New Study Explores Roles of Nurse Practitioners and Physician Assistants in Improving Access to Primary Care

A new report by the Kaiser Commission on Medicaid and the Uninsured looks at the potential of nurse practitioners and physician assistants to increase the supply of primary care, in areas experiencing physician shortages as well as system-wide, as Medicaid expands to cover more uninsured adults. Read the report. 

Updated Bill Tracker

CRHC's Bill Tracker is current through April 28.

State Budget Update

As reported earlier, the FY11-12 Long Bill and several related bills went to conference committee last week. During its negotiations, the committee increased funding for the Primary Care Fund (SB 219), including $1 million for the Health Care Services Fund clinics (eligible for a $1 million federal match) and $413,500 for the Special Distribution Fund clinics. These increases bring the total state funding for the Special Distribution Fund to $2,163,500 and the Health Care Services Fund to $11,750,000 (eligible for a $11.75M federal match). The conference committee report must still be approved by the House and Senate and signed by the Governor and we will keep you updated as the budget bills advance. Thanks to the many clinics and primary care advocates who contacted their state legislators about the importance of primary care funding. 

Friday, April 29 Named Colorado Rural Health Day

In an effort to acknowledge the vital services of rural healthcare practitioners across Colorado, State Representative Tom Massey (R-60) has introduced House Joint Resolution 11-1018 to recognize “Rural Health Day” as Friday, April 29^th, 2011. Senator Betty Boyd (D-21) is the Senate sponsor. CRHC worked closely with Rep. Massey and other state legislators who co-sponsored HJR 1018 to propose a resolution recognizing the hard work being done to provide healthcare to rural communities. Read the press release and contact Sara Schmitt for more information. 

Collaboration with FQHCs

The Affordable Care Act provides a requirement that Community Health Centers (FQHCs) demonstrate that they have made, and will continue to make, reasonable efforts to maintain collaborative relationships with other health care providers in their catchment areas. Specifically, the legislation lists Rural Health Clinics, low-volume hospitals, Critical Access Hospitals, Sole Community Hospitals, and Medicare Dependent Hospitals as the entities with which a Community Health Center should demonstrate a collaborative relationship.

New Access Point grant applications and Service Expansion grants for FQHCs will be judged and scored, in part, on the extent to which they demonstrate the collaboration and coordination of the delivery of healthcare services with other healthcare providers in their service area. A November 2010 Policy Assistance Letter from the Bureau of Primary Health Care provides additional information on this expectation.

This report from Stroudwater Associates is intended to provide non-FQHC healthcare providers with a better understanding of the circumstances regarding FQHC service expansions and it also describes the collaboration efforts encouraged by HRSA when considering expansion.

Comparison Of Medicaid Provisions In Deficit-Reduction Proposals

A new issue brief from the Kaiser Commission on Medicaid and the Uninsured compares several proposals, including ones by President Obama and the House Budget Committee Chairman Paul Ryan (R-Wis.), to address Medicaid spending as part of a broad-based debt- and deficit-reduction package. Click to read the brief. 

Health Care Workforce: Future Supply vs. Demand

A new issue brief from the Alliance for Health Reform assesses the healthcare workforce, which workers are most needed, and gives strategies on dealing with the problem of shortages. Click to read the brief.

New ACO Resources

Health Reform GPS, a joint project between Robert Wood Johnson Foundation and George Washington University, has posted an overview for the Medicare Shared Savings Program for Accountable Care Organizations (ACOs).

The Broadband Speed Divide

A new article on Daily Yonder looks at broadband Internet access between rural and urban areas based on data released this year by the National Telecommunications and Information Administration. The analysis found that nationally the gap in access to broadband Internet between rural and urban areas is narrowing, however significant differences remain in choice of provider and download speeds. These issues are significant for healthcare delivery in rural areas in providing telemedicine as well as health information technology.   

U.S. Supreme Court Does Not Act on ACA

The U.S. Supreme Court deferred taking action on a bid by Virginia’s attorney general for fast-track consideration of the state’s challenge to the Affordable Care Act (ACA). The Court will have another opportunity this month to decide whether to take up the ACA for early consideration. While the Supreme Court is ultimately expected to decide the constitutionality of the ACA, several appeals courts will be hearing challenges to the law throughout 2011. Federal trial judges across the nation have upheld the law but others have declared it unconstitutional. Read more. 

1099 Provision in Health Reform Repealed

President Obama signed a bill repealing a tax-compliance mandate, known as the 1099 Provision, in the Affordable Care Act. The repealed provision, under which companies would have had to report more transactions to the Internal Revenue Service, was to have taken effect in 2012. Read more.

FY 11-12 State Budget Update

The Colorado Senate and House passed the FY 11-12 budget Long Bill and several related bills this week. Although still contingent upon the state declaring a fiscal emergency, funding for Primary Care Fund was included with $1.72 million for the Special Distribution Fund and $10.75 million (eligible for a federal match) for the Health Care Services Fund. These amounts are reductions over last year’s levels. A Senate amendment that would have added an additional $1.8 million to the Health Care Services Fund was not picked up in the House. The final package also adds monthly premiums to the Child Health Plan Plus (CHP+) program for children over 205% of the federal poverty level, cuts Medicaid provider rates by 0.75%, and reduces Medicaid funding for family medicine residency programs.

As each chambers passed different versions (including the Primary Care Fund amendment), the Long Bill now moves to conference committee, consisting of members of the Joint Budget Committee, to work out the differences. Once the committee completes its work, the budget returns to both houses for final passage. Read more.

Federal Budget Update

In Washington, Congress will be voting today on a budget compromise reached last weekend on the FY 11 budget. This agreement cuts $38.5 billion and includes an across-the-board 0.2% reduction in all non-defense discretionary accounts. Specific cuts include $600 million from community health centers and $35 million to eliminate the rural Delta Health Initiative.

While wrapping up FY 11, attention is shifting to work on the FY 12 budget and considering long-term deficit reduction plans. The House is debating a GOP budget resolution that would reduce domestic discretionary spending to below 2008 levels for 5 years, convert Medicaid into a block grant to the states, and shift Medicare into a voucher-like program in which future retirees purchase private insurance plans. In addition to his original FY 12 budget proposal, the President responded yesterday with recommendations, including streamlining Medicaid payments to states in a single rate for both Medicaid and Children’s Health Insurance Plans, strengthening a payment advisory board that would recommend cuts to reimbursement rates if Medicare costs grow too fast, and placing dual-eligible Medicare/Medicaid beneficiaries in Medicaid managed care and extending Medicaid drug rebates to this population.

The House will be debating the GOP budget resolution this week and, while it may not represent the final budget decision, this proposal does create a blueprint that could have significant negative impacts on rural healthcare providers and access to healthcare for rural communities. Please call Congress this week at 202.224.3121 and ask to be transferred to your Representative’s office to leave this message: “Please vote against Rep. Ryan’s budget resolution which will hurt critical healthcare programs for rural communities including Medicaid and Medicare.” Click here to find out who represents you. We will continue to monitor the federal budget situation and post updates. Also stay tuned for a state budget report.

2011 Report from National Advisory Committee on Rural Health & Human Services

The National Advisory Committee on Rural Health & Human Services is a 21-member citizens' panel of nationally recognized rural health experts that provides recommendations on rural issues to the Secretary of the Department of Health and Human Services. The Committee's 2011 report to the Secretary examines three key topics in health and human services and their effects in rural areas: rural childhood obesity, place-based initiatives for rural early childhood development, and the rural implications of Accountable Care Organizations and payment bundling.

Bighorn Leadership Program Seeking Applicants from Roaring Fork Valley & Colorado Springs

The Bighorn Leadership Program presented by Engaged Public and in collaboration with Colorado State University are seeking individuals to participate in The Bighorn Health Care Policy and Project Lab. The program will be taking place simultaneously in two locations: The Roaring Fork Valley & Colorado Springs. The  Lab will include public leadership curriculum with an additional component allowing participants the opportunity to focus on the actual implementation of a health related policy or project. Individuals who live in the Roaring Fork Valley or Colorado Springs and who have a specific interest in developing their own public leadership skills, health care policy and healthy living in order to better serve their communities and constituencies are encouraged to apply. The application deadline is April 15. Download the application and more information.

Webinar on Accountable Care Collaboratives in Colorado

Bringing Health Home is hosting a webinar on Thursday, April 14 from 12:00-1:00 pm titled "Accountable Care Collaboratives--what is happening in Colorado?". Accountable Care Collaboratives are a framework within which other health care initiatives can potentially thrive, such as the medical home, health information technology, and payment reform.  This webinar will introduce folks to the ACC model, the pilots underway in the Colorado Medicaid program, and how it fits with national healthcare reform. Space is limited, click here to register and learn more. 

Plan to Reduce Health Disparities Announced

In a first-of-its-kind report, the U.S. Department of Health and Human Services is recommending steps that states and communities can take to reduce health disparities. Read more.

Impact of a Federal Government Shutdown

Today's Denver Post features an article that describes the local effects of a federal government shutdown and how members of Colorado's congressional delegation are responding.

FY 11-12 Budget Updates

Colorado Senate and House leaders and the Governor have agreed on a budget for FY2011-12, to be introduced this week in the Senate as the Long Bill. The delayed Long Bill and other budget balancing efforts, including action on the Primary Care Fund, were delayed due to disagreements regarding the cuts to K-12 education, the sales tax vendor fee, and the amount of money in the state’s reserves. The bipartisan agreement includes a $250 million cut to K-12 and maintains a 4% general fund reserve. Read more about the proposed budget.

U.S. House and Senate leaders are still negotiating around the nation's FY 11 budget, facing a deadline of April 8 to avoid a government shutdown. House Republicans released their FY 12 budget proposal earlier this week, calling for significant changes to Medicare and Medicaid programs. Read more about the House proposal's impact on healthcare.  

Updated Bill Tracker Available

CRHC's bill tracker is current as of April 1, 2011. Enjoy!

Colorado CRNA Opt-Out Upheld

On March 31 in a verbal ruling, the Denver District Court found that Governor Ritter's September 2010 opt-out from the Medicare requirement that a CRNA must practice under physician supervision in rural communities and Critical Access Hospitals was consistent with Colorado law. A written order is expected to be issued soon. The ruling comes in response to a lawsuit filed against Governor Ritter's opt-out decision.


CRHC thanks the Colorado Hospital Association, Colorado Nurses Association, and the Colorado Registered Nurse Anesthetists who worked diligently to see the opt-out decision upheld. CRHC has long-supported an opt-out of CRNA supervision requirements to improve access to healthcare in rural communities and will continue to keep our readers updated on any new developments.