Author: horizonprofessionalservices

11 Steps that will Help You Sleep at Night!

As a firm who has a demonstrated record of success in hospital tax elections and won $180 million for clients, we have a unique perspective on how to begin the process. These steps are work that you do before you start the real work of public information and outreach. Hospitals who prepare well in the beginning are more successful.

First, research your messaging in the last election and see what promises you made and collect data on the promises you kept.

This step provides you with information that you can use to show that the hospital is trustworthy of another investment by the community. Use photos and descriptions of these completed projects. Get a testimonial from a popular physician on how this progress has helped deliver quality care in your hospital.  

Second, research how other public entities like school boards, city or county or fire departments have succeeded or failed in their recent tax elections. 

This information gives you an idea of the willingness of the voters to support public entities. Look for organized opposition in these past elections because those same folks may oppose your proposition. If this is your first election, this step is critical because you do not have a hospital track record to review. 

Third, determine the capital needs of the hospital that the funds will address. 

Perhaps, technology upgrades, lab expansion, a new clinic, new services like infusion or outpatient surgery are needed. Maybe you actually need a new hospital facility. Even if you are using other funding for your new facility, supplementing it with a community investment is important. Compile a list of your needs and most importantly prioritize them.  

If your funds will be to build a new hospital, you will need to demonstrate why this is necessary and how the community investment fits with the overall funding. 

Fourth, quantify the capital required to meet the needs that you have identified.

You need more than one global number. Today’s voters want to see an itemized list. Make sure that you know the schedule on which you will address the needs and account for any escalation in price. Currently construction costs are considerably higher than they were two years ago. 

Fifth, determine the amount and term of the property or sales tax that is realistic to attain the capital required.  

Get the input of the hospital’s bond counsel. The amount and term of the tax must meet bond obligations. 

Sixth, learn the required schedule of legal events that need to happen in relationship to the various election date options.  

Your bond counsel can provide the schedule. This action begins your decision sequence on which date would be best for your election. It also helps you to plan the public outreach information schedule.  

Seventh, determine what other items or candidates may be on the ballot on your most likely date of the election.  

Voters are influenced by other propositions and candidate elections.  For example – If the school system is unpopular and they have a proposition on the same ballot it may increase your unfavorable votes. 

Eighth, test the favorability of your proposed use of funds and other variables with the voters.   In the preparation phase, you can modify your proposal to ensure your success. Once decisions are made and there is information in the public domain, changes are impossible.  An accurate public opinion survey guides many key decisions in an election effort. 

Ninth, bring key physicians into the decision making process when you feel It’s appropriate.

You need “buy-in” from physicians to be successful. Having a discussion with physicians and getting their input is ensuring that your use of funds is aligned with the needs that they believe are important. It also makes them part of the team rather than part of the spectators to the process. 

Tenth, as you work through this preparatory process, look for allies. 

Some members of your leadership and hospital team have deep roots in the community.  Quietly make a list of those people. As you proceed through the entire community education and outreach process at a later time you will need these allies. 

Eleventh, develop a board strategy to persuade board members to approve your proposition.  

Board members are fearful of losing tax elections and raising taxes in general. If this is a renewal it is easier for board members to approve.  In all cases, board members need information and data to help them make ballot decisions. Survey results are very helpful. Major points must stand on as much data as possible. Preparing your messaging and timing your presentation to your board is extremely important. Questions must be anticipated and nothing must be left to chance.

After you have completed these 11 steps successfully, you are ready to prepare for the next phase, which is gaining the approval of your county board, state bond commission and educating the many stakeholders of the hospital and the public.   TCI can guide the leadership team through this preparation process and provide the research and messaging that you need. We want you to be successful in your next election!

We Help Our Clients Understand Their Environment and to Find Solutions.   Call Us 888-922-2824 or Email barbara@tciconsults.com

The Centers for Disease Control and Prevention (CDC) has announced it has shortened the recommended isolation and quarantine period for people with COVID-19 to five days, if asymptomatic and if persons can wear a mask when around others. 
These updates are recommended as the Omicron variant continues to spread throughout the U.S. and reflect the current science on when and for how long a person is most infectious. Emerging information with the Omicron variant demonstrates that the majority of SARS-CoV-2 transmissions occur early in the course of illness, generally in the one to two days prior to the onset of COVID-19 symptoms and the two to three days afterward. The new CDC recommendations for the general population mean that asymptomatic people who test positive may leave isolation five days after testing if they can continue to consistently and correctly mask for five more days to minimize the risk of infecting others. Infected persons who cannot follow mask guidance after five days, for example, young children, need to remain in isolation for 10 days after testing positive. 
In addition, CDC is updating the recommended quarantine period for those exposed to COVID-19. For people who are unvaccinated or if they are more than six months past their second dose of mRNA vaccine (Pfizer or Moderna) or more than two months after their Johnson and Johnson vaccine and not yet boosted, CDC now recommends quarantine for five days followed by strict mask use for an additional five days. 
If a five-day quarantine for vaccinated, not yet boosted, persons is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but they should wear a mask for 10 days after the exposure. 
For all those exposed, CDC states that best practice would also include a test for SARS-CoV-2 at the fifth day after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms their symptoms are not attributable to COVID-19. 
Everyone is urged to continue to follow recommendations to be vaccinated and those 16 years of age and above to be boosted to reduce severe disease, hospitalization and death. According to CDC, data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against infection for two doses of an mRNA vaccine is approximately 35 percent. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75 percent.
Vaccination remains the best way to protect yourself and others and to reduce the impact of COVID-19 on our communities in light of recent studies showing that the previously widely available monoclonal antibody treatments are not effective against the Omicron variant. 
Definitions of isolation and quarantine are as follows. Isolation relates to behavior after a confirmed infection. Isolation for five days followed by wearing a well-fitting mask will minimize the risk of spreading the virus to others. Quarantine refers to the time following exposure to the virus or close contact with someone known to have COVID-19. 
Visit https://msdh.ms.gov/msdhsite/_static/14,0,420.html for more information on COVID-19.
https://www.cdc.gov/media/releases/2021/s1227-isolation-quarantine-guidance.html

                                                                                                                   
12/28/21

UPDATE 12/07/21 2:30PM – All available spots have now been filled. Thank you for your interest. We are excited to announce a special opportunity for up to 12 rural health clinics in Mississippi to participate at no cost in the National Association of Rural Health Clinic (NARHC) Certified Rural Health Clinic Professional Course (CRHCP) this Spring. The CRHCP Course is designed to educate participants on the operations, rules and regulations to manage a successful rural health clinic. This highly sought after, full-spectrum course is offered to Directors, Consultants, Clinic Administrators & other RHC leaders. Upon course completion & attainment of an 80% or higher exam score, you will earn a CRHCP certification.This opportunity is presented with funding from the Mississippi Office of Rural Health & Primary Care, and will be awarded at a first-come-first-serve basis.  We have 12 scholarships for full tuition to this course.  About the Course The course is delivered in a self-paced, on-demand platform.  It is estimated to take approximately 15-20 hours to complete coursework., with most people requiring 4-6 weeks to complete.  There is a proctored exam that must be taken during the week of March 28 – April 4, 2022 for full course graduation.   Click here to learn more about the course (but do not register through this site). How to Apply To apply, you may click here to view the Mississippi application.  Please submit the completed application to Ryan Kelly at ryan.kelly@mississippirural.org to mail to our office at 31 Woodgreen Place, Madison, MS 39110.  The deadline to submit is December 31, 2021 or until all available spots are taken.

Yesterday, CMS released the interim final regulations requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs. These requirements will apply to approximately 76,000 providers and cover over 17 million health care workers across the country. Facilities covered by this regulation must establish a policy ensuring all eligible staff have received the first dose of a two-dose COVID-19 vaccine or a one-dose COVID-19 vaccine prior to providing any care, treatment, or other services by December 5, 2021. All eligible staff must have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna or one dose of Johnson & Johnson – by January 4, 2022.   At this time, CMS is not allowing for daily or weekly testing of unvaccinated individuals as an alternative to vaccination.  The regulation provides for exemptions based on recognized disability, medical conditions or religious beliefs, observances, or practices.  With regard to recognized clinical contraindications to receiving a COVID-19 vaccine, facilities should refer to the CDC informational document, Summary Document for Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States, accessed at www.cdc.gov/vaccines/covid-19/downloads/….  CMS directs providers and suppliers to the Equal Employment Opportunity Commission (EEOC) Compliance Manual on Religious Discrimination160 for information on evaluating and responding to requests related to religious beliefs, observances, or practices. While employers have the flexibility to establish their own processes and procedures, including forms, CMS points to The Safer Federal Workforce Task Force’s “request for a religious exception to the COVID-19 vaccination requirement” template as an example. Facilities must develop a similar process or plan for permitting exemptions in alignment with federal law. CMS will ensure compliance with these requirements through established survey and enforcement processes.  If a provider or supplier does not meet the requirements, it will be cited by a surveyor as being non-compliant and have an opportunity to return to compliance before additional actions occur. The requirements apply to: Ambulatory Surgical Centers, Hospices, Programs of All-Inclusive Care for the Elderly, Hospitals, Long Term Care facilities, Psychiatric Residential Treatment Facilities, Intermediate Care Facilities for Individuals with Intellectual Disabilities, Home Health Agencies, Comprehensive Outpatient Rehabilitation Facilities, Critical Access Hospitals, Clinics (rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services), Community Mental Health Centers, Home Infusion Therapy suppliers, Rural Health Clinics/Federally Qualified Health Centers, and End-Stage Renal Disease Facilities. NRHA will be reviewing the regulation and submitting comments on behalf of our members expressing concern about the workforce and access implications in rural areas.  Comments on the interim final regulation must be provided within 60 days of November 5th, 2021 to be considered.  To view the interim final rule with comment period, visit: public-inspection.federalregister.gov/… To view a list of frequently asked questions, visit: www.cms.gov/files/document/cms-omnibus-staff-vax-requirements-2021.docx NRHA will be sharing a more detailed summary of the regulation shortly.  In meantime, feel free to contact our government affairs team at ccochran@ruralhealth.us. Thank you.

Hello NRHA members, This week, the Senate Appropriations Committee (SAC) released the text of their nine remaining appropriations bills, including the Labor, Health and Human Services, Education, and Related Agencies (L-HHS) bill. Below is an update on NRHA’s fiscal year (FY) 2022 appropriations requests. Both the House Appropriations Committee (HAC) and SAC recommended increasing funding for the U.S. Department of Health and Human Services (HHS) rural health programs, which are administered by the Federal Office of Rural Health Policy (FORHP). The HAC recommended increasing funding to $70.7 million above the FY 2021 enacted level, and the SAC recommended increasing funding to $73.2 million above the FY 2021 enacted level. NRHA is extremely pleased that both Congressional appropriations committees are seeking to provide more funding for rural health programs. However, we will continue to advocate that both committees match NRHA’s requested allocations for individual programs. The HAC and SAC matched NRHA’s requested funding allocations for the Rural Maternal and Obstetric Management Strategies (RMOMS) program ($10 million) and Rural Residency Planning and Development (RRPD) program ($12.7 million). Additionally, the HAC and SAC included report language to encourage HRSA to expand the current program to include RTTs in obstetrics and gynecology and request a report in the fiscal year 2023 Congressional Budget Justification on the progress made to date and efforts to expand RTTs in obstetrics and gynecology.  The HAC matched NRHA’s requested funding allocations for the Medicare Rural Hospital Flexibility (Flex) program ($61.2 million) and Rural Emergency Hospital (REH) Technical Assistance (TA) program ($10 million) but did not match NRHA’s requested funding allocations for the Rural Provider Modernization Technical Assistance program ($8 million) and Rural Provider Modernization Grants ($13 million). The SAC did not match NRHA’s funding allocation for any of these programs. Neither the HAC or SAC matched NRHA’s requested funding allocations for the United States Department of Agriculture (USDA) Rural Hospital Technical Assistance (TA) program ($5 million.  Below is a chart of FY 2022 requests and allocations:

Links:  

•President Biden’s FY 2022 budget request

•FY 2022 HAC L-HHS bill report

•FY 2022 SAC L-HHS explanatory statement

•FY 2022 HAC Ag bill report

•FY 2022 SAC Ag bill report

The Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), has announced a new application cycle for $25.5 billion in COVID-19 provider funding. Applicants will be able to apply for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments during the application process. PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is open to providers who serve rural patients covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). 

What Is the Provider Relief Fund?
Qualified providers of health care, services, and support may receive Provider Relief Fund payments for healthcare-related expenses or lost revenues due to coronavirus. These distributions do not need to be repaid to the US government, assuming providers comply with the terms and conditions.

What Is ARP Rural?
ARP Rural is intended to help address the disproportionate impact that COVID-19 has had on rural communities and rural health care providers; funding will be available to providers who serve patients in these communities. Eligible applicants can apply for the ARP Rural funds through the same Application and Attestation Portal that is available to apply for the Phase 4 General Distribution. Providers will apply for both programs in a single application.

In order to be considered for an ARP Rural payment, applicants must include any billing Tax Identification (TIN) owned by the applicant. ARP Rural payments will be determined based on the amount and type of Medicare, Medicaid, and CHIP services provided by billing TINs to rural beneficiaries. Applicants do not need to verify whether their beneficiaries live in an area that meets the definition of rural. HRSA will base payments on data already available to it using the Federal Office of Rural Health Policy definition of rural.

Please remember you have to APPLY for this funding. It will not be automatically allocated as with past phase funding.  In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application.

The application is open now and will close on October 26, 2021 at 11:59 p.m. ET. 

Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application. 

Real time technical assistance is available by calling the Provider Support Line at (866) 569-3522, for TTY dial 711. Hours of operation are 8 a.m. to 10 p.m. CT, Monday through Friday.

Please go to the following HRSA web site to find out more information and access resources for your application: 
https://www.hrsa.gov/provider-relief/future-payments

Dear Regional Partners, 

I am pleased to share with you that today, a new application cycle for $25.5 billion in COVID-19 provider funding has opened.  Applicants are able to apply for both Provider Relief Fund (PRF) Phase 4 and American Rescue Plan (ARP) Rural payments during the application process. PRF Phase 4 is open to a broad range of providers with changes in operating revenues and expenses. ARP Rural is open to providers who serve ruralbeneficiaries covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

See a detailed list of eligible provider types and application instructions here.

Applications must be received by October 26, 2021 at 11:59 p.m. ET. Providers who have previously created an account in the Provider Relief Fund Application and Attestation Portal and have not logged in for more than 90 days will need to first reset their password before starting a new application. In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application.Yesterday, the U.S. Department of Health and Human Services (HHS) awarded nearly $1 billion in American Rescue Plan funding to nearly 1,300 Health Resources and Services Administration (HRSA) Health Center Program-funded health centers in all 50 states, the District of Columbia, and the U.S. territories to support major health care construction and renovation projects. These awards will strengthen our primary health care infrastructure and advance health equity and health outcomes in medically underserved communities, including through projects that support COVID-19 testing, treatment, and vaccination.  Health centers will use this funding for COVID-19-related capital needs, constructing new facilities, renovating and expanding existing facilities to enhance response to pandemics, and purchasing new state-of-the-art equipment, including telehealth technology, mobile medical vans, and freezers to store vaccines.    FY 2021 American Rescue Plan Funding for Health Center Construction and Capital Improvements award recipients in Region 6 can be found here. Recent awards of over $5 Million to Expand Services at HRSA’s Health Center Program School-Based Service Sites can be found here
Recent awards of over $48 Million to Health Centers for Ending the HIV Epidemic in the U.S. Initiative can be found here

Finally, on September 17, 2021 HRSA announced nearly $350 million in awards to every state across the nation to support safe pregnancies and healthy babies. Funding will expand home visiting services to families most in need, increase access to doulas, address health disparities in infant deaths, and improve data reporting on maternal mortality. 

FY2021 awards to strengthen maternal and child health in Region 6 can be found here: 

• Maternal, Infant, and Early Childhood Home Visiting
• Healthy Start Initiative
• State Systems Development Initiative – Maternal Health Enhancement Supplement

Our team at the HRSA Office of Intergovernmental and External Affairs (IEA) remain committed to supporting your COVID-19 response efforts.  Please do not hesitate to reach out to us with questions, concerns, or requests for support and engagement.

Best,
Jeri D. Pickett
HRSA Regional Administrator, Region 6

NRHA wanted to notify you of a change to the Provider Relief Fund on justifying what is allowable under expenses.  Page 21 of the attached FAQ from 9.13.21 has eliminated the term “marginal” in the last sentence (see below).  Providers must still relate and document the expenses claimed (net of other reimbursements) to COVID as noted in this and other FAQs.  This clarification in policy also appears to be consistent with the feedback members are receiving when talking with the HRSA PRF hotline.   How do I determine if expenses should be considered “expenses attributable to coronavirus not reimbursed by other sources?” (Modified 9/13/2021)  Expenses attributable to coronavirus may include items such as supplies, equipment, information technology, facilities, personnel, and other health care-related costs/expenses for the period of availability. The classification of items into categories should align with how Provider Relief Fund payment recipients maintain their records. Providers can identify their expenses attributable to coronavirus, and then offset any amounts received through other sources, such as direct patient billing, commercial insurance, Medicare/Medicaid/Children’s Health Insurance Program (CHIP); other funds received from the federal government, including the Federal Emergency Management Agency (FEMA); the Provider Relief Fund COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment, and Vaccine Administration for the Uninsured (Uninsured Program); the COVID-19 Coverage Assistance Fund (CAF); and the Small Business Administration (SBA) and Department of the Treasury’s Paycheck Protection Program (PPP). Provider Relief Fund payments may be applied to the remaining expenses or costs, after netting the other funds received or obligated to be received which offset those expenses. The Provider Relief Fund permits reimbursement of marginal increased expenses related to coronavirus provided those expenses have not been reimbursed from other sources or that other sources are not obligated to reimburse.  NRHA recommends you speak with your financial advisors/council on what this change may mean to your PRF expenditures and reporting.

We wanted to share an update from the Department of US Health and Human Services around policies related to allocation, distribution, and administration efforts surrounding the current monoclonal antibody therapeutics available to combat the COVID-19 pandemic.   Beginning Monday, September 13th HHS made a change to their distribution process to coordinate through a state/territory-coordinated system.  The intent of this change is to maintain equitable distribution, both geographically and temporally providing states and territories with consistent, fairly distributed supply over the coming weeks and while the USG works to procure additional supply.  Key to this change is that administration site (i.e. providers) will not be able to order mAbs directly from the distributor and must work with their state/territory to access the supply.   Weekly distribution amounts will be determined based on weekly reports of new COVID 19 cases and hospitalizations in addition to data on inventories.  Weekly distribution determinations posted on phe.gov/mabs.