Rural Health Briefing  June 20 2005

Page One
32nd Annual Arizona Rural Health Conference in Payson
Convening around the theme Rural Community Health Matters, the 32nd Annual Arizona Rural Health Conference will offer a wealth of workshops and expert talks in Payson on July 17, 18 and 19, 2005. The program includes networking opportunities, issue forum discussion groups, exhibitors and presentations from multiple perspectives.
Before the conference, participants can make their nominations for the following four Rural Health Service Awards: Legislator, Project, Professional and Volunteer of the Year. The deadline is June 30. This also marks the deadline for nominations to the Arizona Rural Health Association Board of Directors.
The Rural Health Office of the UA Zuckerman College of Public Health sponsors the annual conference in partnership with the Arizona Rural Health Association.
Click here for registration details and a complete schedule of events.

National News
1. Rural Health Funding Faces Cuts
2. NRHA Objects to Proposed Restriction on CAHs
3. Health Information Technology as Urgent Priority
4. CAHs Generally More Profitable
5. $1 Billion for Health Care Costs of Undocumented Aliens
6. Rural Children in Poverty

Across Arizona
1. $800,000 to Fight West Nile Virus
2. Bringing Broadband Services to Rural Arizona
3. Hughes Steps Down as Director of Rural Health Office
4. CMS Billing and Coding Training for Arizona CAHs
5. Free Air Transport for Medical Treatment
6. Winter New Health Care Advisor
7. Tribal Public Health and Bioterrorism Preparedness
8. Healthcare Provider Recruitment Services
9. 3rd Annual Western Region Flex Conference

Grants and Opportunities
1. Funding for Rural Telecommunications
2. Innovative Approaches to Vulnerable Populations
3. Public Health Scholarship for Arizona
4. Research on Cancer in Native Americans
5. Rural Cooperative Development Grants
6. Child Abuse Prevention for Tribal and Migrant Programs
7. HIV/AIDS Related Services for Minority Populations
8. Health Care and Minority Populations
9. Funds to Attend Grant Writing Training

Calendar
June 25, Physicians Adopting Computer Technology Conference, Chicago, Illinois
June 27, Balanced Scorecard Implementation in Rural Hospitals, Chicago
June 27-July 1, 2005 National AHEC Organization Leadership Workshop, Tulsa, Oklahoma
July 11, Bringing Broadband Services to Rural Arizona, A virtual roundtable, Various sites in Arizona, 9:00-11:00 a.m.
July 11-15, The Many Faces of Rural Nursing: Advancing the Generalist Role, Pullman, Washington
July 15, EMS Training for ER Nurses and First Responders, Winslow
July 17-19, 32nd Annual Arizona Rural Health Conference, Payson
August 4-5, 16th Annual Southwest Regional Trauma Conference, Tucson
August 10, CMS Billing and Coding Training for Arizona CAHs, Teleconference
August 11-12, National Association of Rural Health Clinics Summer Institute, Reno, Nevada
August 22-26, ORPH’s All Programs Meeting: The Crossroads of Rural Health, Washington, D.C.
August 23-26, 8th Annual National Community Health Workers/Promotores Conference, Phoenix. Contact 928-627-9228 or email here.

MARK YOUR CALENDARS
September 17-21, National Association of Medical Staff Services Annual Conference, Phoenix
September 30, 3rd Annual Arizona Women’s Conference, Tucson
October 5-7, NRHA Critical Access Hospital Conference, Kansas City

National News

1. Rural Health Funding Faces Cuts
The U.S. House of Representatives marked up the 2006 budget on Friday, June 10 with some serious reductions and eliminations on rural health-related funding. Outreach and Network grants that have benefited rural Arizona have been cut, along with state offices of rural health. Rural health research grants have been eliminated. Arizona Critical Access Hospitals will be directly impacted by these cuts in funding.
The legislation now moves through the House and then to the Senate. If you would like to offer an opinion on these cuts, contact your Congressional delegation (See Arizona contact information below).

2. NRHA Objects to Proposed Restriction on CAHs
In a proposed rule, CMS would severely restrict relocation or replacement projects of Critical Access Hospitals (CAHs). The Inpatient Prospective Payment System (IPPS) only allows continued CAH status as necessary providers that are building replacement facilities at another location and can demonstrate their construction plans began before December 8, 2003. That date marked the passage of MMA 2003. The National Rural Health Association (NRHA) is urging its members and other rural health advocates to contact CMS and recommend that this arbitrary date restriction be dropped.

3. Health Information Technology as Urgent Priority
HHS Secretary Mike Leavitt has released the Health Information Technology Leadership Panel: Final Report. The report identifies three urgent imperatives for health information technology (HIT). It calls for widespread adoption of interoperable HIT, leveraging by the federal government’s health care payer status to drive adoption of HIT, and collaboration between private and public sectors.
In addition, the report recommended changing policies to reward adoption of HIT, promotion of harmonized standards and funding of demonstration and evaluations of interoperable HIT projects.
The report, prepared by The Lewin Group, a health care policy consulting firm, through a contract with HHS, contains the findings of nine CEOs from leading U.S. companies who purchase a substantial amount of health care for their employees. The full report can be found at: http://www.hhs.gov/healthit/HITFinalReport.

4. CAHs Generally More Profitable
A recent study, Financial Indicators for Critical Access Hospitals, developed comparative financial indicators specifically for Critical Access Hospitals (CAHs) using Medicare Cost Report data. Twenty indicators deemed appropriate for assessment of CAH financial condition were chosen.
Results showed that, over the six years since 1998, CAHs generally became more profitable and increased their utilization of beds. However, while on average CAHs with long-term care became more liquid and reduced their use of debt over time, those without long-term care became less liquid and increased their use of debt. In the most recent year for which we have data (2003), CAHs without long-term care generally were more profitable, were more liquid, had less debt, and had higher utilization of beds in comparison to CAHs with long-term care. For the complete report, click here.

5. $1 Billion for Health Care Costs of Undocumented Aliens
CMS has set aside $1 billion over the next four years to help hospitals, physicians and ambulance providers recoup the costs of providing emergency medical service to qualified people who are uninsured or cannot afford emergency service. Each state will receive funding based on the formula established in the law.
Complete details here.

6. Rural Children in Poverty
In 2003, 2.7 million rural children were poor, representing 36 percent of the rural poor. Rural child poverty is most persistent and severe in the Rio Grande border area, the Southwest, Central Appalachia, the Deep South and the American Indian communities in the Northern Plains. These distressing facts are among those included in a USDA report, Rural Children at a Glance, Economic Information Bulletin Number 1. The report also tracks racial/ethnic diversity between 1990 and 2000 and compares health insurance coverage of rural and urban children. Click here for the six-page report.

Across Arizona

1. $800,000 to Fight West Nile Virus
16 deaths and 391 documented human cases made Arizona an epicenter of the West Nile Virus in 2004. An additional $800,000 has been obtained from CDC to support local efforts in prevention, education and control. These resources will enhance the state’s lab testing capacity, bolster local mosquito prevention and control efforts and fund radio public service announcements urging Arizonans to “fight the bite.”
West Nile Virus has already been detected this year in Maricopa, Pinal and Pima counties. Such early detection plus a rainy spring points to the strong possibility of a statewide threat in 2005.
Updates on the virus and related programs are at www.westnileaz.com and at the toll-free number, 800-314-9243.

2. Bringing Broadband Services to Rural Arizona
Over $2 billion in loans and loan guarantees can help bring high-speed broadband services to rural America. These programs will be discussed at a virtual roundtable available throughout Arizona on Monday, July 11 from 9:00-11:00 a.m.
Eddie Browning, U.S. Department of Housing and Urban Development (HUD) and Harry Hutson, U.S. Department of Agriculture (USDA) will be among the speakers. For more information on the loan programs, visit: http://www.usda.gov/rus/telecom/broadband.htm.
Tentative videoconference sites include: Phoenix, Tucson, Flagstaff, Springerville, Payson, Douglas, Page, Winslow, Show Low, and Globe. Click here for location updates and more program details.
To participate and receive more information on a videoconference site near you, call Leila Barraza at 520-626-7946, x 246.
This roundtable is sponsored by the Arizona Rural Hospital Flexibility Program/Rural Health Office and the Arizona Telemedicine Program, in collaboration with HUD and the USDA.

3. Hughes to Step Down as Director of Rural Health Office
Alison Hughes will step down as the Director of the Rural Health Office (RHO) on July 1. Dr. Lynda Bergsma will assume the position of Acting Director until a new director is appointed. Lynda is currently the Associate Director for Service at the RHO and has worked there for over 17 years.
Alison was Associate Director of the RHO for 15 years, working with Dr. Andrew Nichols. She assumed the director's position after his untimely death in 2001. She will not disappear from the scene completely and will retain her role as Director of the Rural Hospital Flexibility Program. Commenting on her change of role, she said, "Leadership change is healthy for any organization. Cumulatively, Andy and I led the rural health office for over 45 years! It is time to move aside and give Dean Marie Swanson an opportunity to put someone in the director's job who will bring fresh commitment, ideas and opportunities to rural communities in Arizona."
Alison also served as Associate Director for Outreach of the Arizona Telemedicine Program and will continue to have an active role there. Additionally, she has been active in influencing rural health policy at the national level through her membership on the board of the National Organization of State Offices of Rural Health, and the policy board of the National Rural Health Association.
"I have enjoyed every day I've worked at the Rural Health Office, and am excited about this transition," she said. "I look forward to continuing on in a different role, bringing valuable opportunities to rural communities that are reflective of our college's service mission. I am grateful for the support and confidence our dean gave me when she appointed me director. I promise to continue to do my part.”

4. CMS Billing and Coding Training for Arizona CAHs
CMS will offer a specialized training on improving billing and coding procedures for Critical Access Hospitals on August 10 in collaboration with the Arizona Rural Hospital Flexibility Program. This will be a “By Reservation Only” event conducted by teleconference.
If hospital staff who do billing and coding in Arizona CAHs would like to participate, please reserve a space by sending an email no later than June 30 to Jim Laukes at jlaukes@u.arizona.edu or calling 520-626-7946, x 245. Participants will be given the dial in number and the exact time of the call as soon as they are available.

5. Free Air Transport for Medical Treatment
For the past 21 years, Angel Flight West has recruited volunteer pilots to provide free transport to medical treatment for people who cannot afford public transportation or who cannot tolerate it for health reasons. They operate all across the Western states and are also a member of the national Angel Flight America. They accept requests from individuals or health care professionals and also can help to coordinate connecting ground transportation from local airports to nearby health care facilities. While they have more than 1,600 members who fly more than 2,700 flights per year, they welcome new volunteers. Details here or by calling 888-4-AN-ANGEL (888-426-2643).
For transportation outside of the Western states, referrals can be obtained from the National Patient Travel Center at 800-296-1217.

6. Winter New Health Care Advisor
Anne Winter has been chosen to serve as Governor Janet Napolitano’s policy advisor on health care. Winter currently serves as the Governor’s advisor on Federal Medicaid issues and Director of Efficiency Review.
As policy advisor for health, her purview will include serving as liaison between AHCCCS, ADHS and the Governor’s office in addition to working with health care stakeholders across the state.

7. Tribal Public Health and Bioterrorism Preparedness
The UA Zuckerman College of Public Health under contract with ADHS will be providing a series of public health emergency preparedness and response training for tribes in Arizona. The one and a half day trainings propose to strengthen tribal nations’ preparedness for bioterrorism, outbreaks of infectious disease and other public health threats or emergencies.
Five sessions are tentatively scheduled to be held regionally across the state between July and September.
For details, please contact Juana Casillas, Native American Liaison, Rural Health Office, 520-626-7946, ext. 245 or mailto:casillas@email.arizona.edu.

8. Healthcare Provider Recruitment Services
As part of its mission to serve rural Arizona, the Rural Health Office offers recruitment services at no charge for healthcare providers needed at rural hospitals, clinics, health centers, and private practices.
Currently over 90 health care professionals are seeking jobs in Arizona through this service. These include physicians, nurses, nurse practitioners, physician assistants, dentists, and mental health providers. Specialties include family practice, internal medicine, allergist, dermatologist, emergency medicine, pediatrician, obstetrician/gynecologist, and general surgeon, among others. Both US citizens and J1 waiver physicians are seeking jobs.
If you have a position you need to fill, contact Leila Barraza, Program Coordinator, at semino@email.arizona.edu or 520-626-7946 x246 to see what providers are available. Or go to http://www.rho.arizona.edu/rrr/

9. 3rd Annual Western Region Flex Conference
Over 120 people gathered from across the nation for the 3rd Annual Western Region Flex Conference. Representatives from Critical Access Hospitals, state hospital associations, Indian Health Service and tribal hospitals and related groups met in Phoenix from June 8 to 10. Presentations included Federal perspectives from Marcia Brand and Emily Jane Costich, ORHP/HRSA as well as Michelle Griffin, CMS, Region IX. Other speakers discussed important issues of finance, building community support, EMS challenges, entreprenurial mindsets, working with governing boards and future directions of state Flex programs.
The event was sponsored by the Rural Hospital Flexibility Program in Alaska, Hawaii, Nevada, New Mexico, Oklahoma, Texas, Utah, Wyoming and Arizona.
Click here for the PowerPoints that accompanied the conference presentations.

Grants and Opportunities
Note: Technical assistance is readily available for the development of grant proposals and other funding applications from the experienced staff of the Rural Health Office and the State Office of Rural Health Program. Please contact Jennifer Peashock.

1. Funding for Rural Telecommunications
Submission deadline: June 30, 2005
The Rural Health Care Division (RHCD) of USAC now accepting applications for July 1, 2005-June 30, 2006. These funds assist health care providers in rural areas to obtain the benefits of the Internet and current telecommunications technology. RHCD is posting information on changes in the program to its website. These changes will include new application forms, which are currently under review by OMB. However, to help ensure that applicants have sufficient time to post Form 465 before the Funding Year starts July 1, 2005, RHCD has authorized the using the old Form 465 for Funding Year 2005.
Health care participants may be eligible to receive a 25% discount on their monthly Internet service charges. Emergency Departments of for-profit rural hospitals are also eligible. A complete list of eligible services for both Internet and telecommunications services is available from USAC.
Further details at the USAC website.

2. Innovative Approaches to Aid Vulnerable Populations
Application deadline: June 30, 2005
Local Initiative Funding Partners is a partnership program between Robert Wood Johnson Foundation and local grant makers that supports innovative, community-based projects to improve the health and health care for society's most vulnerable people. Of special interest are projects that address community violence, children’s mental health, the needs of new immigrants and others whose health status is affected by social factors.
$6 million will be awarded in this cycle in amounts of $100,000 t0 $500,000. Details at: http://www.rwjf.org/files/applications/cfp/cfp-lifp2006.pdf

3. Public Health Scholarship for Arizona
Application Deadline: July 1, 2005
The Arizona Public Health Association is seeking applications for the Lloyd E. Burton Scholarship to be awarded at its annual meeting in September 2005. The $500 scholarship is for current, higher education students enrolled in a program related to public health (e.g. nursing, medicine, public health, health administration, etc.).
Click here for details.

4. Research on Cancer in Native Americans
Letter of Interest Deadline: June 30, 2005
Application Deadline: October 3, 2005
The Native American Cancer Research Partnership, a National Cancer Institute (NCI) sponsored cooperative agreement between Northern Arizona University (NAU) and the Arizona Cancer Center (AZCC) which is affiliated with the University of Arizona (UA), is seeking projects related to cancer in Native Americans. Proposed research may be laboratory, clinical, or community based, will focus on cancer in Native Americans and must be jointly submitted by faculty at NAU and AZCC.
Members of the Partnership are willing to work with interested investigators to develop proposal ideas and if necessary to assist investigators in identifying possible collaborative partners at NAU and AZCC.
Funding will take the form of planning grants (up to $20,000 per year), pilot projects (up to $100,000 per year) and full projects (up to $250,000 per year).
To indicate an interest in submitting a proposal, email a short (one paragraph) description of a research project to Suzie Larson, Suzie.Larson@nau.edu by June 30, 2005.
Guidelines for proposal submission and the RFA guidelines are posted at www.nativecancer.org.

5. Rural Cooperative Development Grants
Application Deadline: July 1, 2005
This USDA program is intended to improve the economic condition of rural areas through cooperative development. These grants can used to facilitate the creation or retention of jobs in rural areas through development of new rural cooperatives, value-added processing and other rural businesses. Non-profit corporations and institutions of higher education are eligible.
Approximately 20 awards averaging $250,000 will be made.
Click here for complete details.

6. Child Abuse Prevention for Tribal and Migrant Programs
Application Deadline: July 5, 2005
This program offers financial support to selected tribes, tribal organizations and migrant programs to prevent the occurrence or recurrence of abuse or neglect within tribal and migrant populations.
Applicants must have the capacity to establish, maintain and evaluate community-based programs.
Up to three awards of approximately $143,000 each will be made.
Click here for complete details.

7. HIV/AIDS Related Services for Minority Populations
Application Deadline: July 13, 2005
The Technical Assistance and Capacity Development Demonstration Grant Program (TA/CD) offers support to develop and improve effective and durable service delivery capacity for HIV prevention and treatment among organizations closely interfaced with targeted minority populations impacted by HIV/AIDS.
Applicants will identify community-based, minority-serving organizations that are well linked with targeted minority populations affected by HIV/AIDS. Applicants will provide technical assistance and capacity building services to those organizations based on their identified needs.
Approximately 22 awards will be made of up to $350,000 each.
Click here for complete details.

8. Health Care and Minority Populations
Application Deadline: July 13, 2005
The National Umbrella Cooperative Agreement Program seeks to increase the diversity of the health-related work force; reduce health disparities and improve quality of care for targeted minority populations through projects that are of national significance; and improve evaluation procedures and the collection and analysis of data on targeted minority populations.
Awards will be made in three categories: Work Force Development, Health Disparities and Quality Care, and Data and Evaluation. Depending upon the category, the following are examples of the types of projects or activities that can be supported: Youth initiatives, health related internships, and fellowships; academic and other support services for students in the educational pipeline; disease prevention/health promotion; health services and behavioral research; health care access, including mental health, and human services support; health information technology and communication; cultural and linguistic competency; health information dissemination; infrastructure development; data collection and analysis on specific minority populations; development of curricula, toolkits, and other educational/instructional materials; and technical assistance, training (e.g., ''Train-the-Trainer''), and other workshops on project evaluation.
Up to seven awards ranging from $250,000 to $350,000 are anticipated.
Click here for complete details.

9. Funds to Attend Grant Writing Training
A limited number of NRHA grants are available to attend a National Association of Community Health Centers grant writing seminar. The NRHA will pay up to $800 for travel, lodging and registration fees for community members and grant writers from selected rural communities who want to attend one of many seminars held around the country. To apply for this assistance, e-mail Courtney Yohe at yohe@NRHArural.org, with answers to the following.
1. Who plans to attend the seminar?
2. What is that person’s job title and expected role in the application process?
3. In what county/ region / state will the grant be applied once the training is complete and the grant has been awarded?
To learn more about the times and locations of these seminars visit www.nachc.org/ela/listing.asp or e-mail Pam Byrnes.

Contact Your Representatives
• 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
• Arizona State Legislators: Available through the Arizona Legislative Information System (ALIS): Call 1-800-352-8404 or follow links at Arizona Legislature.


Editor's Note: This online newsletter is a project of the Arizona Rural Hospital Flexibility Program, housed in the Rural Health Office at the UA Zuckerman 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.
Your valuable comments, helpful suggestions, and enigmatic questions are welcome. Please send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.