Improving Rural Health Network Adequacy

i Mar 2nd No Comments by

NOSORH offered an informative webinar on Improving Rural Health Network Adequacy in February.  In case you missed it, all the materials and recording have been posted to NOSORH’s website.  The Patient Protection and Affordable Care Act (PPACA) has changed the regulatory environment for health network adequacy. New regulations and guidance are being issued at the both Federal and State levels. The webinar explored opportunities for State Offices of Rural Health to participate in the new efforts and approaches to assuring that health networks, including Qualified Health Plans (QHPs) and Accountable Care Organizations (ACOs), have adequate providers and facilities.

As the PPACA continues to rollout, we see that special arrangements are needed to meet inadequate numbers of providers or facilities in rural shortage areas to ensure appropriate access to enrollees. SORHs are knowledgeable about services in these communities and are well placed to participate in efforts to assure appropriate rural health care.

There are several new initiatives designed to improve the regulation of health network adequacy nationwide.  There will be new opportunities at the State and Federal level for SORHs to address this issue with State Medicaid programs, State Insurance Commissioners and Health Exchanges.

Listen to the first webinar on the requirements for Network Adequacy and how SORHs can get involved and help implement strategies that makes the most sense for rural areas.  As this process unfolds, NOSORH will provide more learning opportunities to review the changes in the coming year.


Back to March Branch

Webinar: Improving Rural Health Network Adequacy (2-24-15)

i Feb 25th No Comments by

Improving Rural Health Network Adequacy Presentation

MDL-74 NAIC Model Network Adequacy Act

Viewable Recording

The Emerging Role of Rural Care Coordination in the Post-ACA Environment – A Knudson

i Jan 20th No Comments by

The Emerging Role of Rural Care Coordination in the Post-ACA Environment – A Knudson

NRHD Webinar: ACA and You (11.20.14)

i Nov 20th No Comments by

ACA and You Webinar Presentation

Viewable Recording

Promising Practices: South Carolina Reaches Out to Uninsured Residents Through the Healthy Outcomes Plan (HOP)

i Nov 6th No Comments by

In an effort to provide consistent medical care to thousands of underserved residents, South Carolina’s “Medicaid System” has implemented a statewide program designed to coordinate care and provide a medical home for some of its most at-risk residents.

Now in its second year, the Healthy Outcomes Plan (HOP) asked every hospital in the state to identify a predetermined number of low-income, uninsured residents who visited the emergency department at least five times in the last year, and who suffered from a chronic condition such as diabetes, cardiovascular disease, hypertension, sickle cell or HIV/AIDS.  The size of the hospital determined the number of residents they were required to identify, with 50 being the minimum for the state’s smallest hospitals.  All of South Carolina’s hospitals are participating in the program.  The state’s three largest metropolitan hospitals had to identify at least 750 residents.  “Activity always follows the dollar,” said Graham Adams, Ph.D, CEO of the South Carolina Office of Rural Health (SCORH).  “The hospitals were incentivized to get on board or they would lose the Disproportionate Share Hospital (DSH) money they were already receiving.  Plus, the state gave additional money to every hospital involved in the program.  Our 19 rural hospitals received 100% of their DSH money.”

Dr. Adams went on to say that HOP is particularly important in the rural areas, where residents are less likely to have a medical home and often wait until they are very ill before visiting an emergency department for care.  SCORH provided technical assistance to rural hospitals in the development of the program.  “Rural providers have a close relationship with their patients and as a result were more successful in identifying and bringing new patients into the program.”  The goal for the first year of HOP was to enroll 8,500 residents.

Now in its second year, Dr. Adams said the program has been beneficial because it provides a medical home and a system of care for people who really need it.  “It gives incentives for medical providers to work together for these folks well-being.  Controlling the chronic illnesses of our residents is one of the biggest benefits so far,” he said.  “Overall, it’s been a very positive thing.”


Back to November Branch

Affordable Care Act Update (Dan Derksen)

i Aug 26th No Comments by

Affordable Care Act Update (Dan Derksen)

Webinar: ACA Show and Tell (July 31, 2014)

i Jul 31st No Comments by

ACA Show and Tell – SORH Sharing – Presentation

Viewable Recording

FACT SHEET: Affordable Care Act by the Numbers

i Apr 30th No Comments by


Office of the Press Secretary


April 17, 2014

FACT SHEET: Affordable Care Act by the Numbers

The Affordable Care Act is working.  It is giving millions of middle class Americans the health care security they deserve, it is slowing the growth of health care costs and it has brought transparency and competition to the Health Insurance Marketplace.


  • 8 million people signed up for private insurance in the Health Insurance Marketplace. For states that have Federally-Facilitated Marketplaces, 35 percent of those who signed up are under 35 years old and 28 percent are between 18 and 34 years old, virtually the same youth percentage that signed up in Massachusetts in their first year of health reform.
  • 3 million young adults gained coverage thanks to the Affordable Care Act by being able to stay on their parents plan.
  • 3 million more people were enrolled in Medicaid and CHIP as of February, compared to before the Marketplaces opened. Medicaid and CHIP enrollment continues year-round.
  • 5 million people are enrolled in plans that meet ACA standards outside the Marketplace, according to a CBO estimate. When insurers set premiums for next year, they are required to look at everyone who enrolled in plans that meet ACA standards, both on and off the Marketplace.
  • 5.7 million people will be uninsured in 2016 because 24 States have not expanded Medicaid.


 health care cost growth

  • Health care costs are growing at the slowest level on record: Since the law passed, real per capita health care spending is estimated to have grown at the lowest rate on record for any three-year period and less than one-third the long-term historical average stretching back to 1960. This slower growth in spending is reflected in Medicare, Medicaid, and private insurance.
  • CBO projects the deficit will shrink more and premiums will be lower than expected: CBO previously estimated that the ACA will reduce the deficit by $1.7 trillion over two decades, and, just this week, CBO concluded that lower-than-expected Marketplace premiums and other recent developments will cut $104 billion from our deficit over the next ten years. The CBO report also projects that lower-than-expected premiums will help to save $5 billion this year, and that lower premiums will persist in the years ahead, remaining 15 percent below projections by 2016 (the only year in which CBO provides a precise estimate).
  • Medicare spending growth is down: Medicare per capita spending is growing at historically low rates.  This week, for the fifth straight year, the CBO reduced its projections for Medicare spending over the next 10 years – this time by $106 billion.  CBO projects that Medicare and Medicaid costs in 2020 will be $180 billion below its 2010 estimates.  Recent economic research suggests that the ACA’s reforms to Medicare may have “spillover effects” that reduce costs and improve quality across the health care system, not just in Medicare.

 estimate numbers on aca


  • Up to 129 million Americans with pre-existing conditions – including up to 17 million children – no longer have to worry about being denied health coverage or charged higher premiums because of their health status.
  • 71 million Americans with private insurance have gained coverage for at least one free preventive health care service such as mammograms, birth control, or immunizations in 2011 and 2012.
  • In 2013, 37 million people with Medicare received at least one preventive service at no out of pocket cost.
  • Approximately 60 million Americans have gained expanded mental health and substance use disorder benefits and/or federal parity protections.
  • Since the health care law was enacted, almost 8 million seniors have saved nearly $10 billion on prescription drugs as the health care law closes Medicare’s “donut hole.”
  • 105 million Americans no longer have to worry about having their health benefits cut off after they reach a lifetime limit.


Promising Practices: Online Brochure Provides Information on the Affordable Care Act: March 2013

i Mar 18th No Comments by

An online brochure, created by the  Southwest Rural Policy Network  (SWRPN) and distributed by the  Arizona State Office of Rural Health,  aims to provide quick and easy  information on the Affordable Care Act  (ACA) for a rural audience there.

The brochure was a response to a W.K.  Kellogg Foundation initiative called  Rural People, Rural Policy and was  developed by the SWRPN’s Health  Action Team, according to Joyce  Hospodar, AZ SORH Health Systems  Development Manager and SWRPN  Action Team Chair. Using money from  that initiative, the AZ SORH was able to  make printed copies to distribute in the  state, which so far it has distributed to  many organizations including AHECs,  FQHCs and hospitals. “All the other  material we are seeing on the ACA is so  complicated,” Hospodar said. “We’re  trying to get the information more  understandable to people living in  rural communities. As people become  more aware of the ACA, we’ll be able  to increase their participation in what  they’re eligible for, so more people will  be getting insurance and be involved  with the benefits of the ACA.”

Feedback on the brochure has  been positive, Hospodar said. “The  momentum is increasing, more people  are wanting it. It has been lauded  for ease of use.” By popular demand  the brochure is being translated  into Spanish, and public service  announcements are being written  from it in both English and Spanish,  which will be targeted for national  distribution.

Funding for development of the brochure came from the Kellogg Initiative. Despite the up-front costs of web development and printing,  Hospodar said, she thinks it will  be a good investment. “So many  organizations are working to get the  word out about the ACA that there’s  lots of duplication. We’re trying  to streamline it. The brochure can  be used to answer questions that  patients—and citizens—have about  the ACA quickly and easily.”

Hospodar said that both the online  and print brochure versions can be  modified and used by other State  Offices of Rural Health (SORHs),  but it will require some funding for  the modifications. The New Mexico  members of the Health Action Team  have tailored the brochure for their  state and have made it available  online. To access the Arizona and  New Mexico ACA brochures, visit the  SWRPN Affordable Care Act page.  SORHs that are interested in adapting  the brochure for their use can contact  Hospodar for more information, at or 520- 626-2432.


Promising Practices: Kentucky Office of Rural Health Helping Providers and Patients Get “Kynected”

i Mar 18th No Comments by

The Kentucky Office of Rural Health (KORH) is helping get the word out about the Kentucky Health Benefit Exchange (KHBE), the state-run health insurance program, by helping facilitate information sessions in different regions of the state.

The sessions are geared toward health care providers, administrators, boards of directors, community agencies, coalitions, navigators, mid-level managers, front-line staff and other health care workers. “Our partners wanted more community-type events, so we thought, if they’re willing to put forth the effort, we’re going to give it a shot,” said Kayla Combs, KORH rural project manager. “The people working within the exchange have been wonderful to work with. Since they have been so willing to help we
decided to do a roadshow of sorts.”

The sessions have featured KHBE leaders and staff doing a two-hour presentation, with the first half outlining details of the exchange, followed by a question and answer session. Two sessions have been held so far. The first session, held at the UK Center of Excellence in Rural Health in Hazard, where KORH is located, had 100+ attendees, including some that joined in over iTV. The second was held in Paducah, in the western part of the state, and had around 85 attendees. KORH staff has been on hand at the
sessions to register participants and help facilitate.

Although Kentucky has been one of the most successful states in signing up people for insurance, with more than 10 percent of its estimated 640,000 uninsured signed up by the end of November (an average of 1,000 a day), Combs said that she has been surprised that many providers have been unaware of KHBE, its kynect web site, and how it works. “In smaller practices, the providers are so busy that it just crept up on them, so this educates them on the basics,” she said.

KORH Director Ernie Scott attributes the success of the sessions to “a simplified marketing strategy, as well as great partnering organizations.” KORH has sent out invitations to all area healthcare providers and rural stakeholders. The one-page flyer for the sessions is simple, with meeting information, the kynect logo at the top and a list of sponsors at the bottom. “We encourage everyone to forward it on and distribute it within their communities,” Scott said. “But, locally, we’re finding that email is not the only option.” KORH has been faxing the flyer to doctors’ offices. “Doctors in smaller practices are so busy, they otherwise miss a lot of electronic communications,” he explained.

The next session, planned for January 16th in Morehead, KY, will be the first to offer an additional evening session for the general population. “We’ve been putting out local ads, putting flyers in beauty shops, any place where folks who would benefit can see them,” Scott said. “And kynectors (Kentucky patient navigators) will be available to sign people up on the spot.”

Both Combs and Scott feel an urgency to assist and educate rural providers in getting the uninsured  signed up for coverage. Scott said that a local hospital chain recently sent out notice that it will “no  longer see patients for non-emergency services next year since everyone is expected to have some form of insurance, ‘consistent with the Affordable Care Act’. “If this hospital takes a stand, others will certainly follow,” he said.