Rural Health Briefing,         Vol. 2, No. 1      January 14, 2002

Update: Rural Hospital Flexibility Program

National Progress

2002 Flex Program Reauthorization and Appropriation

2003 Flex Program Reauthorization and Appropriation

State Action

Arizona’s First Critical Access Hospital -

Wickenburg Regional Medical Center

Site Surveys for CAH Designation: Willcox, Douglas, Benson, Page

Hopi Health Care Center Preparing CAH Application

New JCAHO Standards for CAHs

Arizona News

ADHS Funding Cuts

Restructuring at ADHS

Annual Legislative Forum on Health Care

2002 Annual Rural Health ConferenceArizona Association of Community Health Centers

Tribute to Senator Andrew Nichols

Bioterrorism and Disaster Preparedness Workshop

Public Health Resources Tele-Workshops

National News

National Rural Health Association Alert: Rural Health Programs Funding

States Face Medicaid Funding Cuts

Rural Medical Educators

Arizonan Elected to NRHA Policy Board

How to Contact Your Representatives

Congressional Delegation

State Legislators

Grant Opportunities

Revised 398 Grant Application Packet

HRSA’s New Grant Application Center

Rural EMS Training Grants Due This Week - Alert

Rural Information Center Health Service - Grants

Conferences Relevant to Rural Health

Annual Rural Health Policy Institute

Annual NRHA Conference on Rural Health

National Rural Women’s Health Conference

Other

Nominations - Economic Impact of Medical and Health Research Award

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Update: Rural Hospital Flexibility Program

National Action

(1) 2002 Flex Program Reauthorization and Appropriation: Congress approved funding of $40 million for the Rural Hospital Flexibility Program in 2002. This is a $15 million increase over 2001 funding. Although the President has not yet signed the Labor-HHS-Education FY 2002 Appropriations bill, the National Rural Health Association reports there is no controversy about this year’s funding and the President is expected to approve it.

(2) 2003 Flex Program Reauthorization and Appropriation: The National Rural Health Association has issued an Action Alert regarding development of the President’s FY 2003 Labor-HHS-Education budget and its impact on rural health programs (see section on National News below).

b. State Action

(1) Arizona’s First Critical Access Hospital: The Center for Medicare and Medicaid Services (CMS) has approved the application of Wickenburg Regional Medical Center for Critical Access Hospital Designation. CMS authorized billing for cost-based reimbursement retroactive to November 1. The Arizona Flex Program will be meeting with community leaders on February 2 and conducting a training workshop on February 16 for a community health strategic planning initiative.

(2) Site Surveys: The Arizona Department of Health Services’ Division of Licensure and Assurance completed the site survey for Benson Hospital (November 26-28) Northern Cochise Community Hospital in Willcox (December 10–12), and will conduct a site survey for Southeast Arizona Medical Center in Douglas January 14-16. The site survey for Page Memorial Hospital has not yet been scheduled. Following completion of site surveys, these CAH applications can be forwarded to CMS for new provider numbers.

(3) Hopi Health Care Center: The Hopi Health Care Center will be Arizona’s first IHS facility to seek Critical Access Hospital designation. The IHS contracted with a consultant to prepare cost reports for selected IHS facilities around the country – currently, IHS facilities do not use cost-report accounting systems – the Arizona Rural Hospital Flexibility Program worked closely with the Indian Health Service to assure that Arizona’s IHS facilities would be on the national list for cost reports. It is anticipated that the Hopi CAH application will be completed by the end of this month.

(4) New JCAHO Standards for CAHs: The Joint Commission on Accreditation of Healthcare Organizations has released the final draft of Standards for Critical Access Hospitals. Copies are available from the Rural Health Office (a limited number of hard copies or email versions). For organizations interested in learning more about the new Critical Access Hospital accreditation program, a free educational conference call will be held on Tuesday, February 19, 2002 at 1:00 central time. To register for the teleconference, contact Gerry Priemer, Accreditation Services, JCAHO. Phone: (630) 792-5811. Fax: (630) 792-4811. Email: gpriemer@jcaho.org

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Arizona News

a. ADHS Funding Cuts: State budget cuts in the recent special session of the Legislature resulted in a significant loss of funds for programs administered through the Arizona Department of Health Services. Funding for the capital construction grants for rural health clinics and rural hospitals were eliminated as were the health service district program funding, the extended hours funding, and a portion of the Part B (Qualified Community Health Centers) primary care program funding.

b. Restructuring at ADHS: The Bureau of Health Systems Development at ADHS was recently restructured. Patricia Tarango, formerly the chief of the Office of Primary Care within the Bureau, is now the chief of the new Office of Health Systems Development.

c. Legislative Forum on Health Care: This year’s annual Arizona Legislative Forum on Health Care will be held on Thursday, January 17, 2002 from 8:00 a.m. to 4:00 p.m. at the State Capitol Building in the Governor’s Reception Room, 2nd Floor of the Administration Building, 1700 W. Washington in Phoenix. For a copy of the registration form, please contact Rebecca Ruiz at the Rural Health Office (520) 626-7946 or aruiz@rho.arizona.edu. Fax your registration to her at (520) 326-6429.

d. 2002 Rural Health Conference and Award Nominations: Please mark your calendars for the 2002 Rural Health Conference to be held July 22-24 at the Hilton Resort in Sedona.

Planners for the conference, jointly sponsored by the University of Arizona Rural Health Conference and the Arizona Rural Health Association, will be accepting nominations for several rural health awards to be presented at the conference. Please begin now to prepare your nominations in the following categories:

(1) Legislator of the Year: Awarded to the individual who has exhibited commitment and policy support for rendering health care services to people living in rural and/or medically underserved areas, demonstrating a high level of awareness of the issues affecting health care services in rural and/or underserved areas and showing evidence of influencing policy in the provision of service in rural and medically underserved Arizona;

(2) Professional of the Year: Awarded to the individual who has contributed to and/or advanced the cause of rural health in Arizona in a most significant way through distinguished personal leadership, exhibiting an overriding commitment to and effective leadership in the cause of rural health in Arizona;

(3) Project of the Year: Awarded to the project (clinical or non-clinical) which most consistently excels in the provision of services to people ion rural and/or other medically underserved areas. The project is defined as an organized group (two or more people or organization) fulfilling a service function during the year prior to the awards presentation, providing either health services or support services to rural and/or other medically underserved people at either the state or local level; and, demonstrating imaginative and extraordinary service or support;

(4) Volunteer of the Year. Awarded to the program or individual that has excelled in providing volunteer community services to the people of rural and/or other medically underserved areas of Arizona, either providing or contributing to the provision of health services or support services to rural and/or other medically underserved communities and demonstrating imaginative and extraordinary voluntary service or support.

To request a Rural Health Service Awards Nomination Forum, please contact Rebecca Ruiz at the Rural Health Office (520/626-7946; aruiz@rho.arizona.edu).

d. Arizona Association of Community Health Centers Tribute to Senator Andy Nichols

On January 24, the Arizona Association of Community Health Centers will present a tribute to Senator Andy Nichols, who passed away unexpectedly on April 19, 2001, at the Quality Hotel & Resort, 3600 North 2nd Ave., in Phoenix. Dr. Nichols was the long-time directory of the Arizona Rural Health Officer, an AACHC Associate Member, a Professor in the Family and Community Medicine Department of the University of Arizona College of Medicine, a member of the Arizona House of Representatives for four two-year terms, and was in his first term in the Arizona Senate at the time of his death.

Presenters will include Andrew Rinde, Director of the Arizona Association of Community Health Centers; Phyllis Biedess, Director of the Arizona Health Care Cost Containment System (AHCCCS); Jill DeZapien, Coordinator of Community Technical Assistance at the Arizona Rural Health Office; and Alison Hughes, Acting Director of the Rural Health Office. During lunch, awards and testimonials will be given, with immediate family members attending.

For further information about this special tribute event, contact Andrew Rinde, Executive Director, Arizona Association of Community Health Centers, 320 E. McDowell Rd., Suite 225, Phoenix, AZ 85004 (andyr@aachc.org).

e. Bioterrorism and Disaster Preparedness Workshop

As a result of the events of September 11th and the ongoing anthrax threat, the need for information on bioterrorism and disaster preparedness has become essential. This workshop will look at resources that address both topics so that public health officials public librarians, and the general public can be better informed about the events that affect our everyday lives. The workshop will be held January 16, noon - 1pm. For further information, please contact Patricia A. Auflick, Arizona Health Sciences Library pauflick@ahsl.arizona.edu or pauflick@u.arizona.edu. Phone: (520) 626-6770.

f. Public Health Resources Tele-Workshops

The Arizona Health Sciences Library (AHSL) will conduct a two-part tele-workshop in Tucson, Phoenix, and Flagstaff which will cover the basics of public health information resources. The first half of the workshop will look at accessing the "digital library" in electronic resources which are available to all U of A students, faculty, and staff. In the second half, participants will learn about other resources available via the Internet that may be helful in classes or on the job after they graduate.

The Tucson workshop will be held in AHSC Room 3230. The Phoenix workshop will be held at the College of Medicine facility at 4001 N. 3rd St., Suite 415. The Flastaff site is in the Health Related Professions Building, Room 229. To register for the workshop, you can:

a. Call 520-626-6035 in Tucson

b. Go to the web at http://educ.ahsl.arizona.edu/cal

c. Send an email to register@ahsl.arizona.edu (Be sure to

indicate either Tucson, Phoenix, Flagstaff.

Note: Class size is limited due to the seating capacity in the teleconference rooms, so early registration is encouraged. For those of you unable to attend this class, a similar one is being planned for the first full week of classes in January. Information will be posted once the date and time have been confirmed. In addition, the workshop will be videotaped and copies may be borrowed through interlibrary loan. Details will be posted after the workshop.

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3. National News

a. Federal Rural Health Programs Funding

(1) FY 2002 Appropriations for Rural Health Programs: Funding approved by Congress for rural health programs in FY 2002 include: Rural Health Outreach/Network Development Grants Program ($51.5) all numbers shown refer to millions); Rural Health Research ($16.8); Rural Hospital Flexibility Grant Program ($40); Community Health Centers ($1,344); State Offices of Rural Health ($8); Health Professions: Training for Diversity ($115); Training for Primary Care/Dentistry ($93); Area Health Education Centers ($33.4); Health Education & Training Centers ($4.4); Geriatric Programs ($20.4); Interdisciplinary Training ($7); Allied Health and Other Disciplines ($9.5); Health Professions Workforce Info & Analysis ($.82); Public Health Workforce Development ($11.7 ); Nursing ($82.5); National Health Service Corps ($153.5); Telehealth ($39.2); Healthy Start ($99); HIV/AIDS ($977.5); Agency for Healthcare Research and Quality ($298.7); CDC Preventive Health Block Grant ($135); Trauma (10% rural - $3.5); Community Access Program ($120); Rural Access to Emergency Devices ($12.5).

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(2) FY 2003 Appropriations for Rural Health Programs: The National Rural Health Association has issued an Action Alert for support of rural health programs in the FY2003 Labor-HHS-Education appropriations legislation now being developed by the Bush administration. There is concern that due to current events, appropriations for rural health will be slighted.

Specifically, the NRHA urges rural health advocates to contact their representatives in Congress and the White House President Bush support increased strengthening of the rural health care infrastructure in America. NRHA funding recommendations include National Health Service Corps Program ($250 million); Rural Health Outreach and Network Development Grants ($60 million); Rural Hospital Flexibility Program ($40 million); Rural Health Policy Development (Research) ($20 million); Consolidated Health Centers Programs ($1,544 million); State Offices of Rural Heath ($8 million); Health Professions Programs ($690 million).

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(3) States Face Medicaid Funding Cuts: The following article, published in the New York times on January 14, 2002, was forwarded by the National Office of Rural Health Policy and the National Organization of State Offices of Rural Health.

Copyright 2001 The New York Times Company

States Face Hard Choices on Medicaid Cuts

January 14, 2002

By ROBERT PEAR and ROBIN TONER

WASHINGTON, Jan. 13 - Medicaid, the insurance program for 44 million low-income people, is in a fiscal crisis, forcing state legislatures convening around the country this month to look for ways to cut benefits and reduce payments to hospitals, nursing homes and pharmacies.

The 36-year-old program, which pays for one-third of all births and nearly two-thirds of all nursing home patients, is caught in the financial vise of soaring costs and declining state revenues.

Overall Medicaid spending grew by 11 percent last year, and many states report that spending on prescription drugs, which are covered by Medicaid, is rising at an annual rate of more than 20 percent.

At the same time, state revenues are declining because of the national recession, and most states, unlike the federal government, must balance their budgets.

"I think it's quite serious," said Gov. John Engler of Michigan, a Republican who is chairman of the National Governors Association, noting that Medicaid now represented the fastest-growing item in state budgets. States are struggling to decide which services to trim and which

groups should bear the brunt.

"These are terrible choices," Mr. Engler said, "extraordinarily difficult."

Gov. Howard Dean of Vermont, a Democrat and former chairman of the governors association, agreed, saying that Medicaid was "under enormous pressure everywhere because of the catastrophic increase in health care costs, particularly pharmaceutical costs and hospital costs."

The political fallout has already begun. Parents of children with severe illnesses and disabilities held a rally on Wednesday at the Capitol in Little Rock, Ark., to protest new cuts in Medicaid and requirements that families pay some of the costs in the form of co-payments.

Ray Hanley, the Medicaid director in Arkansas, said, "We are getting our brains beat out by health care providers and advocates" for patients who rely on the program.

C. J. Moorman, the father of a Medicaid patient, a 16-year-old boy with cerebral palsy, said, "They could easily co-pay a family to death."

Governors of both parties are putting pressure on the federal government to increase its contribution to Medicaid, which is financed by the federal government and the states.

The need is particularly acute in a recession, officials say, because many people turn to Medicaid when they lose their jobs and their health insurance.

"The need for Medicaid goes up just when the states' ability to pay for it goes down," said Vernon K. Smith, the former Medicaid director of Michigan, who is now a health policy consultant.

The situation in Oklahoma illustrates the hard choices facing many states. The board of the Oklahoma Health Care Authority, the state Medicaid agency, voted on Thursday to adopt stricter income tests for pregnant women, children and the elderly, blind and disabled; to reduce dental services for adults; to reduce payments for prescription drugs; and to delay indefinitely a scheduled increase of 3 percent in payments to hospitals and doctors. The state also decided to eliminate its Medicaid program for people deemed "medically needy" because of very high medical bills.

The cuts will affect at least 50,000 of the 461,000 Medicaid recipients in Oklahoma. Under the new policy, for example, Medicaid will no longer cover children 6 to 18 in families with incomes that are 100 percent to 185 percent of the federal poverty level ($14,631 to $27,065 for a

family of three).

In Indiana, Gov. Frank L. O'Bannon, a Democrat, is trying to cut the state contribution to Medicaid by $251 million, or about 10 percent, over the next two years. State officials made a first round of cuts last fall, reducing payments to hospitals, nursing homes and pharmacies by

about 5 percent. The nursing homes and drugstores filed suit to block the cuts. At a forum this month, state officials unveiled a "Medicaid balanced budget plan" with two dozen options for further cuts.

Prescription drug spending for Medicaid recipients in Indiana grew 20 percent last year, to $549 million, and state officials estimate that it will rise more than 50 percent in the next two years, to $845 million.

To control costs, Indiana officials will develop a list of "preferred drugs" and want to require prior authorization for anyone trying to fill prescriptions for more than four brand-name drugs in a month.

In Idaho, Gov. Dirk Kempthorne, a Republican, told the State Legislature on Wednesday: "Prescription drugs are quickly becoming our single largest Medicaid expense. Prescriptions are expected to cost almost 40 percent more this year than they did two years ago." He, too, wants to require prior authorization. But drug companies oppose such

requirements, saying they limit patients' access to medicines.

Like many governors, Mr. Kempthorne lamented that Medicaid

was taking resources that might be used for other programs. If the state does nothing, he said, "we will see Medicaid growth that continues to outpace that of education and economic development."

In Maine, Gov. Angus King, an independent, proposed on Tuesday a 5.6 percent cut in Medicaid payments to doctors, with slightly deeper cuts for hospitals and nursing homes. Doctors said some Medicaid patients would inevitably be turned away if the Legislature approved the cuts.

Governor Dean of Vermont, a state that takes pride in its health policies, said he was committed to controlling Medicaid costs by reducing benefits, like podiatry or dental coverage, but not the number of people eligible for basic insurance coverage. He said it made no sense to

preserve a generous benefit package for fewer and fewer people.

In his State of the State address on Tuesday, Mr. Dean declared, "As I have said annually for the past decade, I will not allow any child to be cut from the health care rolls."

New York has felt the same fiscal pressures as other states, but with special intensity. The state has lost hundreds of millions in tax revenue as a result of damage done to its economy by the Sept. 11 attacks. Layoffs increased the number of people without health insurance, and many turned to a special temporary program known as disaster-relief Medicaid, which makes benefits available with little screening or paperwork.

Gov. George E. Pataki, a Republican, has led the bipartisan effort by governors to persuade Congress to provide billions of dollars in additional aid for Medicaid.

In Illinois, Gov. George Ryan, a Republican, announced last month that he was cutting state Medicaid payments to hospitals by $114 million, or 13 percent, to help fill a $500 million gap in the state budget. After an outcry by hospital executives, Mr. Ryan said on Tuesday that he would

restore $24 million to hospitals.

To help pay for the restorations, Illinois officials said they would reduce Medicaid payments to doctors, dentists, chiropractors and other health care professionals.

Ohio's Medicaid director, Barbara Coulter Edwards, said the state had expected to see a net increase of about 43,000 in its Medicaid rolls from July to December. The actual increase, driven by the recession, was 84,000, raising the total number of recipients to 1.4 million. "While our

service budget has not been cut, for which we're grateful, we have a real challenge because we're having to serve more people within it," Ms. Edwards said.

Advocates for low-income people are already sounding alarms here in Washington, arguing that Congress and the administration must confront the problem or face renewed growth in the number of uninsured. "I think this is going to be a very tough year for low-income and low- wage

working families who depend on Medicaid as a lifeline," said Ronald F. Pollack, executive director of Families USA, a consumer advocacy group.

In recent years, Medicaid has been an important tool for extending coverage to children and families. In fact, state officials said, their success in adding people to the Medicaid rolls, encouraged by the federal government, is one reason the program is such a burden on states today.

Medicaid provides health insurance for one-fifth of all children and is the largest source of federal grants to states, accounting for nearly one-fifth of state budgets.

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c. Rural Medical Educators: The Rural Medical Educators Special Interest Group of the National Rural Health Association was launched in a meeting held in May 2001, in conjunction with the NRHA Annual Conference in Dallas. Information about the Rural Medical Educators Special Interest Group, as well as resource materials and curricula, is available through the NRHA’s website:

http://www.NRHArural.org/pagefile/RMEpage.htm

d. Arizonan Elected to Policy Board of the National Rural Health Association

Alison Hughes, MPA, Acting Director of the Rural Health Office, was recently elected the Policy Board of the National Rural Health Association.

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4. How to Contact Your Representatives

a. Arizona Congressional Delegation: Links to Representatives are available at http://www.house.gov. Links to Senators are available at http://www.senate.gov.

b. Arizona State Legislators: Available through the Arizona Legislative Information System (ALIS): Call 1-800-352-8404

http://www.azleg.state.az.us/

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Grant Opportunities

a. Revised PS398 Grant Application Packet: If you will use the PS398 grant application this year, you need to be aware that it was revised as of 5/2001 and as of 1/10/02, the NIH will no longer accept applications on the old form. The 5/01 version is not being ent out in a hard copy format any more. It is only available at this link: http://grants.nih.gov/grants/funding/phs398/phs/398.html.

b. HRSA’s New Grants Application Center

New Address ( Effective December 1, 2001)

HRSA Grants Application Center

Attention: Grants Management Officer

901 Russell Avenue, Suite 450

Gaithersburg, MD 20879

1-877-HRSA-123; Fax: 1-877-477-2234

E-Mail: HRSAGAC@hrsa.gov

c. Rural EMS Grants Due This Week - Alert from NOSORH

The Federal Office of Rural Health Policy issued the following alert today via the National Organization of State Offices of Rural Health listserv:

The National Association of Emergency Medical Technicians is offering grant monies for EMS training in rural areas. PLEASE NOTE THAT APPLICATIONS MUST BE SUBMITTED BY THE END OF THE WEEK! Additional information is below.

"First There First Care" is a curriculum developed several years ago by

NHTSA and the American Trauma Society. This 2 hour curriculum is taught by EMS providers (EMT's, Paramedics, Nurses, Doctors, etc.) to the lay public and teaches them how to administer very basic life saving steps to a car crash victim until EMS arrives.

A copy of the mini-grant application, the contract of work, and one of

the press releases NAEMT did on this is attached. Eligibility is based on

NAEMT-affiliated states, applicant must be a NAEMT member and grants are targeted to rural areas.

Currently, the NHTSA-EMS Division is administering a grant to the

National Association of EMTs. NAEMT is dividing this grant into about a dozen mini-grants of $1200-$1500. Unfortunately, there has been a lack of applicants, so NAEMT has granted a ten day extension. Again, these mini-grants are open to rural EMS agencies inside NAEMT affiliated states.

The contact person at NAEMT is Bob Loftus. His phone number is

217-965-4760 and his e-mail is: emtchief@ctllc.com

d. Rural Information Center Health Service - Grants

Information about grant opportunities with deadlines between January-June 2002 are available through the Federal Office of Rural Health Policy’s Rural Information Center Health Service. Grants Relevant to Rural Health webpage is: http://www.nal.usda.gov/ric/richs/grants.htm

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6. Conferences Relevant to Rural Health

Annual Rural Health Policy Institute

The 13th Annual Rural Health Policy Institute will be held March 4-6, 2002 in Washington D.C. Registration materials are available through the website of the National Rural Health Association.

b. Annual Conference on Rural Health

The 25th Annual Conference of the National Rural Health Association will be held May 15-17, 2002 in Kansas City, Missouri. Conference information and registration materials are available online.

c. 2002 National Rural Women’s Health Conference

Call for Papers: The 2002 National Rural Women's Health Conference will explore the correlation between mental health and the quality of life for rural women. This broad perspective integrates mental well-being with physical health, social structures, age, poverty, ethnicity, culture,

environment, and other factors impacting the quality of life for women living in America's rural communities and regions.

The conference planning committee is soliciting research papers, policy papers, best practices presentations, and posters. To learn more about the conference or to submit an abstract, please visit the conference Web site at: http://www.outreach.psu.edu/C&I/RuralWomensHealth/

The deadline for submissions is January 31, 2002.

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7. Other

a. Nominations - Economic Impact of Medical and Health Research Award

Research!America is calling for nominations for a new annual award

designed to recognize those who have contributed outstanding work on the economic impact of medical and health research. The Eugene Garfield Economic Impact of Medical and Health Research Award, which carries an honorarium of $5,000, will be presented on March 19 at

Research!America's Annual Meeting of Members in Washington, D.C. Deadline for nominations is January 31.

Nominations should include the following: (1) A copy of the publication (or thesis) describing the work. To be considered, the work must have been published (or filed, in the case of thesis) between January 1, 1997 and December 31, 2001, inclusive. (2) A 200-word statement summarizing the reasons the work is worthy of recognition. (note: self-nominations are welcome) (3) Descriptive information on the nominee(s). In seeking to encourage the growth of the field, the committee will give preference to early career nominees.

For more details or if you have any questions about the nomination

process, call Pam Lippincott (703) 739-2577 ext. 15 or visit

www.researchamerica.org. or email plippincott@researchamerica.org

Nomination packets should be sent no later than January 28, and addressed to: Garfield Award Committee, Research!America

908 King Street, Suite 400E, Alexandria, VA 22314-3067