93.968: Funding in Support of the Pennsylvania Rural Health Model

93.968

Inactive

Centers for Medicare and Medicaid Services (CMS) [HHS]

Aug. 15, 2022

Aug. 15, 2022

The purpose of this single source funding opportunity for the Funding in Support of Pennsylvania’s Rural Health Model (“Model”) cooperative agreement is to provide Pennsylvania with the start-up and initial implementation funding component of the Model to assist Pennsylvania in accomplishing the health outcomes, financial, and rural hospital scale targets required of Pennsylvania under the Model. A single-source award to the State of Pennsylvania through first, the Pennsylvania Department of Health and later, the Rural Health Redesign Center once legislatively established, will enable CMS to expeditiously provide assistance to Pennsylvania for the following specific activities: model oversight, global budget administration, data analytics, technical assistance, and quality assurance. These activities are necessary for Pennsylvania to achieve the goals of the Model. We note that the other components of the Model (e.g., health outcomes, financial, and rural hospital scale targets) are governed by a separate State Agreement into which Pennsylvania and CMS have entered

B - Cooperative Agreements

This single source funding opportunity provides Pennsylvania with the necessary start-up funding for the Model and is open to Pennsylvania’s Department of Health and later the Rural Health Redesign Center. First, the Pennsylvania Department of Health is uniquely positioned as the initial applicant under this funding opportunity to meet the objectives of this funding opportunity based on its existing knowledge of the Model, its regulatory authority over healthcare in Pennsylvania, and its capacity to administer the Pennsylvania Rural Health Model including operationalizing the Rural Health Redesign Center, and its existing partnerships and collaborations with Pennsylvania providers. • Knowledge of the Model: The Pennsylvania Department of Health is intimately familiar with the objectives of the Model. Pennsylvania’s Department of Health was a key member of the discussions between Pennsylvania and CMS during the development of the Model; the Pennsylvania’s Secretary of Health and staff dedicated significant time, energy, and resources over the past year in partnering with CMS to establish the Model’s financial, health outcomes, and rural hospital scale targets. This existing familiarity and knowledge of the Model will help the Pennsylvania Department of Health to expediently deploy the start-up funding offered under this funding opportunity announcement and successfully operationalize the Rural Health Redesign Center. • Authority and role in administering the Model: The Pennsylvania Department of Health is responsible for ensuring that changes in Pennsylvania’s health system improve the conditions and well-being of Pennsylvanians. The Pennsylvania Department of Health has broad healthcare authority to administer the payments under the model and to improve the health of Pennsylvanians and control the rate of growth in healthcare costs. Additionally, the Pennsylvania Department of Health is a signatory to the Pennsylvania Rural Health Model’s State Agreement and will be supporting the State in achieving its obligations under the State Agreement. • Existing partnership and collaboration: The Pennsylvania Department of Health is located in Pennsylvania and has existing relationships and a history of collaboration with Pennsylvania providers, payers, and community-based resources that would benefit from this funding opportunity. Pennsylvania’s Department of Health has also been working with these stakeholders for their input and participation throughout the development of the Model. Second, the Rural Health Redesign Center as the second applicant, will also be uniquely positioned to meet the objectives of this funding opportunity. Pennsylvania’s Department of Health will legislatively create the Rural Health Redesign Center as an independent entity with authority over the implementation of the Pennsylvania Rural Health Model. The RHRC will approve hospital transformation plans, global budgets, exception adjustments and changes to operational and payment mechanisms associated with the Model as defined under the State Agreement. The RHRC will also establish and build strong relationships with Pennsylvania rural hospitals as the rural hospitals implement the Model. The RHRC will continue to strengthen these relationships as it implements the activities required under the Model. Similar to Pennsylvania’s Department of Health, the RHRC will be uniquely positioned to support this Model as it will be legislatively created solely to provide implementation support for the Model.

CMS is committed to achieving better care for individuals, better health for populations, and reduced expenditures for Medicare, Medicaid, and CHIP. Through the Innovation Center, CMS strives towards these goals by testing innovative payment and service delivery models. CMS believes that states can be critical partners of the federal government and other health care payers to facilitate the design, implementation, and evaluation of community-centered health systems that can deliver significantly improved cost, quality, and population health performance results for all state residents, including Medicare, Medicaid, and CHIP beneficiaries. States have policy and regulatory authorities, as well as ongoing relationships with commercial healthcare payers, health plans, and providers that can accelerate delivery system reform. CMS has previously partnered with states to accelerate delivery system reform through initiatives such as the State Innovations Model (SIM) program. SIM provides state-based healthcare transformation efforts with funding to test the ability of states to utilize policy and regulatory levers to accelerate multi-payer health care transformation. Selected states have been working with state-based payers, including Medicaid and commercial payers, and providers to design and implement care delivery and payment reform. States participating in SIM were selected through two rounds of public Funding Opportunity Announcements released on August 23, 2012 (Round 1) and May 22, 2014 (Round 2). Additionally, CMS has released guidance to SIM state participants in which CMS indicated that in certain instances it will consider state proposals for Medicare’s alignment with state multi-payer payment and care delivery models. According to that guidance, CMS would assess such proposals with consideration of the following principles: 1) patient-centered, 2) accountable for total cost of care, 3) transformative, 4) broad-based, 5) feasible to implement, and 6) feasible to evaluate. Pennsylvania was one state that approached CMS with a desire for Medicare’s alignment with the state’s payment and care delivery model, and Pennsylvania submitted its proposal to CMS on May 23, 2016. CMS reviewed Pennsylvania’s proposal and determined that it met the requirements necessary to explore in detail a potential Pennsylvania-specific model. CMS, the Governor of Pennsylvania and Pennsylvania’s Department of Health, will enter into a State Agreement on the Pennsylvania Rural Health Model. Under the Model, CMS will test the effect of deliberate care delivery transformation of rural acute care hospitals and critical access hospitals (CAHs) on quality and costs of care. The Model places these hospitals on all-payer, prospective global budgets for inpatient and outpatient services. As part of the State Agreement, Pennsylvania committed to legislatively creating the Rural Health Redesign Center (the “RHRC”) to operate the Model. This funding opportunity offers $5M in start-up funding to the Pennsylvania Department of Health to operationalize the RHRC. The RHRC will be the central independent entity operating the Model and supporting hospitals through technical assistance, data analytics, monitoring, and evaluation. This funding opportunity also offers the RHRC (once operationalized by the Pennsylvania Department of Health) to apply for an additional $10 million to begin implementing activities under the Model. In return, Pennsylvania commits to achieving health outcomes, financial, and Rural Hospital scale (number of Rural Hospitals participating in the Model) targets – both for Medicare and across all significant healthcare payers as defined in the State Agreement. CMS believes that model oversight, global budget administration, data analytics, technical assistance, and quality assurance will be necessary in order to implement the Model and achieve the financial, health outcomes, and rural hospital scale targets required under the Model. First, CMS will provide start-up funding to the Pennsylvania Department of Health for 30 months from the date of award. Then, CMS will award a second separate cooperative agreement award. These cooperative agreement awards will support operationalizing the Rural Health Redesign Center and initial Model implementation efforts, and will better enable Pennsylvania to achieve the Model’s financial, health outcomes, and rural hospital scale targets as defined under the State Agreement.

https://sam.gov/fal/54f05b07a17a4f04885f989ecaf6705a/view