Survey Finds One in Five Juggling Medical Bills

A recent survey from the Center for Studying Health System Change and the Robert Wood Johnson Foundation shows that one in five Americans reported trouble paying medical bills in 2010. The medical debt averaged around $6,500, and more than 17 percent of people with medical debt said it would take longer than five years to pay off. Click here to read more.

Advance Payment ACO Model Open Door Forum Call Information Available

The Center for Medicare and Medicaid Innovation is hosting an Open Door Forum to review the Advance Payment ACO Model and application template on Thursday, January 5 from 12:30-2:00 PM MST, call information 800-837-1935 Conf ID 39623933. A slideshow presentation will be posted to the Advance Payment Model ACO Application Information webpage in advance of the call.

The Advance Payment Model is available for physician-based and rural Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program. ACOs in the Advance Payment Model will receive upfront payments that will be recouped from the shared savings they earn. A template of the application for the Advance Payment ACO Model is also now available. 

Budget Works 2012—January 13

The Colorado Fiscal Policy Institute is presenting its annual Budget Works conference on January 13, 2012 at the History Colorado Center in Denver. The day-long workshop will focus on federal funding and how it affects the state budget and Colorado residents. Click here to read more and to register. 

Application Template for Advance Payment ACO Model Available

An application template is now available for the Advance Payment ACO Model. Through the Advance Payment Model, selected physician-based and rural Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program will receive advance payments that will be recouped from the shared savings they earn. Applications for an April 1 2012 start date for the Advance Payment Model will be accepted from January 3- February 1, 2012. For a July 1, 2012 start date, applications will be accepted March 1-March 30.

The Centers for Medicare and Medicaid Services will host an Open Door Forum to review the Advance Payment ACO Model and the application template on Thursday, January 5, 2012 from 12:30-2:00 PM MST. Call in information will be posted on the Advance Payment website.

Congress Approves Two Month "Doc Fix" for Medicare, Rural Extenders

Congress passed legislation today that maintains Medicare provider rates and several rural extender provisions for two months beginning in January. The compromise also extends the payroll tax holiday and unemployment benefits. Click here to read more.

ACA Update from NACRHHS: Webinar Available

The December 2 webinar by the National Advisory Committee on Rural Health and Human Services (NACRHHS) on the effects of the Affordable Care Act is now available for download on the Rural Assistance Center's website. You can watch the presentation and download the slides by clicking here.

House "Disagrees" With Senate's Two Month Medicare Compromise

The U.S. House of Representatives voted to "disagree" with Senate-passed legislation that called for a two month extension of the payroll tax holiday as well as many other provisions including Medicare extenders for several rural programs and delay of the Medicare Sustainable Growth Rate that will reduce physician fee schedule payments by up to 27%. The House called for a conference committee to resolve differences between the two chambers' bills. It's not certain whether either Representatives, who are adjourning today, or Senators, who left DC over the weekend, will be reconvening before the end of 2011. Updates and information will be shared as they are available.

December Revenue Forecast

Positive state revenue forecasts were presented to the Joint Budget Committee today. Both the Office of State Planning and Budgeting and the Legislative Council announced that the state’s economy grew at a slow but steady pace over 2011 and is showing small signs of a modest recovery. Some factors generating increased revenue include improved tax revenues and consumer spending. The JBC will not need to make any reductions in the current year budget. Read the Denver Post’s coverage of the forecast and download the reports by clicking on the links. 

Update on Medicare Provisions

This weekend the U.S. Senate passed legislation that, for a two-month period, would extend the payroll tax holiday along with several Medicare provisions, including an update for the sustainable growth rate within the physician fee schedule as well as rural specific provisions such as the outpatient hold harmless provision, Medicare Section 508 reclassification, reimbursement increases for ambulance services, rural mental health add-ons, and extension of therapy cap exemptions. U.S. House Republican leaders have indicated they will oppose the Senate-passed legislation in favor of a version the House passed last week. The House is advocating for a formal conference between House and Senate to reconcile differences although the possibilities of convening a committee in the last two weeks of the year is uncertain.   

Please visit the National Rural Health Association’s website for an update on these issues. We will continue to post new information and opportunities to contact your elected officials as these issues develop. 

Policy Brief: Health Care Access and Use Among the Rural Uninsured

An article forthcoming in Journal of Health Care for the Poor and Underserved examined access to care and service use among non-elderly uninsured rural and urban residents. Some of the key findings are that both rural and uninsured residents face serious barriers to care compared with those with health insurance coverage; rural uninsured are more likely to have a usual source of care and to have used ambulatory care in the past year than the urban uninsured; and rural residents, insured or not, have difficulty accessing after hours care and traveling to see their usual provider. These findings present important issues to consider for rural providers who may be serving as the usual source of care for uninsured community members and as the state looks to expand health insurance coverage. Read the policy brief on the study by the Maine Rural Health Research Center. 

Congress Completes FY 2012 Appropriations

Congress has reached a tentative agreement on Fiscal Year 2012 appropriations, with final votes expected in the coming days.  The large omnibus package includes funding for rural health programs such as the Medicare Rural Hospital Flexibility Program and Small Rural Hospital Improvement Program. Details on the final numbers are still uncertain and will be provided as soon as they are available; however, both Senate and House ‘mark-ups’ from earlier this year included level funding for these rural programs. The agreement does not include an adjustment for the Medicare sustainable growth rate that will significantly lower physician reimbursement beginning January 1 or any rural "extenders", although lawmakers are continuing to work on a potential fix that can be combined with any extension of the payroll tax holiday. 

Colorado’s Projected Primary Care Needs After Reform

The Colorado Health Institute released a new report that estimates the anticipated primary care workforce needs after healthcare reform is implemented. The analysis found that Colorado may need as many as 140-150 additional primary care physicians, nurse practitioners, and physician assistants. This estimate does not account for the current provider shortages already pressing on rural and underserved communities as well as the impact of Colorado’s aging population and healthcare workforce. Read more. 

Next Steps for HR 3630

Thank you for reaching out to your House member regarding HR 3630. On Monday, the House of Representatives passed H.R. 3630 and the bill now moves to the Senate where its fate is uncertain. It's possible that the Senate may take action on H.R. 3630 as soon as today or later this week. Please contact Senator Udall and Senator Bennet today and ask them to oppose HR 3630. Let our Senators know that the Medicare cuts in H.R. 3630, especially the bad debt and reduced reimbursements to PPS hospitals for hospital-based primary care physician practices will disproportionately impact rural providers. Addressing the Medicare SGR this month is essential  but not at the expense of rural communities.The President has already indicated that he will veto H.R. 3630 if it reaches his desk. Click here for more information from NRHA on H.R. 3630.

Oppose HR 3630—Contact Your House Member Today!

Contact your House representative today and tell them to vote on HR 3630. This bill threatens rural providers and a vote on it is expected as early as this week.

HR 3630 is intended to update the Medicare Sustainable Growth Rate and reauthorize expiring tax provisions; however, it fails to extend various rural provisions including the Outpatient Hospital Hold Harmless Provisions. More problematic, HR 3630 proposes to pay for the SGR fix, expiring extenders, and tax credits by cutting reimbursements to hospitals and clinics. Specifically, HR 3630 would reduce bad debt payments for Critical Access Hospitals, Rural Health Clinics, prospective payment system (PPS) Hospitals, and Federally Qualifying Health Centers and also reduce reimbursements to PPS hospitals for hospital-based primary care physician practices.

While Congress must act this month to address these important issues, shortchanging rural hospitals and providers is not an acceptable solution. Take action today by calling your House member and asking her/him to oppose HR 3630 and to protect vulnerable hospitals and clinics in rural communities when addressing the Medicare SGR and rural extenders. Click here for more information from the National Rural Health Association. Stay tuned for additional information and updates and please contact us with questions or feedback. 

Demand Outstripping Supply for Mental Health Services in Rural Colorado

A report released by Advancing Colorado’s Mental Health Care estimates that 1.5 million residents need mental health care. The report find that rural and frontier counties face critical mental health provider shortages with 86 percent of all the child psychiatrists, 82 percent of practicing psychiatrists and nearly all psychiatrists specializing in substance abuse working in the Denver and Colorado Springs metropolitan areas. Click here to read the report and find additional information. 

Public Radio Segment on Critical Access Hospitals

On its December 8 morning program, National Public Radio featured a segment on Critical Access Hospitals (CAHs) that discussed the differing viewpoints on the need for CAHs and the financial and political pressures facing these important facilities. Click here to read the article and listen to the story. 

Register Now for NRHA Policy Institute

Early registration for the National Rural Health Association's 2012 Rural Health Policy Institute ends on December 30. Join rural healthcare providers and advocates in Washington DC January 30-February 1. Meet Colorado’s members of Congress and learn about important issues impacting rural health. Click here to learn more and to register. 

New Federal Website for Medicaid and CHP+

The Center for Medicaid and CHIP Services has launched a new website—medicaid.gov—to provide information about the Medicaid and Children’s Health Insurance Program (CHP+ in Colorado). The site includes Federal policy guidance; lists of pending and approved waivers; highlights of Affordable Care Act implementation efforts; State-specific program information and data; and improved search capabilities. The website also provides answers to most commonly asked questions, requests for information, and a section for consumers to access information about state programs and health coverage options. 

December 8 Webinar on 2011 Colorado Health Access Survey

Register now for a free webinar on the 2011 Colorado Health Access Survey (CHAS), hosted by The Colorado Trust and the Colorado Health Institute, on Thursday, December 8, 2011 from 8:30 a.m. - 9:30 a.m. The CHAS is the most extensive survey in Colorado of health care coverage, access and utilization. A follow-up to the 2008-2009 Colorado Household Survey, this survey is administered every other year via a random sample telephone survey of more than 10,000 households across the state. Click here for more information and to register for the webinar. 

Resources on Accountable Care Organizations

This fall, the Centers for Medicare and Medicaid Services released its final rule for implementing the Medicare Shared Savings Program for Accountable Care Organizations (ACOs). The Commonwealth Fund has put together an ACO Resource Page with a wide range of blog posts and publications about ACOs. The Advance Payment ACO Model is an initiative developed by the Centers for Medicare and Medicaid Innovation Center designed for rural ACOs in the Medicare Shared Savings Program. Through the Advance Payment Model, selected participants in the Shared Savings Program will receive advance payments that will be recouped from the shared savings they earn. Read more about the Advance Payment Model. 

Colorado Rural Health Care Grant Program Application Available

The application and materials for the fifth cycle of the Colorado Rural Health Care Grant Program, administrated by the Colorado Rural Health Center, are now available. Read more.  

Free Webcast: Health Outcomes Among Children and Families Living in Rural Communities, December 1st and 2nd

The National Institute of Child Health & Human Development (NICHD) will be broadcasting a multi-agency rural health research conference intended to identify gaps in research that address emerging differences between health outcomes for children and families living in rural communities compared to those in urban areas. This conference will be broadcast live via webcast both days, beginning at 6:30 AM MT on December 1 and 6:45 AM MT on December 2. Get additional information about the conference, including the agenda, and click here to access the webcast. 

Next Steps for Federal Deficit Reduction

With the failure of the Super Committee to reach agreement, mandatory budget cuts via sequestration are scheduled to begin January 2013. Under sequestration, Medicare provider reimbursement is subject to up to a 2% reduction from 2013-2021 while Medicaid and Social Security will not be reduced by sequester. Many issues will impact the overall sequestration before it takes effect, including any possible changes in federal receipts, the tax code, and efforts to modify the reductions by members of Congress and advocates. Click to read more about the anticipated reductions and the National Rural Health Association’s response.

Report from the HPSA/MUA Negotiated Rulemaking Committee

In 2010, Health & Human Services Secretary Kathleen Sebelius created a 28-member negotiated rulemaking committee to review criteria for the designation of Medically Underserved Areas (MUA) and Health Professional Shortage Areas (HPSA). The Director of Colorado’s Primary Care Office Steve Holloway served on this committee. HPSA and MUA designations allow clinics, hospitals, and healthcare providers access to many federal incentives including loan forgiveness programs, Medicare bonus payments, increased reimbursement rates, and the ability to be designated as a Rural Health Clinic. The Committee’s report provides recommendations to the Secretary for revising the designation criteria and process. Changes that HRSA may chose to make to the designation process will be open to the public for comment when they are available. CRHC will be sharing more information about the Committee’s recommendations and any changes that occur in the designation process. Please contact Sara with questions or comments. 

CHI Releases Portrait of Colorado’s Nursing Workforce

In its recently released report titled Colorado’s Nurse and Nurse Aide Workforce: A Portrait, the Colorado Health Institute (CHI) brings together findings from three surveys that it conducted between 2006 and 2008 on certified nurse aides, licensed practical nurses, and registered nurses. Click here to download the report. 

Update on Super Committee

Prospects look dim that the Super Committee will reach an agreement to reduce the nation’s deficit by $1.2 trillion over the next ten years. Lawmakers are already looking ahead to required sequestration, to begin in January 2013, that would cut $1.2 trillion from the federal budget over ten years through reductions in defense, discretionary spending, and Medicare provider rates (up to 2%). NRHA has prepared a fact sheet that looks at the impact of sequestrationon Critical Access Hospitals. Additional resources and information will be posted on our website as they are available. 

New Deadlines Announced for Advance Payment Model

Last month, the Centers for Medicare and Medicaid Services announced a new Advance Payment Model for physician-based and rural Accountable Care Organizations selected to participate in the Medicare Shared Savings Program. The selected ACOs will receive advance payments that will be recouped from the shared savings they earn. Organizations interested in applying for the Advance Payment Model must complete separate applications for the Shared Savings Program and the Advance Payment Model. 

Deadlines for the Advance Payment Model application are: April 1, 2012 start date (applications accepted between January 3 and February 1, 2012) or July 1, 2012 start date (applications accepted between March 1 and March 30, 2012). Only ACOs that enter the Shared Savings Program in April 2012 or July 2012 will be eligible for advance payments. For more information about the Advance Payment Model, visit the Advance Payment website.  

New Series on Primary Care Workforce Stats

The Agency for Healthcare Research and Quality’s Center for Primary Care, Prevention and Clinical Partnership will be issuing a “Facts and Stats Series” on primary-care topics on primary care's workforce, capacity and growth needs. While a foundational element of the country’s healthcare system, primary care is struggling under increasing demands and expectations, diminishing economic margins, and increasing workforce attrition. Click here to read more about the series and download the first two fact sheets. 

The Affordable Care Act: An Update from the National Advisory Committee on Rural Health and Human Services

The Rural Assistance Center is hosting a free webinar on December 2, 2011 at 1:00pm MT with The National Advisory Committee on Rural Health and Human Services. The Committee has devoted its work this year to the effects of the Affordable Care Act (ACA) on rural areas. The Committee's 2011 Report to the Secretary, released in March, included a section on Rural Implications of Accountable Care Organizations and Payment Bundling. Click here for more information and to register. 

2011 Colorado Health Access Survey Released

The Colorado Health Access Survey (CHAS), a program of The Colorado Trust and administered by the Colorado Health Institute, is the only statewide survey that focuses on Coloradans’ health insurance status, access to care, usage of health care services, and affordability. The CHAS data are categorized into 21 Colorado Health Statistics Regions. The 2011 CHAS found that an increasing number of Coloradans (more than 1.5 million) are uninsured or underinsured. Click here to visit the CHAS website and download more information, reports, and briefings.

Health Care Innovation Challenge Announced

The Health Care Innovation Challenge will award up to $1 billion in grants to applicants who will implement the most compelling new ideas to deliver better health, improved care and lower costs to people enrolled in Medicare, Medicaid and CHIP, particularly those with the highest health care needs. The Health Care Innovation Challenge will encourage applicants to include new models of workforce development and deployment that efficiently support their service delivery model proposal. Click here for more information and to learn about a webinar on the initiative scheduled for Thursday 11/17 at 12:00pm MT. 

Supreme Court to Hear Challenge to Affordable Care Act in 2012

The U.S. Supreme Court has agreed to decide the constitutionality of the Affordable Care Act. Oral arguments are likely to be held in late February or March, with a ruling by June 2012. Read more.

Medicare Shared Savings Program Application Available

The Centers for Medicare and Medicaid Services (CMS) released the Medicare Shared Savings Program (ACO) application and will begin accepting applications on December 1, 2011. CMS also posted fact sheets for rural providers and on the ACO AdvancePayment model.

Providers and facilities interested in learning more about ACOs have two opportunities this week, a National Provider Call on November 15 and a meeting with CMS on November 16. 

Economic Impact of Colorado's Hospitals

A study commissioned by the Colorado Hospital Association (CHA) found that hospitals in Colorado’s rural regions directly contribute $2.9 billion in economic activity and add  21,400 jobs, creating $4.1 billion in total output and 30,800 jobs due to a multiplier effect. Statewide, Colorado hospitals were responsible for about $18.8 billion in economic output last year and added more than 4900 jobs from 2007 to 2010. The report and an executive summary is available on CHA’s website. 

Celebrate the Power of Rural—National Rural Health Day, November 17

November 17 is the first annual National Rural Health Day, a day to “Celebrate the Power of Rural”. Nearly 62 million Americans, and 20% of Coloradans, live in rural and frontier communities. Rural communities possess a selfless, community-minded, "can do" spirit that has helped our country thrive; they also have unique healthcare needs that should not be overlooked and need to be addressed. How you choose to celebrate National Rural Health Day is entirely up to you, we just ask that you celebrate! CRHC has created a toolkit of resources, information, and ideas for you to use. For more information or to share how your community is celebrating National Rural Health Day, contact Cari Fouts.   

Medicare Shared Savings Program National Provider Call: Application Process and Overview of the Advance Payment Model Application

The Centers for Medicare & Medicaid Services is hosting a call on Tuesday, November 15, 2011 from 11:30-1 pm MT to discuss the application process for the Medicare Shared Savings Program (to create Accountable Care Organizations) and the Advance Payment Model. The Advance Payment Model is intended to provide additional support through upfront resources to physician-owned and rural providers.

In order to receive the call-in information, you must register for the call. Registration will close at 10:00 pm on Tuesday, November 15 or when available space has been filled. No exceptions will be made. Please register early. Please click here for more details and instructions on registering for the National Provider Call.

A Notice of Intent to Apply memo is currently available on the Shared Savings Program Application page and the program application will be posted to this website prior to the call. Call participants are encouraged to review the application prior to the call. 

Health Care Policy & Financing 2010 Annual Report

The Department of Health Care Policy and Financing 2010 Annual Report is available online. The report highlights the Department’s programmatic priorities and outlines progress made toward its 2010 initiatives. 

Community Forum to Discuss Relocating DHS Services to HCPF, November 16

The Department of Health Care Policy and Financing (HCPF) and the Department of Human Services (DHS) submitted a legislative report to the Joint Budget Committee regarding the possible relocation of the Division of Developmental Disabilities, the State Unit on Aging, and the Children's Residential Habilitation Program from DHS to HCPF. This move is being considered to leverage federal health care reform dollars, to streamline the Long Term Care system, and to improve client services. The Departments are seeking public input on the proposal to relocate these programs. The first of several community forums will be held on November 16, 8:15am - 10:15 am at the Fort Logan Auditorium. An option to call in is available: 1-877-820-7831, Participant pass-code: 447596. If you plan to attend, please RSVP by November 14. 

Update to Medicare's 2012 Physician Payment Rates

On January 1, 2012, a 27.4% cut in Medicare payment rates to physicians will take effect due to the Sustainable Growth Rate formula. Congress has intervened to prevent these projected cuts annually since 2002. As the deadline approaches, Congress, the administration, and other government agencies are deciding whether to pass another short-term "doc fix," or find a longer-term solution. A new policy briefby Health Affairs provides the history of this issue, examines some of the proposals under consideration, and suggests what might come next. 

CoverColorado Soliciting Feedback from Providers

CoverColorado, the insurance plan for individuals with pre-existing conditions, is soliciting feedback from all health care providers caring for CoverColorado members on its provider fee schedule that was implemented April 1, 2011. CoverColorado seeks provider input to evaluate the effectiveness of the present schedule and inform any potential changes to the 2012 fee schedule. Written comments are due by December 20, 2011 and can be emailed or submitted to: CoverColorado Attn: Executive Director, Fee Schedule, 425 South Cherry Street, Suite 160, Glendale, CO 80246. CoverColorado is also holding an open meeting on Tuesday, December 13 from 4:00 pm - 6:00 pm in the Molly Blank Auditorium at Denver's National Jewish Hospital where comment will be taken. 

Governor Hickenlooper Releases FY 2012-2013 Budget

Today Governor Hickenlooper delivered his proposed FY 2012-2013 budget to the Joint Budget Committee (JBC). The budget request totals $20.09 billion. His proposal contains few cuts to healthcare programs. No Medicaid provider rate cuts were proposed and Amendment 35 funding will not be transferred to the General Fund but will be granted out through CDPHE to local organizations for prevention and health promotion activities. Cost-sharing for higher income beneficiaries of Medicaid and CHP+ is proposed. New revenue-generating measures are not in the plan; however, it calls for education budget cuts of $90 million for K-12 and $60 million for higher education.

We will share more information about the Governor’s budget as it becomes available. The budget represents the first step in the FY 2012-2013 budget process, continuing with JBC hearings and briefings beginning this month. The JBC will draft the Long Bill that requires the full legislature’s approval and the Governor’s signature.

CHP+ Cost Sharing Proposed Changes

As posted previously in The Rural Voice, new cost-sharing changes are being proposed for the Child Heatlh Plan Plus (CHP+). Upon final approval on November 18, there will be changes in both the annual enrollment fee and copayment structure. This factsheet from Health Care Policy & Financing describes the changes. 

Executive Order Issued to Address Medication Shortages

The Obama Administration today issued an executive order to address the increasing rate of drug shortages across the country. The order instructs the F.D.A. to broaden reporting of potential shortages of certain prescription drugs; accelerate reviews of applications to initiate or change production of these drugs; and provide more information to the Justice Department about possible instances of collusion or price gouging for drugs in short supply. Click here for a fact sheet about today’s order and recent medication shortages.  

Strengthening the Direct Service Workforce in Rural Areas

A recent publication from the Centers for Medicare and Medicaid Services summarizes the challenges of the direct service workforce in rural areas and outlines strategies that communities can use to provide high-quality long term care services and supports. Read more.  

Update on Federal Deficit Negotiations

With a deadline of November 23, the Super Committee continues its work to find at least $1.2 trillion in budget savings over ten years. Proposals have been offered but the group has yet to issue official recommendations. Some issues under consideration that impact rural communities include eliminating the Critical Access Hospital designation, reducing reimbursement to CAHs, and scaling back the Medicaid Provider Fee. If you have not yet contacted your member of Congress, please take a few minutes today to reach out and share your concerns with their healthcare staff. Visit our website for tools and resources to assist your advocacy efforts. 

Are You a Healthcare Innovator?

The Centers for Medicare and Medicaid Services is seeking applicants for the Innovations Advisor Program. The Program will help individuals refine, apply, and sustain managerial and technical skills necessary to drive delivery system reform. Innovation advisors will work with the Center for Medicare and Medicaid Innovation to test new models of care delivery in their own organizations and create partnerships to find new ideas that work and share them regionally and across the United States. The application deadline is November 15, 2011. Click here for more information and to download an application. 

Health and Well-Being of Children in Rural Areas: New Report

Children in rural areas are more likely to face different challenges to their health and have less access to care when compared with children in urban areas, according to a new report from the Health Resources and Services Administration. The National Survey of Children’s Health:  The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation in 2007, which is published every four years, examined the overall health of rural children in the United States from birth to 17 years. The report finds greater prevalence of certain physical, emotional, behavioral, and developmental conditions in rural areas. Children living in rural areas are more likely to have public insurance, such as Medicaid or the Children’s Health Insurance Program, while urban children are more likely to be privately insured. In addition, the percentage of children with chronic conditions such as obesity, asthma and diabetes is highest amongst teenagers living in small rural areas. Read more. 

CRHC’s 2012 Membership Drive Now Underway!

Over the past 20 years, CRHC has become our state’s most trusted resource for rural healthcare. In the current economic landscape, it is more important than ever that we continue to support and advocate on behalf of rural healthcare and the safety net community. We remain loyally committed to ensuring our members have the resources and support they need to keep their communities healthy and vibrant. CRHC is well positioned to provide 20+ more years of support to ensure access to healthcare for all Coloradans, and we recognize that our work would be impossible without the dedication of our loyal members.

 

CRHC has three levels of membership to suit your organizational/individual needs:

• Investing Member

• Classic Sponsor

• Partner

Joining is easy. Click here to join today!

At the Classic Sponsor and Partner level memberships, your organization is given additional opportunities to support and reach out to rural healthcare providers. Please visit our website for more information on the benefits of each level. Feel free to contact Cari Fouts, Director of Communication & Development (cf@coruralhealth.org, or 303-565-5847) if you have questions about your membership or visit our website for more information.

 

With your support, we can continue to ensure all Coloradans have access to high quality healthcare services in 2012 and beyond.

Senator Bennet Releases ACA Grant Guide

Colorado U.S. Senator Michael Bennet has released a comprehensive collection of information on the pilot projects, grants, and workforce development initiatives available to Coloradans through the Affordable Care Act (ACA). Check out the Guide to Grants resource.

HHS Releases Final Regulations for ACOs, Announces Advance Payment Model

The Department of Health and Human Services released final rules for the voluntary Medicare Shared Savings Program aka Accountable Care Organizations (ACOs) and also announced an Advance Payment model available to physician-owned and rural ACOs. The final rule has several changes from the original proposed rule, including that Rural Health Clinics are now eligible entities to form and participate in ACOs. CRHC will closely review the final rule and Advance Payment model and communicate with our members in coming weeks about the potential impacts and opportunities for rural communities. Please contact Sara if you have questions or comments. Click here to read more. 

Revisions to Medicare Conditions of Participation Proposed

The Centers for Medicare and Medicaid Services released proposed revisions to the Medicare Conditions of Participation for hospitals including Critical Access Hospitals (CAH). Some of the proposed revisions include privileging for non-physician staff, incorporating a nursing care plan into an interdisciplinary care plan, and changes to nursing services to allow for the preparation and administration of drugs. Under these revisions, the “direct services” requirement for CAHs would be removed and gives CAHs flexibility in determining whether to provide these services directly, under contract, or through another arrangement. Read the proposed rules here. Please send any comments or questions to Sara Schmitt. 

Child Poverty More Common in Rural Areas

Child poverty is disproportionately more likely to occur in rural areas of the U.S. according to researchers at the Carsey Institute at the University of New Hampshire. In their study, researchers found that 81 percent of counties experiencing persistent child poverty are non-metropolitan. The researchers point to high unemployment, low educational attainment, and physical and social isolation as contributing to high rates of rural poverty, and suggest these factors create problems much different than those faced in densely populated urban areas. They also suggest that urban focus of welfare programs shifts policy makers' attention away from needy families in rural areas. Click here to read the brief.

Medicare Changes Ahead for Hospice

This article from Politico outlines some of the proposed changes in how Medicare pays for hospice services and the potential impacts of these changes, including in rural communities. 

Register for NRHA's 2012 Policy Institute

Make your voice heard in Washington DC! Join rural healthcare providers and advocates at NRHA’s 2012 Rural Health Policy Institute, January 30-February 1. Meet Colorado’s members of Congress and learn about important issues impacting rural health. Early registration ends on December 30. Click here for more information.  

2011 Medicare Payment Basics Series

If you want to learn more about Medicare payment, check out MedPACs 2011Medicare Payment Basics series. The series includes 18 brief summary documents that provide an overview of how different entities are paid under Medicare (including Critical Access Hospitals). Click here for more information. 

CO-OP Health Plans: Can They Help Fix Rural America's Health Insurance Markets? Webinar on October 19, 2011

Curious about insurance CO-OPs aka consumer-operated and oriented plans? Join a webinar on October 19 at 10:00am MT, hosted by the Rural Assistance Center and the State Health Access Reform Evaluation on "CO-OP Health Plans: Can They Help Fix Rural America’s Health Insurance Markets?". Click here for more information and to register. 

2011 Rural America at a Glance

A recent report by the USDA’s Economic Research Service highlights the most recent indicators of social and economic conditions in rural areas. The 2011 edition focuses on the U.S. rural economy, including employment trends, poverty, education, and population trends. Read the report. 

Data Initiative for Critical Access Hospitals

Critical Access Hospitals--please consider participating in MBQIP! The Medicare Beneficiary Quality Improvement Project (MBQIP) is a three-year, voluntary initiative for Critical Access Hospitals (CAH) intended to create a national database of rural appropriate and relevant quality data to demonstrate to policymakers the work CAHs are doing. CAHs that participate in MBQIP will be able to share best practices among one another and be benchmarked against other CAHs across the nation. As Medicare moves toward payment tied to quality and public reporting, MBQIP provides an opportunity for CAHs to prepare for future changes. We all know that rural health is not ‘a smaller version’ of urban healthcare systems and current national measurement and benchmarking systems may not accurately capture and reflect the quality work of rural health providers.

MBQIP’s first of three phases is beginning now. To learn more, watch the short MBQIP video on YouTube and contact Jen Dunn or Michelle Mills for additional information. 

Federal Advocacy Webinar Now Online

If you missed the advocacy webinar earlier this week, a recording is now available on CRHC’s website along with the slides from the presentation and several tools you can use for your personal outreach to members of Congress. Click here for more information and useful resources to get involved in these efforts. Please contact Sara if you have any questions. 

Will Payment Bundling Work in Rural? A New Report

A new report by the Upper Midwest Rural Health Research Center assesses the financial and quality challenges – and potential unintended consequences for rural providers and patients – of implementing bundled payments for acute and post-acute care episodes; explores the possible impact on quality of care delivered under a facility-provider bundled payment system, and suggests measurement opportunities to assess the quality of care delivered under a facility-provider bundled payment system; and describes potential modifications to current bundling proposals (plus additional steps the Centers for Medicare and Medicaid Services could take) that will help address rural-specific issues. Click to read the policy brief and the full report. 

Division of Insurance Holding Forums and Webinars on Insurance Changes

Colorado Commissioner of Insurance, Jim Riesberg, and other Division of Insurance staff will hold forums in Greeley and Grand Junction in October to help people learn about changes to their health insurance. The meetings are designed to address the causes of premium increases, benefits guaranteed in federal health reform, what Medicare participants can do when a claim is denied, and similar consumer issues. The Greeley meeting is on Thursday, October 20 at 6:30pm at the Greeley Ice Haus, 900 8^th Avenue, and the Grand Junction meeting is on Tuesday, October 25 at 6:30pm location TBD. The Division of Insurance is also hosting webinars on Oct. 11 at 6:30pm  and October 18 at 12:00pm to help small-business owners and human-resources professionals learn about changes in insurance. Additional information and links to register are available online.  

What Do Federal Deficit Proposals Mean for Rural?

Decisions are being made in Washington DC that will impact rural health care. If you would you like to learn more about the ongoing negotiations to reduce our nation’s deficit and understand how various proposals could impact rural providers and communities, please attend a Federal Advocacy webinar on Tuesday, October 4, from 2:00-3:00pm. The Colorado Rural Health Center, in partnership with the Area Health Education Centers, will be hosting the webinar to provide information on this important topic and share resources for communicating with your elected officials. Click here to register for the webinar. If you are unable to attend tomorrow, a recording of the webinar will be available on CRHC's webpage and The Rural Voice.

Understanding the Rise in Health Insurance Premiums

A survey released earlier this week found that employer-based health insurance premiums increased by 8 and 9 percent for single and family coverage respectively from 2010 to 2011. A new analysis by the Commonwealth Fund looked at the potential causes of the increase, including the 2010 insurance reforms included in the Affordable Care Act. The analysis finds 1.8 percent increase could be attributable to the insurance reforms. Read more.

October 3 Deadline to Register, Update Voter Registration

If you would like to vote in this November’s elections, you have until October 3 to register or make changes to your existing registration. Click here for more information and resources from the Secretary of State’s office. 

Federal Budget Update and Upcoming Webinar

Although much attention is being directed to the deficit reduction proposals and work of the President and Super Committee, the federal fiscal year 2011 ends on September 30 and none of the FY 2012 appropriation bills have been enacted by Congress. To avoid a government shutdown on October 1, Congress has been working on a Continuing Resolution that would keep programs funded. After some concerns that the two chambers would not reach a compromise, an agreement was reached yesterday evening that should keep the government operating. This Continuing Resolution does include spending reductions from FY 2011 levels that were agreed upon during deficit reduction negotiations earlier this summer.

The Senate did complete its markup of the FY 2012 Labor-HHS Appropriations bill last week, recommending level funding for many rural health programs including SHIP and Flex. The House has not completed its work on the Labor-HHS bill and it’s not clear whether Congress will pass the spending bills or wait for the Super Committee’s recommendations that are due on November 23.

Want to learn more about the current federal budget negotiations? CRHC, in partnership with the Area Health Education Centers, will be hosting a webinar on October 4 from 2:00-3:00 pm to discuss the issues, how they might impact rural providers and communities, and provide information and resources for communicating with your elected officials. Click here to register for the webinar. 

Update on Affordable Care Act—Could Be Heard by Supreme Court in 2012

The Obama Administration did not request a review by a federal appeals court on a recent ruling on the Affordable Care Act (ACA), making it more likely that the Supreme Court would hear the case later this fall and issue its decision in 2012. With split decisions coming from the appeals courts, the Supreme Court is widely expected to render the final word on the constitutionality of provisions within the ACA. Read more. 

Don't Forget to Complete Our Annual Survey!

Thank you to everyone who has already completed CRHC's annual survey! The survey will close on Friday, September 30 so please take a few minutes today to share your thoughts and feedback on our policy and advocacy work.  

Webinar on Colorado's Medicaid Expansion

Colorado’s Department of Health Care Policy and Financing is hosting a webinar on Tuesday, Sept. 27, 2011, from 3:00-5:00 p.m. MT to discuss the Adults without Dependent Children expansion and the proposed 1115 Demonstration Waiver which will be submitted to the Centers for Medicare & Medicaid Services in the fall of 2011. Click for more information or to register.

Proposed Changes to CHP+

The Medical Services Board is proposing new cost sharing requirements for the Children’s Basic Health Plan (CHP+). As outlined in the proposed rules released on Monday, the annual enrollment fee for families with incomes between 200 and 250% of the federal poverty level would be $75/ year for one child and $105/ year for two or more children. The proposed rules would also increase co-payments based on family income. The initial approval date and public comment hearing on these proposals is October 14. Please click here for more information about the meeting and contact Alicia Haywood if you have any questions or feedback. 

Cutting Healthcare Providers Also Impacts Patients

An article in today’s New York Times highlights the impacts that cuts to healthcare providers can have on patients. 

September Revenue Forecast

Colorado’s economic growth has slowed over the summer, according to today’s revenue forecasts released by the Office of State Planning and Budgeting and the Colorado Legislative Council. The state economy faces many national and global threats; however, agriculture and oil prices are strong. The state’s current FY 11-12 budget is in balance, with a $64 million projected surplus. For FY 12-13, forecasters projected a surplus of approximately $370 million, assuming that the current year’s surplus is rolled over and the economic outlook remains steady. Given this minimal projection for the next year and annual increases in demand for services including Medicaid, spending reductions are expected for the coming year. Read more. 

White House Releases Deficit Reduction Proposal Calling for Medicare, Medicaid Changes

The White House proposal that was released today calls for reducing the nation’s debt by $3 trillion over the next ten years. The deficit reduction plan puts forth significant reductions in Medicare and Medicaid spending that will drastically impact rural healthcare providers and communities, including lowering Critical Access Hospital (CAH) reimbursement, eliminating CAH designation for any facility within 10 miles of another hospital, lowering the federal matching rate for Medicaid to the states, and reducing the Medicaid Hospital Provider Fee. As Congress moves forward with deficit reduction activities in the coming weeks, this proposal will be under consideration. Members of Congress need to hear from their constituents about the impact these cuts will have on rural providers and access to care in rural communities. CRHC will be providing additional information, resources, and opportunities to communicate with your elected officials in the coming days. Read NRHA's response to the White House proposal. 

Latest Estimates of Colorado’s Uninsured

Earlier this month, the U.S. Census Bureau released information on Americans’ income, poverty, and health insurance coverage for 2010. Nationally, median household income declined and the poverty rate increased. While the number of Americans without health insurance increased, the overall percentage was not statistically different from the previous year. The Colorado Health Institute (CHI) released a report on state-level findings, noting that Colorado was the only state that recorded a statistically significant decline in the number of uninsured individuals between 2007-08 and 2009-10. Read CHI’s report. 

Community Paramedics Responding to Community Needs

Today’s New York Times features an article on community paramedics, highlighting Eagle County’s program. Read more. 

Deadlines Extended for Medicare Bundled Payment Initiative

The CMS Innovation Center has extended the deadlines for letters of intent and applications for its Bundled Payments for Care Improvement initiative (BPCI) released on August 23rd. Letters of intent for BPCI Model 1 are now due on October 6th, 2011. Applications for BPCI Model 1 are now due on November 18th, 2011. Read more. 

Loan Repayment Application Cycle Opening

Do you have a healthcare provider at your rural facility who is interested in loan repayment? Let them know that the Colorado Rural Outreach Program Loan Repayment Program application cycle is opening in October. Read more.

Nearly Half of Office Based Physicians Working With NPs and PAs

The Centers for Disease Control and Prevention's National Center for Health Statistics reported in an Aug. 17 data brief that 49% of physicians working in office settings work with nurse practitioners, physician assistants, and certified nurse midwives. Primary care practices were the most likely specialty to work with these practitioners. Read more. 

Complete CRHC's Policy and Advocacy Survey Today

Please inform the Colorado Rural Health Center’s (CRHC) policy & advocacy efforts for 2012 by completing our annual survey. Your feedback is invaluable and will help guide our work. The survey should take approximately 5 minutes to complete and can be accessed by clicking here. The survey will be open until Friday September 30, 2011. Please complete the survey only once. Your responses are greatly appreciated!

New Health Information Technology Website Available

The Office of the National Coordinator for Health Information Technology has launched a new website www.HealthIT.gov. The website has information and resources for both healthcare consumers as well as providers. The site also addresses privacy questions regarding electronic health records. 

Nonfinancial Barriers and Access to Healthcare

A recent study found that more U.S. adults postpone or go without medical care for nonfinancial reasons than for financial ones. Although affordability issues did limit access to care, nonfinancial barriers including availability and accessibility of care often overlapped with financial barriers. Read more.

Community Paramedics Meeting Healthcare Needs in Eagle County

Read more about The Community Paramedic Program, a pilot project through the Western Eagle County Ambulance District, that partners paramedics with physicians to provide in-home health monitoring and check-ups. The program is an innovative solution to some of the challenges of providing healthcare in rural communities.

The Budget Control Act of 2011: Implications for Medicare

A new brief by the Kaiser Family Foundation, The Budget Control Act of 2011: Implications for Medicare, provides an overview of the new law that came out of this summer’s negotiations on raising the debt ceiling and deficit reduction, including a timeline and process for raising the debt ceiling and lowering the federal deficit. The brief also describes the role of the new Joint Select Committee on Deficit Reduction, aka the “Super Committee”, examines how Medicare spending could be affected by changes proposed by the Committee, or if that process fails, by sequestration. Click here to read the brief. 

New Website Available to Answer Questions, Provide Information on Health Insurance

The Colorado Division of Insurance has created a new website for consumers and business owners to answer questions and provide information about health insurance, including what drives the cost of insurance premiums, how to select a plan, and how to get help when an insurance claim is denied. Click here to access the website or go to www.askdora.colorado.gov and click on the “Are You Prepared for Changes in Health Insurance?” button.

New Critical Access Hospital Data Initiative

Rural healthcare providers and advocates know that rural health is not ‘a smaller version’ of urban healthcare systems and that current national measurement and benchmarking systems may not accurately capture and reflect the quality work of rural health providers. The Medicare Beneficiary Quality Improvement Project (MBQIP) is a three-year, voluntary initiative for Critical Access Hospitals (CAH) intended to create a national database of rural appropriate and relevant quality data to demonstrate to policymakers the work CAHs are doing. CAHs that participate in MBQIP will be able to share best practices among one another and be benchmarked against other CAHs across the nation. As Medicare moves toward payment tied to quality and public reporting, MBQIP provides an opportunity for CAHs to prepare for future changes. 

MBQIP’s first of three phases begins in September 2011. To learn more, watch the short MBQIP video on YouTube and contact Jen Dunn or Michelle Mills for additional information.

Denver Post Coverage on Scaling Back Medicaid Expansion

Today's Denver Post covers the recent announcement by the Colorado Department of Health Care Policy and Financing that it will be limiting Medicaid coverage for adults without dependent children. Click here for the article.

Update on State Medicaid Expansion

The Colorado Department of Health Care Policy and Financing has made decisions regarding expanding Medicaid coverage to adults without dependent children, including when and how the expansion will begin and who will be eligible in the first phase. Please click here to read the update provided by The Colorado Coalition for the Medically Underserved's Connect Campaign. 

CMS Creates Medicare Bundled Payment Initiative for Interested Providers

The Centers for Medicare and Medicaid Services (CMS) has invited interested providers to “help test and develop” four different models of bundling payments. Under this initiative, CMS would link payments for multiple services patients receive during an episode of care. Three models involve a retrospective bundled payment arrangement and one model would pay providers prospectively. Nonbinding letters of intent must be submitted by Sept. 22 or Nov. 4, depending on the model that providers plan to pursue. Click here for detailed information on this initiative. 

Policy Brief: U.S. Rural Hospital Charges Due to Ambulatory Care Sensitive Conditions

A new policy brief by the RUPRI Rural Health Center for Policy Analysis examines the trends and regional variations of rural hospital charges due to ambulatory care sensitive conditions (ACSCs), by insurance type, from 2000 to 2004. While ACSC-related charges as a percentage of all charges in rural hospitals decreased by 4.5% during this time period, for uninsured and Medicaid patients the percentage of total ACSC-related charges increased from 12.5% to 15.0%. The authors suggest that investing targeted resources that support ambulatory primary care in rural communities could reduce hospitalizations and associated costs. Click to read the brief. 

The Geography of Need: Identifying Human Service Needs in Rural America

A recent study by the Rural Policy Research Institute, The Geography of Need: Identifying Human Service Needs in Rural America, proposes a new methodology for creating a human service profile based on characteristics of a population and also documents how human service needs differ significantly, in both the degree of need as well as the types of needs, in metropolitan and non-metropolitan counties. The study includes county-level maps that illustrate these characteristics and profiles. Click here to read the report. 

ClinicNET and CRHC Release Patient Centered Medical Home Landscape Brief

Quality care delivered in a Patient Centered Medical Home (PCMH) model involves many different tools, staff, and strategies, including health information technology, health information exchange, and patient registries, to deliver culturally and linguistically appropriate care to patients and their families when and where they need it. ClinicNET and CRHC support the PCMH model and provide services to assist clinics in pursuing PCMH certification or designation. To read the new PCMH brief and to learn more about efforts in Colorado, please click here.

Rural Council Report Focused on Economic Growth

The White House Rural Council released a new report entitled Jobs and Economic Security for Rural America. The report lays out the economic landscape facing rural America and highlights five key areas: creating jobs and promoting economic growth, improving access to quality healthcare and education, fostering innovation, expanding outdoor opportunities, and supporting veterans and military families. Click here to read more and download the report. 

Safety Net Clinic Week is Coming Soon—Are You Ready?

Safety Net Clinic Week is just around the corner, August 22-26. This week is a great opportunity to educate lawmakers and communities about the diversity of Colorado’s safety net. Many rural health clinics and community-funded safety net clinics will be participating by hosting state and federal elected officials to their clinics, holding community open houses, etc. Please click here to access a toolkit that will help clinics that would like to participate. Please contact Alicia or Sara to share what activities you are planning for the week or for assistance.  

Update from CHI on Rural APNs and PAs in Colorado

Colorado Health Institute’s Jackie Colby presented new findings about rural nurse practitioners (APN) and physician assistants (PA) practice patterns at CRHC’s annual conference on Thursday, August 11. The new analysis, based on respondents to CHI’s previous APN and PA surveys, found that about 11 percent of both PAs and APNs work in rural areas yet there are nearly twice as many APNs as PAs overall. Read more.

Dual-eligible Medicare/Medicaid Beneficiaries

Earlier this summer, Colorado received $1 million from the Centers for Medicare & Medicaid Services to plan an integrated model of care for individuals who are dually-eligible for Medicare and Medicaid. A new post from Health Reform GPS gives a detailed summary about some of the challenges in coordinating care for these individuals who are typically older and experiencing multiple chronic conditions as well as provisions in the Affordable Care Act that are intended to address these challenges. Read the post.  

Update on Congressional Deficit “Supercommittee”

The deal reached by Congress and the White House that raised the debt ceiling also called for the creation of a bipartisan Congressional “supercommittee” called the Joint Select Committee on Deficit Reduction. This committee is charged with finding at least $1.2 trillion in savings. These recommendations are due by Thanksgiving, with the entire Congress to vote on them by Christmas to avoid automatic cuts in military and healthcare programs, specifically payments to Medicare providers. Nearly all of the members of this committee have been named. Click here to read about this committee and its members to date.  

Colorado Health Benefit Exchange Board to Hold 3rd Meeting

The next meeting of the Colorado Health Benefits Exchange (COHBE) board will be held this Thursday, August 11th from 9:30 AM – 1:00 PM in the Legislative Services Building (200 E. 14th Ave., across the street from the State Capitol). It has not been determined if the meeting will be broadcast on the web. The by-laws committee of the Exchange Board had a conference call yesterday to discuss legal counsel and the process for developing the by-laws. Committee members Steve Erkenbrack, Ken Lund, and Richard Betts will make recommendations to the Board during its meeting Thursday. The Board is also expected to appoint a Chair. 

Peter Marcus of The Colorado Statesman, a weekly nonpartisan political paper, wrote a great article yesterday detailing the Board’s process so far and some of the controversy surrounding its appointments and funding. Click here to read the article.

For more information on the Colorado Health Benefit Exchange, contact Alicia. 

LGBT Health Survey Available Online

The One Colorado Education Fund has created an online survey to measure the healthcare needs and experiences of lesbian, gay, bisexual, and transgender (LGBT) Coloradans. The anonymous survey is available in both English and Spanish and will be open through August 26. The Survey is an opportunity for LGBT Coloradans, including those living in rural communities, to share their experiences and feedback. Click here to access to survey. Read more. 

Defining Rural: Issue for White House Rural Council?

U.S. Agriculture Secretary and Chair of the White House Rural Council Tom Vilsack said that he would ask the Council to consider streamlining the many existing definitions of “rural” in use among federal agencies. The federal government has 16 agencies with 88 programs that have varying and contradictory definitions of rural America for eligibility purposes. Read more. 

New Report on “Modernizing” Rural Healthcare

A recently released report by the UnitedHealth Center for Health & Reform Modernization examines the health needs of rural America and how well the healthcare system is able to respond. The paper looks at coverage, access, and quality in rural communities and also outlines recommendations for addressing issues including greater use of telemedicine, expanded roles for nurse practitioners and physician assistants, designing regulations to meet the needs of rural areas, and engaging more rural consumers in improving their health. Read more. 

Debt Ceiling Update

Congress and the White House reached a deal to raise the nation’s debt ceiling and avoid default. In addition to increasing the federal borrowing limit, the plan also included substantial deficit reduction measures. The agreement, which operates in two parts, would raise the debt ceiling by $900 billion immediately in August and September and require an equal $900 billion spending reduction.  Medicare and Medicaid would not be impacted by these initial cuts, despite earlier information that Medicare payments to rural hospitals could be reduced by roughly $14 billion and Medicaid matching rates would be lowered. Thank you to all who called or wrote their Members of Congress to express concern about these cuts.

The second component of the debt ceiling legislation creates a 12-member “super congress” made up of equal numbers of members of both parties and both bodies of Congress. This committee would be responsible for making recommendations for $1.2-1.5 trillion in additional savings by Nov. 23. The committee may target Medicare and Medicaid for reductions to achieve these savings. The committee’s recommendations would be subject to a simple up-or-down vote before Dec. 23 and could not be filibustered.  If the recommendations pass, the President could request an additional increase in the debt ceiling of $1.5 trillion. If Congress fails to either act on the committee’s proposal or send a balanced budget amendment to the states before the end of the year, then an automatic “trigger” of across-the-board spending cuts totaling $1.2 trillion would go into effect. The cuts would apply to both mandatory and discretionary spending programs beginning in 2013. Medicaid, Social Security, and veterans’ benefits would not be subject to the cuts, but Medicare provider payments would face a cut of up to 2 percent over nine years (2013-2021). The president would then be authorized to request an additional increase in the debt ceiling of $1.2 trillion.

The agreement passed both the House and Senate and the President is expected to sign it as soon as possible. Click here to read more about the agreement and its potential impact on health programs. 

Health Insurance Exchange Focus Groups

Health Insurance Exchanges are online marketplaces where consumers can shop and buy health insurance products in the independent and small business markets.  Given the high number of ranchers, farmers and small business owners in rural areas, it is crucial the experiences and ideas of rural Coloradans are heard in order to ensure the Exchange works for residents from all parts of the state.  The Colorado Center on Law and Policy is hosting focus groups around the state to better understand the consumer needs, opinions and perspectives of the Exchanges.  This is a great opportunity to provide the rural voice in the process.  A list of the meetings outside the Denver-metro area is below. More information can also be found at Colorado Insurance Exchange Focus Groups.

 

Grand Junction

Dates: August 1st and 2nd

Time: 6-8 pm

Place: Mesa County Workforce Center

Sterling

Date: August 8

Time: 6-8pm (room reserved 5.30 to 8.30)

Place: CSU Extension Room

Address: 508 S. 10th Avenue

Greeley

Date: August 1st

Time: 6-8pm (room reserved 5.30 to 8.30)

Place: Centennial Park Library

Address: 2227 23rd Avenue

Pueblo

Date: August 3rd

Time: 6-8pm (room reserved 5.30 to 8.30)

Place: Rawlings Library (Thurston Room)

Address: 100 E. Abriendo Ave