1. Implementation & Transition Work Group Charles Owens - Convener Daniel Diaz Roy Brooks Dan Hawkins Steve Holloway Alice Rarig Ron Nelson *Andy Jordan *Dick Lee *Christina Hosenfeld *Jennifer Rankin (Robert Graham Center)

2. Implementation & Transition Work Group Gotta Plan for: HRSA & ASAPS CMS Primary Care Offices - Pilot PCOs Transition period for implementation and current designation transition to the new rules Timing of MUA/MUP renewals Communication plan for PCOs, PCAs, State Offices of Rural Health, federal stakeholders that currently use designations, FQHCs, RHCs, other providers, State Loan Repayment Programs, elected officials, communities..... endless list

3. Implementation & Transition Work Group HRSA BPHR Staff input Quantity of staff to manage workload during peek implementation/transition ASAPS BPHR (aka: Andy) will serve as contact

4. Implementation & Transition Work Group CMS CMS contact – 1.Eric working with Corinne Axelrod, CMS 2.Jennifer to provide 2008 Graham Report on Geo HPSA provider payments – report will show separately 2008 primary care providers and specialists Impact testing relating to reimbursement Education relating to rule change

5. Implementation & Transition Work Group Primary Care Offices Pilot PCOs – Andy to advise if practical Existing HPSAs transition to new rule Transition period for “no longer eligible” HPSAs Schedule for phased MUA/MUP designation renewals after initial designation under new rule Training and education Ongoing support – staff and peers (regional mentoring groups?) Renewal cycle (~4 years; RHC statute requirement)

6. PCO Concerns PCO Top Concerns from the ASTHO PCO Workgroup: Simultaneously using the old and new methodology Increase in work load – complexity and time commitment requirement for new methodology including MUA/MUP Desire extending renewal cycle Desire to organize implementation by current renewal date Desire to focus on designations with lowest HRSA resources Training…. Training… Training Transition timing to prevent HPSA withdrawals

7. Transition to new designations Points for consideration: –Allow states to develop implementation plan based need and programs –Prioritized approach based on age, urgency, need with a goal of a minimum of 25% annually –Define transitional period – 4 year minimum –New designations, need, urgency, opportunities – including RHC and FQHC development, NHSC; all programmatic opportunities for community benefit –Overlapping or changing service areas –MUA/P vs HPSA simultaneous review Note: RHC statute requires 4yr renewal cycle

8. Transition to new designations - NPRM2 said ~~ NPRM2 said ~~ new criteria for the designation 3 years from date posted in FR Review oldest first Provision for appeal and resolution if service area between MU and HPSA do not coincide

9. Transition to new designations - NPRM2 said ~~ A non-designated service area identify and consider for designation a new service area instead of either area currently designated, identification of the boundaries recommended. –(ii) Any other service area boundaries (of existing designated areas) that the State recommends be revised; –(iii) The State’s suggestions as to which areas should be updated in the first transition year, which in the second, and which in the third; –(iv) The State’s recommendations concerning those areas it suggests be updated during the first transition year; and –(v) The accuracy of the FTE primary care clinician data and other data used in scoring.

10. Transition to new designations - NPRM2 said ~~ Provisions for withdrawal of designations if not updated If the State does not provide recommendations for resolution of issues the Secretary may resolve based on available information.

11. Implementation & Transition Work Group Communication plan Primary Care Offices Primary Care Associations State Offices of Rural Health Political folks Federal stakeholders that currently use designations (CMS, BPHr, ….) State stakeholders (SLRP, Universities, etc) Local providers/stakeholders - FQHCs, RHCs, other providers, State Loan Repayment Programs, communities..... And …………

12. Concerns & Issues 1.RHCs require HPSA designation every 4 yrs – this is covered in our recommendation 2.Designated area overlap resolution process 3.Discussion of an automated process that could help with conversion – main concern that service area may be different under new method 4.Phase out plan for lost designations

13. Key Policy Decisions/Recommendations HRSA to establish a Communication Team and/or Plan –Staff vs contractor –Establish by July 1 –Staff by August 1 Charge: develop clear concise message for individual stakeholder groups

14. Key decisions still pending Phased in approach vs pilot states for implementation Pending Andy indication if option Communication Team – staff vs contractor Programmatic impacts – the designation lost – What happens now issues…. Phase out plan for lost designations …..Many more – we are just getting started!

15. Recommendations for further analyses CMS Medicare Incentive Payment provider data

16. Implementation & Transition Work Group What else?