|
Rural Health Briefing, December 1, 2003
1. National Scene
a. Medicare Update
b. Added Telecom Discounts For Underused Program
c. 242 Loans Easier for CAHs
d. Physician Shortage Predicted
e. Rural EMS Data Sought
f. Munoz Named Regional HHS Director
g. Fire and Emergency Service Funding Approved
h. Acting Against Diabetes: Free Bilingual Resources
i. Maricopa Public Health Leader On National Panel
j. PACE Looks To Rural Applications
k. NRHA Seeks New Community Members
2. Across Arizona
a. Border Hospitals Struggle With Emergency Care Load
b. Health Care Improves In National Ranking
c. Ossowski Named IHS Family Physician of the Year
d. Arizona Awarded Defibrillator Funds
e. AzRHA Memberships
3. Grant Opportunities
a. Community Partnerships for Older Adults
b. Executive Nurse Fellowships
c. Faith in Action Grant Program
d. Native American Congressional Internships
e. Health Information Technology Projects
f. Health Study Grants for Indian Students
4. Events Calendar
December
- · White House Conference on Faith-Based and Community Initiatives, December 5 – Tampa
- · Engaging Our Communities Seminars, December 6 – Tucson and Online
January
- · Legislative Forum On Health Care In Arizona, January 13 - Phoenix
- · Health Action 2004, January 22-24 – Washington, D.C
February
- · 15th Annual Rural Health Policy Institute, February 22-25 – Washington, D.C.
Mark Your Calendars Now
- · May 26, 2004
10th Annual Rural Minority and Multicultural Health Conference – San Diego
- · May 27-29, 2004
27th Annual Rural Health Conference – San Diego
- · June 2-4, 2004
Second Annual Western Region FLEX Conference – Lake Tahoe
- · July 19-24, 2004
Arizona Rural Health Conference – Phoenix
1. National Scene
a. Medicare Update
With reauthorization through 2008, the recently passed HR1 Medicare bill offers significant changes for Flex programs.
- Effective on or after Jan.1, 2004 – Medicare Reimbursement will equal 101 percent of reasonable costs. (Sec 405, (a) (1)
- Effective January 1, 2005, certain costs associated with on call emergency services providers will be reimbursable for physicians, physician assistants, nurse practitioners and clinical nurse specialists. (Previous language specified “emergency room physicians”). (Sec 405, (b) (1 & 2)
- Authorizes Periodic Interim Payments (PIP) on or after July 1, 2004. (Sec 405, (c)
- Critical Access Hospitals no longer must have each physician or practitioner assign billing in order to select Option 2 as of July 1, 2004. Hospitals that previously selected option 2 billing go back to on or after July 1, 2001. (Sec 405, (d)
- Increases acute care bed limit from 15 to 25, effective Jan.1, 2004. Maximum number of beds remains at 25 (including swing). (Sec 405, (e)
- Additional 4-year period of funding. $35 million appropriation authorization in each of fiscal years 2005 to 2008. (Sec 405, (f) (1)
- Requires “Consultation with the State Hospital Association and Rural Hospitals on the most appropriate ways to use grants.” (Sec 405, (f) (4) (A)
- CAHs are granted the authority to have psychiatric and rehabilitation Distinct Part Units (DPUs) effective 10/1/2004. DPUs may not exceed 10 beds and are reimbursed under PPS. DPU beds do not count towards the CAH bed limit. (Sec 405) (g) (1 & 2)
- Eliminates State authority to designate necessary provider after Jan.1, 2006. CAHs designated as “necessary providers” prior to that date will not lose their designation. (Sec 405, (h) (1-3)
Under Medicare's prospective payment system (PPS), skilled nursing facilities (SNF) are paid a predetermined amount to cover all services provided in a day. Certain services and items provided a SNF resident, such as physicians' services, specified ambulance services, chemotherapy items and services, and certain outpatient services from a Medicare-participating hospital or critical access hospital, are excluded from the SNF-PPS and paid separately under Part B. When this statute was originally written, RHC providers were not excluded from the PPS system. Therefore, payment for services provided by RHC professionals at the SNF had to come out of the SNF-PPS payment rather than from Medicare.
As a result of the new Medicare bill passed this week, services provided by a rural health clinic (RHC) provider, delivered in a SNF, would be excluded from SNF-PPS if such services would have been excluded if furnished by an physician or practitioner who was not affiliated with a RHC. The provisions would apply to services furnished on or after January 1, 2004. This means that the RHC would bill for the visit as if it were an RHC visit.
b. Added Telecom Discounts for Underused USAC Program
Rural health providers can obtain better access to telecommunication and information services due to new rules recently adopted by the Federal Communication Commission (FCC). Under the new rules, dedicated emergency departments of rural for-profit hospitals and non-profit entities that function as health care providers on a part time basis will become eligible to receive prorated support in order to equalize rural telecommunication rates with those charged in urban areas. In addition, discounts of twenty-five percent of the monthly cost of Internet access are available. Other changes make for more flexibility in some services. Out of a possible $400 million in FY 2001, only $14 million was discounted. For more information on the program, visit: http://www.fcc.gov/cgb/rural.
c. 242 Loans Easier for CAHs
CAHs and other hospitals will have better access to HUD Section 242 Mortgage Insurance under the Hospital Insurance Act of 2003, Public Law 108-91. For a trial period of three years, CAHs will be granted an exemption from HUD’s requirement that nor more than 50% of a hospital’s patient days be attributable to non-acute care services. The law widens the potential applicant base to include hospitals with large skilled nursing components. Senior care will no longer have to be targeted for elimination before seeking this mortgage insurance.
d. Federal Advisory Group Predicts Physician Shortage Looming
In a dramatic change in policy recommendations, the Council on Graduate Medical Education has cast aside a forecast of a surplus of physicians that it has held since the mid-1980s and now backs a prediction of a shortage. The Council now is calling for a 15% increase in medical school graduates. Carl Getto, MD, chair of COGME and senior vice president for medical affairs for the University of Wisconsin Hospitals and Clinics, said the council's change in perspective was in response to mounting evidence from physician work-force experts and physician recruitment firms.
e. Rural EMS Data Sought
A new study of rural EMS systems may have a profound impact on policy making and funding. NRHA in partnership with two national EMS and rural health system leadership groups is already underway with Rural/Frontier EMS Agenda for the Future. This guide is intended to define the real needs of rural and frontier EMS systems. Dennis Berens, chair of the project steering committee, said, “We want to hear from anyone who has an issue, best practice or idea about the provision” of these services. The deadline for this information collection period is December 31, 2003. After a draft report is circulated next summer, the final guide is expected to be released in October. To facilitate this entire process, go to the website: http://www.nrharural.org/EMSagenda/
In Arizona the national Rural EMS Agenda for the Future was used as a model to create an Arizona Rural EMS Agenda for the Future. Arizona's agenda, which is now available for comment, was a collaborative effort involving representatives of Tribal and non- Tribal EMS systems in the state. Copies of the Arizona document may be obtained at the from the Arizona Flex program.
f. Munoz Named HHS Regional Director
Calise Munoz will assume the position of Director of HHS Region IX effective in mid-January. Ms. Munoz, an attorney, has served as Deputy Director for Policy, in the office of the Secretary of Health and Human Services in Washington, D.C.
g. Fire and Emergency Service Funding Approved
Congress has passed the Staffing for Adequate Fire and Emergency Response Firefighters Act (SAFER Act) The act authorizes funds for a competitive grant program for localities to hire more fire fighters in career, volunteer and combination departments. President Bush is expected to sign it into law. This authorization establishes the particulars, but Congress must provide funding. It will be eligible in FY 2005. Grants are for a four- year period and will be awarded on the basis of need through a competitive, peer-reviewed process.
h. Acting Against Diabetes: Free Bilingual Resources
Healthier twists on traditional Latino recipes coupled with original songs to a Latin dance beat are few of the free offerings of the National Diabetes Education Program (NDEP). Prevengamos la diabetes tipo 2. Paso a Paso (We Can Prevent Type 2 Diabetes: Step by Step) was developed in response to the results of a clinical trial, which found that simple changes could reduce the risk of diabetes, by more than half. Of 30 million Hispanics in the United States, about 2 million have diagnosed diabetes. Untreated, type 2 diabetes can lead to serious problems including blindness, amputation and kidney and heart disease.
Beyond the kitchen and dance floor, the campaign offers Spanish and English fact sheets, school-oriented educational tools, and radio, television and print ads.
To obtain any of the campaign materials or a free copy of Movimiento, Por Su Vida (Movement, for Your Life), the music CD, call 1-800-438-5383 or visit www.ndep.nih.gov.
i. Maricopa Public Health Leader Added to National Panel
Doug Campos-Outcalt, MD, MPA, clinical professor of Family and Community Medicine at the University of Arizona, Phoenix campus, has been named to a three-year term on the National Advisory Council for the Agency for Healthcare Research and Quality. The council provides advice to the Secretary of Health and Human Services and to the Director of the Agency. The council is comprised of 21 members from the private sector and eight ex-officio members from other federal health agencies. Campos-Outcalt is former medical director of the Maricopa County Department of Public Health. After attending his first meeting, he said that the agency wants to make research more immediately beneficial. Comments or suggestions can be sent to Campos-Outcalt at dougco@u.arizona.edu. .Further info at: http://www.ahrq.gov/about/council.htm
j. PACE Looks to Rural Applications
Will a successful urban program have the same effectiveness in the countryside? PACE, Programs of All-inclusive Care for the Elderly, currently serves people over 55 in need of nursing home care with the goal of maximizing their independence in the community. Now the National PACE Association (NPA) and the National Rural Health Association are developing a set of resources to assist rural providers. The key focus will be technical assistance in starting PACE programs and using those programs as training grounds for health care professionals. “So much traditional health care is designed around building a facility where certain types of care and services are delivered,” said Shawn Bloom, president of NPA. “The PACE model places the needs of each individual being served at the center of activity instead of the needs of the facility. It takes effort to organize a system that can do that.” Details available at NPA: http://www.npaonline.org/content/rural/index.asp or call 703-535-1515.
k. NRHA Seeks New Community Members
In search of greater participation from community members, NRHA has unveiled a new dimension: the Advocacy Member. Benefits for those who join include subscriptions to Rural Roads, a quarterly magazine, and the bi-monthly eNews, as well as access to online discussion rooms and Action Alerts about pressing legislative issues. The annual cost is $35. NRHA works on rural health through advocacy, communications, education and research. Further information at www.NRHArural.org
2. Across Arizona
a. Border Hospitals Struggle with Emergency Care Load
A record 151 immigrants died crossing the Arizona desert between October 1, 2002 and October 1, 2003. The flood of immigrants is impacting border hospital emergency rooms. One result of this demand is that other services must be closed down because of limited budgets. Jim Dickson, director of Bisbee’s Copper Queen Community Hospital, is in the heart of the storm. He said that in 1999, unreimbursed emergency care for immigrants cost the hospital $30,000. This year, the cost will be more than $400,000. Bisbee’s predicament is a scale model of Arizona’s as a whole. On the Tohono O’odham Indian Reservation, immigration related policing consumed up to a third of the nation’s law enforcement budget last year, including $250,000 for autopsies on immigrants who died in the desert. (Adapted from The Price of Passage, Denver Post, October 20, 2003 http://www.denverpost.com/)
b. Health Care Improves In National Ranking
In a recent study by the Milken Institute (www.milkeninstitute.org), researchers looked at the components of America's health care industry and ranked regions and states in terms of jobs, facilities and impact. In terms of employment growth in all health care-related industries, Arizona ranked #7 among the states, registering a 54.4% increase from 1990-2000 and 18.7% from 1996-2001.
c. Ossowski Named IHS Family Physician of the Year
Eric Ossowski, MD, Chief of Family and Primary Care Medicine at the Phoenix Indian Medical Center, has been selected as the 2004 National Family Physician of the Year. He began his career with the IHS in 1980 and has provided primary care at Salt River Pima-Maricopa Health Clinic and the Gila Bend Primary Care Clinic.
d. Arizona Awarded Defibrillator Funds
Arizona Department of Health Services will receive over $200,000 from the Federal Office of Rural Health Policy to buy needed defibrillators. This support will allow purchase of the FDA-approved automated external defibrillators and training of emergency and community personnel in their proper use. Automatic defibrillators are lightweight, portable devices, which provide an electrical shock capable of restoring the normal heart rhythm of cardiac arrest victims, greatly improving chances of survival.
e. AzRHA Memberships
The AzRHA advocates on behalf of the health needs of rural Arizonans at national, state and local levels. Its multidisciplinary membership provides a respected and highly effective group of rural health practitioners and community residents. For example, the AzRHA has actively and successfully advocated with the state legislature for funding for tele-medicine and mobile clinics in all fifteen counties of the state. Memberships are available at $25 for individuals, $10 for students and $100 for organizations. Register online at: http://azrha.org/join.html
3. Grant Opportunities
a. Community Partnerships for Older Adults
This national program fosters community partnerships that will improve long-term care and supportive services systems to meet the current and future needs of older adults. Diversity is a guiding principle of this initiative. The program seeks applications from existing community partnerships or collaborative groups with broad and diverse memberships from communities. A maximum of 17 communities will receive development grants of up to $150,000 for 18 months. Letters of intent are due January 9, 2004. The full Call for Proposals and information about how to apply are
available online at the program Web site: http://partnershipsforolderadults.org/.
b. Executive Nurse Fellowships
The Robert Wood Johnson Foundation is accepting applications for its Executive Nurse Fellows Program for 2004. The three-year fellowships allow senior executive nurses to remain in their current positions and are intended to offer participants the experiences and skills necessary to advance in health services, public health and nursing education. Up to 20 fellowships will be awarded in 2004. Application deadline is January 30, 2004.
The complete Call for Applications is available on The Robert Wood Johnson Foundation web site www.rwjf.org/cfp/executivenursefellows or by calling (415) 502-6451.
c. Faith in Action Grant Program
Faith in Action funds programs that bring together religious congregations of all faiths, and other community organizations such as hospices, clinics, and hospitals, in a common mission to provide volunteer care to their neighbors in need. Special consideration will be given to programs designed to reach people living in low-income or underserved communities. Awards are up to $35,000 for a 30-month startup period. Catherine Manley is the Arizona mentor and can be reached at 877-714-1913 or cehanleyaz@aol.com. Application deadline: February 1, 2004. Applications are available on the program web site. To apply, contact the Faith in Action national office for a complete application packet at http://www.fiavolunteers.org/funding/index.cfm.
d. Native American Congressional Internships
Through the Udall Foundation, twelve Native Americans will be selected for a ten-week intensive internship in Washington, D.C. These interns will work full-time in congressional offices or federal agencies, fulfilling tasks ranging from special research and writing projects to general support work. Through an enrichment part of the program, students are provided with an opportunity to network, meet key decision-makers and attend lectures and other special events. If you have any questions or need assistance in completing your application please contact: Kristin Kelling, Program Manager, 520-670-5609 or 520-670-5529, kelling@udall.gov, The Morris K. Udall Foundation, Internship Program, 130 South Scott Avenue, Tucson, AZ 85701-1922. The deadline is February 3, 2004. Further details at: http://www.udall.gov/p_int_guide.htm
e. Health Information Technology Projects
Planning and implementation grants are available from the Agency for Healthcare Research and Quality (AHRQ). The Agency expects to award up to $24 million to fund as many as 48 new implementation grants under the first Request for Applications, with up to $14 million going to small and rural hospitals and communities. The RFA emphasizes the importance of community partnerships. AHRQ will provide up to 50 percent of the total costs in matching funds, not to exceed $500,000 per year, for each project. Letters of intent are due February 22, 2004, and applications are due April 22, 2004. For further information, go to the NIH Guide at http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-04-011.html.
A second RFA will fund up to 35 new planning grants for communities to prepare for future implementation grants. Projects can last up to one year with budgets up to $200,000. Letter of intent are due March 22, 2004 and applications are due by April 22, 2004. For further information, go to the NIH Guide at http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-04-010.html.
f. Health Study Grants for Indian Students
Scholarships totaling more than $2 million will be made to encourage American Indians and Alaska Natives to enter the health professions. Awards in the Health Professions Preparatory and Pregraduate Scholarship Program for Indians are for 10 months duration and the average award for a full-time student is approximately $20,000. February 24, 2004 is the application deadline. Application packets and other inquiries can be obtained from Norm Cavanaugh, Scholarship Coordinator, Phoenix Area IHS, Two Renaissance Square, 40 North Central Avenue, Suite 600, Phoenix, AZ 85004, 602-364-5220. For grants information, contact Mr. Bernard Covers Up, Grants Scholarship Coordinator, Grants Management Branch, Division of Acquisition and Grants Operations, Indian Health Service, 801 Thompson Avenue, Suite 120, Rockville, Maryland 20852; Telephone 301-443-5204. (This is not a toll-free number.)
Events Calendar
December 5 – Tampa White House Conference on Faith-Based and Community Initiatives
The White House and the Departments of Justice, Agriculture, Labor, Health & Human Services, Housing & Urban Development and Education and the Agency for International Development will host a conference in Tampa, to help faith-based and community organizations learn more about President Bush's Faith-Based and Community Initiative. The conference will take place at the Tampa Convention Center, 333 S. Franklin Street from 8:00 a.m.-5:00 p.m. The Conference is free, but pre-registration is required. Registration is on a first-come, first-serve basis. For more information, please call 202-456-6718, send an email to fbci@dtihq.com, or visit www.fbci.gov to register.
December 16 – Tucson and online Planning for the Rural Health Issues.
Alison Hughes and Howard Eng, Rural Health Office, Arizona College of Public Health will be presenting at this session. This free offering of the Engaging Our Communities Public Health Seminars bring together experts from around Arizona and the nation to discuss the most salient public health issues. They are held in Kiewit Auditorium in the Arizona Cancer Center, 1515 N. Campbell, Tucson from noon to 1 p.m. CEU’s are offered. Future events in this Tuesday series can be found at http://www.ahsc.arizona.edu/opa/news/sep03/seminar.htm.
Presentations are teleconferenced to the Arizona Health Sciences Center Phoenix Campus and Northern Arizona University's College of Health Professions. In addition, they are broadcast through the Arizona Telemedicine Program. Presentations also may be viewed live, via the Streaming Video Server: http://video.biocom.arizona.edu/video/videolibrary/cph/PHGR0203/default.htm.
For more information, please call Jennie Mullins, professional development coordinator 520-626-3200, ext. 106.
January 13 - Phoenix Legislative Forum On Health Care In Arizona
The 2004 Health and Human Service Agenda: How Does it Impact You?
This annual forum will help participants prepare for the upcoming legislative session. Meetings with state legislators, health care advocates, providers and educators will examine the health and human services agenda. This educational forum will be held at the Arizona State Capitol, Governor’s Reception Room, 1700 West Washington, Phoenix from 8:30 a.m.-5:00 p.m. The registration cost is $45.00, which includes lunch and materials. For further information, contact Rebecca Ruiz, 520-626-7946, aruiz@rho.arizona.edu, Rural Health Office, Mel and Enid Zuckerman College of Public Health, University of Arizona, 2501 East Elm Street, Tucson, AZ 85716. or visit our website: http://www.publichealth.arizona.edu/community/3_ruralhlth.htm
January 22-24 – Washington, D.C. Health Action 2004
The conference will focus on several broad issues: the future of Medicaid, recent federal Medicare and prescription drug legislation, private market and employer-provided health care, and state strategies for universal health care, among others. Conference sessions will be held at the Mayflower Hotel, 1127 Connecticut Ave., NW, Washington, D.C. Online registration and information about the conference is available on the Families USA Web site at:
http://www.familiesusa.org/site/PageServer?pagename=conference_2004
or by calling 202-628-3030.
February 23-25 – Washington, D.C. 15th Annual Rural Health Policy Institute
NRHA will bring a mix of perspectives to pressing national questions such as quality, insurance, EMS, workforce, medical technology and other issues. Sessions and housing will be located at the Grand Hyatt Washington, 1000 H Street, NW, Washington, DC. Complete details are available at: http://www.nrharural.org/index.html
Mark Your Calendars Now
May 26, 2004
10th Annual Rural Minority and Multicultural Health Conference – San Diego
May 27-29, 2004
27th Annual Rural Health Conference – San Diego
June 2-4, 2004
Second Annual Western Region FLEX Conference – Lake Tahoe
July 19-24, 2004
Arizona Rural Health Conference – Phoenix
Important Links
Editor's Note: This online newsletter is a project of the Arizona Rural Hospital Flexibility Program, housed in the Rural Health Office at the Mel and Enid Zuckerman Arizona College of Public Health, and supported through a grant from HRSA (Office of Rural Health Policy). The Rural Hospital Flexibility Program was created by Congress to improve the financial viability and stability of health care in rural areas, including creation of a new designation for rural hospitals as Critical Access Hospitals (CAHs). Designated CAHs are eligible for cost-based reimbursement for services provided to Medicare patients. In some states, including Arizona, additional reimbursement is also available for CAH services provided to Medicaid patients.
Comments, suggestions, questions, as well as address changes and additions to distribution list or removal from distribution list should be sent to Rural Health Briefing.
|
