$13.7 million bonus to state for increased Medicaid enrollment

Colorado will receive a $13.7 million performance bonus from the Department of Health and Human Services for increasing children's enrollment in Medicaid. To qualify for the bonus, Colorado had to show it implemented at least five of eight recommended enrollment simplification policies and that it met a target for increasing enrollment. Read more about the performance bonuses and Colorado's efforts.

Work on health insurance exchange in Colorado continues

One component of federal health reform is the development of health insurance exchanges, organizations that individuals and small businesses can use to shop for insurance plans and to access federal subsidies. A recent Denver Post article provides an overview of Colorado's efforts to develop an exchange and the steps that lie ahead in 2011.

Securing High Quality Health Care in Rural America: The Impetus for Change in the ACA

The Affordable Care Act calls for the development of a National Health Care Quality Strategy and Plan that will affect millions of healthcare consumers and providers in rural areas and across the country. A new report by the Rural Policy Research Institute, Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act, focuses on rural considerations that should be addressed in this quality strategy to ensure full participation by and inclusion of rural providers and communities.

Study maps need for kids’ doctors in rural areas

Today’s Denver Post highlights a recent study that shows the need for pediatricians and family practitioners in rural areas. The study found that while the number of pediatricians and family physicians have outpaced increases in the U.S. child population, the distribution of primary care doctors for children is uneven. Using national data to calculate the per-child supply of working pediatricians and family physicians in geographic regions, low-supply regions were mostly rural. Read the article.

December Revenue Forecast

The Office of State Planning & Budgeting  and the Colorado Legislative Council Staff released their budget revenue forecasts today. Both forecasts indicate that Colorado’s economy is recovering slowly and neither report indicate much change from the September forecast. Revenues are forecast to increase slightly, providing enough General Fund revenue to fully fund budgeted appropriations in FY 2010-11, but revenue will be $137.0 million short of the amount needed to fully fund the 4.0 percent reserve required by law. The loss of one-time federal stimulus funds, particularly $67.2 million in Medicaid funds, may increase this amount to $204.2 million. FY2011-2012 continues to present significant fiscal challenges, with estimates up to a $1 billion shortfall due to increased enrollment in state programs and reduced federal stimulus funds. Read the OSPB and CLCS reports. 

Register for NRHA’s Rural Health Policy Institute in Washington DC, January 24-26

Join rural healthcare providers and advocates in Washington DC at NRHA’s Rural Health Policy Institute from January 24-26. Meet Colorado’s Congressional members and learn about important federal issues that will impact rural health. Discount registration ends on December 27. Learn more and register online.

President signs bill to delay Medicare cuts

President Obama signed legislation that delays for one year a cut in Medicare payments to physicians that was scheduled to take effect on January 1, 2011. Advocates and lawmakers hope to take advantage of the one-year delay to develop a sustainable solution to the Medicare payment formula.

State releases health reform implementation road map

The Governor's Office has prepared an initial assessment of the work completed and the tasks ahead as Colorado addresses health reform and the Affordable Care Act. Implementing Health Care Reform: A Roadmap for Colorado identifies key issues and opportunities for Colorado and provides information for all Coloradans to better understand the many pieces of federal health reform legislation and the state's role in implementing them.

Congress approves 12-month Medicare ‘doc-fix’, rural provisions extended

Today the House approved the Senate’s plan to avoid a scheduled 25% cut in physician Medicare payments, extending current payment rates until January 1, 2012. The approved legislation also extended several provisions in Medicare that benefit rural providers. Read NRHA’s report on the agreement and rural provisions.

Congress reaching agreement on avoiding Medicare cuts

Republican and Democratic Senate leaders have announced a plan that eliminates the 25% cut in Medicare physician payments that is scheduled for January 1 and extends current rates for a year, giving Congress time to work on a sustainable solution. The plan still needs to be approved by Congress and signed by the President. Lawmakers are proposing a tightening of the rules on tax credits in the healthcare law to finance this measure. Read more.

Colorado drops to 13th in health rankings, high geographic health disparities found

As reported in today’s Denver Business Journal, Colorado fell five places to 13th among states in the latest edition of America’s Health Rankings. The annual rankings, published jointly by the United Health Foundation, the American Public Health Association and Partnership for Prevention, placed Colorado ahead of most other states for its low rates of cancer, obesity, cardiovascular death, and preventable hospitalizations but found the state to be lagging behind others in immunization coverage and with high geographic health disparities. Check out the state rankings and learn more about the measures. 

CMS Hosting Listening Session on December 10: Health Care Delivery System Reform

The Centers for Medicare & Medicaid Services (CMS) is hosting a listening session on Friday, December 10 from 9:00-11:00am on Health Care Delivery System Reform, co-hosted by Health and Human Services Regional Director Marguerite Salazar and CMS Regional Administrator Jeff Hinson. The session will be at The Children’s Hospital in Aurora and will highlight three areas: The Accountable Care Organization Shared Savings Program; The Center for Medicare and Medicaid Innovation; and The Federal Coordinated Health Care Office. Participants will learn what CMS is doing in these three areas and also have an opportunity to make oral statements. 

Seating is limited and will be based on a first come, first served basis. Those interested in attending must register no later than close of business on Wednesday, December 8th. Click here to register. For more information go to CMS's website or contact the CMS Denver office at 303.844.7130.

House approves one-month Medicare payment extension

This afternoon the House approved a bill passed by the Senate earlier this month that postpones a 23 percent cut in Medicare physician payments that was scheduled to take effect December 1. The president is expected to sign the bill. The legislation freezes current rates for services provided through December 31, giving Congress additional time to craft a longer-term solution to the formula used to determine Medicare physician payments.

Colorado's rural ambulance services under pressure

Today’s Denver Post highlights ambulance services in several rural counties and how they are trying to address falling revenue and budget cuts while also providing critical emergency services for their communities. Read the article. 

Join the National Summit on Advancing Health through Nursing webcast on November 30

The Colorado Center for Nursing Excellence and AARP invite you to attend a special meeting on Tuesday, November 30 for a facilitated webcast of the National Summit on Advancing Health through Nursing. The meeting will provide more information about the Institute of Medicine and Robert Wood Johnson Foundation recommendations on the “Future of Nursing” and will allow leaders across Colorado to discuss the recommendations and their implications. The program is from 8:00-11:30am and will be held at AARP's Denver office at 303 E. 17th Avenue Suite 510. For more information and to RSVP, contact Wendy Krzeczowski at Wendy@coloradonursingcenter.org or 303.715.0343 x18.

Colorado Health Professions Workforce Policy Collaborative releases 2011 policy agenda

Read and download the recently released 2011 policy recommendations of the Colorado Health Professions Workforce Policy Collaborative. Created in 2008 through support by The Colorado Trust and convened by the Colorado Rural Health Center, the Collaborative brings together a multidisciplinary group of policy leaders, health care providers, educational institutions, economic development, and workforce planning authorities to better understand the complex nature of healthcare workforce policy and to develop and support effective changes. This year’s policy recommendations “Addressing Colorado’s Primary Care Provider Shortage” span across healthcare professions and provide evidence-based and actionable steps that state policymakers can take to ensure Colorado will have the healthcare workforce that it needs.

Senate approves one-month Medicare rate extension

On Thursday, November 18 the U.S. Senate passed a one-month extension of the current Medicare physician payment rates in an effort to avert a 23 percent cut scheduled to take effect Dec. 1. Now the U.S. House must approve the extension, which is intended to give lawmakers additional time to work out a longer-term solution. The House should take up the measure on November 29. Stay tuned for more news and thanks to all who contacted their elected officials last week on this important issue.

Challenges facing Colorado's nurse practitioners

An article in today's Denver Post highlights the challenges that Colorado's advance practice nurses face in being credentialed and reimbursed by insurance companies.

Calls needed to stop looming Medicare cuts

Congress is back in session and needs to act now to avoid a 23 percent Medicare payment cut that is scheduled for December 1 (with another 2 percent cut following on January 1). These cuts will greatly impact rural residents, as there is a larger portion of elderly living in our rural areas already dealing with provider shortages, and rural healthcare providers who are struggling to cover their costs and care for our communities. The American Medical Association (AMA) and the U.S. Health and Human Services Department are supporting a 13-month halt to any cuts while Congress works on creating a more permanent solution to Medicare funding for physicians.

Please consider contacting Senator Udall, Senator Bennett, and your 2010 member of Congress this week and ask them to avoid these Medicare cuts!

Senator Mark Udall: 202-224-5941; 303-650-7820
Senator Michael Bennett: 202-224-5852; 303-455-7600

Representative Diana DeGette: 202-225-4431; 303-844-4988
Representative Jared Polis: 202-225-2161; 303-484-9596
Representative John Salazar: 202-225-4761; 970-245-7107
Representative Betsy Markey: 202-225-4676; 970-221-7110
Representative Doug Lamborn: 202-225-4422; 719-520-0055
Representative Mike Coffman: 202-225-7882; 720-283-9772
Representative Ed Perlmutter: 202-225-2645; 303-274-7944

You can also use the AMA’s Patient Action Network by calling 888-434-6200 (you will need to submit your zip code). Not sure who represents you in Congress? Click here.

Medicare Updates: 2011 OPPS Final Rule, Physician Payments and the SGR

Earlier this month, the Centers for Medicare and Medicaid (CMS) issued final rules updating Medicare policies and rates for 2011, including several changes relating to physician supervision that impact rural providers. Read more about these changes as well as other components of the final rule. Some of the highlights include:

• Delayed the enforcement of supervision requirements for outpatient therapeutic services in both critical access hospitals (CAHs) and small rural hospitals through calendar year 2011
• Changed definition of “immediately available”
• Finalized a proposal for 16 services requiring direct supervision by a physician or non-physician practitioner during an initiation period, followed by ‘general’ supervision for the reminder of the service
• Announcement that CMS will convene a panel in 2012 to review supervision requirements for all outpatient services

While we’re on the topic of Medicare, as Rural Voice readers recall from last week’s post, Medicare physician payments will be cut by 23% beginning December 1 without congressional action. Why so high? In very oversimplified terms, the formula used to determine Medicare payments, the Sustainable Growth Rate (SGR), ties Medicare physician payments to factors related to the overall national economy. Put another way, SGR says the growth in payments per Medicare beneficiary cannot grow more than the economy as a whole…and slower economic growth requires lowering physician payments to control Medicare costs. Reimbursements were cut in 2002 but since that time payment reductions have been postponed (and been accumulating) while SGR remains in place. Many organizations and individuals will be calling on Congress next week to take action to avert these cuts and create a more stable, sustainable method for determining physician payments. Stay tuned for opportunities to contact your congressperson next week to share your concerns about potential Medicare cuts and what they will mean for rural communities and providers. 

Want to learn more about SGR and how Medicare pays physicians? Check out this policy brief by Health Affairs that summarizes the issues and possible solutions.

Share your ideas and priorities on rural public health for Rural Healthy People 2020

Complete a brief, online survey to assist rural health policy makers and researchers in identifying the most important health issues facing rural residents. The project, Rural Healthy People 2020, is designed to identify the most significant preventable threats to the health of rural people and to establish goals for reducing these threats. The survey should take 5-10 minutes to complete and does not require a professional background in health issues.

Rural Healthy People 2020 is an important companion document and resource to Healthy People 2020, a national framework for health and prevention. You can find a good article on the 2020 initiative written by Kim Krisberg in the American Public Health Association's The Nation's Health.

Federal Health Reform Accounts for Less than 5% of Rate Increases in Colorado

In response to speculation about the effects of federal healthcare reform on health insurance premiums in Colorado, the Division of Insurance, lead by Insurance Commissioner Marcy Morrison, conducted an analysis of recent rates and found that “while federal changes have minimally affected premium costs, numerous other factors are more significant across the board”. Read the news release from the Division of Insurance and learn more about factors which are driving healthcare insurance rate increases.

Looking ahead...but not too far

By now most of us have probably learned about the outcomes of yesterday’s election. In Washington, the House of Representatives will be Republican-controlled beginning January 2011 and Democrats will have a narrower margin in the U.S. Senate. Colorado voters will send Michael Bennett (D) back to the Senate for another term. Re-elected Representatives Mike Coffman (R), Diana DeGette (D), Doug Lamborn (R), Ed Perlmutter (D), and Jared Polis (D) will be joined in January by the newly elected Cory Gardner (R) and Scott Tipton (R).

But there’s work left to be done this year in Washington. Lawmakers will return to D.C. later this month for a post-election “lame duck” session and they will have a lot on their plates. On the agenda are spending bills for most government programs (including important rural and workforce provisions) and addressing a 23.6% Medicare payment cut for physicians that is scheduled to begin on December 1. National organizations are already mobilizing and we will keep you informed of opportunities to contact your member of Congress about these important healthcare issues.  

Back here in Colorado, voters rejected several tax cutting initiatives including Amendment 60, 61, and Proposition 101 as well as Amendment 63. Republicans appear to have taken a majority in the State House, the Democrats have maintained their majority in the State Senate, and John Hickenlooper (D) is the Governor-elect. With our state facing significant revenue shortfalls, FY 2011-12 budget briefings and hearings are scheduled to begin later this month.

Read a complete list of Colorado’s election results. And thanks for voting!

Governor Ritter’s FY2011-12 proposed budget released

In the midst of election activities (more to come on that later), Governor Ritter released his proposed budget plan for fiscal year 2011-2012.  Addressing a shortfall of over $714 million, the proposal includes targeted reductions in Medicaid and Children’s Basic Health Plan (CHP+), payment delays for Medicaid providers, and also a reduction in scheduled provider fee payments to hospitals. No direct cuts to Medicaid provider rates were proposed, however the payment delays and other proposed reductions will negatively impact Medicaid providers. This proposal is not yet final, as the Legislature and Governor-elect John Hickenlooper can make changes to the budget. CRHC will continue to monitor the budget process for opportunities to advocate on behalf of rural healthcare and share updates as they unfold. I welcome your feedback on budget issues—send me an email at ss@coruralhealth.org. 

New report features Colorado clinics using non-physician clinicians

A new report by the Colorado Health Institute provides case studies of clinics throughout Colorado that utilize interdisciplinary collaborative models for the provision of primary care. Working under physician supervision or independently (depending on their training and practice setting), nurse practitioners, certified nurse midwives, and physician assistants are providing a range of primary care services to patients. Read the report "Collaborative Models of Primary Care: Case Studies in Colorado Innovation". 

Family Medicine Residency Training in Rural Locations

A survey of U.S. family medicine residency programs found that 33 rural programs account for over 80% of family medicine training occurring in rural sites. Published by the WWAMI Rural Health Research Center, the report includes responses from family medicine residency programs about their rural training programs and provides policy recommendations to encourage the growth of medical training that supports rural primary care. Read the full report.

Other health clinics need support, too

The Denver Post published Colorado Rural Health Center CEO Lou Ann Wilroy’s letter “Other health clinics need support, too” in response to an article on the state’s rural safety-net clinics.

Health Insurance Exchange Forums this week in Colorado Springs and Greeley

Public forums on health insurance exchanges will be held this week--on Tuesday, October 26 in Colorado Springs at the Pikes Peak Regional Development Center, located at 2880 International Circle and on Friday, October 29 in Greeley at the Panorama Room of the UNC University Center, located at 2045 10th Avenue. Both forums will be held from 10:00 a.m.-12:00 p.m. Information on these meetings as well as materials and minutes from previous forums are available on the state's Exchange Forums website.  

As part of the Affordable Care Act, states are responsible for developing health insurance exchanges. The exchanges will be virtual marketplaces where Coloradans will be able to obtain information to select and purchase health insurance plans and determine eligibility for federal subsidies and tax credits. The Colorado Coalition for the Medically Underserved, the Colorado Consumer Health Initiative, and the state's Health Reform Implementation Board have been hosting a series of community forums across Colorado to discus the options for our state and collect input from stakeholders and communities. 

Governor announces additional cuts to re-balance budget

Facing an shortfall of about $261.7 million in FY 2010-11, Governor Ritter released a budget re-balancing plan totaling $296.5 million. Proposed health-related items in the plan include a three week provider payment delay for fee-for-service Medicaid providers. More information on the proposed provider payment delay, including a provider payment schedule, is available on the Department of Health Care Policy and Financing website. 


More budget news is on the horizon. The Governor will present his FY 2011-12 balanced budget request on November 1, anticipating an estimated $1.1 billion shortfall for the year beginning July 1, 2011. Additional budget cuts for FY 2010-11 may be needed following December’s revenue forecast. 

Impact of Amendment 60, 61, and Proposition 101 on healthcare in rural communities

If passed, Amendment 60, 61, and Proposition 101 will have dire consequences for healthcare across Colorado, especially in rural communities. The Bell Policy Center has written an article on how these ballot initiatives will directly impact three rural hospital districts in Garfield, Huerfano, and Yuma counties, severely limiting their abilities to maintain facilities and provide services. Read the article and download fact sheets for these three counties. For information on how these initiatives will impact other Colorado counties, visit Looking Forward.  

Don't forget to cast your ballot--by early voting, by mail, or at the polls on November 2. Read the Secretary of State's 2010 Voter's Guide for more information. 

Health Reform Hits Main Street

Looking for an easy-to-understand source for learning more about the health reform law? The Kaiser Family Foundation has produced a short, animated movie that explains some of the concerns about the current healthcare system, the changes that are happening now, and the changes to come in 2014. 

California Court Approves CRNA Opt Out

The California Superior Court in San Francisco has upheld Gov. Arnold Schwarzenegger's June 2009 decision to opt out of the federal physician supervision rule for certified registered nurse anesthetists (CRNA).  The presiding judge ruled that California state law does not specifically require CRNAs to be supervised by physicians when administering anesthesia, and therefore Gov. Schwarzenegger was within his rights to opt out of the federal rule.

Colorado’s Governor Ritter opted-out of the CRNA Medicare supervision requirement in rural and Critical Access Hospitals in September, becoming one of fifteen states that have opted out of the requirement. The Colorado Society of Anesthesiologists and the Colorado Medical Society filed suit in Denver District Court to block Governor Ritter’s opt-out decision and this legal challenge is still pending.

CRHC congratulates California on this important victory and applauds the Colorado advocates of CRNA opt-out, including the Colorado Hospital Association, Colorado Nurses Association, Colorado Association of Nurse Anesthetists, and many individuals and healthcare providers who all support this effort. 

Denver Post Article Discusses Amendment 63

The Colorado Rural Health Center (CRHC) is mentioned in an article in today's Denver Post as one of several members of Colorado’s medical community that is opposed to Amendment 63. This confusing and costly amendment would alter the state’s constitution to block Colorado from adopting federal health reform legislation that requires individuals to have health insurance coverage. While not taking a position on the individual mandate issue, CRHC opposes Amendment 63 and does not believe a constitutional amendment is the appropriate way to address this issue. Read more about CRHC’s positions on the November ballot measures. 

CRNA Opt-Out Update

Last month Governor Ritter exercised the option to exempt Colorado’s Critical Access Hospitals and rural hospitals from the Medicare requirement that certified registered nurse anesthetists be supervised by a physician, joining 15 other states that have already opted-out of the requirement. Both the Colorado Board of Nursing and the Colorado Medical Board voted on and supported the CRNA opt-out and a study found that opting out of the oversight requirement did not diminish quality of care or threaten patient safety. The Colorado Society of Anesthesiologists and the Colorado Medical Society filed suit to block Governor Ritter’s decision and this legal challenge is still pending.

CRHC thanks the many individuals and organizations who support this effort to improve access to healthcare in rural Colorado and have worked tirelessly toward the opt-out decision, including the Colorado Hospital Association and the Colorado Nurses Association. The Rural Voice will continue to update readers on this important issue. 

Department of Insurance to Assist on Child-Only Policies

Colorado’s Department of Insurance announced yesterday that it will assist families with finding “child-only” health insurance policies. Federal health legislation that took effect on September 23, 2010 prohibits insurers from denying coverage to children based on pre-existing conditions. Read the Department’s updates on Child-Only policies.  

Navigating Health Reform Implementation

Confused about what is in the Patient Protection and Affordable Care Act of 2010 and how it will be implemented? While the Act’s four major components — market reforms, state health insurance exchanges, Medicaid expansions, and employer and individual responsibility provisions — do not take effect until January 1, 2014, other aspects of the legislation have already taken effect or will be soon. Two resources for information are the Kaiser Health Reform Gateway, sponsored by the Kaiser Family Foundation, and Health Reform GPS, a joint project of the Robert Wood Johnson Foundation and George Washington University's School of Public Health and Health Services. 

Know the Issues for November 2!

Coloradans will be heading to the polls (or mailing in their ballots) in just over a month—get ready. 

The Colorado Legislative Council has published The Blue Book, a detailed analysis of each of the ballot initiatives. CRHC is opposing Amendment 60, Amendment 61, and Proposition 101 along with a growing coalition of organizations. Please visit Don’t Hurt Colorado for more information. CRHC also opposes Amendment 63, Health Care Choice. To learn more about Amendment 63, go to www.NoOnAmendment63.com. 

Don't forget! Voter registration ends on October 4, be sure to register or update your voter registration.

Legal challenge issued in response to Governor Ritter’s CRNA opt-out

The Denver Post featured an article today about the Colorado Society of Anesthesiologists and the Colorado Medical Society filing a suit in Denver District Court on Tuesday, September 28 to block Governor Ritter’s decision to opt-out of the certified registered nurse anesthetist Medicare supervision requirement in rural and Critical Access Hospitals. 

Colorado awarded over $6.7 million to strengthen healthcare workforce

Congratulations to the Colorado recipients of recently-announced HHS grant awards to expand and support the state's healthcare workforce. Below is a listing of Colorado grantees, programs, and amounts awarded.

Expansion of Physician Assistant Training Program

University of Colorado Denver – Aurora: $855,360

State of Colorado for Red Rocks Community College – Lakewood: $399,495

Nurse Managed Health Clinics

University of Colorado Denver – Aurora: $1,498,206

Primary Care Residency Expansion

Regents of the University of Colorado – Aurora: $1,920,000

University of Colorado Denver – Aurora: $1,920,000

State Health Care Workforce Grants: Planning

Colorado Department of Public Health and Environment – Denver: $150,000

Governor Ritter Signs Opt-Out for CRNA Supervision

Today Governor Ritter took an important step in preserving and improving access to quality, safe, and affordable healthcare services in Colorado by opting-out of the certified registered nurse anesthetist (CRNA) Medicare supervision requirement in rural and Critical Access Hospitals. Read the Governor's press release.

CRHC has long supported the opt-out of the Medicare requirement for CRNAs to be directly supervised by the attending physician, dentist or podiatrist, which adds another barrier to accessing healthcare for rural residents. Opting-out also gives hospitals the flexibility to structure their anesthesia services around the needs of their communities and patients. With today’s action, Colorado joins 15 other states that have already opted-out of this requirement. CRHC applauds Governor Ritter for helping increase access to care for rural Coloradans. Thanks to everyone who took action in support of this important issue.

Getting Started...

Hello from CRHC's new Policy Analyst! A big thanks goes to Terri Hurst for her expert guidance and leadership in this role and I wish her well in her new position.

A little bit about myself...I came to CRHC in May as a recruitment coordinator with Colorado Provider Recruitment, assisting rural and underserved communities in recruiting and retaining healthcare professionals. Prior to relocating to Colorado with my family and joining CRHC, I worked in managed care and program planning at the University of Chicago Medical Center and earned my Master’s Degree in health administration and policy from the University of Chicago. I also served as policy/advocacy coordinator for several years with the AIDS Foundation of Chicago.

I welcome your feedback and input on The Rural Voice and look forward to working with you to ensure that every Coloradan has access to quality healthcare services. We have much to do in the year ahead and I'm excited to get started!

Are Rural Health Clinics Part of the Rural Safety Net?

A report that highlights the importance of Rural Health Clinics (RHCs) to the healthcare safety net was just released today. Published by the Maine Rural Health Research Center, this policy breif entitled, Are Rural Health Clinics Part of the Rural Safety Net? highlights the importance of RHCs in providing primary care services in rural areas. In particular, in communities without a Community Health Center (CHC), RHCs provide a majority of care to those insured by Medicaid & CHP. The report also highlights the lack of funding and resources for RHCs, as they have been left out of funding from both the stimulus bill and federal health reform. While there are measures in the federal health reform law to incentivize RHCs to collaborate with CHCs, RHCs in and of themselves have been largely overlooked as part of the healthcare safety net. Read the full report by clicking HERE.

September Revenue Forecast

The September Revenue Forecast was released today by both the Office of State Planning & Budgeting and the Colorado Legislative Council Staff. While the numbers vary slightly in both of the forecasts, one thing is certain.......Colorado state services will continue to experience cuts as the state is facing a shortfall from projected revenue. For our current fiscal year, FY10-11, Colorado is upwards of $257 million short, which means future cuts are on the horizon. The cuts may not tally as high as $257 million as there are many factors at play, though $257 million appears to be the ceiling, at least for now. For FY11-12, which doesn't even start until July 1, 2011, and for which the budget hasn't even been created yet; the state is expected to be upwards of $1.1 billion short. FY11-12 is going to be tough fiscally for the state as federal assistance through the stimulus package & FMAP extension will not be available anymore.

The next budget revenue forecast will be released in December. Even though it's only September, my wish for the upcoming holiday season (and next revenue forecast) is that our state does not have to continue cutting an already meager budget.

CRHC Opposes Amendment 63!

Coloradans will have 9 state ballot measures to vote on this November. CRHC has already taken a position of opposition and urges you to vote no on Amendment 60, Amendment 61, and Proposition 101. These anti-tax measures would end state funding for public schools, diminish funding for EMTS services, and basically stop any future infrastructure (roads, bridges, schools, etc) from happening. For more information on these measures, please visit Don't Hurt Colorado.

CRHC has now officially taken a position of opposition on Amendment 63, which is entitled Health Care Choice. This amendment would amend the state constitution to block Colorado from adopting federal legislation passed earlier this year through the Patient Protection and Affordable Care Act to require all U.S. citizens to get health insurance coverage. CRHC does not believe that a constitutional amendment is the appropriate solution to this issue. Colorado's constitution is four times longer than the U.S. Constitution and adding an amendment like Amendment 63 will not actually impact or override the federal law. CRHC has not taken a position of opposition or support regarding the individual insurance coverage mandate, but urges you to vote NO on Amendment 63 as it is not a substantive and constructive alternative!!!

The Colorado Legislative Council has published The Blue Book, where you can read each of the ballot initiatives, read the pros & cons of each side, and educate yourself on these issues prior to arriving at the voting booth in November. CRHC will be posting more information about these ballot measures and more as we get closer to the elections. Stay tuned......

My Aloha from CRHC......

It is with much sadness and excitement that this issue of The Rural Voice will be the last that is published by yours truly. After two and a half years, I am leaving CRHC and will be the Director of Public Policy at the Colorado Behavioral Healthcare Council. It has been an absolute pleasure working at CRHC and for all of you, as we have worked hard to improve access to healthcare services for those who call rural Colorado home. CRHC will continue to be the voice for rural Colorado to ensure that every Coloradan has access to quality healthcare services.

If you need further assistance or have any policy questions, please contact Cari Fouts, Director of Communication & Development, at cf@coruralhealth.org

Denver Post Supports CRNA Opt-Out

The Denver Post published an editorial today that supports Colorado opting-out of the CRNA Medicare supervision requirement. My previous two blog posts provide more information on this issue and I encourage you to read them if you are not familiar with this issue. In the meantime, we are anxiously awaiting Governor Ritter's decision, which will hopefully come in the next week or so.

NY Times Editorial: Who Should Provide Anesthesia Care?

Is this perfect timing or what!? The New York Times featured an editorial yesterday discussing the Certified Registered Nurse Anesthetist (CRNA) supervision opt-out issue (see my Sept. 2nd post for more information). The editorial highlights two reports that have concluded patient safety and quality has not been compromised in the 14 states that have opted-out of the Medicare supervision requirement (California chose to opt-out last year, making it 15 states altogether). In fact using CRNA's to deliver anesthsia services is more cost-effective and is a more feasible option for rural hospitals.

Let's hope Governor Ritter makes Colorado the 16th state to opt-out.

Urge Governor Ritter to Improve Access to Healthcare Services in Rural Colorado!

Governor Ritter needs to hear from you about opting-out of the certified registered nurse anesthetist (CRNA) Medicare supervision requirement. As you know, CRHC has long supported the opt-out of the Medicare requirement for CRNAs to be directly supervised by the attending physician, dentist or podiatrist, which adds another barrier for rural residents in accessing quality healthcare services. A recent study published in Health Affaris showed that there was no diminished quality of care or threat to patient safety in the 14 states (2005) that had opted-out of the supervision requirement. In fact, the study recommends that CRNA's in every state be allowed to work without the supervision requirement. As of July 2009, 15 states had chosen to opt-out of the supervision requirement.

Recently, both the state Board of Nursing and the Colorado Medical Board voted on and supported the CRNA opt-out. Both respective entities stated that opting-out is consistent with the Nurse Practice Act and the Medical Practice Act. It is now up to Governor Ritter to submit a letter to the Center for Medicare & Medicaid Services (CMS) requesting Colorado be exempted from the supervision requirement.

If you have minute, please call the Governor at (303) 866-2471 and urge him to opt-out of the CRNA supervision requirement.

There are 42 rural hospitals in Colorado. Of those 4 do not provide anesthesia services at all. Of the remaining 38 that provide anesthesia services:
• 5 provide anesthesia services using physician anesthesiologists ONLY
• 9 provide anesthesia services using a combination of part time anesthesiologists and part time CRNAs
• 24 provide anesthesia services using CRNA’s ONLY and do not have anesthesiologists on staff.

Opting-out of CRNA supervision will not harm patient safety. It will not diminish the need for physicians and anesthesiologists in the healthcare arena. It WILL help increase access to care for the 700,000 plus residents of our state that call rural Colorado home. Tell Governor Ritter to increase healthcare access for rural residents by opting-out of the CRNA supervision requirement!

Rural Community Hospital Demonstration Program

Health & Human Services Secretary Kathleen Sebelius has announced the expansion of the Rural Community Hospital Demonstration Program. The Demonstration Program began in 2005 as per the Medicare Modernization Act. The pilot originally funded 13 hospitals that were located in 8 sparsely populated states. There are currently ten hospitals still participating in the program. With the passage of the Affordable Care Act, 20 additional hospitals (in 20 additional states, which includes Colorado) may be eligible to participate in the Program. In order for a hospital to be eligible to apply and participate in the Program they must be located in a rural area, have fewer than 51 acute care beds, provide 24-hour emergency care, and not be eligible for nor currently be designated as a Critical Access Hospital. Approximately 3 hospitals in Colorado may have the potential to apply to participate in this Program.

The Demonstration Program tests the feasibility and advisability of providing reasonable cost reimbursement for small rural hospitals. Hospitals selected for participation in the Program will receive payment for inpatient services, with the exclusion of services furnished in a psychiatric or rehabilitation unit that is a distinct part of the hospital, using the following rules:
1. Reasonable cost for covered inpatient services, for discharges occurring in the first cost reporting period on or after the implementation of the program;
2. For subsequent cost reporting periods, the lesser amount of reasonable cost or the previous year’s amount updated by the inpatient prospective payment update factor for that particular cost reporting period.

Mental Health First Aid for Suicide Prevention Webcast 9.10

Did you know that the rate of suicide among rural men is significantly higher than urban men? The rate of suicide among rural women has also been increasing the past few years and research has shown that rural residents are more successful in their suicide attempts due to the prevelance of the use of guns. Join the National Council for Community Behavioral Healthcare on World Suicide Prevention Day for a Mental Health First Aid webinar geared toward suicide prevention on Friday, September 10th from 11a - 12p MST. Learn how you can recognize the symptoms and risk factors that can lead to suicide and tools that can be used to help prevent suicide from happening.

Open Meeting 9.14: CoverColorado Provider Fee Schedule Meeting

CoverColorado, one of Colorado's high risk insurance pools, is restructuring its fee schedule for providers. CoverColorado currently insures approximately 12,000 Coloradans who are unable to obtain insurance from other avenues. In order to ease some of the financial strain CoverColorado has been experiencing, legislation was passed during the 2010 session that allows CoverColorado to create a new fee schedule for reimbursing providers who provide services to those insured through CoverColorado.

CoverColorado is seeking input from providers in regards to the new fee schedule. A meeting is scheduled for Tuesday, September 14th from 4-6pm at the Molly Blank Auditorium at National Jewish Hospital in Denver. Interested individuals who cannot attend the meeting in person may also submit written comments to sbgamble@covercolorado.org.

Please visit the highlighted links for more information on CoverColorado or the Public Meeting set for September 14th.

Colorado Awarded Almost $800,000 for Rural Healthcare Priorities

On Monday, Health & Human Services Secretary, Kathleen Sebelius, announced the awarding of $32 million in grants to support rural health priorities. Congratulations to the Colorado Rural Health Center, which was awarded over $500,000 for the Rural Hospital Flex Program. The Rural Hospital Flex Program supports improvements in healthcare quality in communities served by Critical Access Hospitals (CAHs). CAHs are rural hospitals with fewer than 25 beds that provide critical care to rural and remote areas of our state. There are 29 CAHs throughout Colorado that will benefit from this funding.

Congratulations are also in order to the Plains Medical Center located in Limon, Colorado, that received close to $200,00 for Rural Health Workforce Development.

To see a list of all the awardees, please visit the Health & Human Services website or click here.

The Colorado Health Foundation Blog on 60, 61 and 101

Shepard Nevel, Vice President for Policy and Operations at the Colorado Health Foundation, published an excellent post on the negative impact Amendment 60, 61 and Proposition 101 would have on healthcare services in Colorado.

The Colorado Rural Health Center is one of many organizations opposed to these three ballot measures. Please visit Looking Forward Colorado to learn more about the impact these ballot initiatives would have on Colorado.

Safety-Net Facilities Improvement Grants

The Kresge Foundation, based in Michigan, is accepting grant applications on an on-going basis for safety-net facilities to improve their infrastructure. It is a challenge grant, so there are funding requirements (ex: raising a percentage of funding) in order to be eligible for these funds. This is a great opportunity for communities to come together and support Rural Health Clinics, Critical Access Hospitals, and Community Funded Safety Net Clinics since none of these entities received resources for infrastructure through the federal stimulus package.

Please read the following for more information and to link to the grant website:

Safety-net Facility Improvements

This grant opportunity extends Kresge’s long history of awarding challenge grants to organizations conducting capital campaigns for new building construction and facility renovation. In addition to facilities-capital challenge grants, we are increasing our investment in community-based health centers through a variety of funding methods, including program-related investments or below market rate loans.

Clinics that are expanding and/or improving their physical infrastructure in order to increase accessibility, availability, and the quality of services provided to disadvantaged, uninsured and under-insured populations are typically competitive applicants. Anchor organizations that assume a leadership role in facilitating meaningful and relevant community change by strengthening the safety-net or improving their ability to respond to priority community health issues are encouraged to apply. Consideration also is given to projects that are environmentally sustainable and adopt the Green Guide for Health Care.

To apply for facilities capital, visit the challenge grant page for complete information, including letter of inquiry requirements, and to apply online.

Conferences, Conferences, and More Conferences!!

With summer winding down, a large portion of our organizational partners are gearing up for their fall conferences. I've listed some of them below and included links for your convenience. Enjoy!

Progressive 15 - Fall Conference & Candidate Forum
September 16 - 17 at the Fountains of Loveland, Loveland

Action 22 - Annual Conference
September 24 - 25 at the Crowne Plaza Hotel, Colorado Springs

Club 20 - Fall Meeting & Debates
September 10 - 11 at Two Rivers Convention Center, Grand Junction

Colorado Coalition for the Medically Underserved - Annual Conference
Friday, October 8th at The Children's Hospital, Aurora

Federal Medicaid Extension Signed by President Obama

President Obama signed into law the $26 billion jobs bill, which contained funding for the FMAP extension. As previously written about here, the FMAP is the matching funds the federal government provides states to operate Medicaid. This means that Colorado lawmakers will not have to make an estimated $200 million in cuts that would have happened if the FMAP had not been extended. If and when the state will have to make future cuts will become more apparent as 2010 rolls along. The next budget revenue forecast will be released September 20th. With the passage of this bill, Congress is now on recess until the middle of September, so things should be relatively quiet at the federal level. That being said, with primary election results being decided yesterday, stay tuned for the campaigning fun to begin!

HHS Awards $159.1 Million to Support Health Care Workforce Training

Congratulations to all of the Colorado recipients of the Health & Human Services Health Care Workforce Training Grants! Colorado will receive a total of $1.4 million!
These funds will be used to expand training in nursing workforce. Here is a breakdown of who & what was funded in our state:

Advanced Education Nursing Grants
University of Colorado, Denver - Aurora: $315,433.00
University of Colorado, Denver - Aurora: $249,103.00
University of Colorado, Denver - Aurora: $293,049.00

Advanced Education Nursing Traineeship Grants
University of Colorado Health Sciences Center - Aurora: $80,543.00
Regents of The University of Colorado, Colorado Springs: $38,602.00
Regis University, Denver: $164,077.00
University of Northern Colorado, Greeley: $27,745.00

Nurse Education, Practice, Quality and Retention Grants
Chi Colorado Foundation (doing business as St. Mary-Corwin Health Foundation) Pueblo: $195,201.00

Senate Passes FMAP Extenstion - House Expected to Vote this Week

See what happens when I go on vacation.....the Senate finally voted on extending the FMAP! With a vote of 61-39, the Senate approved a slightly scaled back version of the FMAP extension. Beginning in January 2011, the FMAP extension will provide a 3.2%first quarter increase, which is reduced to 1.2% in the second quarter. There are exceptions for states with high unemployment rates (not sure what the definition of "high unemployment rates" is), which will continue to receive the enhanced FMAP without any decrease.

The House, which had began summer recess, has been called back to D.C. and is expected to vote on the bill this week. It is critical that the House pass this legislation or Colorado's current budget will be short approximately $200 million. If you have a minute, please consider calling your Representative and encouraging them to vote yes on extending the FMAP.

Representative Diana DeGette: 202-225-4431
Representative Jared Polis: 202-225-2161
Representative John Salazar: 202-225-4761
Representative Betsy Markey: 202-225-4876
Representative Doug Lamborn: 202-225-4422
Representative Mike Coffman: 202-225-7882
Representative Ed Perlmutter: 202-225-2645

Rural Provisions Appropriated, but still need Congress Approval

The Senate Labor, Health & Human Services, Education and Related Agencies marked up its draft appropriations bill and released a final version July 29th. The bill provides $169.9 billion in discretionary funds for a variety of programs, some of which would be very helpful for rural healthcare consumers & providers. In particular to note is the $5.1 million for the Rural Physician Pipeline program, which was introduced by Colorado Senator Udall. This program was included in the federal health reform bill, but did not receive appropriated funding through the bill. There are a host of other rural friendly & workforce provisions in the bill including funding for primary care training, nurse faculty loan forgiveness, and public health workforce training. You can read more about what was appropriated by clicking HERE.

The big pickle with this bill is that it is not likely to be voted on by Congress until after the elections in November. According to our partners at the National Rural Health Association, Senate Labor-HHS-Education Appropriations Subcommittee Chairman Tom Harkin (D-IA) was quoted as saying, "this bill probably won't see the light of day until December, maybe January." Not promising news........

FMAP Vote to Happen Before 5p Tomorrow

The Senate is expected to vote on the FMAP extension no later than 5p tomorrow. I will be out of town and not able to provide an update until Monday. Fingers crossed that the extension is approved!

FMAP Vote to take place ???????

Looks like the FMAP vote that was allegedly set to take place last night (Monday 8.2) was postponed. The Senate might vote on it tonight. Perhaps tomorrow. No one really knows. Isn't our political system fun!?!?!

On another note, the House is on recess until Tuesday, September 14th. This is a great time to try and meet with your district Representative. As part of Safety Net Clinic Week (Aug. 30th - Sept. 3rd) ClinicNET and CRHC will be reaching out to policy makers and scheduling site visits so that our elected officials learn about the often overlooked healthcare safety net providers: Rural Health Clinics and Community Funded Safety Net Clinics. Please feel free to contact me if you are interested in hosting a site visit.

TCT Video about Colorado Workforce Collaborative

New video features Colorado Workforce Collaborative
Click on the above link to watch a video from The Colorado Trust highlighting some of the issues faced in recruiting and retatining healthcare professionals in rural and underserved areas of Colorado and how the Colorado Health Professions Workforce Collaborative is working to address some of these issues.

Senate Expected to Vote on FMAP Extenstion

Details are foggy right now, but it sounds as if the Senate is expected to vote tonight on extending the FMAP bump to states. As has been previously mentioned here in The Rural Voice, the FMAP is the methodology used by the federal government to provide states funding for the Medicaid program. Prior to the stimulus bill, Colorado was a 50/50 state. For every dollar Colorado spent on Medicaid, the federal government matched that with a dollar. Since the stimulus package went into effect, Colorado's FMAP has been approximately 60/40, which has provided the state some relief. Currently, the big issue facing our state (as well as 20+ other states) is that Colorado crafted the state FY10-11 budget assuming our state would get the FMAP extension that is being voted on tonight. The increased FMAP bump is set to expire at the end of December 2010. If Congress fails to extend this FMAP increase, Colorado will be approximately $200 million short in our current fiscal year, which ends July 31, 2011. This will mean major cuts to state services as we move into 2011.

On a good note, this past weekend the Denver Post reported that revenues for the state are better than expected since last budget revenue forecast. This means the $75 million in cuts that Governor Ritter was set to address this month may not have to happen afterall. Keep your fingers crossed and as always, stay tuned for more budget fun as the next budget revenue forecast will come out in September.

Challenges for Improving Health Care Access in Rural America

Rural Health Research and Policy Centers, funded by the Federal Office of Rural Health Policy, recently released a compendium entitled Challenges for Improving Health Care Access in Rural America.

This compendium is a great tool to continue discussions surrounding healthcare reform and the challenges faced in rural communities as implementation moves forward. As previously stated in The Rural Voice, some of the rural and workforce provisions in federal healthcare reform were authorized, but not funded. This point must not be forgotten as Colorado and the rest of the country move forward with implementation efforts.

CCHI Seeking Healthcare Stories

The Colorado Consumer Health Initiative (CCHI) is seeking stories from rural residents who are having or have had a difficult time finding primary care services in your community. If you or someone you know has had trouble accessing primary care healthcare services and you would like to share your story, please contact Christina Yong at christina@cohealthinitiative.org

Vote No on Proposition 101, Amendment 60, and Amendment 61

As Colorado gears up for elections this November, the Colorado Rural Health Center has decided to oppose a trio of ballot initiatives that would severely impact Colorado's fiscal situation: Proposition 101, Amendment 60 and Amendment 61. If you think the past few years have been tough (keep in mind, our state isn't even close to being finished with budget cuts and I know all of us have been impacted by the current cuts that have occurred) these three ballot measures would severely cripple state and local services.

We encourage all of our members to get the word out and vote no on these! Tell your friends! Contact your elected officials! Vote NO on Proposition 101, Amendment 60 and Amendment 61!!!

During the next few months, CRHC will be providing you more information on these measures or you may visit the Looking Forward website to learn more. You can find county specific data as to how much your county will lose if any of these three passed. You may also sign on to oppose these measures, along with a host of other organizations including our rural partners Club 20, Action 22, and Progressive 15 by visiting Don't Hurt Colorado. I will be providing continued information about these ballot initiatives in the upcoming months in efforts to ensure these do not pass this November.

Below is a quick synopsis of what these three measures would do to local & state services.

Proposition 101 would eliminate taxes and revenue collected from car registrations and vehicle fees. This revenue helps fund local school districts, emergency medical services, and maintenance of roads & bridges. If passed, the state would lose about $2 billion a year (approximately $600,000 of that would impact local communities). This would greatly impact healthcare services by eliminating the ability of communities to have ambulance and emergency services.

Amendment 60 would overturn prior local election decisions regarding taxes & fees, cut local support for schools and charge new taxes on public services. This measure would greatly impact local funding for school districts who would expect to lose about 50% of their propery tax revenue. In total, A60 would cut over $1 billion of local funding. It would also charge new taxes on public universities & colleges, water authorities, and the Division of Wildlife.

Amendment 61 would bar the state from borrowing money, including short term loans, which are used for construction projects, roads, universities, and hospitals. Basically, the state of Colorado would freeze once this was enacted as the state would be unable to upgrade, build, or improve any infrastructure in the state.

All together these three measures would cause the state to lose about $6.3 billion annually from state and local goverment. This means that healthcare services would be greatly impacted as the state would not be able to completely fund Medicaid, reimburse providers (who have already been cut by 5.5% the past two years) and greatly diminish emergency medical services in the state. Colorado cannot afford any of these measures to pass.

Stay tuned for more information about these three and how you can mobilize your communtity, friends, and family members to vote NO!!!!

Safety Net Clinic Week: Aug. 30th - Sept. 3rd

In efforts to raise awareness of Colorado's healthcare safety net providers and clinics, ClinicNET in partnership with the Colorado Rural Health Center (CRHC), is declaring August 30th - September 3rd as Safety Net Clinic Week. The week will be devoted to educating the public and policy makers about Community Funded Safety Net Clinics and federally certified Rural Health Clinics. While there is a plethora of entitites that comprise the healthcare safety net, this week will focus on the often overlooked clinics that are affiliated with ClinicNET and CRHC.

There are currently 26 identified Community Funded Safety Net Clinics (CSNCs) in Colorado. These clinics tend to be non-profit, rural & urban, privately funded and provide primary care services to uninsured and underinsured individuals.

Colorado has 52 federally certified Rural Health Clinics (RHCs) that provide primary care services in some of the most rural and remote areas of Colorado. During 2009,CSNCs and RHCs collectively provided services to approximately 250,000 inidividuals in Colorado.

If you are a CSNC or an RHC and are interested in participating in Safety Net Clinic Week by hosting a site visit with policy makers, please contact Terri Hurst at: th@coruralhealth.org.

Doctors for America Health Reform Conference Call with Mary Wakefield

On Tuesday, July 27th, Doctors for America will be holding a conference call with Mary Wakefield, HRSA Administrator, to discuss health reform implementation. HRSA plays a large role in healthcare workforce programs and rural healthcare services. Participants on the call are encouraged to submit questions about healthcare provisions and how they will impact your community.

As most of you know, federally certified Rural Health Clinics and Community Funded Safety Net Clinics, providers of primary care services in rural and underserved areas that are an essential part of the healthcare safety net, were largely overlooked in healthcare reform. This is a great opportunity to ask HRSA what support and resources will be available for these rural healthcare safety net providers as health reform is implemented.

For more information and to register for the call, please visit Doctors for America.

Centura Health: Rural Health Video

Centura Health just created a Rural Health Video about the programs and services they offer to improve access to healhcare services in rural Colorado, such as Flight for Life, which provides critical care transport services, and Connected Care , which is expanding specialty care to four rural communities through the use of telemedicine.

Health Insurance Exchange Forum: Friday July 23rd

The Colorado Coalition for the Medically Underserved (CCMU), the Colorado Consumer Health Initiative (CCHI), and the state's Health Reform Implementation Board will be holding community forums regarding Colorado's efforts to create health insurance exchanges. Under the Affordable Care Act, states are responsible to develop health insurance exchanges – virtual marketplaces -where thousands of currently uninsured Coloradans will seek information to select and purchase health insurance. Many of these individuals and families will be eligible for federal subsidies to help them pay their insurance premiums.

The community forums will give stakeholders and the public an opportunity to learn more about health insurance exchanges and provide input as Colorado begins moving forward on health reform implementation efforts. The first forum will be held on Friday, July 23rd from 9a-11a in Denver at the National Jewish Hospital (1400 Jackson Street) in the Molly Blank Center.

New High Risk Pool: GettingUSCovered

Beginning July 6th, the state began accepting applications for Colorado's new federally funded high-risk pool to cover uninsured individuals who have pre-exisitng conditions. GettingUSCovered is administered by Rocky Mountain Health Plans and Cover Colorado. GettingUSCovered stems from the Accountable Care Act and will cover apporoximately 4,000 Coloradans who have been denied access to insurance due to their health status. To be eligible for GettingUSCovered, you must have been uninsured for 6 months prior to enrolling into the program. GettingUSCovered will become effective on September 1, 2010.

Director of Colorado's Primary Care Office Appointed to National Rulemaking Committee

Health & Human Services Secretary Kathleen Sebelius announced the 24-member negotiated rulemaking committee that is tasked to review criteria & methodology for designating Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA). Congratulations to the Director of Colorado's Primary Care Office, Steve Holloway, who will be serving on the committee!!

HPSA and MUA methodologies date back to the 1970's and have not been updated since. HPSA and MUA designations allow clinics, hospitals, and healthcare providers access to a host of incentives, which include: loan forgiveness programs, Medicare bonus payments, increased reimbursement rates, and the ability to be designated as a Rural Health Clinic, just to name a few. Fifty-seven (57) out of Colorado's 64 counties have been designated for primary care health professional shortage.

For more general information on HPSAs and MUA, please visit the Health Resources & Services Administration website.

Click on the following to learn more about Colorado's Primary Care Office and HPSA & MUA desingations in Colorado.

Did you know........

Medicare payments to hospitals with 50 beds or fewer represent less than 2% of the overall Medicare budget?!?!?

For more facts on rural healthcare, visit our national partner organization the National Rural Health Association.

The White House Project - CO Rural Go Lead 2010

The White House Project is a non-profit agency that seeks to advance women's involvement in the political process. On Saturday, July 31st, The White House Project will be holding an event in Montrose, Colorado entitled: Colorado Rural Go Lead 2010. It will be held from 10a - 4p at the Montrose Pavillion. Cost is $25.

Rural Go Lead participants can expect to learn more about The White House Project, hear from other women in the community about their paths to leadership, and to dispel some of the myths about running for office.

The Magnitude of Underinsurance in Colorado

The Colorado Trust recently published an issue brief entitled The Magnitude of Underinsurance in Colorado. The brief discusses the current state of Coloradans who are underinsured and how the underinsured experience similar problems faced by those who are uninsured. Underinsurance is defined as, "having public or private insurance coverage that does not adequately cover the costs of medically necessary services relative to family income, resulting in out-of-pocket expenses that exceed an insured individual's ability to pay."

Approximately 13% of the state's population is considered underinsured. Unfortunately, a majority of the underinsured reside in rural counties. Using the 21 Health Disparities Regional Profiles established by CDPHE, 13 of the regions reported an underinsurance rate higher than 13%. Seven of those regions were rural counties with Region 5 (Cheyenne, Elbert, Kit Carson, Lincoln) reporting 23.2% of the population being underinsured.

State Loan Forgiveness Program Accepting Applications

Starting tomorrow, July 1st, the Primary Care Office will open up the next opportunity of funding for the Colorado Health Service Corps (CHSC). CHSC is the state's health professions loan repayment program, which provides funding to primary care physicians, nurse practitioners, physician assistants, certified nurse midwives, licensed mental health professionals and oral health professionals who agree to practice in a rural or underserved area of our state. Applicants are eligible to receive up to $105,000 in loan forgiveness for a committment of two or three years of service. Eligible health professionals must be employed or seeking full-time employment in an outpatient practice in an area of Colorado with a health professional shortage.

For more information on the CHSC or to learn how to apply, please visit the CHSC website.

July 7th - Rural Hospital Webinar on 340B Enrollment

With the passage of federal health reform, a number of new catagories of hospitals are eligible for the 340B drug discount program. Newly eligible hospitals include Critical Access Hospitals, Sole Community Hospitals, and Rural Referral Centers. Safety Net Hospitals for Pharmaceutical Access along with the National Rural Health Association is holding a free webinar next Wednesday, July 7th from 11a - 12:30p MST. Registration is limited to hospitals and non-profit organizations that work with hospitals. Click here to be taking to the registration page.

Comment on State Policy Recommendations for Disabled Citizens

The Colorado Department of Health Care Policy & Financing (HCPF) is seeking comment on a document entitled Olmstead: Recommendations and Policy Options for Colorado. This report recommends policy options for the state in regards to disabled citizens and people with long term care needs who wish to live in community based settings. You have until 5p on Saturday, July 17th to submit comments.

Temporary SGR Fix Extended Until November 30th

On Friday, President Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. Whew! That's a mouthful. What this means is that Medicare claims will now be processed with a 2.2% increase (retro to June 1st). This slight bump in reimbursement will be in effect until November 30, 2010. It is assumed that Congress will come up with a permanent fix to the Medicare SGR rate in the interim, though if history repeats itself, we will be scrambling again in November to try and avoid major cuts to physicians who care for Medicare patients.

The Center for Medicare & Medicaid Services (CMS) released a statement stating that all Medicare claims are on hold temporarily until the 2.2% increase can be tested to ensure that claims will be processed correctly and paid at the new rate. They expect to begin processing claims with the increase no later than July 1st.

Rural Health Research & Policy Center: Rural Health Care & Health Reform

The Rural Health Research & Policy Center just released an 85 page document summarizing the impact of federal health reform on rural healthcare delivey called: The Patient Protection and Affordable Care Act: A Summary of Provisions Important to Rural Health Care Delivery.

HHS Announces $250 Million for Primary Care Workforce

With all the doom and gloom in regards to the state budget and reimbursement delays & cuts, I am happy to share with you the following news. Kathleen Sebelius, Secretary of Health & Human Services, along with the Health Resources & Services Administration (HRSA) announced the availability of $250 million over the next 5 years to strengthen the primary care workforce. RFPs have already been released for some of the following:

Creating additional primary care residency slots: $168 million for training more than 500 new primary care physicians by 2015;

Supporting physician assistant training in primary care: $32 million for supporting the development of more than 600 new physician assistants, who practice medicine as members of a team with their supervising physician, and can be trained in a shorter period of time compared to physicians;

Encouraging students to pursue full-time nursing careers: $30 million for encouraging over 600 nursing students to attend school full-time so that they have better odds of completing their education;

Establishing new nurse practitioner-led clinics: $15 million for the operation of 10 nurse-managed health clinics which assist in the training of nurse practitioners. These clinics are staffed by nurse practitioners, which provide comprehensive primary health care services to populations living in medically underserved communities.

Encouraging states to plan for and address health professional workforce needs: $5 million for states to plan and implement innovative strategies to expand their primary care workforce by 10 to 25 percent over ten years to meet increased demand for primary care services.

June 2010 State Economic Forecast

Ladies & Gentleman. The moment we've all been waiting for.......The offical first day of summer! And for policy wonks like myself, the June Revenue Forecast (listed under Budget Balancing News in the middle of the page).

An initial glance does not look promising. Even with the delay in Medicaid payments, the state is approximately $74 million short for FY09-10, which ends June 30th. With this updated forecast, it appears that the FY10-11 budget is close to $215 million short. I would imagine an official announcement of the June revenue forecast and what sort of cuts our state can expect will occur shortly.