February 1 2004

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Rural Health Briefing February 1 2004

National News
1. Comments sought to expansions in Universal Services Fund
Allowable distance, EMS, satellite services, internet charges changed
2. Flex makes workforce difference
National survey shows cash flow improvements help with retention
3. CMS updates
- Payment increases for physicians in M edicare Reform
- Revised payment policies for hospital Medicare outpatient services
- Heart failure targeted in Arizona and California
- Special geographic classifications appeals procedure
- Payment increases and expanded flexibility
4. Consequences of underinsurance
Report by Institute of Medicine consolidates evidence on health, social, and
economic effects
5. Heart attacks in elderly Mexican Americans
Prevention vital due to high mortality rate of second attacks
6. AHRQ issues National Healthcare Disparities Report and access to Tools
- Comprehensive effort to study differences in use and access
- Clearinghouse of tools for providers, policy makers, patients and
purchasers
7. Medicaid Home Care for Tribal Health Services
UCLA offers tool kit for developing new programs
8. 2004 Rural Health Awards nominations sought
NRHA to name practitioner of the year
9. Best practices for co-occuring substance abuse and mental disorders
Technical assistance center and help line from SAMHSA
10. Care Across the Continuum
Framework to guide policy development in rural areas
11. Rural transportation assistance
USDA offers to help small or emerging businesses and non-profits

Across Arizona
1. Arizona’s rural hospitals rally behind new rural hospital bill
SB 1191 would create fund to address disparities

2. Rural collaborations called for by committee chaired by Arzberger and Hanson
Hearings report on medical care, malpractice
3. American Indian housing supported
$2 million in projects funded by Arizona Department of Housing
4. Bud (Warren J.) Day dies in Flagstaff
Human rights champion active in rural health issues
5. St Luke’s funds RHO database
Comprehensive rural health assessment going online
6. Copper Queen seeking CAH designation
Board cites careful budget analysis as reason
7. Yavapai Nation welcomes new health services wing
Wassaja Memorial Health Center expands
8. Hopi networking moves forward
Planning grant awarded by ORHP
9. HSAG awarded CMS special study contracts
High performer components, measures management and HCAHPS targeted
10. RBHA network expands
Bandwidth, bridges and new sites improve capacities
11. New tools for Continuous Chest Compression CPR
Improved survival rates for out-of-hospital sudden cardiac arrest
12. American Indian tour guide
Crossing Paths published by American Indian Tourism Association and America West Magazine

Grants and Opportunities
1. Arizona Commission of Indian Affairs grants and fellowships
Variety of useful listings

2. Rural cooperative home-based health care pre-development and revolving loans
Applications due February 13, 2004

3. Summer Biomedical Research Opportunities in Tucson
Applications due March 1, 2004

4. Cornell seeks Native American Ph.D. candidates in medical sciences
Applications due March 1, 2004

5. www.grants.gov
New central location for federal grants

Events Calendar
1. February 10, 2004, Quality Improvement: Tools to Benchmark and Measure Performance - AHRQ’s web-assisted audio conference
2. February 12 – Meeting the Demands of Growth, Arizona Association of Community Health Centers, Phoenix
3. February 12 - Rural Health Care Division (RHCD) of USAC, outreach conference call
4. February 14 – Healthy Heart Conference, Tucson
5. February 17 – Reducing Health Disparities in the Mexican American Population, teleconference originating at UA College of Nursing
6. February 18 - Using Measurement Data to Improve Quality - AHRQ’s web-assisted audio conference
7. February 25 - Iron and Manganese Control Workshop, Parker, Arizona
8. February 26 - 9th Annual State Association Council Skill-building Workshop at National Rural Health Policy Institute, Washington, D.C.
9. February 29-March 4 - 6th Annual National Tribal Transportation conference, Albuquerque
10. March 4 - Online Fellowship in Physician Ethics and Professionalism, online
11. March 6 – Alzheimer’s Disease and Dementia Update: Care of Native American Elders, Phoenix
12. March 10-12 – American Health Quality Association, and Foundation Technical Conference, New Orleans
13. March 31 - Narrative Medicine, Rita Charon, University of Arizona, Tucson
14. April 4-7 - National American Indian Conference on Child Abuse and Neglect
"Putting Our Minds Together to Leave No Indian Child Behind, Denver
15. May 2-5 - Ninth Annual American Telemedicine Association meeting and exposition, Tampa
16. May 25-29 – National Rural Health Association conference, San Diego
17. May 26 - 10th Annual Rural Minority and Multicultural Health Conference, San Diego

National News
1. Comments sought to expansions in Universal Services Fund
Allowable distance, EMS, satellite services, Internet charges changed

The FCC has adopted new rules to increase participation in the Universal Services Rural Health Care (RHCD) support program. The RHCD program, with an annual availability of $400 million, has created a demand of only about $20 million annually. This program has been in existence for six years, with an estimated 8,000 to 9,000 eligible health care providers, but only 1,800 are currently participating.
A Notice of Proposed Rule Making (NPRM) has been posted seeking comments on: 1) the definition of a rural area; 2) support for satellite services for mobile rural health clinics; 3) further streamlining of the application process, and; 4) the need for additional outreach efforts to rural providers. Comments are due on or before February 23, 2004.
To link directly to the full text of the NPRM from the Federal Register, or to link to the FCC Web site where comments can be submitted, click on the following link:
http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/03-31684.html
The FCC announced that it would expand the Universal Services program to include discounts for internet access for rural health care providers. For more information about this program designed to make telecommunications affordable in rural areas, see:
http://www.fcc.gov/cgb/consumerfacts/usp_RuralHealthcare.html.

To learn more about the new Internet discounts, visit:
http://www.rhc.universalservice.org/whatsnew/112003.asp#111403
Expansions to the Universal Services program for rural health care access are welcome, because the six year old program has only spent around $14 million in discounted telecommunications services out of $400 million per year allocated for this program. To read NRHA’s policy recommendations on this topic, go to: http://www.nrharural.org/dc/policybriefs/UniversalSvcs.pdf.
2. Flex makes workforce difference
National survey shows cash flow improvements help with retention
The University of Washington surveyed CAH administrators in 2003 about workforce staffing. 329 hospitals responded from 43 states. Over 80 % agreed, “cash flow improvements have allowed us to implement programs that helped with retention.”
Registered nurses and radiology personnel were described as even more difficult to recruit than physicians. Personal networking, educational scholarships and working with local community colleges proved most successful. The improved reimbursement has assisted hospitals with retention and partnerships with network hospitals have also reportedly helped with workforce issues. The full report is available at http://www.rupri.org/rhfp-track/

3. CMS updates
• Payment increases for physicians in Medicare Reform
CMS issued a final rule that will increase payments to more than 875,000 physicians and healthcare professionals by an average of more than 1.5 percent for calendar year 2004. Physicians in some rural and other areas will see an additional increase in payments. This provision will increase Medicare payments in some areas of the country by as much as 4.8 percent. CMS extended until February 17 the deadline for physicians to decide whether or not they want to participate in Medicare in 2004.
• Revised payment policies for hospital Medicare outpatient services
The Centers for Medicare & Medicaid Services today issued an interim final rule with comment period revising payment policies for hospital outpatient services to Medicare beneficiaries. The rule modifies payments to hospitals in rural areas and payments for certain radiopharmaceuticals, drugs, and biologicals that were established in a final rule published in November. These changes reflect provisions in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (DIMA), which was signed by President Bush on December 8, 2003. The new rule extends for two years special payments to small rural hospitals to ensure that they are paid at least as much under the outpatient prospective payment system (OPPS) as they had been paid under the prior cost-based methodology. Details at http://www.cms.hhs.gov/media/press/release.asp?Counter=931
• Heart failure targeted in Arizona and California
CMS has announced a pilot project aimed at improving care for chronically ill Medicare patients in California and Arizona that suffer from heart problems. This initiative complements the local effort of the Arizona Flex program and HSAG which will be accessible to hospitals with under 100 beds. It will include payment for all disease management services and prescription drug costs, whether or not they related to the beneficiary’s chronic health condition. HeartPartnersSM, a Santa Ana-based collaboration among PacifiCare, Qmed, Alere Medical and Prescription Solutions expects to serve 15,000 beneficiaries with heart failure in California and Arizona during the three-year project. The demonstration is intended to enable CMS to assess whether disease management programs, along with outpatient drug coverage, can improve medical treatment plans, reduce unnecessary hospital admissions and promote other desirable outcomes. Further details at http://www.cms.hhs.gov/media/press/release.asp?Counter=908
• Special geographic classifications appeals procedure
CMS has outlined procedures for hospitals meeting specific criteria to request reclassification to geographic areas with higher payment rates under Medicare’s inpatient prospective payment system (IPPS). This appeals process will provide relief to certain hospitals in rural areas that fall just outside Medicare’s existing criteria for those geographic areas. Congress has allocated up to $900 million over three years for the added payments to those hospitals. To be considered for reclassification, the appeal must be filed by February 15, 2004. The notice in the Federal Register can be found at http://www.cms.hhs.gov/providerupdate/regs/cms1373n.pdf
• Payment increases and expanded flexibility
CMS announced two new policies that will increase reimbursement to critical access hospitals for services to Medicare beneficiaries, and will allow these hospitals to use up to 25 beds for acute care services. These policies implement provisions in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 intended to bolster health care services in rural areas. As a result of these changes, payments to the 863 critical access hospitals that play a crucial role in the delivery of rural health care are expected to increase by $900 million over the next ten years.
As a result of the new law a critical access hospital can have up to 25 beds designated as either acute care beds or swing beds - beds that may at times be used for acute care, and at other times for post-acute care.
In addition to increasing the permissible number of beds, the new policies put into effect a provision of Medicare law that increases the payment for both inpatient and outpatient services rendered by critical access hospitals from 100 percent to 101 percent of reasonable costs.

4. Consequences of underinsurance
Report by Institute of Medicine consolidates evidence on health, social, and economic effects
More than 43 million U.S. residents lacked health coverage in 2002 and unless private or public coverage programs expand, the number of uninsured could continue to rise over the next decade. To address this growing problem, the Institute of Medicine (IOM), with support from The Robert Wood Johnson Foundation, has been conducting a three-year study of the uninsured to assess and consolidate evidence about the health, economic and social consequences of uninsurance for those without insurance, their families, health care systems and institutions, and communities as a whole.
The sixth and final report in the IOM series, Insuring America’s Health: Principles and Recommendations, was released on January 14. This paper seeks to raise awareness and improve understanding by both the general public and policy makers of the magnitude and nature of the consequences of lacking health insurance. The study recommends principles to guide reform of the health care system and expand coverage to the uninsured, based both on the previous five reports and on new analyses of past and present efforts to reduce uninsurance. The report also seeks to demonstrate how those principles may be used to assess policy options, though it does not recommend a specific coverage strategy. Report available at http://www.iom.edu/project.asp?id=4660.

5. Heart attacks in elderly Mexican Americans
Prevention vital due to high mortality rate of second attacks
Nearly half of Mexican-American elders who said they had suffered a heart attack died of another heart attack within 7 years, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11618). Preventing heart attacks is particularly important in this ethnic group to avoid early mortality, conclude Max E. Otiniano, M.D., M.P.H., and colleagues at the University of Texas Medical Branch.

In the study, they examined the heart attack incidence, prevalence, and 7-year mortality rates among 3,050 Mexican-American elders in five Southwestern States. They assessed sociodemographic factors, health factors, and self-reported heart attack during interviews at baseline (1993-1994), as well as new heart attacks in 1995-1996, 1998-1999, and 2000-2001.
Overall, 9.1 percent of those interviewed said they had suffered a heart attack at baseline. New heart attack incidence was 6.1 percent, 9.1 percent, and 7.9 percent, respectively, for the three subsequent followup interviews. Of the Mexican-American elders who said they had suffered a heart attack during the initial interview, nearly half (42.4 percent) had died of heart attack by the 7-year followup. Older age, male sex, diabetes, hypertension, and stroke were significantly associated with heart attack at baseline. Age was a significant predictor for new heart attack at each followup.
Having impaired function in activities of daily living, such as dressing or feeding oneself, nearly tripled the likelihood of self-reported heart attack. Limitations in carrying out instrumental activities of daily living, such as doing housework or shopping, more than doubled the likelihood of heart attack.
See "Self-reported heart attack in Mexican-American elders: Examination of incidence, prevalence, and 7-year mortality," by Dr. Otiniano, Kenneth J. Ottenbacher, Ph.D., Kyriakos S. Markides, Ph.D., and others, in the July 2003 Journal of the American Geriatrics Society 51, pp. 923-929.

6. AHRQ issues National Healthcare Disparities Report and access to Tools

- Comprehensive effort to study differences in use and access
The National Healthcare Disparities Report, developed by the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, represents the first national comprehensive effort to measure differences in access and use of health care services by various populations. The report includes a broad set of performance measures that can serve as baseline views of differences in the use of services. The report presents data on the differences in the use of services, access to health care, and impressions of quality for seven clinical conditions, including cancer, diabetes, end-stage renal disease, heart disease, HIV and AIDS, mental health, and respiratory disease as well as data on maternal and child health, nursing home and home health care, and patient safety. It also examines differences in use of services by priority populations. Future reports will help the nation make continuous improvement by tracking differences through a consistent set of measures that will be updated as new measures and data become available. Prepublication copies of the report are available at http://www.qualitytools.ahrq.gov/
- Clearinghouse of tools for providers, policy makers, patients and purchasers
QualityTools defines a "tool" as a web site, database, report, fact sheet, guide, or other mechanism to assist health care professionals, policymakers, health plans, employers, patients, and consumers in the development, promotion, or enhancement of health care quality within a practice, organization, or in an individual's daily life.
At present, 125 tools are available at http://www.qualitytools.ahrq.gov/resources/measureindex.aspx .

7. Medicaid Home Care for Tribal Health Services
UCLA offers tool kit for developing new programs
A new publication from the UCLA Center for Health Policy Research -- "Medicaid Home Care for Tribal Health Services: A Tool Kit for Developing New Programs" -- provides a road map for tribal health programs that are considering community-based long-term care services, with a focus on personal care services for the elderly and disabled people that can be funded by Medicaid.
The tool kit provides information on a number of topics, including:
• Why Provide Medicaid Personal Care Services
• What Are Personal Care and Other Non-medical In-home Services
• Medicaid Programs that Provide In-home Services
• How Personal Care and
• Other In-home Services Are Provided
• Tips for Developing a Plan for Delivering Medicaid Home Care Services
State-specific Medicaid home care details, such as services reimbursed by home and community-based care programs and key contact information, are also available for more than 20 states. A copy of the tool kit can be found at the Center's Web site: http://www.healthpolicy.ucla.edu/pubs/publication.asp?pubID=79.

8. 2004 Rural Health Awards nominations sought
NRHA to name practitioner of the year and other distinguished professionals
This is your opportunity to show your support and admiration for those individuals who are dedicated to the advancement of health care in rural and frontier areas. We encourage you to seek out those individuals, practices and programs that deserve this type of recognition and submit a nomination form on their behalf. Neither the candidate nor the nominator is required to be an NRHA member. Nominations are due April 22, 2004. In an effort to increase the number of nominations and individual eligibility, the Distinguished Researcher Award name has been changed to the Outstanding Researcher Award. This name change is an effort to encourage and recognize researchers who have contributed influential or important rural health research over the course of the year and moves away from a lifetime achievement focus. Nominations are also being sought for practitioner of the year, outstanding program, distinguished educator, outstanding practice and the Louis Gorin Award for outstanding achievement in rural health care. A nomination form and full details can be found at http://www.nrharural.org/conf/04awardsnom.pdf.

9. Best practices for co-occuring substance abuse and mental disorders
Technical assistance center and help line from SAMHSA
The Substance Abuse and Mental Health Services Administration (SAMHSA) has established a new technical assistance center and help line designed to support state efforts to provide effective treatment services for persons with co-occurring substance abuse and mental disorders. All requests for technical assistance must be made in writing and sent to The Co-occurring Center for Excellence, Jill Hensley, Project Director, 5530 Wisconsin Avenue, Suite 1600, Chevy Chase, MD 20815 or by e-mail to samhsacoce@cdmgroup.com. Any questions regarding these services should be directed to the COCE team at 301-951-3369.

The Co-Occurring Center for Excellence will help identify best practices in treating co-occurring substance abuse and mental disorders and will support the application of these practices through technical assistance and cross-training, state of the art materials, and a website. The Rural Health Office encourages submission of rural models. The CDM Group Inc., Chevy Chase, Md., working with the National Development & Research Institutes, Inc., New York, the Center for Behavioral Health, Justice & Public Policy at the University of Maryland, and the National Opinion Research Center at the University of Chicago, will operate the technical assistance center under a $2.6 million one year contract renewable for 5 years. Assistance will be available to all states, and to substance abuse, mental health, criminal justice, education, and other social and public health systems seeking to enhance their ability to serve individuals with co-occurring disorders.
“This program builds on SAMHSA’s Report to Congress on Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders,” SAMHSA Administrator Charles G. Curie, said. “That report acknowledged that too often individuals are treated for only one of the two disorders, if they receive treatment at all. This contract is part of SAMHSA’s action plan to help states and other entities create a system for treating people for both disorders, so any door the individual walks through for medical care will be the door to comprehensive treatment.”

10. Care Across the Continuum
Framework to guide policy development in rural areas
The Rural Policy Research Institute’s Center for Rural Health Policy Analysis is releasing a working paper entitled Care Across the Continuum: Access to Health Care Services in Rural America written by Keith J. Mueller, Ph.D. and A. Clinton MacKinney, M.D., M.S. This paper describes a seven-stage continuum of care that can be used as a framework to guide policy development affecting the delivery of health care services in rural areas. The principles are derived from publications of the Institute of Medicine's Committee on Quality of Health Care in America and from the definition of primary care put forth by the IOM's Committee on the Future of Primary Care, which together argue for a system that is patient-centered, continuous, coordinated, accessible, and based on scientific knowledge. Copies of the paper are available upon request or at:
http://www.rupri.org/publications/abstract.pdf.

11. Rural transportation assistance
USDA offers to help small or emerging businesses and non-profits
The Rural Passenger Transportation Technical Assistance Program, funded through a Rural Business Enterprise Grant by the U.S. Department of Agriculture (USDA), is designed to assist rural communities enhance economic growth and development by improving community transportation services. Program objectives include helping small and emerging businesses and stimulating economic development through new and improved transportation programs. The program provides planning assistance for facility development, transit service improvements and expansion, new system start-up, policy and procedure development, marketing, transportation coordination, training and public transit problem solving activities.
To qualify for technical assistance, a project must be located in a rural area with a population of less than 50,000. Requests for technical assistance may be submitted by private for-profit or non-profit organizations or agencies. Public entities are not eligible recipients; however, eligible recipients can usually be identified in most communities. The project must also benefit new or existing small and emerging businesses.
Applications for technical assistance are submitted directly to CTAA for review. Potential projects are reviewed to establish eligibility, and are scored and ranked according to the selection criteria described below:
* Will project help create or preserve jobs or small businesses?
* Is project located in an economically distressed area?
* Is project likely to be implemented after technical assistance has been provided?
* Are project goals directly linked to economic development?
* Will technical assistance be utilized innovatively to help resolve transportation issues and
economic concerns?
* Is there local consensus and community support for the project?
Projects with more limited scopes may be eligible for short-term technical assistance, which has a streamlined review process.
Based on information collected during the initial site visit and needs assessment, CTAA will develop a refined scope of work which will define the project approach, work tasks, deliverable products and various "roles" of all project participants. If the project requires assistance from independent consultants, a consultant work plan, budget and request for proposals may be developed by CTAA. Further details at http://www.ctaa.org/adaview.asp?pageid=1940
Or contact:
Charles A. Rutkowski, Assistant Director
(202) 628-1480, Ext. 119
Fax (202) 737-9197
E-Mail: rutkowski@ctaa.org <mailto:rutkowski@ctaa.org>
Postal:
CTAA
1341 G Street, NW, 10th floor
Washington, DC 20005

Across Arizona
1. Arizona’s rural hospitals rally behind new rural hospital bill
SB 1191 would create fund addressed to disparities
On January 22, rural hospital executives gathered in Phoenix with state legislators to discuss a serious AHCCCS payment disparity that could put some of the state’s rural hospitals out of business. An AHCCCS study conducted between 2000-2002 showed that rural hospitals receive only 51 percent of their reimbursement costs from AHCCCCS, but hospitals statewide receive 94 percent of their costs.
Senate Bill 1191, sponsored by Senator Marsha Arzberger and numerous other legislators, would create a rural hospital fund of $7 million for the purpose of eliminating the payment disparity. The Arizona Hospital and Healthcare Association is working hard to promote passage of the bill. See details of the bill at ALIS Online http://www.azleg.state.az.us/DocumentsForBill.asp?Bill_Number=sb1191
2. Rural collaborations called for by committee chaired by Arzberger and Hanson
Hearings report on medical care, malpractice
The Rural Physician Study Committee, co-chaired by Arizona State Senator Marsha Arzberger and Representative Phil Hanson, held its final meeting on December 2 after listening to testimony from numerous experts on the issue of malpractice insurance. The Committee was established by the state legislature and signed into law on May 6, 2002, with an end date of December 31, 2003.
The committee voted to recommend the continuation of the Study Committee with a new charge of monitoring the multiple and complex issues affecting the delivery of medical care in the State that focuses on professional malpractice liability on access to care and quality of care, and on critical issues relating to physicians, hospitals, and nursing homes. Details of the current Senate Bill 1103 can be found at http://www.azleg.state.az.us/DocumentsForBill.asp?Bill_Number=SB1103. The legislative staff published the Committee report entitled, “Report of the Rural Physician Study Committee,” in December 2003.

3. American Indian housing supported
$2 million in projects funded by Arizona Department of Housing
The Arizona Department of Housing has recently funded American Indian housing in the state in the amount of $2 million. The money comes from the federal Low Income Housing Tax Credits, which are administered by the state, supplemental state grants to tribal LIHTC recipients, and a deferred, forgivable loan to Cocopah Indian Housing Development.
Arizona is one of the few states that have a mandatory set-aside for tax credits to assist housing on tribal lands. Its 2003 awards have included three developments on reservations, and a fourth to benefit urban Indians in the Phoenix area. In all, Native projects were awarded a little more than $1 million out of a state tax credit total of $10 million. The state department added more than $900,000 in supplemental money from its Housing Trust Fund. The money will go to build or rehab about 150 units of housing More details can be found at http://IndianCountry.com/?1072817313.

4. Bud (Warren J.) Day dies in Flagstaff
Human rights champion active in rural health issues
Peace activist and human rights champion Bud (Warren J.) Day died at the age of 76 from complications of a brain tumor at his home in Flagstaff on December 17th. Bud wed his commitment to justice with peace to practical applications, by making use of his education at Union Theological Seminary and at the University of Illinois where he specialized in environmental engineering. Early in his career he spent more than a decade in Allahabad, India, where he was deeply involved with student work and later served in similar positions at Southern Illinois and Michigan State Universities. More recently, he worked in Bangladesh, Tanzania, Mozambique, Swaziland and Zimbabwe, also teaching at UCLA and University of Arizona medical schools, and Northern Arizona University. He was active in Arizona rural health issues. Bud worked overseas in order to learn, returning home to struggle for justice and peace in US policy. He was co-convener of the Justice and Peace Coalition in Flagstaff.
Born in Centralia, Illinois to Harry and Harriet Day, he grew up in Carbondale. During seminary, he worked in East Harlem, Puerto Rico and Ganado, Navajo Nation; these experiences broadened his concern for those excluded from mainline society. He was an ordained minister in the Presbyterian Church (USA). Surviving him in Flagstaff are his wife Carol Thompson, daughter Shari Peralta and grandson Robert. Carol, a Professor of Political Science at Northern Arizona University, worked with him many years in Southern Africa, sharing his passion for building roads to lasting peace. Memorial contributions may be made to the Justice and Peace Coalition, c/o Kim, 223 W. Cherry, Flagstaff, AZ 86001 or to a peace organization of your choice.

5. St Luke’s funds RHO database
Comprehensive rural health data going online
The Southwest Border Rural Health Research Center is establishing a comprehensive rural health data website with the help of an $18,706 grant from the St. Luke’s Health Initiatives. The website will include information on Arizona population demographics, all 15 counties and rural communities, health workforce trends, health facilities, telemedicine sites, health coverage trends, health service utilizations and health indicator trends. This is intended to help identify rural health care gaps, to advocate for increased access to health services, to determine specific workforce needs, to monitor changes in rural health and to develop a comprehensive rural health plan for Arizona. Dr. Howard J. Eng of the Rural Health Office directs the project. The website is scheduled to be operational in mid-2004.

6. Copper Queen seeking CAH designation
Board cites budget analysis as reason
Meeting on December 22, 2003, Copper Queen Community Hospital’s board in Bisbee voted to seek CAH designation on the fast track. James Dickson, CEO, said the choice was clear based on expectation of improved reimbursement. Copper Queen is the community sole provider and has seen a shift from inpatient to more outpatient service. Careful budget analysis was the most important consideration. Dickson said their application will be submitted by February 15 and approval could come within four months .

7. Yavapai Nation welcomes new health services wing
Wassaja Memorial Health Center expands
Fort McDowell Yavapai nation’s social, health and family services will now be housed under one roof after the opening of a new wing in the Wassaja Memorial Health Center. Once squeezed into a tiny 400 square foot space, the tribe now has a state-of-the-art 20,000 square foot building, providing “one-stop” services to Yavapai and other Native community members. FMYN Health and Family Services Director Sandra Pattea emphasized that the new facility and related services was the result of consultation between the tribal council and community members, especially Yavapais Against Substance Abuse, a grassroots organization.
Dr. Melanie Madelin, Wassaja’s medical director, said, “By combining medical, behavioral and family services, we understand that we have to balance mind, body and spirit. Council Member Gwen Bahe thanked tribal members for their patience and encouraged the community’s young people to continue their education so they can be part of FMYN’s success. “Never in my lifetime did I dream that we would have all these good services,” commented FMYN Vice President Bernadine Boyd. (adapted from ACIA Newsletter, January-March 2004 http://www.indianaffairs.state.az.us)
8. Hopi networking moves forward
Planning grant awarded by ORHP
Hopi Tribe received the award under a new initiative of the Office of Rural Health Policy, HRSA - Rural Health Network Development Planning grant for $100,000. The project officially started December 1, 2003, said Laverene Dallas of the Hopi Tribe. They are planning and developing the Hopi Regional Health Care Network to enhance regional and community partnerships in the area to ensure the comprehensive provision of health care on the Hopi Reservation. The Hopi Health Care Center is one of the partners which is a CAH designated facility and an IHS facility providing services to Hopi, Navajo, and the Kaibab Paiute of Southern Utah. The other partner is Tuba City Indian Medical Center, formerly an IHS facility, which provides services to Navajo, Hopi, and San Juan Southern Pauite Tribes.

9. HSAG awarded CMS special study contracts
High performer components, measures management and HCAHPS targeted
Health Services Advisory Group (HSAG), the Medicare Quality Improvement Organization (QIO) of Arizona, was awarded three special study contracts from the Centers for Medicare & Medicaid Services (CMS). The special study contracts are:
• Coordination of the National Implementation of the Hospital CAHPS (HCAHPS) Survey
• Identification and Synthesis of Components Essential to Achieving 'High Performer' Status in Various Provider Types
• Measures Management: Developing a Decision-Making Process to Support CMS in Determining if Existing Quality Measures Should be Retained, Amended, or Refined
CMS also selected HSAG as a subcontractor on a fourth study for "Best Practice Methods." On this contract, HSAG will work with Qualis Health, the QIO of Washington.
For the HCAPHS study, HSAG will partner with the National Committee for Quality Assurance (NCQA), RAND, Westat, and expert consultants from the Harvard Medical School to design and implement a strategy for the national implementation of the HCAHPS. The HCAHPS is a standard survey instrument used to collect and report information on hospital patients' perspectives on the care they receive. The purpose of the “High Performer” study is to identify and study high performing providers and share study findings with QIOs and providers-at-large in an attempt to change behavior and enhance organizational performance.
For the “Measures Management” study, HSAG will provide technical assistance and support to CMS in the coordination of a comprehensive quality performance measurement strategy. RAND will be a subcontractor to HSAG on this study. On the "Best Practice Methods" study, HSAG will work with Qualis Health to assist CMS and the QIO community in answering questions regarding best practice interventions used by external change agents to influence health care providers.
For more information about the four CMS special study projects or HSAG portfolio of Quality Improvement Services, contact Debbie Nixon, Vice President, Corporate Development & Communications at 602 665 6108 or dnixon@hsag.com .

10. RBHA network expands
Bandwidth, bridges and new sites improve capacities
The Arizona Council of Human Service Providers and the Arizona Foundation for Human Service Providers joined the RBHA video network in September with one Phoenix video location. The Council and Foundation are statewide agencies that promote and maintain a comprehensive continuum of services to help Arizona's children, families, and adults build lives of quality and self-sufficiency. The Council and Foundation accomplish this through education, participation in the public policy arena, and participation in activities that enhance professionalism within the industry. The groups intend to use their videoconferencing connection for board of directors meetings and trainings. The video site is scheduled through this website.
The Arizona State Hospital is about to bring five new video sites online to replace the single site it disconnected when it expanded to a new campus in January 2003. All five units are installed within the State Hospital's secure patient areas; therefore these sites will be for internal use only, primarily for patient services. They will not be available for outside groups' use or administrative meetings.
The EXCEL group has added a Quartzsite video site to its telemedicine network. All eight EXCEL sites connect to the EXCEL hub in Yuma, which is connected via a full T1 line to the NARBHA bridge in Flagstaff.
PGBHA has purchased its own videoconferencing bridge for its nine-site network. The new PGBHA bridge, with full T1 connections to both NARBHA and BHS, will allow more bandwidth, bridge resources, and flexibility for the entire statewide network. Scheduling procedures for PGBHA are still being worked out.
From NARBHA website: http://www.narbha.org/
11. New tools for Continuous Chest Compression CPR
Improved survival rates for out-of-hospital sudden cardiac arrest
Significant research findings that have surfaced in the past few years have convinced the Sarver Heart Center of the need to immediately apply new techniques that have been proven to save more lives. A new and easier way to do CPR, called Continuous Chest Compression CPR has been developed. Heart Center researchers discovered years ago that overwhelming numbers of people will not perform CPR because they do not want to do mouth-to-mouth breathing. More recent research has found that stopping for mouth-to-mouth breathing is more harmful than helpful. Standard CPR, which calls for two mouth-to-mouth breaths after every 15 compressions, leads to a dire consequence: When chest compressions are stopped, none of the body's organs are receiving any oxygenated blood. With CCC-CPR, there not only is a better chance of bystander participation, but a much greater chance that the victim will survive.
A free guide to CCC-CPR and online demonstrations can be downloaded from http://www.heart.arizona.edu/publiced/lifesaver.htm or call the UA Sarver Heart Center at 520-626-4883.

12. American Indian Arizona tour guide
Crossing Paths published by American Indian Tourism Association and America West Magazine
The new Arizona Indian tourism guide, "Crossing Paths: A Tour of Arizona's Indian Reservations," is out. This 24-page booklet, which originally appeared as a section in the Dec. 2003 issue of America West Magazine (AWA), contains information on Arizona tribal peoples, cultures and attractions. A directory places tribal tourism information at your fingertips.
Produced in conjunction with the Arizona American Indian Tourism Association (AAITA) and AWA, the lavishly illustrated publication is available free of charge by calling the Arizona Commission of Indian Affairs at (602) 542-3123 or the Arizona American Indian Tourism Association at (480) 315-8187.

Grants and Opportunities
1. Arizona Commission of Indian Affairs grants and fellowships
Variety of useful listings
This regularly updated resource lists possibilities into the following sets: grants, tribal scholarships, fellowships/scholarships, top 100 scholarships for students of color. Further details at: http://www.indianaffairs.state.az.us/careered/grants.html.

2. Rural cooperative home-based health care pre-development and revolving loans
Applications due February 13, 2004
- Pre-development grants
USDA Pre-planning grant funds up to $50,000 are available to retain a demonstration project organizer to accomplish the following:
a. Provide outreach to home-based health care providers, and assess worker needs,
b. Work with local level human service providers,
c. Build community support among those who have contact with the elderly (social workers, physicians, pharmacists, clergy, hospitals, hospice, meals on wheels, etc.),
d. Select and train membership for the steering committee,
e. Conduct a survey of potential members,
f. Analyze market for home-based health care services,
g. Prepare a business plan,
h. Assist in the incorporation of the cooperative,
i. Assist the cooperative in the preparation and adoption of bylaws and the election of a board of directors, and
j. Hire a local cooperative service administrator and set up office.
The required forms and certifications can be downloaded from the RCDI Web site at http://www.rurdev.usda.gov/rhs/rcdi/index.htm.
- Revolving loans
Revolving loan grants will be made available to qualified public or nonprofit intermediary organizations (including tribal) proposing to carry out a program of financial and technical assistance.
Revolving loan grant funds will be used by the recipient organization to:
a. Fund and administer a revolving loan program to provide start-up and operating funds to newly created home-based health care cooperatives.
b. Provide technical assistance to pre-planning grant recipients and the home-based health care cooperatives, including development of financial plans for the cooperative, establishing the cooperative's financial records process, and providing follow-up as the cooperative progresses from implementation to full operation. A maximum of ten percent of the grant funds and matching funds may be used by the revolving loan grant recipient to provide technical assistance to the pre-planning grant recipient and the newly formed home based health care cooperative. To be eligible, applicants must be nonprofit organizations or public bodies, including federally recognized tribes and have at least 3 years prior experience working with cooperatives.
The required forms and certifications can be downloaded from the RCDI Web site at http://www.rurdev.usda.gov/rhs/rcdi/index.htm.
For more information contact:
Stephen Wetherbee, Senior Loan Specialist, Community Programs, RHS, USDA, STOP 0787, 1400 Independence Avenue, SW., Washington, DC 20250-0787, Telephone: (202) 720-1503, Facsimile (202) 690-0471, E-mail: stephen.wetherbee@usda.gov.

3. Summer Biomedical Research Opportunities in Tucson
Applications due March 1, 2004
The University of Arizona Graduate College is offering summer research opportunities focusing on health issues that affect minority communities in a disproportionate manner, e.g., diabetes, cancer, AIDs, cardiovascular disease, obesity, and other diseases.

American Indian/Alaska Native, African American, Hispanic/Latino, and Native Hawaiian/Other Pacific Islander undergraduates between their junior and senior years in majors leading to biomedical careers will engage in specific research projects at the University of Arizona under the supervision of faculty conducting research on minority health issues. The research objectives of the program are substantial and will require full-time commitment. Participants will work on research project for a total of 40 hours a week and attend required workshops and seminars to enable them to become highly competitive for graduate school.
Dates: June through August
Stipend: Students will receive a stipend of $3,000
Travel: Round-trip airfare is provided to Tucson from anywhere within the United States and Puerto Rico
Adobe downloadable application: http://grad.arizona.edu/multi/mhdapp.pdf If you have further questions, please contact: Sandi Bartell at bartell@email.arizona.edu (520) 626-0095
4. Cornell seeks Native American Ph.D. candidates in medical sciences
Applications due March 1, 2004
The Weill Cornell Graduate School of Medical Sciences in New York City seeks to attract Native American and Alaskan Native applicants to their Ph.D. program in the biomedical sciences.
These programs include:
Biochemistry & Structural Biology
Cell Biology & Genetics
Immunology
Molecular Biology
Neuroscience
Pharmacology
Physiology, Biophysics, and Molecular Medicine

The programs run 5-6 years in length depending on the program and the type of research undertaken. Half of the faculty of the school are shared jointly with Memorial Sloan-Kettering Cancer Center -- recognized as the foremost cancer research and treatment center in the country.

Gligor Tashkovich, assistant to the dean, is searching for two categories of students:
(1) Students who have graduated since May 2003 or who will graduate by Summer, 2004 with a B.S. degree principally in physics, chemistry, or biology, who have research experience in a laboratory, and who have taken (or who will take) the GREs (Graduate Record Exam). Ideally, they should have a GPA of 3.0 or better.
(2) Students who are currently sophomores or juniors working towards a degree in physics, chemistry, or biology who are considering a career in the biomedical sciences and would be interested in gaining research skills at a top institution over the course of the Summer 2004. Taskovich can be reached at (914) 764-5573.

For accepted applicants, both programs fully cover the costs of attending, including travel costs and living expenses. More information is available at: www.med.cornell.edu/gradschool.

5. www.grants.gov
New central location for federal grants
A new Web site, Grants.gov, contains information for anyone interested in finding and/or applying for federal grants. Navigating the site is relatively simple. Use the "Find Grant Opportunities" tab/feature to search for information on available grant opportunities using a number of criteria, including a key word search or Agency search. This feature also includes a registration function to receive email updates as new grant opportunities are added. Simply click on the link, chose between the type of grant announcements that you want to be notified about, and sign up for email alerts using a valid email address.
Once you have found the grant(s) you want to apply for, you must first complete three, one-time registration procedures. The registration process can take up to a week from start to finish and is recommended that the grant community begin immediately. In addition, before you can apply for any grant you must first download and install a free software program (PureEdge Viewer) to view, access, complete, and submit grant applications.
The following agencies have posted application packages: the United States Department of Commerce, Education, Energy, Justice, & Health and Human Services. Finally, for more information on "getting started" it is recommended that you read through the fall edition of Succeed, the Grants.gov newsletter, which is available online at: www.grants.gov/assets/GrantsFallNewsletter2003.pdf

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.

1. Arizona Commission of Indian Affairs grants and fellowships
Variety of useful listings
This regularly updated resource lists possibilities into the following sets: grants, tribal scholarships, fellowships/scholarships, top 100 scholarships for students of color. Further details at: http://www.indianaffairs.state.az.us/careered/grants.html.

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