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Rural Health Briefing Vol I, No. 1 July 17, 2000
An E-Health Newsletter published by the Arizona Critical Access Hospital (CAH) Program of the University of Arizona Rural Health Office
Collector’s First Edition!
Table of Contents
1. Editor’s Introduction
2. Arizona Rural Health Conference
3. Balanced Budget Refinement Act and Rural Hospitals
4. Medicare Reimbursement Policy
a. Crisis of Rural Seniors in Arizona
b. Health Care and Profits
c. National Legislation
d. Emergency Medical Services
5. How to Contact Your Representatives
a. Congressional Delegation
b. State Legislators
6. Rural Health Outreach Grants
a. Grant Application Information
b. Technical Assistance
c. Recent Arizona Grant Awards
7. Rural Health Network Grants
a. Grant Application Information
b. Technical Assistance
c. Recent Arizona Grant Awards
8. Other Opportunities
a. Federal Grants
b. Foundation Grants
c. Conferences
9. Other Useful Information
a. Resources for Grant Writers
b. Resources for Health Care Professionals
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1. Editor’s Introduction: Welcome to the University of Arizona Rural Health Office’s new online newsletter, Rural Health Briefing.
The newsletter is a project of the Arizona Rural Hospital Flexibility Program, supported by the Federal Office of Rural Health Policy. The goal of the Flex Program is to improve the financial viability and stability of rural hospitals by creating a new designation for Critical Access Hospitals (CAHs). Designated CAHs are eligible for cost-based reimbursement for services provided to Medicare patients. The Arizona program is currently supporting financial feasibility studies for rural hospitals considering this option. The studies include an analysis of the impact of the Balanced Budget Act on hospital revenues projected over the next four years, as well as projected revenues if the hospital converts to CAH status. For more information, please visit the project web site: http://www.rho.arizona.edu/cah/azruralflex.html.
The purpose of Rural Health Briefing is to provide folks concerned about health care issues in rural Arizona, and particularly rural hospitals, with timely reports and useful information about state and federal policy initiatives, current events, and available resources. The newsletter may seem longer than others published online, but there is a reason for this. Some of you can access web sites, but others cannot, so we will often reprint articles or provide details about programs for those who cannot access web sites.
This first "Collector’s Edition" (save for future auction on E-Bay to fund your health care plan) is stuffed with all kinds of goodies we wish to share. Future issues will be briefer. Please let us know what is useful or interesting to you, and what is not. We invite your comments, questions, requests, contributions, and suggestions.
Sincerely,
Alison Hughes, MPA, Associate Director:
University of Arizona Rural Health Office
Phone: (520) 626-7946; Fax: (520) 326-6429
ahughes@u.arizona.edu.
If you know of someone who would like to be added to our distribution list, or if you wish to be removed from the list, please contact Anne Trombley, Administrative Assistant, University of Arizona Rural Health Office at atromble@rho.arizona.edu.
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2. Arizona Rural Health Conference
Please join us at the Arizona Annual Rural Health Conference, July 24-26, 2000 at the Hon-Dah Resort, Pinetop, Arizona. Information about the conference and registration materials are available online: http://www.rho.arizona.edu/cah/azruralconference.html
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3. Balanced Budget Refinement Act and Rural Hospitals
Rural Hospitals Asking for Medicare Changes: Witnesses at a Senate hearing Tuesday, July 11 testified that changing the wage index and disproportionate share payment methodologies will do the most to help struggling rural hospitals still suffering the after-effects of the Balanced Budget Act of 1997.
The hearing, which was attended only by the Subcommittee Chair, Senator Thad Cochran, focused on how changes in the BBA are affecting rural hospitals, which are often a key component in rural economic development.
Senator Charles Grassley (R-IA) opened the hearing by pushing for support of his bill, S. 2828, which would change the way Medicare pays for the labor portion of hospital costs. Currently, Medicare adjusts hospital payment by a wage index that accounts for varying wage costs incurred by hospitals around the country. Rural advocates have long complained that this adjustment puts rural hospitals at a disadvantage. Senator Grassley’s bill would require Medicare to make a wage adjustment that is based on a hospital’s actual, rather than its estimated, labor costs.
Dr. Mary Wakefield, head of the Center for Health Policy at George Mason University, also pointed to refining the wage index as a way to help struggling rural hospitals. Dr. Wakefield suggested that rural hospitals might also be helped by making an occupational mix adjustment that would more accurately reflect the comparable labor costs faced by urban and rural hospitals. She also said that Medicare should refine how it groups hospitals into different labor markets.
Dr. Robert Berenson, testifying for the Health Care Financing Administration, said his agency is interested in examining the wage index methodology to see if rural hospitals are, in fact, treated unfairly but stopped well short of endorsing the Grassley bill or any of the other suggestions made by the panelists. Dr. Berenson said the approach taken by Senator Grassley’s bill poses some operational challenges for HCFA in terms of verifying the wage data supplied by hospitals and that further research is needed to assess the impact of any other changes to this payment formula.
The panelists at the hearing also believe rural hospitals are put at a disadvantage by the current methodology of the Medicare disproportionate share payment. These are add-on payments made by Medicare to recognize the burden faced by hospitals that provide a significant amount of care to the poor.
The hearing panelists say the current formula for these payments make if far easier for urban hospitals to qualify for this adjustment. Currently, 95 percent of Medicare DSH payments go to urban hospitals compared to 5 percent for rural hospitals. Dr. Wakefield said that the Medicare Payment Advisory Commission, on which she sits, has made recommendations to the Congress for the past few years to move to a uniform formula that treats urban and rural hospitals the same.
Tom Scully, head of the Federation of American Health Systems, expressed support for refining both the wage index and DSH payments to help rural hospitals. However, he urged the Committee not to do so at the expense of urban hospitals, which are also struggling as a result of the BBA. Scully urged the Congress to add money to the Medicare program to cover the costs of these provisions. If Congress does not provide additional funds to cover any changes in either payment methodology, lawmakers would only be able help rural hospitals by reducing payments to urban hospitals in a budget neutral manner.
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3. Medicare Reimbursement Policy
a. Rural Arizona Seniors in Crisis: ( The following story and editorial column were published in The Arizona Republic, on July 16 and 18. In the article, writer Maureen West chronicles the plight of rural seniors in Arizona; columnist Ricardo Pimentel raises questions about the place of health care in a free enterprise, democratic economy. A description of current legislation being considered on Capitol Hill to address the need for Medicare prescription coverage and key highlights of proposed legislation, follow the Arizona news reprints.)
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“KEARNY - A health care meltdown in rural Arizona this summer is forcing elderly residents to go to Mexico for affordable drugs, lie about their addresses to maintain coverage and take menial jobs to help pay for their care. Many retirees in rural communities are cutting back on their medications because the HMO programs that recently provided prescription benefits are gone.
More than 54,000 seniors have been dropped from HMOs in rural Arizona since 1998. And those who have gone back to traditional Medicare programs say they can't afford to pay for their medications.
At the Kearny United Drug Store in this eastern Arizona mining town, there is a bin near the cash register where customers pick up their orders. Each month, dozens of prescriptions are left behind, many by sticker-shocked elderly customers who walk away from the counter, unable to afford their medicine. In his 50 years as a pharmacist, Luis Mendoza hasn't seen anything like it. Some customers tell him that they will just have to go without. Others say they can get the same drugs in Mexico for less than half the price.
Margaret Stores of Flagstaff says she begs for medical samples from her doctors or sometimes does without. She has a $636 monthly income and spends $200 a month on medications. It would be $400 if she bought everything her doctor says she should be taking.
Joe Lindenmayer, 56, a disabled mechanic who lives in the little southeast Arizona town of Cochise, has a cash flow problem: He requires a pain prescription that costs him $750 a month. His income is $593 a month. To get by, he has cut back on the pain medication and learned to live with nausea. There is a pill he is supposed to be taking for the nausea, but that would be $150 a month. "Enough to make you ill," he says.
Pharmacists, doctors, elder advocates and seniors throughout Arizona seem to agree that rural Arizona seniors are victims of a health care crisis that began three years ago and will reach a crescendo in January, when the remaining HMOs leave all but one rural county. By then, only tiny Santa Cruz County, just north of the Mexican border at Nogales, will have an HMO Medicare program. That is a stark change from three years ago, when many seniors in rural Arizona had a choice of managed health care plans. A state that was once a model for statewide access to HMOs has totally reversed course. "I really don't know what people are going to do," says Mayetta Payton, a Kearny drugstore clerk.
Though HMO pullouts in rural areas and high prescription costs are national issues, rural Arizona is hit harder. Almost all rural counties in the state have experienced double-digit growth during the past decade, with much of the growth coming from retirees, some coming for the peace and quiet and scenery, but many seeking lower living costs.
Many blame legislators for allowing HMO programs to avoid serving rural areas, while others blame Congress for not moving fast enough to provide a prescription benefit for Medicare. The United States is the only Western nation to not have prescription drugs included in its elder health care program. Any blame left over is commonly directed at the drug companies for charging the world's highest drug prices to the same taxpayers who subsidized the development of many of the drugs.
Although some worry that a forced reduction in prices would reduce the money available to drug companies for the development of new drugs, others say the high prices charged in America allow drug companies to spend huge sums lobbying in Washington and state capitals to protect their current price structure .
According to a study released earlier this month by Public Citizen, a consumer watchdog group, prescription drug companies spent $235.7 million from 1997 to 1999 to lobby Congress and the White House, and spent tens of millions more for supportive ads in the media. On the Medicine drug benefit and drug pricing issue alone, drug companies hired 297 lobbyists - one for every two members of Congress, according to the study. The drug industry also shelled out $33.4 million in direct political contributions to candidates and parties since 1993, according to
Public Citizen. HMOs donated more than $14million to political campaigns since 1995, according to an earlier study by the same group.
Virginia Giuliano, 64, of Dripping Springs, near Winkelman, says she wonders if the lagging access to affordable drugs has anything to do with an obituary surge she's noticed among those ages 65-70 in Copper Country News. She is organizing letter writing, petition drives and protests by seniors. Groups from the Hayden, Globe and Payson areas plan to join her. She hopes to bombard Congress before this year's election with letters asking that Medicare have a decent prescription drug benefit.
Giuliano, with one kidney, heart disease and diabetes, has $800 in prescription drugs to buy each month. From Hayden, she takes a long bus ride to Mexico, where she now gets her medicine for $350. Older and sicker people cannot do that, she worries. "It's crazy to have to go there. The Mexican pharmacies don't take credit cards or a check, so seniors have to carry hundreds of dollars in cash, and some shouldn't even be driving or out of their homes," she says.
Retiree Bob Jones of Kearny says the Legislature should require HMOs that want to do business in Arizona to serve people regardless of where they live within the state. Though some retirees are expected to migrate to urban areas because of the health crisis, others will look for loopholes.
"Some just lie about where they live," says Della Soliz of Hayden. "Sons and daughters in Phoenix or Tucson are letting their parents use their addresses. The situation is forcing many to become liars." Last year, after her HMO left, she rented a post office box a mile away, across a
county line, to be eligible for coverage. But she gave up. "I couldn't live with that lie," Soliz says. "I have lived in Hayden for 42 years, and that is home." Those who lie about their permanent residence are committing fraud and risk having their claims denied.
Nancy Lent, a benefits counselor with the Area Agency on Aging in northern Arizona counties of Yavapai, Coconino, Navajo and Apache counties, says that she has been receiving more calls from potential retirees planning ahead. "Before moving here, they now ask about health care along with housing information," Lent says. That caution could spell an economic change for the state's growth patterns, says Robert Dubits, who counsels seniors about Medicare benefits in southern Arizona counties of Graham, Greenlee, Cochise and Santa Cruz. He is carefully watching the discussions in Congress, but believes they have a long way to go. Half of the seniors and disabled people he counsels are below the poverty line. One of the congressional plans calls for a $250 premium, with seniors paying 50 percent of the cost of their prescription drugs. Many of the rural people I counsel don't have $30 or $40 extra in the bank," he says.
Many retirees are taking on small jobs for a work-related prescription benefit, or for the extra cash to buy their medicines. Waitress Judy Leivas, 68, of Kingman, earns mostly tips, four days a week, at an Interstate-40 truck stop. But it isn't the money she's working for; it's the health insurance. Leivas, who has been a waitress since 1947, says she can't count on Medicare covering her health costs. A drug she takes for pancreatic problems three times a day now costs her only $7 a month, compared with $33. When she came down with bronchitis this winter, all her tests were fully covered. Under Medicare, she would have had to pay for 20 percent of the care, not easy on her Social Security income. Retirement sounds nice, but it isn't an option, she says.
Bullhead City retirees are going over to casinos in Laughlin, Nev., and washing dishes or busing tables, just enough work to get health benefits that cover prescriptions. Other former retirees around rural Arizona are working at drugstores to get prescription discounts.
Others are too old or ill to work. Dr. Jeff Crawford, one of two family practice physicians in Kearny, finds himself spending more time calming down his older patients, who become panicked by costs. He tells his retirees to consider moving to Apache Junction on the far edge of the Phoenix area, the only Pinal County ZIP codes where coverage is offered. He urges them to raise their political voices to change Medicare and get what they need to survive. He worries that his advice is not enough. "I can sense a social depression developing," he says. He worries that fear will harm his older patients' health.
"If this isn't already a health care crisis, we are getting there fast," says Anne McKinley of Prescott, an expert on rural health care. So many small-town hospitals have closed that people now have to drive great distances for care. Even government facilities such as the Veterans Affairs hospital in Fort Huachuca have been downgraded to clinics where surgery is no longer available. As a result, McKinley says, the elderly are becoming totally dependent on friends or family members who have cars and time. From Ash Fork or Seligman, it is a 70-mile drive to a hospital. From Cordez Junction or Hayden, it is 40 to 50 miles. "Increasingly," she says, "the medical option available to many rural elders is to pray for a miracle."
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b. Profit May Not Have a Place in Health Care, July 18, 2000, The Arizona Republic, Editorial Opinion, Ricardo.Pimentel.
Let's get this straight. The Republican plan to provide prescription-drug coverage for our elderly under Medicare would pay the HMOs to provide such care. Yet, as a very detailed package of stories in Sunday's Republic explained, these are the same HMOs that have abandoned many of Arizona's rural elderly because serving them is deemed unprofitable. The dateline is Arizona, but this could be Anywhere, USA.
Why in the world would we trust organizations motivated by profit, even subsidized organizations, to do the right thing for seniors? If this doesn't have the makings of a campaign slogan for someone, someone isn't paying attention. Under our current health care system, the right thing to do is to make money. This, of course, is the credo of free-marketeers everywhere. It's a credo with much to recommend it in many circumstances - arguably, however, not in health care.
According to the stories by Della de Lafuente and Maureen West, 10,243 elderly Arizonans were abandoned by HMOs in rural areas in 1999; this year it is 30,902 seniors; and next year, another 13,033 are projected to be left without HMO coverage. Nationally, about 700,000 seniors will be jilted by profit-fickle HMOs.
This forces the seniors into pure Medicare, which does not include prescription-drug coverage and offers fewer benefits generally. Yet, prospects are dim that Congress will pass a prescription-drug plan for Medicare this year.
A Democratic congressional plan differs from the GOP model in that it has lower premiums, no deductible, catastrophic coverage kicking in at lower amounts, and more sensible protections for lower-income seniors. But it differs most starkly in its administration.
The Republican plan would pay private HMOs as an incentive to provide the service, while the Democratic plan envisions the benefit coming directly from Medicare.
For a glimpse of how the GOP plan might work, one need look no farther than Nevada, which, like Arizona, has many struggling seniors in its rural areas. Nevada, proposing to use its tobacco settlement money over the next 25 years, adopted a plan similar to the GOP's. Insurance companies have not been attracted by the subsidies. We'd see a similar outcome nationally. In fact, health insurers have told Congress that they have no interest in providing a drug-only benefit to seniors.
Don't be surprised if some politics is involved in arriving at a congressional plan. If you're a Democrat running for office, you're licking your chops at the prospect that the Republicans will actually pass a prescription-drug plan that can be characterized as too little, too late and way too ineffective. If you're Republican, you're praying that the president will veto such a bill so you can go into the election posturing that the tax-and-spend party and its president stymied reform. And underlying it all is the certainty that seniors vote.
I don't dispute that HMOs find it difficult to make a profit off rural seniors. That just means, however, that profit may not have any place in such a health care scenario. This, however, might be a bitter pill for some to swallow.
We are, we're told, about to become a country of aged boomers. So far, we've had quite a violent reaction to the concept of universal health coverage. The last time someone tried to make some sense out of apportioning health care equitably, they were thoroughly lambasted as socialist scum.
A prediction: As we age, we will find the concept far more palatable. We will find other names to call it, so we will be able to look at ourselves in the mirror.
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c. RX for Medicare: Prescription Drugs + Competition: (The following information was forwarded to us from national organizations based in Washington DC. Additional information is available via Progressive Policy Institute’s Front and Center Webpage: http://www.ppionline.org/index.cfm. If you wish a detailed section-by-section analysis of the proposed Breaux-Frist legislation, please let us know and we can email it to you individually.)
With America’s budget in surplus, it’s only a matter of time before Congress agrees to spend a chunk of the fiscal windfall on a new prescription drug benefit in Medicare, the government’s health program for retirees. But some key questions remain: How big will the benefit be and how much will it cost? And, most important, will the new benefit be part of larger -- and long overdue -- effort to modernize Medicare for the 21st Century?
The House has scheduled a vote on a GOP prescription drug proposal, following the Senate’s recent rejection of a Democratic alternative on a party-line vote. The dueling partisan proposals differ in two key respects: First, the Democrats are much more generous, proposing to spend about $250 billion over 10 years compared to the GOP’s $155 billion. Second, the Democratic bill authorizes the government’s Health Care Financing Agency to manage the new benefit, while Republicans favor private health insurance options.
Despite the election year posturing, there are signs that the two sides may be inching toward common ground. Stung by criticism that their subsidies for seniors were too small to stimulate a viable private market for prescription drug benefits, the GOP now seems willing to up the ante. And Democrats have at least adopted the rhetoric of using competition rather than government price regulation to help keep drug costs under control and spur innovation in the drug industry.
That’s important, because competition is the key to reforming Medicare’s antiquated benefits and its highly bureaucratic structure as well as containing its costs as the massive baby boom generation retires. Progressives should insist that prescription drug benefits go hand in hand with structural reforms aimed at expanding individual choice, fostering competition and innovation, and updating Medicare for the needs of elderly Americans in the 21st century.
This “third way” on medicare and prescription drugs is embodied in a new, bipartisan proposal by Senators John Breaux (D-La) and and Bill Frist (R-Tenn). It contains universal subsidies to help seniors purchase drug coverage, and to give private health plans an incentive to offer that coverage nationwide. And by fostering competition between medicare’s traditional fee-for-service program and private health insurance plans, this approach would hold down costs and allow seniors to pocket much of the savings.
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d. The Medicare Prescription Drug and Modernization Act of 2000: (Breaux-Frist 2000) Medicare for the 21st Century
IMPROVED MEDICARE MANAGEMENT AND ADMINISTRATION
- Restructures the 1965 Model:
Establishes a new executive branch agency, the Competitive Medicare Agency, outside of the Department of Health and Human Services to oversee Medicare+Choice plans and outpatient prescription drug coverage. Eliminates the inherent conflict of interest of HCFA managing both fee-for-service Medicare and Medicare+Choice plans that compete for the same beneficiaries. Establishes a new mission for Medicare in the 21st century leaving behind the bureaucracy and outdated mindset that continues to plague the program and instead guaranteeing seniors choice, health care security, and improved benefits and delivery of care.
MEDICARE PRESCRIPTION DRUG AND SUPPLEMENTAL BENEFITS PROGRAM
- Establishes Voluntary, Universal Outpatient Prescription Drug Coverage
Allows all Medicare beneficiaries who are entitled to Part A benefits and enrolled under Part B to elect outpatient prescription drug coverage beginning in 2003. Beneficiaries can receive drug coverage through either a Medicare Prescription Plus Plan, designed for beneficiaries remaining in traditional Medicare, or through a Medicare+Choice Plan.
- Guarantees Medicare Benefits, Standard Coverage for Prescription Drugs, and Protections Against High Out-of-Pocket Drug Costs
Maintains all current Medicare benefits and offers standard outpatient prescription drug coverage, which includes a $250 deductible, $2,100 in initial coverage and 50% cost-sharing. Provides coverage and security against escalating out-of-pocket drug costs by requiring that all outpatient prescription drug coverage offered to beneficiaries include stop-loss protection of $6,000 so a beneficiary never pays for drugs out of their own pocket beyond this amount. Provides beneficiaries the choice of coverage that best suits their individual needs by allowing the offering of different drug benefit plans, while ensuring the benefit value of standard coverage is maintained along with all stop-loss protections. Guarantees Price Discounts off Prescription Drugs
- Requires price discounts negotiated between pharmaceutical companies and insurers to be passed along to beneficiaries through a prescription drug discount card program offered by the plan, to ensure beneficiaries never pay retail prices for prescription drugs at any time.
- Guarantees Affordable Drug Coverage through Universal Premium Subsidies
Offers all beneficiaries a 25% subsidy toward the premium costs of prescription drug coverage. In addition, all beneficiaries will enjoy the benefits of additional premium reductions as a result of the federal government sharing in the risk of covering high-cost beneficiaries
- Protects Low-Income Beneficiaries
Provides subsidies for beneficiaries with incomes below 135% of poverty by offering 100% full coverage of premiums, deductibles and co-pays associated with prescription drug coverage. Beneficiaries between 135% and 150% receive premium subsidies on a sliding scale from as much as 100% to no less than 25%. Since 39% of beneficiaries with incomes below 150% of poverty have no drug coverage under Medicare, this provision alone will provide comprehensive drug coverage for over 5 million seniors and individuals with disabilities.
MEDICARE+CHOICE PROGRAM IMPROVEMENTS
- Improves Benefits and Health Care Delivery under Medicare
Implements payment reforms for Medicare+Choice plans to preserve and expand choice for seniors and the disabled enrolled in such plans and helps to stabilize plan payments in rural or low payment areas. In 2003, establishes a new competitive system under Medicare+Choice where plans bid for the costs of delivering care and compete based on benefits, price, and quality so that beneficiaries receive the highest-quality, affordable health care. Allows maximum flexibility for plans to reduce current beneficiary Part B premiums and cost-sharing as well as offer new and additional benefits to beneficiaries, including outpatient prescription drug coverage.
BENEFICIARY PROTECTIONS, OUTREACH, AND ENROLLMENT
- Encourages Informed Choice and Maintains Beneficiary Protections
Establishes Medicare Consumer Coalitions, beneficiary supported organizations, designed to provide beneficiaries timely and accurate information at the federal, state, and local levels with respect to Medicare benefits and options. Ensures beneficiaries are protected through appropriate grievance and appeals processes for all Medicare benefits, including outpatient prescription drug coverage.
MEDICARE SOLVENCY MEASURES
- Establishes Fiscally Responsible Measures of Solvency
Provides a true and accurate measure of solvency by establishing reporting requirements for the Medicare program as a whole, including both Parts A and B, in determining the financial health of Medicare. Requires reports to Congress by the Medicare Trustees to evaluate general revenue spending in the program, provide historical spending trends, provide 10-year and 50-year projections, and provide information regarding the rate of spending under the program compared to the rate of growth in the gross domestic product.
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d. Medicare Reimbursement for Emergency Medical Services: (The following information was provided to TASC, the national technical assistance agency of the Rural Hospital Flexibility Program and Critical Access Hospitals, by Gary Wingrove, Gold Cross Ambulance in Minnesota.
On July 13, 2000, US Senator Rod Grams (R-Minn) introduced S.2858 in the US Senate.
As you may know, the Balanced Budget Act (BBA) of 1997 is set to impact ambulance services nationally in 2001. The BBA contained two provisions, mandatory Medicare assignment and the development of a fee schedule. While HCFA has not yet published the proposed rule that contains the official fee schedule reimbursement amounts, many EMS providers, experts and policy makers around the country are concerned about impended failures of ambulance services. While urban areas will be hit hard, rural areas will be in particular trouble. Senator Grams has been in the fore-front of EMS legislation in the US Senate before. After seeing what occurred in other segments of health care related to the BBA, a demonstration of the need to address his impending crisis was sufficient for Senator Grams to decide quickly this legislation is necessary.
The next steps are for grass-roots involvement. Please spread the word to
your EMS colleagues around town, around the state and especially around the country. Procedurally, the next steps are to solicit the co-sponsorship of the bill with as many US Senators as possible as quickly as possible. In addition, a House sponsor for a companion bill will be identified. In order to achieve a large number of co-sponsors, the endorsement of the bill by individuals, businesses, organizations, regulatory agencies and local governments in all 50 states is essential.
A web site has been established with more information and for tracking the progress of the bill. On the site you can read background material about the reimbursement problem, read a summary of what the bill does, view or download a copy of the bill and find out how you can get involved. I encourage you to immediately go to http://www.ncemsc.org to find out more. Please feel free to forward this e-mail to all your EMS-related contacts. If you want to receive updates regarding the bill's progress, send a request to s2858@ncemsc.org.
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5. How to Contact Your Representatives:
a. Arizona Congressional Delegation: Available through the Publication Technology Project at Arizona State University: http://aspin.asu.edu/~pctp/azdeleg.html. To get Congressional Handbook, http://www.congresshandbook.com. Links to Representatives are available at http://www.house.gov. Links to Senators are available at http://www.senate.gov.
Senate:
John McCain (R-AZ) DC Phone 202-224-2235; DC Fax 202-228-2862
State Offices: Phoenix 602-952-2410; Tucson 520-670-6334; Mesa 602-491-4300;
Email: John_McCain@mccain.senate.gov
Jon Kyl (R-AZ) DC Phone 202-224-4521; DC Fax 202-224-2207
State Offices: Phoenix 602-840-1891; Tucson 520-575-8633; Email: info@kyl.senate.gov
House of Representatives:
Matt Salmon (R-1-AZ) DC Phone 202-225-2635; DC Fax 202-225-3405; Tempe 480-946-3600; Email: msalmon@mail.house.gov
Ed Pastor (D-2-AZ) DC Phone 202-225-4065; DC Fax 202-225-1655; Tucson 520-624-9986; Phoenix 602-256-0551; Yuma 520-726-2234; Email: edpastor@mail.house.gov
Bob Stump (R-3-AZ) DC Phone 202-225-4576; DC Fax 202-225-6328;
Phoenix Phone: 602-379-6923.
John Shadegg (R-4-AZ) DC Phone 202-225-3361; DC Fax 202-225-3462; Phoenix 602-263-5300; Email: j.shadegg@mail.house.gov
Jim Kolbe (R-5-AZ) DC Phone 202-225-2542; DC Fax 202-225-0378; Tucson 520-881-3588; Sierra Vista 520-459-3115; Email: jim.kolbe@mail..house.gov
J.D. Hayworth (R-6-AZ) DC Phone 202-225-2190; DC Fax 202-225-3263; Mesa 602-926-4151; Flagstaff 520-556-8760.
b. Arizona State Legislators: Available through the Arizona Legislative Information System (ALIS): Call 1-800-352-8404 http://www.azleg.state.az.us/members/members.htm.
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6. Rural Health Outreach Grants
a. Grant Information: Program Guidelines for the FY 2001 Rural Health Outreach Grant Program are now available: http://www.nal.usda.gov/orhp/orprog01.htm.
Purpose: To support projects that demonstrate creative models of outreach and health care services delivery in rural areas that lack basic health services. Grants are awarded either for the direct provision of health services to rural populations, or to enhance access to and utilization of existing available services. The average grant award is $170,000 for one year. In FY 2001, up to 35 awards will be made with approximately $6 million available for new projects. No less than 50 percent of funds awarded must be spent in rural areas or to provide services to residents of rural areas.
Eligibility: The grant recipient must be a public or nonprofit private entity which meets one of the following four requirements: (1) applicant’s central administrative headquarters is located in a rural county or jurisidiction and all aspects of the project must be carried out in a rural area; (2) located in rural census tract within an urban county (list included in application kit); (3) organization exists exclusively to provide services to migrant and seasonal farmworkers in rural areas and is supported under Section 330G of the Public Health Service Act; (4) applicant is a Native American Tribal or quasi-tribal entity for services delivered on reservation or federally recognized tribal lands.
To obtain Application Kit: call 877-477-2123 (Request Kit #93.912A)
Deadline for grant proposals: October 16, 2000.
b. Technical Assistance: A grant application technical assistance conference call will be held on September 12, 2000, 2:00 pm Eastern Daylight Time. To participate in the call, email Lilly Smetana at: L Ismetana@hrsa.gov. Provide your name, telephone number, and fax number, and confirm you want to participate in the conference call. Anyone without email can call 301/443-6884. Reservations must be received by noon, September 11, 2000.
Technical assistance workshops will be held on August 15 (Denver), August 17 (Dallas), August 22 (Chicago), August 25 (Atlanta), and August 29 (Philadelphia). Call 1/877-477-2123 to be put on list for applications.
c. Recent Awardees
Chiricahua Community Health Center, Elfrida: Jennifer Ryan (520) 642-2222; Sunset Community Health Center, Somerton: Whitney Reel (520) 637-8108.
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7. Rural Health Network Development Grants
a. Grant Information: Program Guidelines for the FY 2001 Rural Health Network Development Grant Program are now available: http://www.nal.usda.gov/orhp/netgde-1.htm
Purpose: To support the planning and development of integrated health care networks in rural areas. Networks must be composed of three different types of providers. The emphasis of the program is on projects to develop the organizational capabilities of these networks. The network is a tool for overcoming the fragmentation of health carre delivery services in rural areas. Average size of awards: $159,000; estimated project period, three years; estimated number of awards to be made, 12; estimated amount of awards, $1,908,00.
Eligibility: Rural public or nonprofit private organization that is or represents a network which includes three or more health care providers or other entities that provide or support the delivery of health care services. The administrative headquarters of the organization must be located in a rural county or in a rural census tract of an urban county, or an organization constituted exclusvely to provide services to migrant and seasonal farm workers in rura areas under Section 330(g) of the Public Health Service Act.
To obtain Application Kit: Call 1-877-477-2123 (Request Kit #93.912B).
Application Deadline: October 23, 2000.
b. Technical Assistance: Technical assistance workshops scheduled for the Rural Health Outreach Grant Program (see list above) will also include technical assistance for the Rural Health Network Development Grant Program.
c. FY 2000 Grant Awards Announced in July
The White Mountain Apache Tribe was awarded a FY 2000 Rural Health Network Grant this month. The Apache Health Network was designed to develop a mechanism to provide an integrated health care delivery system among three entities: i) the White Mountain Apache Tribal Health Authority; ii) Indian Health Services, and iii) John Hopkins University.
The project will (1) develop a plan to expand and enhance health care services through input from all stakeholders including community members; (2) design a state-of-the-art database that will provide an accurate picture of health care service delivery conditions; coordinate interagency transportation resources, case management training, and data collection; and (3) improve the tribe’s access to additional resources, including increased revenues through third party billing.
The goal of the Apache Health Network is to coordinate and improve quality of care for tribal members, specifically those in isolated villages, and ultimately reduce average health care costs per tribal member.
Southwest Alliance of Navajo Vertically Integrated Health Care Network was created to bring services closer to the people, rather than having the people travel to the services. A midlevel provided to be onsite at an IHS satellite clinic under supervision of the IHS physician in Winslow. Collaboration with Arizona Kidney Disease and Hypertension Centers, Rural Integrated Health Services Network, and Fresenius Medical Corporation for development of preventive and treatment services for kidney disease and hypertension within the community.
For more information about the Rural Health Outreach Grant and the Rural Health Network Development Grant: http://www.nal.usda.gov/orhp/funding.htm
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8. Other Opportunities
The Rural Information Center Health Service (RICHS) is a joint project of the Office of Rural Health Policy, Department of Health and Human Services, and the National Agricultural Library. The RICHS web site provides a wealth of information about grant (federal and foundation) opportunities, publications, conferences, and other resources: http://www.nal.usda.gov/ric/richs.
a. Current federal grant opportunities related to rural health are available at http://www.nal.usda.gov/ric/richs/grants.htm.
(Note: Many of the following grant programs have cyclical application deadlines; the soonest deadlines are shown here. Also indicated is the agency sponsoring the grant program. Agency contact information is at the end of the list. If you’re not overwhelmed with work, you’re not doing your work!)
1) Residency Training in Primary Care (BHPr, HRSA), October 2
2) Podiatric Residency Training in Primary Care BHPr), Oct 27
3) Advanced Education Nursing Traineeship (BHPr), November 1
4) Advanced Education Nursing-Anesthetist (BHPr), November 1
5) Predoctoral Training in Primary Care (BHPr), November 3
6) Public Health Conference Support,(CDC/ATSDR), October 2
7) Healthy Start Initiative (MCHB, HRSA), January 5
8) Community/Migrant Health Ctrs (HRSA), (120 days;variable)
9) Comm.-Initiated Prevent/Interventions (SAMHSA), Sept 10
10) Initiative for Minority Students-Baccalaureate (NIGMS), Nov 14
11) Initiative for Minority Students-Doctorate (NIGMS), Nov 14
12) Drug Abuse Prevention Intervention (NIDA), Feb 1
13) Aging Women and Breast Cancer (NIA, NCI, NINR), Feb 1
14) Econ. Eval./HIV/Mental Disorders (NIMH, AHCPR),Sept/Oct 1
15) Knowledge Dissemination Conference (SAMHSA), Sept 10
16) Integrating Mental Health Res./Behavioral Sci. (NIMH), Oct 1
17) Local Pop/Area Epid. Research Drug Abuse (NIDA), February 1
18) Socioec. Status and Health Across Life Course (Various), Oct 1
19) Health Care Encounters, Elderly Patients (NIA/NINR), Feb 1
20) Health/Effective Functioning, Middle/Later Years (NIA), June 1
21) Health Services Research on Alcohol (NIAAA), October 1
22) Psychosocial Geriatrics Research (NIA), June 1
23) Priorities in Behavioral Research, Cancer (NCI/NIDR), Oct 1
24) Health Services Research on Rural Health (AHCPR), October 1
25) Drug/Alcohol Use/Rural America (NIDA/NIAAA/USDA), 10/1
26) Risk Reduction: Community-Based Strategies (NINR), Oct 1
27) Drug Use/Minority/Underserved Pops (NIDA), October 1
28) Research/Quality Care/Mental Disorders (NIMH), October 1
29) Women’s Mental Health Research (NIMH), October 1
30) HIV Risk Behav/ Determinants/Consequences (NIMH), Oct 1
31) Brief Interventions to Prevent Spread of AIDS (NIMH), Oct 1
32) Linkage/Drug Abuse Treatment/Medical Care (NIDA), Oct 1
33) Cancer Prevent./Control Res. Small Grants (NCI), Oct 1
34) Ed. Intervention Res./High Risk Youth (NCI), Oct 1
35) Integrated Advanced Info. Mgmt Systems (NLM), Oct 1
36) National Library of Med. Resource Grant (NLM), Oct 1
37) Native Amer/Alaskan/Hawaiian Mental Hlth (NIMH), Oct 1
38) Preventing Alcohol Problems/Ethnic Minorities (NIAAA), Oct 1
39) Res./Mental Health in General Health Setting (NIMH), Oct 1
40) Occupational Safety/Hlth Res/Demonstration (NIOSH), Oct 1
41) Low Birth Weight/Minority Populations (Varied), October 1
42) AIDS/Chronic Long-Term Illness (NIMH/NIDA/NINR), Oct 1
43) Econ. Studies/Cancer/Screening/Care (NCI/AHCPR), Oct 1
44) Cancer Surveillance/Claims-Based Data (NCI/AHCPR), Oct 1
45) Epid. Research on Drug Abuse (NIDA), October 1
46) Drug Use, Sexual Risk Behaviors, HIV/Men (NIDA), Sept 1
47) Conference Support Small Grant Program (AHCPR), Nov 15
48) Small Grants for Cancer Epidemiology (NCI), November 20
49) Small Research Grant Program (AHCPR), November 24
50) Small Grants for Behavioral Research/Cancer, NCI, August 20
51) NIAAA Alcohol Abuse Spec. Emphasis Areas (NIAAA), Oct 1
52) NIMH Small Grants Program, October 1
53) Loan Repayment for Health Professions (IHS), January 14
54) Family Planning Services Grants (PHS), Vary by region.
55) NHSC Loan Repayment Program, HRSA, August 31
56) Alcohol Education Project (NIAAA), Ongoing
57) State Children’s Health Insurance Program (HCFA), Ongoing
58) Community Facilities Loans, USDA, Ongoing
59) Health Ed. Assistance Consolidation Loan, HRSA, Ongoing
60) National Civilian Community Corps (CNCS), Ongoing
61) Planning-Biomed. Epid/Intervention, NIA/NIEHS, Ongoing
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b. Agency Contacts for Application Kits
- AHCPR - Agency for Health Care Policy and Research (301-435-0714). BHPr/HRSA - Bureau of Health Professions, Health Resources and Services Administration (1-877-477-2123).
- CDC/ATSDR - Centers for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry (1-888-6874).
- CNCS - Corporation for National and Community Service (202-606-5000, Ext. 144)
- HCFA - Health Care Financing Administration (410-786-2019)
- IHS - Indian Health Service (301-443-3396)
- NCI - National Cancer Institute (301-435-0714)
- NIA - National Institute on Aging (301-435-0714)
- NIAAA - National Institute on Alcohol Abuse and Alcoholism (301-435-0741)
- NICHHD - National Institute of Child Health and Human Development (301-435-0714
- NIDA - National Institute on Drug Abuse (301-435-0741)
- NIDCR - National Institute of Dental and Craniofacial Research (301-435-0714)
- NIDR - National Institute of Dental Research (301-435-0714)
- NIEHS - National Institute of Environmental Health Sciences (301-435-0714)
- NIGMS - National Institute of General Medical Sciences (301-435-0714.
- NIMH - National Institute of Mental Health (301-435-0714)
- NINR - National Institute of Nursing Research) (301-435-0714)
- NIOSH - National Institute for Occupational Safety and Health (301-435-0714).
- NLM - National Library of Medicine (301-496-4621; 301-594-4882).
- PHS - Public Health Service
- SAMHSA - Substance Abuse and Mental Health Services Administration (1-800-729-6686).
- USDA - U. S. Department of Agriculture (301-734-8596)
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c. Foundations: Current Funding Programs and Master List: http://www.nal.usda.gov/ric/richs/foundat.htm.
Noteworthy Foundation Grant Programs:
* ADA Health Foundation, Chicago (312-440-3526)
Funding for national and regional dental access programs that make dental care available to the underserved, including children.
* AVONCares Program for Medically Underserved Women, New York (800-813-4673, Ext. 8356). Financial assistance and relevant education and support to low income, under- and uninsured, underserved women throughout the country in need of diagnostic and/or related services for the treatment of breast, cervical, and ovarian cancers.
* Public Welfare Foundation, Washington DC (202-965-1800)
Grassroots Organizations Funding to expand access to health care for the poor.
* Robert Wood Johnson Foundation
# Local Initiative Funding Partners Program 2000, Princeton, Jew Jersey (609-275-4128). Matching grants program designed to establish partnerships between RWJ and local grantmakers in support of innovative, community-baed projects that focus on underserved and at-risk populations. Grants may be made to local service organizations, hospitals, universities, and state agencies.
# Medicaid Managed Care Initiative: Strengthening the Safety Net, Princeton, New Jersey (609-279-0700). To build capacity among consumers, health care providers, managed care organizations and state agencies to make managed care work for vulnerable populations covered by Medicaid. One-year feasibility grants ($100,000); three-year demonstration and evaluation projects ($500,000) involving collaboration between states and Medicaid managed care providers); technical assistance to states on key design and operational issues.
* W.K. Kellogg Foundation (800-677-1098)
Managing Information with Rural America (MIRA). Clusters of Community Teams grants will support those who are building community capacity to use information systems/technology to enhance community development activities. Community Support Organizations grants will support rural communities through direct services in training, technical assistance, leadership development, or civic participation activities. Also eligible will be organizations in rural communities which develop or capitalize on economic opportunities such as workforce development, microenterprise development, and access to capital. Policy Support Organizations grants will be awarded to those which propose using technology to serve rural communities in their policy efforts, and promote a two-way exchange of information with rural communities in an effective, inclusive way.
* MultiPlan Rural Health Initiative Partnership for Health: Caring for the Country (800-677-1098). Multiplan, in partnership with the National Rural Health Association, has launched a program to help rural hospitals in obtaining accreditation from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
* Donald W. Reynolds Foundation Community Services Center Program, Nevada (702-804-6000). Funds smaller non-profit organizations to co-locate a number of non-profit organizations to provide complementary services for the convenience of clients in order to minimize duplication of effort and reduce operating costs.
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d. Upcoming Conferences Relevant to Rural Health: Are you bored? Have nothing to do? Let your “inner child” choose one of the following::
AUGUST
* Strategic Planning for Rural Health Networks, Academy for Health Services Ressearch and Health Policy, Cambridge, Maine, August 24-25, (202) 292-6730.
* Bridging Rural Women’s Health into the New Millenium (Milton S. Hershey Medical Center, Pennsylvania State University, Washington DC, August 18-19 (717-531-6483).
* Using Policy Analysis and Research More Effectively in Decision Making, Agency for Healthcare Research and Quality User Liaison Program, Rensselaerville, New York, July 30-August 4 (301) 594-6668.
* Thirteenth Annual State Health Policy Conference, National Academy for State Health Policy, Bloomington, MN, August 6-8), (207-874-65-24).
* Public Health Informatics and Distance Learning Conference 2000, Association of Schools of Public Health, Centers for Disease Control and Prevention, Health Services and Resources Administration, Agency for Toxic Substances and Disease Registry, August 7-10 (202-296-1099).
* 63rd Annual Meeting of the Rural Sociological Society, “Policy and Rural Communities: Challenges for the 21st Century,” Washington DC, August 13-17 (409-845-9781).
* Fourth World Rural Health Conference, “Progress Through Partnerships,” University of Calgary, Alberta, Canada, August 16-19 (+1 403 219 6100)
SEPTEMBER
* Association of Telemedicine/Telehealth Service Providers Fourth Annual Conference, “Telemedicine and E-Health: Common Paths to the Patient,” Minneapolis, MN, September 6-8 (800-852-3591 or 503-222-2406).
* Eleventh Annual Conference, National Organization of State Offices of Rural Health (NOSORH), Park City, Utah, September 13-16 (816-756-3140).
* Twelfth Annual Rural Nursing Conference, Centennial Area Health Education Center, Estes Park, Colorado, September 14-16 (970-330-3698).
OCTOBER
* Enhancing Outcomes in Women’s Health:Translating Psychosocial and Behavioral Research into Primary Care, Community Interventions, and Health Policy – An Interdisciplinary Conference, American Psychological Association, Washington DC, October 4-6 (202-336-6120).
* 2000/2001 Migrant Farmworker Stream Forums, Midwestern Stream, National Center for Farmworker Health, Albuquerque, New Mexico, October 26-28 (512-312-2700).
NOVEMBER
* 128th Annual Meeting of the American Public Health Association (APHA): Eliminating Health Disparities, Boston, Massachusetts, November 12-16 (202-777-2478).
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9. Other Useful Information
a. Resources for Grant Writers: For those of you who need data/information to support grant proposals, the following resources are available online or by phone:
Arizona Department of Health Services
Vital Statistics
http://www.hs.state.az.us/plan/ohpes.htm
Office of Epidemiology and Statistics
Bureau of Public Health Statistics
Phone: (602) 542-1216
Fax: (602) 542-2940
Arizona Department of Health Services
Arizona Primary Care Area Datasets
http://209.196.47.42/hsd/Pca.htm
Bureau of Health Systems Development
Phone: (602) 542-1219
Fax: (602) 542-2011
Arizona Department of Commerce
Arizona Profiles (Including State, Community, Indian,
and County Profiles)
http://www.commerce.state.az.us/publications/
community_profiles.htm
Phone: (602) 280-1300
b. Resources for Health Care Professionals: For those of you who need information for health care professionals, the following resources are available online or by phone:
University of Arizona Health Sciences Library
http://www.ahsl.arizona.edu/
Phone: (520) 626-6241
Arizona Health Information Network (AZHIN)
http://HInet.medlib.arizona.edu/azhin
Arizona State Health Library
http://www.hs.state.az.us/phl/phlib.htm
Phone: (602) 542-1013
Fax: (602) 542-1132
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That’s all folks!
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