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.