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Feds Seek to Redefine FAR Areas

 |  By John Commins  
   November 14, 2012

When it comes to monitoring the smorgasbord of healthcare mandates from the federal government, rural providers already have a full plate.

There are questions about the Patient Protection and Affordable Care Act that include the future status of funding for critical access hospitals, expansion of the Medicaid rolls, how—and if—the health insurance exchanges will function, and who gets what under bundled payments for coordinated care.

From now until Jan. 7, 2013 the Department of Health and Human Services is asking for public comment on the methodology used to determine what exactly constitutes a Frontier and Remote (FAR) area.

Here's a snippet from the six pages of dust-dry verbiage filed Nov. 5 in the Federal Registry: "Using data from the Census Bureau, every census tract in the United States is assigned a (Rural-Urban Commuting Area) code. Codes range from 1 through 10, with 23 sub codes, with code 1 representing the most densely populated urban areas and code 10 representing rural areas with primary commuting to a tract outside an Urbanized Area or Cluster."

Nobody will mistake this prose for Tolstoy.

This is utterly arcane wonkery for most people, but it could be a very big deal to rural communities. The dry methodology that is eventually adopted will be used to determine appropriate levels of federal funding and grants for rural healthcare providers.

"We highly encourage anybody who could be impacted or who is considered remote or frontier to look closely at this definition and ask questions and provide content," says Susan Wilger, director of programs for the National Center for Frontier Communitie. "Is the definition appropriate? Does it need to be fixed? If it is a good definition, that is a possibility too. If it is going to have positive impacts on frontier and remote communities we want to get that feed back as well."

Right now, Wilger says rural healthcare advocates haven't come to a determination about the value of the new definition and whether or not it will help rural providers.

"We have a number of questions," Wilger says. "Our concerns fall within several areas. One is conceptual. How is this consistent with existing definitions to frontier? Is this going to be a dramatic change that could have implications if certain federal agencies adopt this definition?"

Wilger says there are also several questions about the methodology that is being used as the foundation for the definition. "Currently, you will see that it is still based on the 2000 census data, not 2010 and that not all 50 states are incorporated. It's still lacking Hawaii and Alaska," she says. "We wonder how often the data sets are going to be refreshed."

A preliminary review of federal data earlier this year found that there was no frontier or remote data available for at least 130 ZIP Codes in New Mexico. "We're not sure why. Maybe they are still loading the data into their data set," Wilger says. "This ran several months ago so we don't want to alarm people but we have to go back and rerun it based on what they have now on their website."

Wilger says NCFC, the National Association for Rural Health, and the National Organization for State Offices of Rural Health are in the midst of their review of the FAR definition and are planning a webinar next month for providers. Interested readers should check their websites for scheduling updates.

In the meantime, as long as there are more questions than answers about the proposed FAR definition, Wilger says it's imperative that rural providers defend their turf. "We don't want to water down the few resources that are available to rural, frontier and very remote healthcare service providers," she says. "They are already dealing with really sparse resources and unique challenges."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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