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Rural Health Briefing November 18 2004
National News
1. Bonus Payments from CMS to Scarce Rural Physicians
2. Special Medicare Drug Card for American Indians, Alaska Natives
3. An Agenda to Strengthen Rural/Frontier EMS Systems
4. Improving Mental Health Services in Rural Areas
5. Universal Services Funding Delayed
6. IOM Recommends Steps to Improve Rural Healthcare Quality
7. National Rural Development Coordinating Committee
Across Arizona
1. Recruiting Resource for Health Facilities
2. Rural Health Clinic Designation Instruction Manual
3. Flu Information Line in Arizona
4. APHA Redesigns Website
5. Results from Rural Health Briefing Survey
Grants and Opportunities
1. Rural Wireless Community Vision Program
2. New Access Points for Health Care Centers
3. Pediatric Health and Nutrition Programs
4. Nursing Workforce Diversity Grants
5. New Provider Practicum in Migrant Health
6. HRSA 2005 Funding Review
7. Rural Community Development Initiative
8. Nominations for Jonathan Mann Award for Global Health and Human Rights
9. Robert Wood Johnson Executive Nurse Fellows Program
Calendar
- November 19, Southern Arizona Rural Health Forum, Tucson
- December 1-3, Empowering Tribal Communities: Strengthening and Building Family Services, Inter Tribal Council of Arizona, Prescott, Arizona
- December 8, Arizona Healthcare Forecast 2005: Crisis or Opportunity?, St. Luke’s Health Initiatives, Phoenix
- December 9, Surveillance of Vaccine-Preventable Diseases, CDC audioconference
- December 12-14,16th Annual Forum on Quality Improvement in Health Care, Orlando, Florida
- January 9-12, 2005, 18th Annual Rural Health Care Leadership Conference, Tucson
- January 11, 2005, Arizona Health Policy Forum, Phoenix
Mark Your Calendars!
- March 8-10, 2005, Arizona Interagency Farmworker Coalition Annual Conference, contact Jean McClelland, 520-626-7946 ext. 239, Yuma, Arizona
- March 21-23, 2005, Rural Health Policy Forum, Washington, D.C.
- June 8-10, 2005, Third Annual Western Region Flex Conference, Phoenix
National News
Bonus Payments from CMS to Scarce Rural Physicians
Effective January 1, 2005, CMS will begin making a 5% bonus payment to physicians who provide services to Medicare beneficiaries in areas that are designated as Physician Scarcity Areas (PSAs). There will be separate PSAs for primary care and specialty care based on the ratio of providers to Medicare beneficiaries in rural counties and census tracts of urban counties with a Rural Urban Commuting Area (RUCA) code of 4 or above. CMS will automatically make the payments to most physicians, however physicians who provide services in eligible areas for which the zip code is not considered dominant for the area will need to add a modifier to their claims to receive the bonus payment. In addition, CMS will automate payments for the 10% bonus available to physicians providing services to Medicare beneficiaries in Geographic Health Professional Shortage Areas (HPSAs).
A list of eligible zip codes and those which will be paid automatically is available at the following website: http://www.cms.hhs.gov/providers/bonuspayment/
Special Medicare Drug Card for American Indians, Alaska Native
Low income American Indians and Alaska Native (AI/AN) Medicare beneficiaries who utilize Indian health program pharmacies can now begin taking advantage of two specially endorsed Medicare-approved drug discount cards and the $600 credit tailored for their needs.
The two special drug cards for Indian health program pharmacies are Criterion Advantage and Pharmacy Care Alliance. The AI/AN Medicare beneficiaries who enroll in these drug cards can use their card at other pharmacies. More information about the drug discount cards as well as other drug cards can be obtained by calling 1-800- MEDICARE (633-4227) or by going to the Medicare Website at http:\\www.medicare.gov
Low-income AI/AN Medicare beneficiaries may also qualify for the $600 credit for this year and another $600 for next year. Further information on the drug cards can be found at http://www.criterionadvantage.com and http://www.pcacard.com.
An Agenda to Strengthen Rural/Frontier EMS Systems
The National Rural Health Association (NRHA), National Organization of State Offices of Rural Health (NOSORH) and National Association of State EMS Directors (NASEMSD) have released a new agenda providing a roadmap to restructure and strengthen rural and frontier Emergency Medical Services (EMS). The Rural/Frontier EMS Agenda for the Future offers recommendations to support and improve emergency services in rural and frontier communities by focusing on restructuring, reimbursement and recruitment issues.
The Agenda is the result of an extensive, multi-year consultation process that included all of the major rural and frontier EMS stake-holders including many local and regional EMS providers. Click here for a copy the Agenda.
In 2003, the Arizona Flex Program worked locally to help develop the Arizona Rural EMS Consensus Project Agenda for the Future.
Improving Mental Health Services in Rural Areas
To address inadequate access to mental health care in rural areas and the stigma of such conditions, a recent report highlights successful strategies of media campaigns and community collaborations to achieve improved services. The report emphasized that the stigma and discrimination associated with mental illnesses are even worse in rural areas than in urban areas. Exemplary programs that focus on the needs of teens to seniors and cover individual communities up to multi-state regions are described in this detailed memorandum. A sampling of research findings and public health editorials complete this good resource. It was published by SAMSHA’s Resource Center to Address Discrimination and Stigma and can be found online.
Universal Services Funding Delayed
Funding from the federal program designed to assist rural health care providers in paying for telecommunication services is temporarily on hold. The Federal Communications Commission (FCC) has directed the Universal Service Administration Company (USAC) to change their accounting system to be consistent with the methodology used by the Federal Government. This requires USAC to change the rules used to account for various financial transactions, including funding commitments in the E-Rate and RHCD programs, and comply with the Anti-Deficiency Act. Because of this change, USAC cannot issue any new funding commitments until additional non-obligated funds are available.
Advocates of rural telecommunications are urging Congress to exempt USAC from this requirement. If allowed to stand, they predict a 40% increase in the federal surcharge on American’s telephone bills. Congress granted the Federal Highway Trust Fund a similar exemption with no negative impact on that program, the Federal budget or taxpayers according to a statement by the Coalition for Equitable and Affordable Rural Service.
IOM Recommends Steps to Improve Rural Healthcare Quality
On November 1, the Institute of Medicine released a report outlining a five-pronged strategy to address quality challenges in rural communities. The report, Quality Through Collaboration: The Future of Rural Health, examines the quality of healthcare in rural America. Because rural communities often face unique healthcare challenges such as limited financial resources, an older and sicker population and greater difficulty recruiting caregivers, the IOM recommends creating a “rural quality initiative” with standardized performance measures appropriate for rural providers; greater congressional funding for workforce development programs in rural areas; rural tracks and rotations in schools that train health professionals; a report to assess the adequacy of payments to rural providers and outline steps to ensure their financial stability; congressional action to expand broadband networks and high-speed Internet access in rural areas; and financial incentives for rural providers to invest in electronic health records and other information technology.
Click here for an outline of the strategies and the twelve recommendations. To order a copy of the complete report, visit http://www.iom.edu/report.asp?id=23359.
National Rural Development Coordinating Committee
A National Rural Development Coordinating Committee (NRDCC) is being formed to attempt to incorporate the goals and vision of state, local, federal, tribal, non-profit and private for-profit sectors into one overarching national rural strategy. The NRDCC will be a senior-level executive committee with representatives from key agencies and organizations. It was established to coordinate and oversee the activities of the State Rural Development Councils and to improve the quality of life in rural America by implementing a unified rural strategy and improving program effectiveness to rural areas. Agriculture Secretary Ann M. Veneman will chair the committee. Details here.
Across Arizona
Recruiting Resource for Health Facilities
Arizona Health Provider Resources (AHPR, pronounced A-hyper) in the Rural Health Office offers free posting of position openings for primary providers in rural areas. Any rural health facility—hospital, clinic, health center, IHS facility, or private practice—can post job openings in primary care to the Rural Recruitment and Retention (3RNet) web site. The postings can be viewed by hundreds of health care providers seeking jobs. Since January 2004, over 650 health care providers interested in working in Arizona have registered at the site.
If you have any questions or problems posting an opening, please contact Amy Oggel, AHPR Coordinator, at 520-626-7946 x243 or aeo5@coph.arizona.edu.
Rural Health Clinic Designation Instruction Manual
The Rural Health Clinic Designation Instruction Manual is intended to help rural clinics determine whether or not this designation is right for them. It describes the fiscal benefits of rural health clinic (RHC) designation, and provides a step-by-step guide that leads through the application process in Arizona.
In some states dozens of RHC’s have been designated but Arizona has only nine. Once designated, RHC’s can obtain cost-based reimbursement for Medicare and Medicaid visits, and no longer have to use the Prospective Payment System (PPS) for reimbursements. In addition, rural health clinics are eligible to apply for federal grant programs.
Details for designation are useful for both independent clinics operated by physicians and nurse practitioners, as well as for hospitals that manage outpatient clinics.
This manual was produced by the Rural Health Office and can found online at http://www.rho.arizona.edu/resources/rhc/index.htm.
Flu Information in Arizona
A telephone information line about the flu is now available for Arizona residents.
The telephone number is 602-364-4500. Outside the Phoenix metropolitan area, the toll-free information line number is 800-314-9243.
Recorded information on the line will be updated regularly throughout flu season in both English and Spanish. Information includes updates on the vaccine shortage, the high-risk groups that should receive the vaccine this year, and other information about the flu including its symptoms and steps people can take to avoid getting the flu. The Arizona Department of Health Services (ADHS) provides this information service.
On Thursday, December 16, a Rural Health Telemedicine Roundtable will take up influenza issues from 8:30-9:30 a.m. The videoconference in Tucson and Phoenix will also be linked to Douglas, Flagstaff Ganado, Polacca, Tuba City, Whiteriver, and Springerville. This is a tentative list. If you wish to participate from other sites on the Arizona Telemedicine or NARHBA networks, please contact Leila Barraza at 520-626-7946, ext. 246. The roundtable is sponsored by ADHS, the Arizona Telemedicine Program and the Rural Health Office.
Awards Made at Annual AzPHA Meeting
The Arizona Public Health Association (AzPHA) honored extraordinary achievements at its September meeting. Kevin Driesen was presented with the Andrew W. Nichols Award for his pivotal role in border health issues.
AzPHA has launched a redesigned website as part of its ongoing efforts in education and advocacy. APHA advocates for public health issues, fosters professional development, supports incubator opportunities for emerging public health issues, and promotes public health awareness. The site lists upcoming events, relevant publications, scholarships, membership and award information. Click here to go to the site.
Results from Rural Health Briefing Survey
An October survey asked readers of the Rural Health Briefing to give feedback on the length of notices and issue frequency of the electronic publication. From a total subscriber list of over 600, 37 responses were received. 30 people said the length and number of the news items were about right while 4 people replied that there were too many items and they were too long. On the frequency of the Briefing, 4 replied that it was too often, 29 that it was often enough and 1 answered, not often enough. We send our thanks to all those who replied.
Grants and Opportunities
Rural Wireless Community Vision Program
Deadline: December 1, 2004
USDA is offering grants to accelerate access to advanced wireless telecommunications across rural America. The VISION Program brings the FCC’s Wireless Communications Bureau knowledge of regulatory and technical issues and the USDA-RUS Telecommunications Program’s expertise in financing projects directly to America’s heartland.
Rural communities will be chosen to participate in the VISION Program on the basis of a two to five page VISION Essay that describes the community’s vision for wireless connectivity and services and how the community will benefit from this vision.
Details here. Or contact Nancy Plon, 202-418-2899.
New Access Points for Community Health Centers
Deadlines: December 1, 2004 and May 23, 2005
This program will support the establishment of new service delivery sites for each type of Community Health Center funded under Section 330 of the Public Health Service Act. Each application for support to establish a new site must identify a population in need of primary health care services, and propose a specific plan to increase access to care and reduce disparities identified in the population or community to be served. Public and non-profit private entities, including tribal, faith-based and community-based organizations can qualify. Details here. Or contact Tonya Bowers at 301-594-4300.
Pediatric Health and Nutrition Programs
Deadline: December 1, 2004
The Gerber Foundation provides funding for national and regional programs that have a significant impact on issues facing infants and young children. The Foundation supports programs in the areas of pediatric health, pediatric nutrition, and nutrient competitors (environmental hazards). Applicants should first submit a letter of intent. Details: http://www.gerberfoundation.org/
Nursing Workforce Diversity Grants
Deadline: December 3, 2004
Grants are awarded to increase nursing education opportunities for individuals from disadvantaged backgrounds (including racial and ethnic minorities underrepresented among registered nurses) by providing student scholarships or stipends, pre-entry preparation, and retention activities. Eligible applicants are: schools of nursing, nursing centers, academic health centers, State or local governments, an Indian Tribe or Tribal organizations, other public or private non-profit entities including faith-based organizations and community-based organizations, and for-profit entities capable of carrying out the legislative purpose. Details here. Or contact E. Michele Richardson, 301-443-6193.
New Provider Practicum in Migrant Health
Deadline: December 31, 2004
The Practicum provides a four-month working and learning experience in a Migrant Health Center. The purpose of the Practicum is to increase the understanding of migrant health care issues for the participants as they consider careers working with underserved populations. Students or graduates of a Physician Assistant, Nurse Practitioner, Nurse-Midwife, or Dental Hygienist program in good standing, with expected graduation by June 15, 2005 are eligible. Proficiency in Spanish is required. The stipends are up to $15,000. Click here for details or call Candace Kugel at 814-238-6566.
HRSA 2005 Funding Review (repeated from October Rural Health Briefing)
HRSA has released application guidance preview information for a range of 2005 competitive grant programs including several in rural health. Further details can be found at ftp://ftp.hrsa.gov/guidance05/preview.pdf. Note: The programs are not included in the current Federal budget for FY 2005. Potential applicants for these funds should consider this announcement provisional until final Congressional action on appropriations is taken.
(a) Rural Emergency Medical Service Training and Assistance Program (REMSTEP)
HRSA-05-116
Application deadline: January 10, 2005 (Application available on November 10)
The REMSTEP program seeks to fund entities that propose to develop improved emergency medical services in rural areas. To be eligible, the entity must be located in or serve residents of a non-metropolitan statistical area, an area designated as a rural area by any law or State regulation, or the most recently published Goldsmith Modification.
For further information, contact Blanca Fuertes, 301-443-0835.
(b) Public Access Defibrillation Demonstration Projects (PADDP)
HRSA-05-006
Application deadline: January 10, 2005 (Application available on November 10)
This program will support projects that will increase public access to emergency medical services and devices. Applications will be evaluated based on how well the project: (1) demonstrates the greatest community need for services and programs, (2) uses innovative, comprehensive, community-based public access to defibrillation, or (3) proposed an effective mechanism for the collection of data regarding resuscitation, defibrillation, and survival rates within the setting served by the project.
For further information, contact Blanca Fuertes, 301-443-0835.
(c) One Year Rural Health Research Grant Program
HRSA-05-005
Application deadline: March 11, 2005 (Application available on January 14, 2005)
Recipients of these grants will conduct and disseminate policy-relevant research on issues of national significance in the area of rural health services. Recipients will examine critical issues facing rural communities in their quest to secure adequate, affordable, high quality health services. Research findings will be of interest to national, state and local decision makers with concerns about rural communities.
For further information, contact Nisha Patel, 301-443-0835.
Rural Community Development Initiative
Deadline: January 25, 2005
These grants will be made to qualified intermediary organizations (including tribal) that will provide financial and technical assistance to recipients to develop their capacity and ability to undertake projects related to housing, community facilities, or community and economic development. Definitions that describe eligible organizations and other key terms are listed on the program website. Details here. Or contact William Kenney, 202-720- 1506.
Nominations for Jonathan Mann Award for Global Health and Human Rights
Deadline: January 31, 2005
The Jonathan Mann Award for Global Health and Human Rights is presented annually to honor a leading practitioner in health and human rights, and to help call attention to the vital links between health and human rights. The award will be presented to a practitioner in health and human rights, be it an individual or organization. The award is a substantial cash prize and is intended to allow its recipients a measure of freedom to pursue their work in the area of global health and human rights.
The review committee will be sure that individuals and organizations working at the grassroots level are given the same attention and opportunities of those operating at the national or international level.
Details here.
Robert Wood Johnson Executive Nurse Fellows Program
Deadline: February 1, 2005
This program offers leadership development for nurses who have senior executive roles in health services, public health, and nursing education and who aspire to help shape the U.S. health care system of the future. The three-year fellowships offer participants the experiences, insights, competencies, and skills necessary for executive leadership positions in a health care system undergoing unprecedented change. Apply online by clicking here.
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 or follow links at Arizona Legislature.
Important Links
Editor's Note: This online newsletter is a project of the Arizona Rural Hospital Flexibility Program, housed in the Rural Health Office at the Mel and Enid Zuckerman Arizona College of Public Health, and supported through a grant from HRSA (Office of Rural Health Policy). The Rural Hospital Flexibility Program was created by Congress to improve the financial viability and stability of health care in rural areas, including creation of a new designation for rural hospitals as Critical Access Hospitals (CAHs). Designated CAHs are eligible for cost-based reimbursement for services provided to Medicare patients. In some states, including Arizona, additional reimbursement is also available for CAH services provided to Medicaid patients.
Your comments, editorial suggestions, and discerning questions are welcome. Please send them as well as address changes to Jim Laukes, Editor, Rural Health Briefing.
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