4A (Expenses $ 17853088 including grants of $ 192867) (Revenue $ 22835961)
CLEARWATER VALLEY HOSPITAL AND CLINICS (CVHC) IS CREATED AND ORGANIZED TO OWN, MAINTAIN, OPERATE AND CONDUCT, DIRECTLY OR INDIRECTLY, AND TO ASSIST AND COORDINATE ACTIVITIES OF FACILITIES FOR HEALTH CARE, EDUCATION, CARE FOR THE AGED AND SOCIAL SERVICES, INCLUDING CHARITABLE CARE TO PERSONS UNABLE TO PAY. CVHC OPERATES A 23-BED CRITICAL ACCESS HOSPITAL THAT PROVIDES GENERAL MEDICAL AND SURGICAL CARE FOR INPATIENT, OUTPATIENT, AND EMERGENCY ROOM PATIENTS IN CLEARWATER COUNTY AND THE SURROUNDING AREAS AND PRIMARY CARE CLINICS IN OROFINO, PIERCE, AND KOOSKIA. CVHC PROVIDED 2,584 HOSPITAL PATIENT DAYS, 17,707 OUTPATIENT VISITS, 3,885 ER VISITS, AND 17,775 CLINIC ENCOUNTERS DURING THE YEAR.

FACILITY 1, CLEARWATER VALLEY HOSPITAL & CLINIC - PART V, LINE 3E
IDENTIFICATION AND PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS BEGIN ON PAGE 14 OF THE CHNA LOCATED ON THE HOSPITAL'S WEBSITE.

FACILITY 1, CLEARWATER VALLEY HOSPITAL & CLINIC - PART V, LINE 5
A STEERING COMMITTEE WAS FORMED BY CLEARWATER VALLEY HOSPITAL & CLINICS, INC. TO LEAD THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS FROM APRIL 2018 TO DECEMBER 2018. PARTNERS WERE SELECTED FOR THE STEERING COMMITTEE TO ENSURE THE ASSESSMENT PROCESS WAS GUIDED BY COMMUNITY STAKEHOLDERS THAT REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. AS SUCH, THE PARTNERS REPRESENTED THE PUBLIC HEALTH PERSPECTIVE AND THE INTERESTS OF MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, OR INDIVIDUALS. OTHER ORGANIZATIONS REPRESENTED ON THE STEERING COMMITTEE INCLUDED: OROFINO BOARD OF EDUCATION, CLEARWATER ECONOMIC DEVELOPMENT COUNCIL, OROFINO AMBULANCE, LOCAL BUSINESS LEADERS, OROFINO CHAMBER OF COMMERCE, OROFINO POLICE DEPARTMENT, CITY OF OROFINO, FAITH-BASED ORGANIZATIONS. A COMMUNITY SURVEY WAS PUBLISHED ONLINE AND DISTRIBUTED BY THE ADVISORY COMMITTEE AND CLEARWATER VALLEY HOSPITAL STAFF. THE SURVEY WAS DEVELOPED BASED ON AN EXISTING TEMPLATE UTILIZED BY IDAHO PUBLIC HEALTH, NORTH CENTRAL REGION AMONG ITS AFFILIATES AND CITIZENS, AND AUGMENTED TO CAPTURE INPUT REGARDING UNIQUE HEALTH-RELATED CHARACTERISTICS THAT EXISTS WITHIN THE CLEARWATER VALLEY HOSPITAL SERVICE AREA. MORE THAN 300 COMMUNITY MEMBERS RESPONDED TO THE SURVEY. THE SURVEY WAS COMPLETED BY A WIDE VARIETY OF AGES AND LOCATIONS. SIGNIFICANT EFFORT WAS TAKEN TO ENSURE THAT THE SURVEY WAS ACCESSIBLE TO INDIVIDUALS WHO ARE PART OF THE MEDICALLY UNDERSERVED, LOW-INCOME, OR MINORITY POPULATIONS. CLEARWATER VALLEY HOSPITAL & CLINICS, INC. DID NOT RECEIVE ANY COMMENTS ON THEIR PREVIOUS CHNA. ANY COMMENTS WOULD HAVE BEEN TAKEN INTO CONSIDERATION IN THE DEVELOPMENT OF THE CHNA.

FACILITY 1, CLEARWATER VALLEY HOSPITAL & CLINIC - PART V, LINE 6A
THE CHNA WAS CONDUCTED IN COLLABORATION WITH ESSENTIA HEALTH CARE SYSTEMS INCLUDING ST. MARY'S HOSPITAL, INC., A RELATED ORGANIZATION, IN ORDER TO ALIGN RESOURCES AND STRENGTHS TO BETTER SERVE OUR COMMUNITY.

FACILITY 1, CLEARWATER VALLEY HOSPITAL & CLINIC - PART V, LINE 6B
TO HAVE THE GREATEST IMPACT ON THE COMMUNITY SERVED, CLEARWATER VALLEY HOSPITAL AND CLINICS, INC. WORKED COLLABORATIVELY ON THE ASSESSMENT PROCESS WITH IDAHO PUBLIC HEALTH AND NORTH CENTRAL REGION. NOT ONLY DID THIS ENSURE FEEDBACK FROM A REPRESENTATIVE OF PUBLIC HEALTH THROUGHOUT THE ENTIRE COMMUNITY HEALTH NEEDS ASSESSMENT, IT ALSO PROVIDED THE BACKBONE FOR CONTINUED COLLABORATION ON THE IMPLEMENTATION PLANS.

FACILITY 1, CLEARWATER VALLEY HOSPITAL & CLINIC - PART V, LINE 11
CLEARWATER VALLEY HOSPITAL AND CLINICS, INC. ADDRESSED THE SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENT ASSESSMENT: MENTAL HEALTH EDUCATION AND SUPPORT; CHILDREN ARE ACTIVE AND HEALTHY; ACCESS TO RELIABLE TRANSPORTATION. WITH FEW EXCEPTIONS THE HOSPITALS PLAY A PRIMARY ROLE IN ESTABLISHING THE FRAMEWORK FOR PROGRESS IN EACH OF THESE AREAS. PRIORITY AREA 1: MENTAL HEALTH EDUCATION AND SUPPORT CLEARWATER COUNTY CURRENTLY DOEES NOT HAVE SPECIFIC SERVICES AIMED AT ADDRESSING MENTAL HEALTH ISSUES IN CHILDREN UNDER AGE 18; HOWEVER, IN THIS SMALL, RURAL POPULATION THERE ARE MANY FAITH-BASED ORGANIZATIONS, YOUTH GROUPS, AND A STRONG 4-H PROGRAM TO HELP ENGAGE CHILDREN AND GIVE THEM A SENSE OF PURPOSE. IN CLEARWATER COUNTY, THE COMMUNITY HEALTH ACTION TEAM OFFERS SUICIDE PREVENTION TRAINING FOR THE COMMUNITY, DISTRIBUTES GUNLOCKS FOR THOSE THAT WANT THEM, AND THE SCHOOL DISTRICT PROVIDES TRAINING TO TEACHERS TO HELP IDENTIFY AND DEAL WITH MENTAL HEALTH ISSUES IN STUDENTS. ADDITIONALLY, A CRISIS INTERVENTION FACILITY WILL BE CREATED TO HELP THE HOSPITAL PROVIDE RESPITE CARE ON A SHORT-TERM BASIS. PRIORITY AREA 2: CHILDREN ARE ACTIVE AND HEALTHY OROFINO OFFERS A ROBUST OUTDOOR LIFESTYLE FOR ITS CITIZENS AND GUESTS. FISHING, HUNTING, SWIMMING, AND HIKING ARE ALL AVAILABLE RIGHT OUTSIDE YOUR DOOR. STRONG YOUTH PROGRAMS SUCH AS BASEBALL AND SOCCER ARE ALSO AVAILABLE TO THE AREAS CHILDREN, AND A SKATE PARK AND A PUBLIC SWIMMING POOL ARE IN PROCESS OF BEING BUILT TO ADD TO THE COMMUNITIES ALREADY RICH RESOURCES. OROFINO WAS AWARDED A 250,000 COMMUNITY TRANSFORMATION GRANT (CTB) FROM THE BLUE CROSS OF IDAHO FOUNDATION FOR HEALTH. CTG IS A THREE-YEAR GRANT FOCUSED ON IMPROVING YOUTH ACCESS TO HEALTHY FOODS AND ACTIVE LIVING. YEAR ONE WAS SPENT LEARNING, BOTH FROM THE OROFINO COMMUNITY AND FROM COMMUNITY HEALTH EXPERTS, WITH ONE PROJECT INITIATED. AS WE ENTER YEAR TWO, WE ARE WORKING TO EXPAND THE ACTION PLAN THAT WILL GUIDE HOW FUNDS WILL BE SPENT. AREAS OF SPECIFIC FOCUS INCLUDE: A - POLICIES: ORDINANCES, RULES, REGULATIONS, PRACTICES, AND PROCEDURES. PUBLIC POLICIES INCLUDE ZONING CODES, SUBDIVISION RULES AND REGULATIONS, SITE DESIGN GUIDELINES, ROADWAY DESIGN STANDARDS, ETC.; PRIVATE POLICES INCLUDE FARMERS MARKET REGULATIONS, SCHOOL WELLNESS POLICIES, WORKSITE POLICIES, ETC. B - PROGRAMS: OUTREACH, EDUCATION AND BEHAVIOR CHANGE ACTIVITIES; EVENTS AND EDUCATION; POP-UPS, DEMONSTRATIONS, AND TRIALS. C - PROJECTS: CHANGES TO PHYSICAL INFRASTRUCTURE AND THE BUILT ENVIRONMENT; VENDING AND CONCESSION OPTIONS, GARDEN OF MARKET SPACE, FOOD LABELING, PRICING STRATEGIES, ETC. D - PARTNERSHIPS: ENGAGED ORGANIZATIONS AND COMMUNITY MEMBERS WITH ALIGNED RESOURCES WORKING TOGETHER TOWARD A COMMON GOAL (I.E. TO IMPROVE YOUTH ACCESS TO HEALTHY, AFFORDABLE FOOD AND INCREASED PHYSICAL ACTIVITY). THE PROPOSED PROJECTS CURRENTLY IDENTIFIED FOR THE AWARDED GRANT FUNDS ARE A NEW SKATE PARK, UPGRADED TENNIS/PICKLEBALL COURTS, SCHOOL GARDENS, WALK/BIKE PROGRAMS, OPEN GYM AVAILABILITY, AND EXPANDED CITY PARK FACILITIES AND EQUIPMENT. THE PROJECTS WILL TIE INTO THE GOALS OF OFFERING A HEALTHIER LIFESTYLE THROUGH PHYSICAL FITNESS, GROUP ACTIVITIES, AND BETTER NUTRITION. PRIORITY AREA 3: ACCESS TO RELIABLE TRANSPORTATION THIS IS A LARGELY UNADDRESSED PRIORITY IN THE REGION AND WORK ON THIS IS IN ITS INFANCY. WITH THE ABSENCE OF ANY TYPE OF PUBLIC TRANSPORTATION, SIGNIFICANT WORK WILL NEED TO BE DONE. THERE IS ONE HOME-DELIVERY OPTION PROVIDED BY AN INDEPENDENT COMPANY BUT THEIR SCOPE OF SERVICE AND AREA IS INADEQUATE TO MEET THE DEMAND. ISSUES IDENTIFIED THROUGH THE PROCESS BUT NOT INCLUDED AMONG THE TOP THREE PRIORITIES INCLUDED LACK OF MENTAL HEALTH COUNSELORS, SCHOOL NURSES, ASSISTED LIVING HOUSING, FAMILY HOUSING, AND MEMORY CARE FACILITIES. WHENEVER POSSIBLE WE WILL SEEK TO ADDRESS THESE NEEDS, IN PART, THROUGH THE SELECTED PRIORITIES AS SOME OF THEM ARE INTERRELATED. OTHER IDENTIFIED ISSUES WILL CONTINUE TO BE EVALUATED AND STRATEGIES WILL BE SOUGHT WHENEVER POSSIBLE.

SCHEDULE H, PART I, LINE 3C
ASSETS WILL BE CONSIDERED ALONG WITH THE PATIENT'S INCOME TO DETERMINE ELIGIBILITY FOR THE FINANCIAL ASSISTANCE PROGRAM. ASSETS MAY INCLUDE, BUT ARE NOT LIMITED TO, SUCH ITEMS AS CHECKING AND SAVINGS ACCOUNTS, IRAS, 401(K)S, PENSIONS, HEALTH SAVINGS ACCOUNTS, ADDITIONAL PROPERTY, AND ANY OTHER RETIREMENT FUNDING.

SCHEDULE H, PART I, LINE 7G
THE HOSPITAL HAS INCLUDED COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES IN PART I, LINE 7G IN THE AMOUNT OF 2,606,780 IN COLUMN C AND 2,184,524 IN COLUMN D.

SCHEDULE H, PART I, LINE 7
THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COST-TO-CHARGES (WORKSHEET 2) FOR FIGURES REPORTED IN THE TABLE RELATED TO CHARITY CARE AND UNREIMBURSED MEDICAID (TOTAL OPERATING EXPENSES LESS NON-PATIENT CARE ACTIVITIES, TOTAL COMMUNITY BENEFIT, AND TOTAL COMMUNITY BUILDING EXPENSES). ACTUAL COSTS WERE USED FOR THE REMAINDER OF THE COMMUNITY BENEFITS REPORTED.

SCHEDULE H, PART III, LINE 2
THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS.

SCHEDULE H, PART III, LINE 3
DISCOUNTS, CHARITY CARE, AND BAD DEBT EXPENSE ARE ACCOUNTED FOR AS REDUCTIONS TO REVENUE. BAD DEBT EXPENSE ON PATIENT ACCOUNTS WOULD BE IDENTIFIED AS ANY BALANCE ON THE ACCOUNT, LESS ANY PREVIOUS PAYMENTS AND DISCOUNTS, THAT HAS AGED AND IS ABSENT OF ANY PAYMENTS. IF, DURING THE COLLECTION PROCESS, IT BECOMES KNOWN THAT THE PATIENT QUALIFIES FOR CHARITY CARE, THE AMOUNTS INCLUDED WITHIN BAD DEBT EXPENSE WOULD BE RECLASSIFIED TO CHARITY CARE. CVHC APPLIED A HIGH-LEVEL, CONSERVATIVE ANALYTICAL REVIEW BY MULTIPLYING THE RATIO OF CHARITABLE ALLOWANCES TO GROSS PATIENT REVENUE AGAINST BAD DEBT EXPENSE TO ARRIVE AT AN APPROXIMATION OF CHARITY CARE THAT RESIDES IN BAD DEBT. CVHS INCORPORATES THE COST OF BAD DEBT AS A COMMUNITY BENEFIT. AS A TAX- EXEMPT HOSPITAL, WE MUST PROVIDE THE NECESSARY SERVICES REGARDLESS OF THE PATIENT'S ABILITY TO PAY FOR THAT CARE. IN DOING SO, WE MAKE QUALITY PATIENT CARE AVAILABLE TO ALL IN OUR COMMUNITY, REGARDLESS OF THEIR ECONOMIC MEANS.

SCHEDULE H, PART III, LINE 4
THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE AUDITED FINANCIAL STATEMENTS IS FOUND IN FOOTNOTE 1 ON PAGE 27 OF THE KOOTENAI HEALTH CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THE PROVISION FOR BAD DEBTS IS ALSO INCLUDED IN FOOTNOTE 1.

SCHEDULE H, PART III, LINE 8
"THESE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR. THE REPORTED MEDICARE ALLOWABLE COSTS ARE OBTAINED FROM THE HOSPITAL'S GENERAL LEDGER AND THEN ADJUSTED AND REPORTED IN ACCORDANCE WITH CENTERS FOR MEDICARE SERVICES (CMS) ""COST FINDING"" GUIDELINES AS PUBLISHED IN THEIR PROVIDER REIMBURSEMENT MANUAL. ONCE THE MEDICARE ALLOWABLE COSTS ARE DETERMINED FROM THE HOSPITAL'S COST REPORT, ANY COSTS ATTRIBUTED TO SUBSIDIZED HEALTH SERVICES, AND MEDICAL EDUCATION, ARE REMOVED AND REPORTED SEPARATELY. EXPLANATION FOR ANY PRIOR YEAR SETTLEMENTS FOR MEDICARE-RELATED SERVICES IN THE CURRENT TAX YEAR: THE HOSPITAL IS REQUIRED TO FILE A MEDICARE COST REPORT 5 MONTHS AFTER THE CLOSE OF THEIR FISCAL YEAR. THE COST REPORT PROVIDES MEDICARE WITH INFORMATION THAT IS USED TO DETERMINE UTILIZATION AND SPENDING TRENDS BUT ALSO IS USED TO SET FUTURE PAYMENT RATES FOR MOST MEDICARE SERVICES. IF THE INTERIM PAYMENTS PAID TO A HOSPITAL ARE HIGHER OR LOWER THAN THE FILED COST REPORT ALLOWABLE REIMBURSEMENT THERE WILL BE A SETTLEMENT FOR THAT FISCAL YEAR. THIS CAN BE DUE TO CHAGNES IN UTILIZATION OR COST OF PROVIDING SERVICES FOR CRITICAL ACCESS HOSPITALS (CAH) OR DIFFERENCES BETWEEN INTERIM AND FINAL PAYMENT FACTORS FOR DISPROPORTIONATE SHARE, BAD DEBTS, OR INDIRECT MEDICAL EDUCATION FOR NON-CAH HOSPITALS. AN ESTIMATE FOR THESE SETTLEMENTS IS RECORDED AT THE CLOSE OF THE FISCAL YEAR. IF THE ESTIMATE VARIES FROM THE FINAL SETTLEMENT RECEIVED 6-7 MONTHS AFTER THE FISCAL YEAR ENDS, THEN THESE AMOUNTS ARE RECORDED AS PRIOR YEAR MEDICARE REVENUE. ANY MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS REPORTED IN PART III, LINE 7 ARE TREATED AS COMMUNITY BENEFIT. THE RATIONALE FOR THE HOSPITAL'S OPINION IS PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE AND IT IS LIKELY TO GET WORSE. MANY MEDICARE BENFICIARIES ARE POOR AND ARE ELIGIBLE FOR MEDICAID IN ADDITION TO MEDICARE. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL IN ORDER TO COTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY."

SCHEDULE H, PART III, LINE 9B
THE POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR THE FINANCIAL ASSISTANCE POLICY (FAP) AND FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR FINANCIAL ASSISTANCE, AND THE PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS/HER PAYMENT AGREEMENTS. CVHC OFFERS EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS AND WILL NOT CHARGE A PATIENT THE GROSS AMOUNT OF CHARGES FOR ANY UNINSURED TREATMENT. UNINSURED DISCOUNTS WILL BE APPLIED TO THE GROSS CHARGES PRIOR TO ANY FINANCIAL ASSISTANCE OR OTHER DISCOUNTS. IF AT ANY TIME CVHC RECOGNIZES THAT A PATIENT MAY BE ELIGIBLE FOR STATE OR FEDERAL PROGRAMS, A REPRESENTATIVE WILL ASSIST THE PATIENT IN OBTAINING INFORMATION ABOUT THESE PROGRAMS OR PROVIDE CONTACT INFORMATION FOR THESE PROGRAMS. CVHC CONTRACTS WITH AN OUTSIDE PATIENT ADVOCACY AGENCY, WHICH MAY PROVIDE ASSISTANCE TO THE UNINSURED PATIENT IN APPLYING TO CERTAIN STATE AND FEDERAL PROGRAMS. AT ANY STAGE OF THE PATIENT EXPERIENCE AND UP THROUGH THE COLLECTION PROCESS, THE PATIENT MAY EXPRESS A CONCERN THAT THEY ARE UNABLE TO PAY THEIR BILL IN FULL OR MEET THE PAYMENT PLAN REQUIREMENTS. AT THAT TIME, THE PATIENT WILL BE GIVEN EVERY OPPORTUNITY TO COMPLETE AND SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. CVHC TRAINS ITS OUTSIDE DEBT COLLECTION AGENCIES AND ATTORNEYS ABOUT THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION ABOUT THE FAP OR SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. CHVC REQUIRES ITS OUTSIDE COLLECTION AGENCIES AND ATTORNEYS TO REFER PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BACK TO THE HOSPITAL. IF A PATIENT HAS SUBMITTED AN APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, CVHC SUSPENDS ALL COLLECTION ACTIVITY UNTIL THE PATIENT'S FINANCIAL ASSISTANCE APPLICATION HAS BEEN PROCESSED AND CVHC HAS NOTIFIED THE PATIENT OF ITS DECISION. PATIENTS ARE ADVISED AT THAT TIME TO NOTIFY THE COLLECTION AGENCY TO HOLD THEIR ACCOUNT. THE OUTSIDE DEBT COLLECTION AGENCIES ARE NOTIFIED BY CVHC ONCE AN ACCOUNT ADJUSTMENT HAS BEEN MADE.

SCHEDULE H, PART VI, LINE 2
WE ASSESS AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE THROUGH MANY WAYS INCLUDING THE FOLLOWING: MARKETING RESEARCH - CLEARWATER VALLEY HOSPITAL AND CLINICS, INC. AND ST. MARY'S HOSPITAL, INC. REVIEW INTERNAL DATA TO BETTER UNDERSTAND THE NEEDS AND USES(S) OF OUR SERVICES. THIS INCLUDES ACCESS TO SERVICE AREAS (I.E. PRIMARY CARE), PAYOR INFORMATION, AND OVERALL GAPS IN SERVICES. ASSESSMENTS HAVE RESULTED IN STRATEGIC PLANS FOR GROWING SERVICES, AS WELL AS, CHANGES TO INTERNAL PROCESSES FOR HEALTH CARE ACCESS. POPULATION CARE MANAGEMENT - WE REGULARLY COMPARE OUR HEALTH RANKINGS AND RATINGS TO STATE AND NATIONAL DATA TO IDENTIFY GREATEST AREAS OF HEALTH CARE NEEDS. WE PREPARE INTERVENTIONS TARGETED TO AREAS OF GREATEST NEED, SUCH AS UNCONTROLLED DIABETES OR PRE-DIABETES. WE THEN MEASURE THE EFFECT OF INTERVENTIONS COMPARED TO OVERALL COUNTY RANKINGS. WE USE THIS DATA TO ASSESS THE IMPLICATIONS OF EXPANDING PILOT PROGRAMS. PLANNED INTERACTION WITH VARIOUS COMMUNITY HEALTH, HEALTHCARE, AND SOCIAL WELFARE GROUPS - AN UMBRELLA COALITION OF COMMUNITY HEALTH, HEALTHCARE, AND SOCIAL WELFARE GROUPS MEETS REGULARLY TO SHARE PERSPECTIVES ON COMMUNITY NEEDS AND THE ROLE THE HOSPITAL CAN PLAY IN ADDRESSING THOSE NEEDS AS A COLLABORATIVE PARTNER. INTERACTIONS HAVE RESULTED IN SUCCESSFUL PROGRAMS FOR NURSE CASE MANAGEMENT, COMMUNITY REFERRAL COORDINATOR, COMMUNITY HEALTH WORKER, AND BENEFITS COUNSELOR POSITIONS. INTERNAL QUALITY INDICATORS - WE TRACK DATA THAT LEAD TO THE IMPROVED CARE AND TREATMENT OF PATIENTS WITH CHRONIC DISEASES, TOBACCO USE, AND MENTAL HEALTH CONDITIONS. THIS INCLUDES PATIENT ACTIVITY AND OUTCOMES, ALLOWING FOR THE HOSPITAL TO BETTER IDENTIFY THE NEEDS OF THE PATIENTS, WHICH CAN BE UTILIZED TO ASSESS THE OVERALL HEALTH OF THE COMMUNITIES WE SERVE. HEALTH DATA PROVIDED BY PAYOR ORGANIZATIONS, NAMELY GOVERNMENT AND COMMERCIAL HEALTH INSURERS - THIS HEALTH DATA TYPICALLY INVOLVES MEDICAL TREATMENT AND OUTCOMES THAT REFLECT TRENDS OF UNHEALTHY LIFESTYLES AND BEHAVIORS. OUR OBJECTIVE IS TO UNDERSTAND THESE RELATIONSHIPS AND TO DEVELOP ACTION STEPS TO INTERVENE ON THE FRONT END TO PREVENT SUCH MEDICAL SITUATIONS FROM OCCURRING. EXAMPLES INCLUDE MANAGEMENT OF CARDIOVASCULAR HEALTH AND OPIOID USE. THE CHNA CAN BE FOUND ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTPS://SMH-CVH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/

SCHEDULE H, PART VI, LINE 3
CVHC MAKES INFORMATION ON ITS FINANCIAL ASSISTANCE POLICY (FAP) READILY AVAILABLE TO PATIENTS. INFORMATION ABOUT FINANCIALS ASSISTANCE PROGRAMS IS AVAILABLE ON THE HOSPITAL WEBSITE (SMH-CVH.ORG) WHERE THE INFORMATION AND APPLICATION IS EASILY ACCESSIBLE TO BE VIEWED, DOWNLOADED, AND PRINTED AT NO CHARGE TO THE PATIENT. NOTICES ON THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE CONSPICUOUSLY POSTED IN EMERGENCY ROOM DEPARTMENTS. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE DURING THE PRE-ADMISSION FINANCIAL SCREENING, AT THE TIME OF REGISTRATION ,AND PRIOR TO A HOSPITAL DISCHARGE. INFORMATION ABOUT THE FAP IS IN ALL COLLECTION LETTERS AND PATIENT STATEMENTS. FAP INFORMATION AND/OR APPLICATIONS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. CVHC EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS PROVIDING DIRECT PATIENT TREATMENT AND WHO WORK IN ADMISSIONS, BILLING, AND COLLECTIONS, ABOUT THE EXISTENCE OF THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION. ANNUAL EDUCATION/AWARENESS OF THE FAP IS PROVIDED TO ENSURE ALL EMPLOYEES WITH PATIENT CONTACT ARE AWARE OF THE PROGRAM AND HOW PATIENTS CAN OBTAIN ADDITIONAL INFORMATION. CLINICAL AND HOSPITAL STAFF WHO PROVIDE DIRECT PATIENT CARE HAVE KNOWLEDGE OF THE FAP AND KNOW TO DIRECT PATIENTS TO A REGISTRATION INTERVIEWER OR BUSINESS OFFICE REPRESENTATIVE. REGISTRATION STAFF HAVE AN UNDERSTANDING OF THE POLICY, KNOWLEDGE OF WHERE THE RELATED DOCUMENTS ARE LOCATED, AND WHERE TO DIRECT THE PATIENT FOR MORE INFORMATION ON THE FAP. DESIGNATED EMPLOYEES (FINANCIAL COUNSELORS & PATIENT ACCOUNTS REPRESENTATIVES) HAVE A THOROUGH UNDERSTANDING OF THE FAP AND OFFER THE INFORMATION ON THE FAP TO THOSE PATIENTS WHO MAKE AN INQUIRY ABOUT THE PROGRAM OR ARE DETERMINED THROUGH A FINANCIAL SCREENING TO BE ELIGIBLE FOR THIS PROGRAM. PATIENT ADVOCACY SERVICES ALSO INFORM THE PATIENT ABOUT THE AVAILABILITY OF ASSISTANCE. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT, A PATIENT'S GUARANTOR, A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. THE ORGANIZATION RESPONDS TO ANY ORAL OR WRITTEN REQUESTS FOR MORE GENERAL INFORMATION ON THE FAP MADE BY A PATIENT OR ANY INTERESTED PARTY. DUE TO THE SMALL SIZES OF THE LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS OF THE COMMUNITIES SERVED BY CVHC, CVHC WAS NOT REQURIED TO TRANSLATE THE FINANCIAL ASSISTANCE POLICY (FAP), THE FAP APPLICATION FORM, OR THE PLAIN LANGUAGE SUMMARY OF THE FAP TO OTHER LANGUAGES. THE FAP, FAP APPLICATION AND FAP PLAIN LANGUAGE SUMMARY CAN BE FOUND ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTPS://APPS.PARA-HCFS.COM/PTT/FINALLINKS/STMARYS_V2.ASPX

SCHEDULE H, PART VI, LINE 4
CVHC IS LOCATED IN OROFINO, IDAHO AND OPERATES A CRITICAL ACCESS HOSPITAL AND 3 CLINICS THAT SERVE THE COMMUNITIES OF IDAHO IN LEWIS AND CLEARWATER COUNTIES COVERING 2,400 SQUARE MILES. THE OVERALL COMMUNITY IS DESIGNATED NOT ONLY AS RURAL, BUT ALSO AS FRONTIER. FRONTIER REGIONS ARE DEFINED AS THE MOST GEOGRAPHICALLY REMOTE, SPARSELY POPULATED, AND UNDEVELOPED TERRAIN IN THE UNITED STATES. THE SERVICE AREA IS APPROXIMATELY 27,000 PEOPLE WITH AN AGE DISTRIBUTION OF 19% UNDER THE AGE OF 18; 56% BETWEEN THE AGES OF 18 AND 65; AND 25% OVER THE AGE OF 65. THE RACIAL MAKEUP OF THE SERVICE AREA IS 91% CAUCASIAN; 3% HISPANIC, AND 6% OTHER. THE GENDER SPLIT RATIO IS 48% WOMEN AND 52% MEN. THE AVERAGE INCOME FOR THE SERVICE AREA IS APPROXIMATELY 40,000. CVHC IS COMMITTED TO SERVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. APPROXIMATELY 3.9% GROSS REVENUE DOLLARS WERE FROM SELF-PAY PATIENTS AND 12.6% FROM MEDICAID RECIPIENTS. CVHC HAS CLINICS IN IDAHO COUNTY AND THE PIERCE-WEIPPE SERVICE AREA ARE CURRENTLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS. THERE ARE 4 OTHER HOSPITALS THAT SERVE THE COMMUNITY.

SCHEDULE H, PART VI, LINE 6
CVHC IS PART OF KOOTENAI HOSPITAL DISTRICT DBA KOOTENAI HEALTH, A FULLY INTEGRATED HEALTH SYSTEM WITH 3 HOSPITALS AND MORE THAN 40 CLINICS IN IDAHO. KOOTENAI HEALTH IS ORGANIZED AND EXISTS AS A POLITICAL SUBDIVISION UNDER THE LAWS OF THE STATE OF IDAHO TO PROVIDE HEALTH CARE SERVICES WITHIN THE DISTRICT. KOOTENAI HEALTH SERVES A RURAL POPULATION WHOSE MEDIAN INCOMES GENERALLY FALL BELOW STATE AVERAGES. THE PRESENCE OF OUR CLINICS AND HOSPITALS ENSURES THAT PEOPLE WITH FEW ECONOMIC RESOURCES DO NOT HAVE TO DRIVE AN HOUR OR MORE TO RECEIVE BASIC (AND IN SOME CASES LIFESAVING) MEDICAL CARE. IN ADDITION TO STAFFING HOSPITALS AND CLINICS IN FEDERALLY RECOGNIZED UNDERSERVED AREAS, KOOTENAI HEALTH SUPPORTS THE HEALTH OF COMMUNITIES THROUGH ACTIVE OUTREACH PROGRAMS INTO SMALL HOSPITALS AND CLINICS, RANGING FROM ONCOLOGY TO CARDIOLOGY. KOOTENAI HEALTH ALSO PROMOTES THE HEALTH OF ALL OF ITS COMMUNITIES THROUGH ADHERENCE TO EVIDENCE-BASED BEST PRACTICE STANDARDS AND CLINICAL QUALITY GOALS DESIGNED TO ENSURE THAT PATIENTS RECEIVE THE SAME HIGH STANDARD OF CARE AT ANY KOOTENAI HEALTH HOSPITAL OR CLINIC. TELEHEALTH ALLOWS PATIENTS TO RECEIVE CARE FROM A PROVIDER IN THEIR HOME. TELEHEALTH APPOINTMENTS TAKE PLACE IN LOCAL CLINICS OR HOSPITALS THROUGH SECURE INTERACTIVE VIDEOCONFERENCING. PATIENTS FEEL LIKE THEY ARE IN THE SAME ROOM WITH THEIR DOCTOR. THIS EXPERIENCE OFFERS THE SAME HIGH- QUALITY CARE THAT PATIENTS EXPECT DURING AN IN-PERSON VISIT. KOOTENAI HEALTH IS INVOLVED IN SEVERAL JOINT RELATIONSHIPS TO PROVIDE NEEDED HEALTH SERVICES TO IDAHO RESIDENTS. THESE RELATIONSHIPS ARE IN THE AREAS OF IMAGING SERVICES, MAGNETIC RESONANCE IMAGING SERVICES, REHABILITATION SERVICES, AMBULATORY SURGICAL SERVES, OUTPATIENT LABORATORY SERVICES AND RADIATION THERAPY SERVICES. WE ALSO SUPPORT COMMUNITY HEALTH THROUGH THE KOOTENAI HEALTH FOUNDATION AND THROUGH CONTRIBUTIONS THAT FOCUS ON PROGRAMS AND SERVICES THAT BENEFIT THE OVERALL HEALTH OF THE COMMUNITIES WE SERVE.

SCHEDULE H, PART VI, LINE 5
CVHC BOARD OF DIRECTORS IS COMPOSED MAINLY OF VOLUNTEER REPRESENTATIVES FROM THE PRIMARY SERVICE AREA AND DEDICATE TIME TO ENSURING THEY UNDERSTAND THE HEALTH AND WELFARE NEEDS OF OUR COMMUNITY. CVHC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY WHO ARE PROPERLY SCREENED. ALL APPLICANTS THAT APPLY MUST MEET THE CREDENTIALING STANDARDS AND BE APPROVED BY THE GOVERNING BOARD IN ORDER TO PROVIDE SERVICES AT THE HOSPITAL. IN ADDITION, THE HOSPITAL SERVES AS A CLINICAL PRACTICE SITE FOR MANY STUDENTS IN X-RAY TECHNOLOGY, NURSING, PHYSICIAN ASSISTANT, NURSE PRACTITIONER, AND MEDICAL RESIDENCY PROGRAMS. THIS IS ESPECIALLY IMPORTANT BECAUSE IDAHO HAS ONE OF THE LOWEST PHYSICIAN PER CAPITAL RATES IN THE NATION. ANY SURPLUS FUNDS ARE REINVESTED INTO THE FACILITY, EQUIPMENT, AND EMPLOYEE EDUCATION. WE REGULARLY REVIEW FACILITIES AND EQUIPMENT AND DEVELOP AN ATTRITION PROCESS TO REPLACE AGING PLANT OPERATIONS AND EQUIPMENT. WE ALSO LOOK FOR OPPORTUNITIES TO BRING NEW SERVICES TO THE COMMUNITIES VIA INVESTING IN NEW SKILLS AND TECHNOLOGY WHERE APPROPRIATE. CVHC ENGAGED COMMUNITIES IN COMING TOGETHER AND CREATING SOCIAL CONNECTIVITY THROUGH SUPPORT OF LOCAL EVENTS AND COMMUNITY PROGRAMS. THESE INCLUDE THE FORMATION OF COMMUNITY AND SCHOOL GARDENS, HEALTH TALKS, SPONSORSHIP OF RACES, AND PARTICIPATION IN COUNTY FAIR ACTIVITIES. WE PROMOTE BETTER MENTAL HEALTH BY BRINGING CHILD AND ADULT PSYCHIATRISTS TO OUR FRONTIER COMMUNITIES USING TELEMEDICINE. THIS MODEL HAS WON STATE AND NATIONAL AWARDS FOR INNOVATION IN REACHING THE MEDICALLY UNDERSERVED. WE ARE ALSO ACTIVE PARTICIPANTS IN NATIONAL DEMONSTRATION PROJECTS AND OTHER COLLABORATIONS TO PROVIDE AN EVIDENCE BASE FOR EFFECTIVE PROCESSES TO PROMOTE RURAL HEALTH. IN ADDITION TO THE ACTIVITIES LISTED IN PART I, LINE 7 AS WELL AS PART V, SECTION B, LINE 11, SOME OTHER PROJECTS UNDERTAKEN BY CVHC INCLUDE THE FOLLOWING: MOST MONTHS WE HAVE AN OVERALL THEME TARGETING A CHRONIC DISEASE STATE WITH SPECIAL PROGRAMS AND OUTREACH TO OUR COMMUNITIES (I.E. FEBRUARY IS HEART MONTH, OCTOBER IS BREAST CANCER AWARENESS, NOVEMBER IS DIABETES AWARENESS, ETC.). DOC TALKS ARE GEARED TO THE MONTHLY THEME WITH SCREENINGS AND INFORMATION PROVIDED AT THE EVENTS. OUR CARE MANAGERS, REFERRAL COORDINATORS, AND QUALITY DIRECTOR ARE ESPECIALLY ACTIVE IN COORDINATING THESE ACTIVITIES AND REACHING OUT TO PATIENTS WHO MAY NOT BE AWARE OF THE SERVICES OFFERED. COMMUNITY HEALTH WORKERS ARE HOSTING CHRONIC DISEASE SELF-MANAGEMENT AND CHRONIC PAIN SELF-MANAGEMENT CLASSES THROUGHOUT OUR SERVICE AREA. COLON CANCER AWARENESS AND SCREENING HAS BEEN A MAJOR OUTREACH EFFORT AT HEALTH FAIRS, LOCAL BAZAARS, SOME OF THE FARMER'S MARKET DAYS, AND WITHIN ALL OF THE CLINICS OVER THE PAST YEAR. CVHC IS AN ACTIVE PARTICIPANT IN ATTENDING AND SITTING ON THE BOARDS OF THE LOCAL HUMAN NEED COUNCILS WITHIN THE SERVICE AREAS. WE HAVE A PRESENCE ON MULTIPLE COALITIONS THROUGHOUT THE NORTHERN AND NORTH CENTRAL IDAHO. THIS IS OFTEN ACCOMPLISHED BY PHONE CONFERENCING IN ORDER TO PARTICIPATE IN THE DISCUSSIONS AND GROWTH WITHOUT INCURRING TRAVEL EXPENSE. WE ARE ALSO ACTIVELY ENGAGED IN STATE COALITIONS ON CHRONIC DISEASE AND COMMUNITY HEALTH WORKER PROGRAMS (OFTEN SEEN AS MENTORS WITHIN THESE GROUPS FOR THE ACCOMPLISHMENTS ACHIEVED OVER THE PAST FEW YEARS). FUNDRAISERS AND VOLUNTEER EFFORTS ARE ESTABLISHED AND ONGOING WITH LOCAL FOOD BANKS, CLOTHING DISTRIBUTION DRIVES, AND OTHER VOLUNTEERS THAT ARE GEARED AROUND NATURAL DISASTERS AND OTHER NEEDS WITHIN OUR AREA. EFFORTS ARE BEING MADE TO BRING SAFE WALKING AND BIKE TRAILS TO COMMUNITIES WITHIN OUR SERVICE AREAS. A RESULT OF ALMOST EVERY SURVEY AND CONVERSATION IS THAT THE COMMUNITIES WANT MORE WAYS TO ENGAGE SAFELY IN PHYSICAL ACTIVITY AT LITTLE OR NO EXPENSE. COMMUNITY HEALTH WORKERS HAVE WORKED WITH COMMUNITY PARTNERS TO HOST WEEKLY WALKS THROUGHOUT THE REGION PROVIDING BOTH AN EDUCATION COMPONENT AND A SAFE WALKING PATH FOR THE DAY. COMMUNITY HEALTH WORKERS COORDINATE AND HOST SCREENING EVENTS IN VARIOUS LOCATIONS THROUGHOUT THE SERVICE AREA TO HELP SCREEN FOR DIABETES, DEPRESSIONS, SDOH ISSUES, AND COLON CANCER. SOME OF THE SCREENING EVENTS ARE HELD IN CONJUNCTION WITH A FOOD BANK DISTRIBUTION SITE. CVHC IS PART OF KOOTENAI HOSPITAL DISTRICT DBA KOOTENAI HEALTH, A FULLY INTEGRATED HEALTH SYSTEM WITH FACILITIES IN IDAHO. KOOTENAI HEALTH REINVESTS SURPLUS REVENUES INTO TECHNOLOGY, INFRASTRUCTURE AND CLINICAL PROGRAMS TO INCREASE THE HEALTH AND VITALITY OF THE COMMUNITIES WE SERVE. KOOTENAI HEALTH PROVIDES SERVICES IN RURAL COMMUNITIES AND IS COMMITTED TO ELIMINATING GEOGRAPHIC BARRIERS TO CARE. WE INVEST IN FACILITY UPGRADES, TECHNOLOGY, AND STAFFING THAT ENHANCE CARE IN THESE COMMUNITIES TO ENSURE PATIENTS CAN RECEIVE AS MUCH CARE AS POSSIBLE CLOSE TO HOME. TELEHEALTH ALLOWS PATIENTS TO RECEIVE CARE FROM A PROVIDER IN THEIR HOME. TELEHEALTH APPOINTMENTS TAKE PLACE IN LOCAL CLINICS OR HOSPITALS THROUGH SECURE INTERACTIVE VIDEOCONFERENCING. PATIENTS FEEL LIKE THEY ARE IN THE SAME ROOM WITH THEIR DOCTOR. THIS EXPERIENCE OFFERS THE SAME HIGH- QUALITY CARE THAT PATIENTS EXPECT DURING AN IN-PERSON VISIT. KOOTENAI HEALTH'S CLINICALLY INTEGRATED NETWORK, KOOTENAI CARE NETWORK (KCN), CONTINUES TO GROW ITS PROVIDER MEMBERSHIP AND COVERED LIVES. BY THE END OF 2020 THERE WERE APPROXIMATELY 600 PARTICIPATING PROVIDERS AND MORE THAN 40,000 COVERED LIVES IN THE NETWORK. THE NETWORK NOW HAS THREE HOSPITALS, KOOTENAI HEALTH AND TWO CRITICAL ACCESS HOSPITALS. THE GOAL OF THE NETWORK IS TO IMPROVE THE OVERALL HEALTH OF OUR COMMUNITY BY DELIVERING EFFICIENT, HIGH QUALITY CARE COLLABORATIVELY DESIGNED PATIENT CARE BY INDEPENDENT AND EMPLOYED PHYSICIANS AND ADVANCED PRACTICE PROFESSIONALS, HOSPITALS, POST-ACUTE CARE PROVIDERS, COMMUNITY HEALTHCARE PARTNERS AND PAYERS. KCN IS THE SOLE MEMBER OF KOOTENAI ACCOUNTABLE CARE, LLC, FORMED IN 2017 WHICH WAS GRANTED APPROVAL TO PARTICIPATE AS A MEDICARE SHARED SAVINGS PROGRAM (MSSP) ACCOUNTABLE CARE ORGANIZATION (ACO) TRACK 1 IN DECEMBER 2017 FOR THE THREE-YEAR PERIOD BEGINNING JANUARY 1, 2018 PLAN YEAR WITH AN ESTIMATED 12,700 ATTRIBUTED MEDICARE BENEFICIARIES. FOR FINANCIAL PERFORMANCE, IN 2020 KOOTENAI ACCOUNTABLE CARE WAS RANKED 6 OUT OF 128 MSSP ACOS THAT STARTED IN 2018. THE NETWORK INITIATED DISCUSSIONS WITH IDAHO MEDICAID AND OTHER ORGANIZATIONS AROUND THE STATE TO FORM VALUE CARE STRATEGIES IN SUPPORT OF THE MEDICAID POPULATION. KCN HAS A TEAM OF CARE MANAGERS TO HELP PATIENTS WITH CHRONIC CONDITIONS TO MANAGE THEIR CARE. THESE CHRONIC CONDITIONS INCLUDE CHRONIC OBSTRUCTIVE PULMONARY DISEASE, HEART FAILURE, DEPRESSION, AND ANXIETY. THE CARE MANAGERS WORK WITH A VARIETY OF PATIENTS, CAREGIVERS, AND HEALTHCARE EXPERTS WITHIN KCH TO PROVIDE EFFICIENT, HIGH QUALITY CARE FOR THE COMMUNITY. EACH YEAR KOOTENAI HEALTH MAKES SUBSTANTIAL FINANCIAL AND IN-KIND DONATIONS THAT BENEFIT THE COMMUNITY. THESE INCLUDE DONATIONS TO GROUPS SUCH AS THE SUICIDE PREVENTION ACTION NETWORK AND THE COMMUNITY CANCER FUND. KOOTENAI HEALTH PROVIDES FREE AND LOW COST HEALTH SCREENINGS AND SUPPORT GROUPS FOR PATIENTS WITH DIABETES, CANCER, MENDED HEARTS, PARKINSON'S, AND PULMONARY DISEASE. KOOTENAI HEALTH PROVIDES TRAINING OPPORTUNITIES FOR PHYSICIANS, NURSES, AND OTHER HEALTHCARE WORKERS. TOGETHER , THESE SERVICES ARE IMPROVING HOW PEOPLE ARE CARED FOR IN THE GEOGRAPHICALLY DIVERSE COMMUNITIES WE SERVE.