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Rural Health Briefing, Vol. 4, No. 1 January 28, 2003
1. Update: Rural Hospital Flexibility Program
a. State Action
- Special Medicaid Fund
- Training for IHS/Tribal Critical Access Hospitals
- Rural EMS Working Group News
- Flex Program Quality Improvement Workshops
- 2003 Annual Flex Conference
b. National Action
- CMS Proposed Rule: Use of RNs as EMS Personnel in CAHs
- Fire and Safety Regulations for Facilities
- Medicare Manual Changes Related to Flex Program Objectives
2. Arizona News
a. Tohono O'odham Buckle-Up for Safety Projects
b. GAO Study of Border Hospitals
c. Western Migrant Stream Forum
d. Accelerated Degree Program for Nurses
e. Magnet Recognition Program for Nursing
f. 2003 Legislative Forum Report
g. 30th Annual Arizona Rural Health Conference
3. National News
a. NRHA Rural Health Appropriations Update
b. Rural Assistance Center
c. February HRSA Reimbursement Training in Phoenix
d. Wired Communities: Putting the e in Public Health Webcast:
e. HHS Rule on J-1 Visa Waivers
f. Medicare Resources: Open Door Forum on Rural Health
g. Health Care Reform Issues
- Health Care Background of Senate Majority Leader
- Public Citizen's Health Care News
h. HHS Rule on Faith-Based and Community Initiatives
i. Impact on Women of Insurance Tax Credits
j. Rural Poverty in the United States
4. How to Contact Your Representatives
a. Arizona Congressional Delegation
b. Arizona State Legislators
5. Grant Opportunities
6. Conferences Relevant to Rural Health
7. Other: New Websites of Interest
1. Update: Rural Hospital Flexibility Program
a. State Action
(1) Special Medicaid Fund: At the Arizona Legislative Forum on Healthcare Issues held in Phoenix on January 21, Sue Gerard, Health Policy Advisor to Governor Napolitano, reported that funds allocated to AHCCCS for enhanced Medicaid reimbursement for patients served by the state's critical access hospitals will not be touched in the process of addressing the state's budget problems.
(2) Training for IHS/Tribal Critical Access Hospitals: On January 9, 2003, the Arizona Rural Hospital Flexibility Program hosted a teleconference meeting between national Indian Health Service staff, staff of Trailblazers, Inc., the fiscal intermediary for IHS and tribal critical access hospital staff, to provide training related to changes in billing and reimbursement procedures as critical access hospitals. The Phoenix Area Indian Health Service is currently planning a training package related to swing beds for Phoenix IHS clinical leaders. The Flex Program will contribute financial support for this training. For further information, please contact: Victor Herring at (602) 364-5167.
(3) Rural EMS Working Group News: In December 2002, the Arizona Rural Hospital Flexibility Program extended an invitation to participate on a statewide Rural EMS Working Group to 100 emergency medical services providers, including ambulance services, air flight transport services, emergency room directors, community fire departments, behavioral health authorities, tribal emergency medical services, representatives of the state's Regional EMS Councils, staff of the Arizona Department of Health Services' Bureau of Emergency Medical Services, and emergency medical services and trauma system education programs. Approximately one-third of those invited asked to be included. The purpose of the working group is to create a single, or number of, EMS networks designed to enhance services provided by the state's critical access hospitals service areas.
On December 20, an initial teleconference meeting resulted in the creation of two subcommittees: (1) a conference planning group and (2) a model demonstration planning group. Representatives of the Central Arizona Regional EMS Council are working with the conference planning group to develop a Rural EMS Track at the central region's EMS conference scheduled for June 19-20, 2003, with Flex funds providing support for critical access hospital participants' attendance. The model demonstration planning group is reviewing model EMS projects with critical access hospitals in other states, as well as considering development of a Rural EMS Agenda for the Future based on the National Highway Traffic Safety Commission's EMS Agenda for the Future, but modified to reflect the unique environment of rural emergency medical services.
If you would like to participate on the Rural EMS Working Group, please contact: Sonya Roberts at 626-7946 Ext. 236 (next conference planning meeting is January 30 at 1:30 p.m.) or Marcos Rodriguez at 626-7946 Ext. 246 (next model demonstration planning meeting is January 31 at 9:00 a.m.).
(4) Flex Program Quality Improvement Workshops: The Flex Program is collaborating with Arizona's Quality Improvement Organization, Health Services Advisory Group, Inc., to provide training in clinical topics and indicators for quality assurance and other staff of the state's critical access hospitals. The training will focus on clinical topics that are prevalent among Medicare patient populations, using a rapid cycle model that will also be taught to workshop participants. PDSA (Plan, Do, Study, Act) is a model in which participants receive training in a clinical topic area at a learning session, develop a plan for implementing the QI plan in their hospitals, and implement the plan in their hospital. The Rural Policy Research Institute (RUPRI)'s Year 3 Report from The Rural Hospital Flexibility Tracking Program, Chapter 3B describes a similar QIO initiative in Minnesota. CAH Quality Improvement Strategies
(5) 2003 Annual Flex Conference: On January 14, the Arizona Flex Program hosted a teleconference meeting with representatives of Flex Programs in 14 of 17 western states to discuss the possibility of holding a western states regional Flex conference this year. States participating on the call included: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oklahoma, Oregon, Texas, Washington, and Utah. The National Flex Program Officer also participated in the call. A second teleconference meeting is scheduled for January 31 at 2:00 pm MST.
b. National Action
(1) CMS Proposed Rule: Use of RNs as Emergency Services Personnel in Critical Access Hospitals: On December 31, CMS published proposed rules for the Medicare Physician Fee Schedule for 2003. Included in the rule was a provision allowing states to interpret emergency care services to allow critical access hospitals to use a RN in order to comply with the emergency services personnel requirement stated in the regulations at Sec. 485-618. The agency stated that the rule is anticipated to reduce costs for small CAHs in frontier areas and remote locations, because they will no longer be limited to hiring only a physician, nurse practitioner, or physician assistant to provide emergency coverage in the absence of the sole practitioner. The rule requires that the state submit a letter to CMS, signed by theGovernor, following consultation with the State Boards of Medicine and Nursing, and in accordance with state law, requesting that RNs be included as emergency personnel in Sec. 485.618(d). The comment period ends on March 3, 2003 for the proposed rule, which is scheduled to take effect on March 1. CAH EMS Proposed Rule
(2) Fire And Safety Regulation for Facilities: This final rule amends the fire safety standards for hospitals, long-term care facilities, intermediate care facilities for the mentally retarded, ambulatory surgery centers, hospices that provide inpatient services, religious nonmedical health care institutions, critical access hospitals, and Programs of All-Inclusive Care for the Elderly facilities. Further, this final rule adopts the 2000 edition of the Life Safety Code and eliminates references in our regulations to all earlier editions. Fire and Safety Regs
(3) Medicare Manual Changes Related to Flex Program Objectives:
Medicare Hospital Manual Payment for Services Furnished By a CAH
Medicare Intermediary Manual Expanded
Medicare Intermediary Manual Ambulance Fee Schedule
2. Arizona News
a. Tohono O'odham Buckle-Up for Safety Project: The Arizona Rural Health Office recently received a small grant to partner with the Tohono O'Odham Nation (TON) in the Partners for Rural Traffic Safety-Community/Partner Training Academy project, a cooperative initiative of the National Rural Health Association (NRHA) and the National Highway Traffic Safety Administration (NHTSA). Three team members attended the project's state team training in Washington, D.C. on January 23-24, 2003: Marcos E. Rodriguez, Sr. Program Coordinator, RHO; Arleen Thomas, Community Health Worker, TON Department of Human Services; and Lt. Malcolm Lewis, Chief-Ranger Division, TON Sells Police Dept. This project will implement a traffic safety process model and campaign promoting seat belt use and traffic safety activities in four TON rural communities involving the Tohono O'Odham Nation's sectors of law enforcement, medical/health, education, business and tribal communities. Project partners include the TON-Department of Human Services, (TON)-Sells Police Department, Arizona Governor's Office of Highway Safety, Tribal Emergency Response Commission (TERC), Cooperative Extension-University of Arizona, Indian Health Service (IHS)-San Xavier/Sells. A 30-day campaign is targeted for May 2003 and will assist the TON in advocating for a seat belt law. For further information contact: Marcos E. Rodriguez
b. GAO Study of Border Hospitals: On Wednesday, January 22, 2003, the Sierra Vista Herald published the following article by Dana Cole about a GAO investigation of the impact of uncompensated care on border hospitals. The article was forwarded by the Arizona-Sonora Health Service Cluster, a group of interested health and medical professionals in the Arizona-Mexico border region border health issues. For further information about the Cluster, please contact: Marisa Walker. GAO Study of Border Hospitals
c. Western Migrant Stream Forum: The 12th Annual Western Migrant Stream Forum is being held January 31-February 2 in Mesa, Arizona. The forum provides an opportunity to network with clinicians, administrators, health educators, researchers and students actively involved with farmworker health issues. For further information, please see Migrant Stream Forum or contact: Helen M. Ferris.
d. Accelerated Degree Program for Nurses: The University of Arizona College of Nursing is offering a new 14-month accelerated BSN degree program. Program information sessions will be held on February 19, March 26, April 23, and May 14. For further information, see the website at: Accelerated BSN
e. Magnet Recognition Program for Nursing: The Arizona Nurses Association recently published the results of a Nursing Work Environment Study conducted last year. The purpose of the study was to assess the professional practice work environment of hospital-employed registered nurses in Arizona and compare it to "Magnet" facilities certified by the American Nursing Credentialing Center (ANCC) as best practice facilities based result are successful in recruitment and retention of highly qualified and professional nurses. A total of 2,673 RNs in 44 of the 82 hospitals in Arizona participated by completing a survey. For survey results, see ANA Nursing Study. In July 2002, Congress passed the "Nurse Reinvestment Act," which includes grants to encourage facilities to implement Magnet criteria for excellence in nursing services, and JCAHO released a report on the nursing shortage that recommended that facilities adopt the characteristics of Magnet hospitals. For more information about the Magnet Recognition Program, see: Magnet Recognition Program and Magnet News
f. 2003 Annual Arizona Legislative Forum on Healthcare Issues: The Legislative Forum held on January 21 was attended by 22 legislators and over 80 participants representing rural interests throughout the state. Participants heard the latest updates on budgetary issues affecting rural health programs at the state and federal levels. Senator Ken Bennett, President of the Arizona State Senate, projected that health programs would not experience funding reductions this year, but would not receive increases either. Former Senator Sue Gerard, now the Governor's Health Policy Advisor indicated that the most important legislative action to be taken this year is that which preserves the continuation of AHCCCS.
g. 30th Annual Arizona Rural Health Conference: The Rural Health Office and the Arizona Rural Health Association has issued a Call for Workship Presentations and Call for Poster Sessions for the 2003 Arizona Rural Health Conference, "Policies, Programs, and Practices for Preserving Arizona's Rural Public Health Safety Net," to be held July 21-23 at the Sheraton El Conquistador Resort in Tucson.
Applicants are encouraged to submit workshop presentations and proposals for poster sessions around four key conference themes: Access to Health Care (e.g., health professional shortages, clinical opportunities for rural students, oral health, undocumented workers); Economics of Rural Health Care (e.g., impact of workforce, long-term care services, tort reform, undocumented workers); Rural Disaster Preparedness (e.g., bioterrorism, networking capabilities, resources); and Public Health Enemy #1: Obesity, Diabetes, and Heart Disease (e.g., rural problems compared to urban, policy changes, models that work). Within these themes, each workshop or poster should address the preservation and enhancement of Arizona's rural public health care safety net for one or more of the following populations: children, adults, the elderly, special populations, and behavioral health.
Presentations that incorporate "best practice" models and problem solving techniques are highly sought. Presenters are also encouraged to prepare appropriate handouts for workshop participants to use as reference materials. Workshops will be one hour in length, may be conducted by one or more presenters, and will be held at various times on all three days of the conference. Poster sessions are intended to showcase programs, studies, and or research. Each poster presenter will be provided one side of a standard cork board (approximatley 4' x 6' surface area). Poster presentations will be mounted for display on Mnday afternoon, July 21, and presenters must be in attendance during the poster session from 5:30 to 7:00 pm. Presenters are encouraged to provide a handout summarizing their poster session for poster viewers to take away with them.
Deadline: All proposals and submissions must be received by mail, fax, or email on or before February 21, 2003 at 5:00 pm. Notification of the review panel decision will be sent on March 21, 2003. For an application form, please contact: Rebecca Ruiz.
3. National News
a. NRHA Rural Health Appropriations Update: Congress is nearing completion of FY03 apropriations, federal programs have been operating at FY02 levels since the end of the fiscal year. Last week, the Senate passed its long-awaited FY03 appropriations legislation. The House of Represenatives also released its own version. Negotiators from the House and Senate will meet to reconcile the differences in the two bills and create the final appropriations package. It is hoped an agreement can be reached and a final package passed in early February.
Below you will find a comparison of some of the key rural health programs. The Senate numbers are clearly more favorable to rural health. NRHA urges members to contact their Representative and Senators and request they support the Senate funding levels as the final FY03 appropriations package is considered.
National Health Service Corps (NHSC) Health Professions (w/o Ped. GME)
02 Level: $145 m 02 Level: $377 m
Pres. Request: $189 m Pres. Request: $95 m
House Bill: $155 m House Bill: $378 m
Senate Bill: $189 m Senate Bill: $189 m
Rural Outreach Grants State Offices of Rural Health
02 Level: $52 m 02 Level: $8 million
Pres. Request: $38 m Pres. Request: $4 million
House Bill: $38 m House Bill: $4 million
Senate Bill: $51 m Senate Bill: $10 million
Rural Hospital Flex Grants
02 Level: $40 m
Pres. Request $25 m
House Bill: $30 m
Senate Bill: $45 m
b. Rural Assistance Center: In December 2002, HHS established a new national resource on rural health and human services information -- the Rural Assistance Center -- through a partnership of the University of North Dakota Center for Rural Health and several other top-rated rural health and human services organizations in the United States. The RAC is intended to provide a single point of entry for people seeking information about health and human services in rural America. The Rural Assistance Center can be accessed by calling 1-800-270-1898, or on the web at: Rural Assistance Center
c. February HRSA Reimbursement Training in Phoenix: The HRSA Center for Health Services Financing and Managed Care sponsors a free Third Party Reimbursement Training and Technical Assistance Program for organizations which receive HRSA grant funds directly from HRSA (HRSA grantees) and organizations which receive funding from states and localities that is supplemented with HRSA grant funding (HRSA subgrantees).. The purpose of the training is to assure that wherever possible, third-party coverage should pay for the cost of health care for insurance program beneficiaries, thereby allowing federal grant dollars to be focused on the health care of the uninsured and underinsured. This training will be available in Phoenix, Arizona February 6-7, 2003. For further information: Third Party Reimbursement Training Program
Training Curriculum
d. Wired Communities: Putting the e in Public Health Webcast: On January 31, a national satellite teleconference meeting will be broadcast from 11:00 a.m. to Noon Pacific Time by Public Health Grand Rounds, a project sponsored by the University of North Carolina School of Public Health and the Centers for Disease Control and Prevention. "Wired Communities" will "describe an electronic community network (Blacksburg, Virginia), identify three informatics competencies that are key to success in establishing and maintaining an electronic community network, identify three ways in which an electronic community network promotes the overall health and well being of the community, and describe the National Library of medicine's role in providing electronic resources to the local public health workforce and their community partners.
You won't have to leave your desk to watch it if you have a few essentials: an Internet connection, speakers, and RealPlayer. You can download RealPlayer if you don't already have it, from RealPlayer You will also need to register for the program and get a participant ID by going to the web site for Public Health Grand Rounds at Public Health Grand Rounds and clicking on Participant Registration.
d. HHS Rule on J-1 Visa Waivers: HHS issued an interim final rule in the December 19, 2002 that will allow the agency to review applications from community health centers, rural hospitals, and other health care providers to waive return-home requirements for foreign physicians so that they can remain in the country to practice in underserved aeas. HHS would make recommendations on these requests to the State Department. Comments must be received by February 3. HHS Visa Waiver Rule
e. Medicare Resources: Open Door Forum on Rural Health: A CMS Open Door initiative formed 12 "open door" groups of interest for individuals and entities who interact regularly with the agency, including beneficiaries and health care providers. Open Door groups are chaired by senior-level agency officials. Participation in ODR meetings is possible by conference call and a schedule of meetings is available online. Open Door Forum Rural Health Open Door Forum
f. Health Care Reform Issues
(1) Health Care Background of Senate Majority Leader:An article published in the Washington Post on January 25 offers some insight into the perspectives about health care issues of the new Senate Majority Leader, Bill Frist of Tennessee, who will be directing President Bush's proposed Medicare reforms through the legislative process. Health Care
(2) Public Citizen's Health Care News: The Public Citizen's Health Care Listserv distributed the following articles related to current administration health care proposals and other health care issues.
Drug Benefit Linked to Managed Care
Requirement to Join Managed Care to Receive Drug Benefit
Funds to Speed Generic Drug Approvals
Democrats Tackle Insurance Industry and Malpractice Premiums
Bill to Reverse Insurers' Exemption from Antitrust Laws
g. HHS Rule on Faith-Based and Community Initiative: In December, HHS announced proposed regulations to clarify the rights and requirements for religious organizations that use HHS funds in deliverying services to needy Americans. The proposed regulations would implement Charitable Choice laws by clarifying: Faith-based organizations cannot be excluded from the competion for program funds simply because they are religious; religious organizations that receive federal funds must serve all eligible participants, regardless of those persons' religious beliefs; religious organizations that receive federal funds may continue to carry out their missions consistent with their beliefs; religious organizations that receive funds from covered programs have a federal right, under existing civil rights law, to take their faith into account in making employment decisions, permitting them to limit hiring to employees who share their religious beliefs; religious organizations may not use direct program funds to support any inherently religious activities (such as worship, religious instruction, or proselytization); recipients of HHS-supported services may receive services from a provider to which they have no religious objection; for certain programs, religious organizations must maintain separate accounts for the federal funds they receive. For further information, see: Faith-Based and Community Initiative
h. Medicaid Disease Management Programs: The Association of State and Tribal Health Organizations (ASTHO) reports that Medicaid Disease Management Programs implemented in eight states in the 1990s helped to reduce preventable health complications and unnecessary health service utilization. To review the report, see: Disease Management Programs
i. Impact on Women of Insurance Tax Credits: A new study by The Commonwealth Fund finds that tax credits within the range of those contemplated in recent federal policy proposals might not be high enough to make health insurance affordable to women with low incomes. The report concludes that unless tax credits ae combined with options to buy into group insurance, individual insurance market refors, or other protections, relatively few low-income women are likely to use them. Health Insurance Tax Credits
j. Rural Poverty in the United States: A recent New York Times article describes the decline of rural communities associated with rural poverty. Pastoral Poverty: The Seeds of Decline
4. How to Contact Your Representatives
a. Arizona Congressional Delegation: Links to Arizona members of the U.S. House of Representatives are available at: U.S. Representatives Links to Arizona members of the U.S. Senate are available at: U.S. Senate
b. Arizona State Legislators: Available through the Arizona Legislative Information System (ALIS): Call 1-800-352-8404 Arizona Legislature
5. Grant Opportunities
a. Rural Assistance Center Grant Funding Guides RAC Funding
b. Rural Information Center Funding Resources RIC Funding
6. Conferences Relevant to Rural Health
a. Rural Assistance Center Calendar of Events: RAC Calendar
b. Other Conferences
(1) March 3-5: Rural Health Policy Annual Institute, Washington, DC.
Contact: NRHA Government Affairs Office (703) 519-7910 dc@NRHArural.org.
Website: http://www.NRHArural.org/pagefile/PolicyInstAnnounce.html
(2) March 28-30: National Conference on HIV/STD Prevention in Rural Communities: Sharing Successful Strategies III, Bloomington, Indiana. Contact: Alex Conchola, National Rural Health Association, 1 West Armour Blvd., Suite 203, Kansas City, Missouri 64111, (816) 756-3140, Fax: (816) 756-3144, conchola@NRHArural.org
Website: http://www.NRHArural.org/pagefile/HIV-STDconf.html
(3) April 1-4: Energizing Entrepreneurship in Rural America: A Train-the-
Trainers Academy for economic development specialists, educators, and trainers focusing on entrepreneurship as a development approach. Nebraska City, Nebraska Contact: Reggi Carlson, Heartland Center for Leadership Development, 941 O Street Suite 920, Lincoln, NE 68508. 1-800-927-1115 rcarlson@heartlandcenter.info
Website: http://www.heartlandcenter.info
7. Other: New Websites of Interest
- National EMS Information System: NEMSIS
- Rural Medics: Rural Medics
- El Consultorio: Spanish Language
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