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Federal Office of Rural Health Policy

The Federal Office of Rural Health Policy (FORHP) coordinates activities related to rural healthcare within the U.S. Department of Health and Human Services. Part of the Health Resources and Services Administration (HRSA), FORHP has department-wide responsibility for analyzing the possible effects of policy on residents of rural communities. Created by Section 711 of the Social Security Act, FORHP advises the Secretary on health issues within these communities, including the effects of Medicare and Medicaid on rural citizens' access to care, the viability of rural hospitals, and the availability of physicians and other health professionals.

FORHP administers grant programs designed to build healthcare capacity at both the local and State levels. These grants provide funds to 50 State Offices of Rural Health to support on-going improvements in care, and to rural hospitals through the Medicare Rural Hospital Flexibility Grant. Through its community-based programs, FORHP encourages network development among rural healthcare providers; upgrades in emergency medical services; and places and trains people in the use of automatic external defibrillators. FORHP also oversees the Black Lung Clinics grant program and the Radiation Exposure Screening and Education grant program. While these efforts are not solely focused on rural health issues, many of the populations affected reside in rural areas.

Structure

FORHP programs and staffs are organized in four divisions and a team:

  • The Community-Based Division houses programs providing direct support to community organizations for health service delivery and creating and sustaining health networks.
  • The Hospital-State Division supports grants and activities for State Offices of Rural Health and support and technical assistance to small rural hospitals, including critical access hospitals.
  • The Office for the Advancement of Telehealth promotes the use of telehealth technologies for healthcare delivery, education, and health information services, and provides funding for telehealth grants and resource centers.
  • The Policy-Research Team coordinates policy work impacting rural providers and beneficiaries, as well as fund research and analysis of key policy issues facing rural communities.

Definition of Rural

There are measurement challenges with both the Census Bureau and Office of Management and Budget (OMB) definitions. Some policy experts note that the Census definition classifies quite a bit of suburban area as rural. The OMB definition includes rural areas in metropolitan counties including, for example, the Grand Canyon which is located in a metro county. Consequently, one could argue that the Census Bureau standard includes an overcount of rural population whereas the OMB standard represents an undercount of the rural population.

FORHP accepts all non-metro counties as rural and uses an additional method of determining rurality called the Rural-Urban Commuting Area (RUCA) codes. Like the metropolitan statistical areas, these are based on Census data which is used to assign a code to each Census Tract. Tracts inside metropolitan counties with the codes 4-10 are considered rural. While use of the RUCA codes has allowed identification of rural census tracts in metropolitan counties, among the more than 70,000 tracts in the U.S. there are some that are extremely large and where use of RUCA codes alone fails to account for distance to services and sparse population. In response to these concerns, FORHP has designated 132 large area census tracts with RUCA codes 2 or 3 as rural. These tracts are at least 400 square miles in area with a population density of no more than 35 people. Following the 2010 Census the FORHP definition included approximately 57 million people, about 18% of the population and 84% of the area of the U.S. RUCA codes represent the current version of the Goldsmith Modification.

Grants

HRSA rural health grant programs fund rural hospitals, health centers and local clinics.

  • Community Based Division
    • Black Lung/Coal Miner Clinics Program
    • Radiation Exposure Screening and Education Program
    • Rural Health Care Delta Program
    • Rural Health Care Services Outreach
    • Rural Health Information Technology Network Development
    • Rural Health Network Development
    • Rural Health Network Development Planning
    • Rural Health Workforce Development
    • Small Health Care Provider Quality Improvement
    Community-Based Division Outreach Funding Opportunity ForecastView larger
  • Hospital State Division
    • Medicare Rural Hospital Flexibility (Flex)
    • Small Rural Hospital Improvement Program (SHIP)
    • State Offices of Rural Health (SORH)
  • Office for the Advancement of Telehealth
    • Licensure Portability
    • Telehealth Network
    • Telehealth Resource Center
  • Policy and Research
    • Frontier Extended Stay Clinic
    • Rapid Response to Requests for Data Analysis
    • Rural Health Research
    • Rural Policy Analysis
    • Rural Health Best Practices and Community Development
    • Rural Training Track Technical Assistance Program