Medicare cuts loom yet again......

Physicians, yet again, face a 21% cut to Medicare reimbursement rates unless Congress acts prior to June 1st. Congress is set to begin the Memorial Day recess tomorrow and Democrats are struggling to have enough votes to pass H.R. 4213 (Tax Extender Bill). The bill is being seen as a Stimulus Part 2 and is generating a lot of debate due to the increase it will add to the federal deficit. The Medicare SGR forumla was expected to be "fixed" in the bill, but it is looking more and more like Congress will pass a temporary fix instead of getting at the root of the problem. If these cuts occur, it ultimately means that more physicians will stop seeing Medicare patients due to the gap in actual cost versus reimbursement and it will also mean diminished access to healthcare services for Medicare patients. As of this writing there is talk of temporarily extending the SGR forumula, but it remains to be seen what Congress will do the next day and a half.

Rural Center for AIDS/STD Prevention Requests Submissions for 2011 Monograph

SUBMISSIONS SOLICITED FOR 2011 Rural Center for AIDS/STD Prevention (RCAP) MONOGRAPH

RCAP will be publishing its eighth monograph on AIDS/STD prevention in rural America in early 2011. To help inform rural HIV/STD prevention specialists about what others are doing, we will devote about one-half of the monograph to brief reports of promising HIV/STD behavioral intervention programs in rural communities, like those described in Chapter 7 Behavioral Interventions That Might Work of the RCAP publication, Tearing Down Fences: HIV/STD Prevention in Rural America. This opportunity to describe a prevention program that might work in the monograph is open ONLY to programs not already described in FENCES.

If you work in HIV/STD prevention in a rural community and have a promising HIV/STD behavioral intervention program that you would like to describe and possibly be included in the next RCAP monograph please consider submitting to RCAP (by July 15, 2010) a one-half page abstract about your program. The directions are listed below.
The RCAP co-directors will review all of the submitted abstracts and select about eight to ten to be included in the monograph. We will then invite the author(s) of these abstracts to send in a more thorough program description (6-10 typed pages) that will be published in the monograph.

Directions for abstract submission:
1. submit a typed, one-half page description of the program and include it as an email attachment or place it in the body of an email;
2. include in the abstract: (1) title of the program, (2) intended audience and where implemented, (3) brief description of project and any evaluation, and (4) contact person(s) with contact information;
3. submit to aids@indiana.edu and place “RCAP monograph” in email subject line. If an email is not possible, please fax to: 812-855-3936;
4. submit by July 15, 2010.

340B Prescription Drug Program - Call to Action!

This message is from our national partner orgnanization the National Rural Health Association (NRHA). :

The original Senate health reform bill (HR 3590), passed on March 23, included an expansion of 340B availability to critical access hospitals, rural referral centers, sole community hospitals, free-standing cancer hospitals, and children’s hospitals. In the follow-up legislation, the House Reconciliation bill (HR 4872), however, a couple of changes to the 340B section were included at the last minute to the originally passed Senate bill. One of these changes was the elimination of newly-eligible hospitals’ ability to utilize the 340B program for what are classified as orphan drugs, or drugs intended to treat very rare forms of disease. These typically very expensive orphan drugs, of which the FDA currently classifies about 300, are grouped into two categories: 1) Being used to treat diseases affecting less than 200,000 patients nationwide, or 2) being so expensive to produce that its costs exceed the overall sales generated.

This change, to disallow the newly eligible 340B hospitals from receiving orphan drugs at the program’s discounted rate, could make a huge impact on rural hospitals ability to treat patients with cancer or other rare diseases. Furthermore, because of the limitations the 340B program puts on participating hospitals’ ability to use group purchasing organizations, these hospitals could be paying even more for orphan drugs than prior to health reform.

Therefore a legislative fix to reverse this change is needed. As part of a tax extenders bill being currently developed in the House and Senate, there is a slight window of opportunity to include this fix to allow the newly eligible 340B hospitals’ ability to receive orphan drugs at the program’s discounted rate.

We need your help urging House and Senate members to support a legislative correction to the 340B prescription drug discount program expansion to Critical Access Hospitals, Rural Referral Centers, Sole Community Hospitals, Children’s hospitals and free-standing cancer hospitals included as part of the health reform bill. If you have regular contact with your House or Senate member’s health staffer(s) or Senate HELP, Senate Finance, House Ways and Means, or House Energy and Commerce staff, please call or email them to let them know how important this is for rural patients and providers.

Senator Bennet is on the Senate HELP Committee: 202-224-5852 or 303-455-7600. His healthcare staffer is Rohini Ravindran: rohini_ravindran@bennet.senate.gov

Diana DeGette is the Vice-Chairman on the House Energy & Commerce Committee: 202-225-4431 or 303-844-4988. Her healthcare staffer is Heather Foster: heather.foster@mail.house.gov

2010 CRHC Legislative Summary

Another legislative session has come and gone! During the 2010 Legislative session, there were approximately 119 bills introduced that specifically addressed healthcare, of those, a handful of bills focused on rural healthcare services. The CRHC 2010 Legislative Summary touches on a few of the bills CRHC tracked this session. If you would like more information or a more thorough overview, especially in regards to private insurance bills, please contact me directly (Terri Hurst: 303-407-2031 or th@coruralhealth.org

Update on Rural Substance Abuse Grant Program

In 2009 the Colorado General Assembly passed HB09-1119, which established the Rural Substance Abuse Prevention & Treatment Program within the Colorado Department of Human Services, Division of Behavioral Health (DBH). This program is reliant on cash funds collected from DUI and other impaired driving offenses. The DBH hopes to begin funding contracts for this program in July 2011. While this is still over a year away, once funds are secured, grants will be available to entities in counties with populations of less than 30,000 people. Funded grant projects will fall under two categories: the Rural Youth Alcohol & Substance Abuse Prevention & Treatment Project, which will target youth between the ages of 8 and 17 years of age; and the Rural Detoxification Project for adults.

CHSC Awards $1.60 Million to Health Professionals in Rural & Underserved Areas

Colorado's Primary Care Office, which administers the state's loan repayment program, the Colorado Health Service Corp (CHSC), has awarded $1.60 million in loan forgiveness dollars to health professionals who provide healthcare services in rural and underserved areas of our state. Congratulations to all the loan forgiveness recipients!

CHI Rural Workforce Presentation

The Colorado Health Institute (CHI) is a wealth of information for all things health-related in Colorado. Recently CHI conducted studies focused on both rural dentists and rural physicians. Christine Demont-Heinrich, Interim Workforce Program Manager, created a presentation highlighting some of the key findings from the CHI research, which include:

Of the 711 rural physicians who completed the survey, approximately 17% stated they do not accept Medicaid. The majority of physicians who did not accept Medicaid (98%) reported that reimbursement rates were too low.

The average age of both rural physicians and dentists is 51 years.

14% of rural physicians and 8% of rural dentists plan to leave their practice in the next year.

Nine rural counties have no licensed dentists.

Trinidad State Nursing Home - Possible Closure

For the past year, there has been a lot of scrutiny and focus on the Trinidad State Nursing Home and whether the state should sell it, has the legal authority to sell it, and what selling the nursing home would mean for its residents, employees and the community. A bill that would have required the state to wait until 2011 to sell the Home was killed last week and it appears the state may be moving forward on selling. The following message comes from Marty Hackett, Director of Communications, Trinidad & Las Animas County Chamber of Commerce:

It has been announced that the state could call for closure of the Trinidad Nursing Home as early as tomorrow. Those at the nursing home have asked, and I now do too, for everyone to call the Governor and ask him to delay closure of the nursing home at least until November, 2010.

This delay will allow the nursing home and board, Las Animas County, and perhaps the voters to make decisions about ways to keep the home open past that time.

Call Governor Ritter and ask him to keep the home in Trinidad open for a few more months to give us one last chance to find way to keep the nursing home in Trinidad.
Call him at (303) 866-2471

It's Never Too Early to Start Thinking about November!

I know, I know. The legislature isn't officially over until tomorrow, but it's never too early to start thinking about the November elections. Coloradans will be voting on the following:
Governor & Lt. Governor
Senator
Secretary of State
State Treasurer
Attorney General
All 7 Congressional District (House of Representatives) seats also are up for re-election

In addition, with our General Assembly term limits, there are 13 open seats (out of 65) in the House and 7 open seats (out of 19) in the Senate. The Senate is comprised of 35 members, though 16 of those Senators are not term limited or up for re-election until 2012. As spring turns to summer, I will be posting more information about some of the competetive districts and in particular any of the hotly contested rural districts.

While there are always politics occuring at the legislature and I've witnessed some of the most contentious, polarizing discussions under the Gold Dome; I'm afraid the real politics are yet to begin!

HRSA Announcement Regarding HPSA/MUP Designations

The Health Resources and Services Administration (HRSA) published a rule today that would form a negotiated rulemaking committee that will be charged with looking at the methodologiy and criteria of how Health Professional Shortage Areas (HPSA) and Medically Underserved Populations (MUP) are designated. HPSA and MUP designations are necessary for certain federal programs including the National Health Service Corps (federal healthcare provider loan forgiveness program), federally certified Rural Health Clinics (RHC), and Centers for Medicare & Medicaid (CMS) Medicare Incentive Program, which provides higher reimbursement rates for physician services delivered in a HPSA. HPSA and MUP methodologies date back to the 1970's and HRSA has unsuccessfully attempted to change these methodologies previously.

The public is able to comment on this rule no later than 5pm(EST) June 10th. The rule has 12 specific questions regarding HPSA and MUP designation & methodology that the public may comment on (See page 26169; Part B). In addition, this rule seeks to create a Negotiated Rulemaking Committee whose task is focused on coming to a consensus on new methodologies and criteria for HPSA and MUP designation (Also page 26169. part III).

CRHC will be working with the state's Primary Care Office and the Primary Care Association (Colorado Community Health Network) on this rule and any comments that are submitted.

Governor Launches Health Reform Website

The Governor's Office launched the Health Care Reform in Colorado website today. The site will be updated on a regular basis with the most pertinent and important information regarding healthcare reform and what it means for Colorado. There will also be information regarding the newly created Interagency Health Reform Implementing Board and how Coloradans can provide input & feedback as health reform measures begin to be implemented in Colorado.

Final Bill Tracker Update 5.5.10

Aaaaah, spring in Colorado. Things are slightly starting to green. The sun is shining one minute, and then it may snow. Hailstorms and thunder. Flowers and baseball. And the end of the legislative session is only a week away! Believe it or not, bills are still being introduced, though nothing that looks like it will greatly impact rural healthcare services. Stay tuned in the next few weeks for an end of session summary, a summary of federal healthcare reform and rural healthcare, and some information regarding the upcoming political battles that are likely to ensue as things begin to heat up for the November elections. They are going to be here before we know it.........