  Summary/Lessons Learned/Next Steps