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.........

Updated Bill Tracker 4.21.10

The finsh line is getting closer! We are officially 4 weeks away from the end of the 2010 Legislative Session. Of the seven bills CRHC has supported this session, three have been signed by the Governor already and one has been postponed indefinitely. Hopefully the remaining weeks will be relatively quiet, but there is still talk of some possible late bills that may be introduced. Stay tuned.....

Also, as most of you may know already, the Governor signed an Executive Order yesterday creating the Interagency Health Reform Implementing Board, which is tasked with implementing the federal healthcare reform legislation. I will provide more information about the Board and what it is going to look like moving forward as soon as that information is made available.

A note for all of you who follow this blog, I will be offline until Tuesday, May 4th. Enjoy the next 2 weeks and will post here again in May!

Gov. Ritter Healthcare Press Event @ 12:30p Tuesday 4.20.10

Governor Ritter, along with various legislators, will be holding a healthcare press conference tomorrow, April 20th @ 12:30pm, to announce Colorado's plans for implementing federal health reform. The event will take place at Denver Health, Wellington Webb Center for Primary Care, 301 W. 6th Ave. Denver.

Governor Ritter will also be signing the following four health-related bills into law. Please note CHRC supported both HB1138 and SB058!

HB 1004 – Standardized Health Insurance Information (MASSEY—FOSTER)
HB 1166 – Plain Language in Insurance Policies (KEFALAS—NEWELL)
HB 1138 – Colorado Health Services Corps (GAGLIARDI—MORSE)
SB 058 – Nursing Teacher Loan Forgiveness (TAPIA—GAGLIARDI)

Medicare Physician Cuts Postponed......AGAIN!

While it's not a permanent fix, Congress yet again extended the Medicare SGR physician payment methodology. The 21.2% reimbursement cuts that were set to begin April 1st, have now been extended through May 31st. This gives Congress 6 weeks to try to permanently address this issue or physicians will face, yet again, a possible 21.2% reimbursement cut come June 1st.

HB1138: Colorado Health Service Corps on its way to becoming law!

Woo-hoo! The Senate today passed HB1138: Colorado Health Service Corps, which will allow our state to more efficiently & effectively administer the state healthcare professional loan repayment program. The bill also rebrands the state healthcare professional loan repayment program, lovingly referred to as SLRP. The name, the Colorado Health Service Corps, now will reflect the federal health professional loan repayment program, the National Health Service Corps. Also, with the passage of this bill, oral health providers will now be eligible to apply for loan forgiveness dollars through the state's Primary Care Office. The bill does not need to be reconciled, so should be finalized soon and sent to the Governor for his signature.

This is a great victory for our state and for rural & underserved residents and healthcare providers as loan forgiveness programs are a great incentive in strengthening the healthcare workforce in rural and underserved areas.

Updated Bill Tracker 4.12.10

We are 5 weeks away from the end of the 2010 Colorado Legislative Session and yet I think the political fun is just about to begin! The House and Senate have both passed the FY10-11 budget, though differences between the bills still need to be ironed out. Once a final budget has been approved and signed by the Governor, I will post relevant information here. Once the legislative session ends (scheduled for May 12th as of right now), you can expect campaining for November elections to begin in full force. All 65 House seats are up for reelection and 17 Senate seats.

Congress is back in session and the Senate should be voting today to extend the Medicare SGR, which lapsed April 1st. While it would be ideal for Congress to finally address the SGR, so that these temporary fixes don't have to keep occurring, Congress needs to act quick so that physicians do not experience a 21% reimbursement cut for Medicare services.

2010 Colorado Health Resource Book

I wanted to post a link to this resource published every year by the Colorado Legislative Council staff. This was just published in March. It's a great overview of health care issues in Colorado and provides an understanding of how the state spends healthcare dollars within each healthcare department.

Health Reform for Rural Americans

Here is a fact sheet from the White House about the impacts on health reform on rural Americans.

Also, the National Rural Health Association has fact sheets and information on what health reform means for rural providers and consumers.

Webchat on Health Reform with HHS Secretary

U.S. Department of Health and Human Services Secretary Kathleen Sebelius and Small Business Administrator Karen Mills hosted a webchat to discuss the benefits of the new health reform law. Click on the link above to watch the 30 minute YouTube discussion.

Updated Bill Tracker 4.2.10

With the state having a furlough day today, I was finally able to catch up and update the bill tracker! You'll see the majority of the new bills listed all pertain to the FY10-11 Budget. Things will pick up again next week as a lot of bills that have been hanging out in limbo in the Appropriations Committee (in both the House & Senate) will start moving forward. There are about 6 weeks left in the session, so we can expect bills to start moving quickly!

Update on 21% Medicare Cuts

With Congress failing to act on preventing the 21% Medicare reimbursement cuts to physicians, CMS has announced they will not pay claims for the first 10 business days in April.

Medicare Physician Cut Set for April 1st

With the Senate failing to extend the Medicare SGR formula before Congress left for the 2-week recess, physicians again are faced with a 21.3% cut in Medicare reimbursement effective April 1st. The House already passed H.R. 4851, which includes an extension of the SGR Medicare formula, in addition to COBRA and unemployment benefits, but the Senate was not able to vote on this bill prior to recess. The Senate is planning to call for a cloture vote after recess, which if supported by 60 Senators, will allow the Senate to vote on the legislation. This is expected to occur April 12th. This means that there will most likely be a gap that will include the 21.3% reduction in Medicare reimbursement. The Center for Medicare and Medicaid (CMS) should be making an announcement soon discussing how they will handle this issue. Other policy sites are stating that judging on past experience, CMS will be forced to process claims at the reduced reimbursement rates for at least 10 days.

Health Reform & State Update

Well, as most everyone knows by now, the U.S. has undertaken the biggest social policy change since the 60's with the passage of the healthcare bill that President Obama signed into law on Tuesday. There is still a reconciliation bill that corrects a lot of (what I like to call) political garbage that was in the orginal bill that was passed. The Senate is ironing out the reconciliation bill and should be voting on it today or tomorrow. There has been some slight tweaks to the bill, so the House will have to vote on the bill again before being sent to the President to sign.

I've been frantic with other policy fun here at the state level this week and have not had time to fully digest what is in the health reform bill. I am including some links for you to follow if you'd like to read more about the health reform bill. I hope to have something posted that has some more in depth information next week.

National Rural Health Association
American Medical Association
Kaiser Health News

At the state level, HB10-1138 (Colorado Health Service Corps) is up for hearing today at 1:30 in SCR 356. You can listen online by clicking HERE. This is a bill CRHC is in support of as it will strengthen the state's ability to more efficiently and effectively administer the state loan repayment program. It does not have any opposition that I'm aware of, so should sail through the Senate Health & Human Services Committee without issue.

Also, the Long Bill (aka FY10-11 Budget) should be introduced next week. I will be dissecting what is in the budget in regards to rural healthcare services and posting that information here as soon as I'm able.

APN/PAs Spared 10% Cuts!

CRHC is pleased to announce that the Joint Budget Committee did not approve the Colorado Department of Health Care Policy and Financing recommendation to cut Medicaid reimbursement rates for Advance Practice Nurses and Physician Assistants (APN/PA) by 10% to help balance the state budget for FY10-11. Unfortunately due to the state’s fiscal situation, the JBC did support an across the board 1% Medicaid provider reimbursement cut. While CRHC does not support the idea of balancing the state budget on the backs of healthcare providers, CRHC considers the JBC actions regarding APN/PAs a victory for rural healthcare providers and patients.

Thanks to all of you who contacted the JBC and for your continued support of ensuring that rural Coloradans have access to quality, affordable healthcare services!

Health Reform????

Well folks, the end is near. Either we are about to see the culmination of the past year come forward with the passage of health reform or we are about to witness a huge political failure. As of this writing, sources say the House is still shy 3 votes of having the 216 votes needed. Regardless, the President has postponed his oversees trip and is hoping to have something signed before Easter recess on March 26th. The House is expected to vote on Sunday on the health reform bill, which now consits of the Senate bill that was passed on Christmas Eve along with a reconciliation bill that the House drafted to address some of the issues in the Senate bill.

Should be an interesting weekend folks, especially since we are expecting a big snowstorm to welcome in the offical beginning of Spring on the 20th!

One more thing......the House Committee on Energy & Commerce has detailed information on how the health reform bill will impact each of the 435 congressional districts in the country.
This is a great resource.

CMS Delays OPPS Rule for CAHs

The Centers for Medicare & Medicaid (CMS) issued a notice on Monday stating that the supervision requirement for Outpatient Therapeutic Services will not be enforced for Critical Access Hospitals (CAHs). This is good news as most CAHs were not able to comply with the recent outpatient prospective patient system rule of "direct supervision" for therapeutic services furnished in hospital outpatient departments. The "direct supervision" rule unfortunately still applies to rural hospitals who are not CAHs and who will still face a difficult time complying with the CMS rule. The delay in enforcement for CAHs is through the end of 2010. CRHC will be working with our CAHs and organizational partners to make permanent changes to this rule to ensure that CAHs and rural hospitals will be able to comply with future supervision requirements.

For a fact sheet on the OPPS rule, please click here.

To read the CMS notice, please click here.

Updated Bill Tracking List

As I mentioned last week, there aren't any new bills posted on the bill tracker, though most of the bills we are following have been scheduled for a hearing. Of note is HB10-1138: Colorado Health Service Corps. CRHC is supporting this bill, which is seeking to rebrand the state loan repayment program, expand eligible providers who have access to these funds, and also make some administrative changes so that the Primary Care Office can most efficiently and effectively operate the program. This bill has already passed out of the House and is scheduled to be heard in the Senate Health & Human Services Committee on Thursday, March 25th. I will post more information on this bill and contact information for the Senate HHS Committee in the upcoming days for those of you interested in contacting your Senator to urge their support of this bill.

We Need to Hear from CAHs

The Centers for Medicare & Medicaid (CMS) proposed rule changes to the 2010 Outpatient Prospective Payment System (OPPS) recently went into effect. There has been quite a bit of outreach from other state's in regards to this final rule especially in regards to the physician supervision requirements for outpatient therapeutic services. If you are a Critical Access Hospital (CAH) or rural hospital in Colorado and are concerned about this new ruling, we need to hear from you!

According to information gathered on a recent call with CMS:

• Although the CAH Conditions of Participation don’t require a CAH to have a physician on-site 24/7, the 2010 OPPS Final Rule does require a physician or non-physician practitioner (NPP) to be on-site and immediately available whenever the CAH is providing OP therapeutic services in order to bill for these services, including normal business hours, after hours/overnight. Having the physician or NPP on-call is not sufficient to meet the 2010 OPPS final rule billing requirements for these services. Observation services and IV treatments are included in OP therapeutic services.

• An ED physician or NPP could potentially provide direct supervision of OP therapeutic services (within their scope). It is up to the CAH’s discretion to determine if the ED physician can meet the “immediately available” criteria under the rule depending on their patient volume.

• “Immediately available” means the physician or NPP can be interrupted – for example, a surgeon performing an 8-hour surgery is not considered immediately available.

CMS has received many questions and comments since the 2010 OPPS rule went into effect. CRHC has been contacted by Senator Udall's office to inquire about how this rule will impact CAHs and if we should be actively trying to change this.

Please contact Terri Hurst, th@coruralhealth.org, and let CRHC know what sort of impact this rule has on your facility’s ability to provide OP therapeutic services. We’ll keep you informed of any additional guidance from CMS on this issue.

State & Federal Updates

I won't be posting the bill tracking list this week as there have been no real substantive changes since last week. We are anxiously awaiting the HCPF figure setting, which is set to occur on Tuesday, March 16th. We'll know then if the JBC is recommending the 10% cuts to APN/PAs or if they are willing to share the pain across all providers. It is bad policy to cut provider reimbursement rates to help balance the state's budget, but it is even worse policy to target specific provider types as a reason to cut reimbursement rates. Please see my post from March 2nd to learn more about this issue and how you can get involved.

At the federal level, the Senate passed H.R. 4213 Tax Extenders Act of 2009 (aka jobs bill) yesterday. This bill will extend a lot of expiring provisions which include extending the FMAP increase for an additional 6 months to June 30, 2011 and delaying Medicare physician cuts until October 1st 2010. The House passed a similar bill in December 2009. The two chambers will now have to reconcile the differences between the two bills before it is sent to President Obama. Currently, Medicare physician cuts are set to occur April 1st. Hopefully Congress can work through their differences and get this bill enacted prior to that time.

Federal Healthcare Reform Update

Well, it sounds like this is it folks. Either we are about to witness federal healthcare reform move forward or we will not see anything happen......Or at least, that is what every policy wonk is saying from D.C. to California. Here's the latest and greatest on what people are anticipating will happen the next couple of weeks:

The House will pass the Senate bill that was passed on Christmas Eve 2009. The pickle here is that the House will essentially be supporting all the "junk" in the Senate bill that the President has announced he wants out and has outlined in his "correction's" bill.

After and IF the House pass the Senate bill, the Senate will then have to pass the President's "correction's" bill through reconciliation, which will strip out some of the "junk" that is currently in the bill (ex: Federal government paying for all of Nebraska's Medicaid program AKA the Cornhusker kickback).

Then, the "correction's" bill will have to pass the House......and then, it would be sent to President Obama to sign.

Whew......

As of today, there are not enough votes in the House (218 are needed) to pass the Senate bill. There was talk of a vote by St. Patrick's Day (not sure why our Government has been using holidays as timelines....), but it now seems people are hoping for a vote by March 26th before the Congressional recess. Regardless, it seems that time is ticking and if something does not occur soon, then the past year of debates, discussions, and movement will be another example of a failed attempt by the feds to reform healthcare.

3.5.10 Updated Bill Tracker

Not a lot of new bills added this week. Seems like the hot button issues are still concerning the budget supplementals and medical marijuana. Stay tuned next week for HCPF figure setting by the JBC on Thursdsay, March 11th. Please see my post from March 2nd concerning APN/PA rate reductions.....

In federal health reform news, President Obama wants something passed and now we're just waiting to see when and how healthcare reform will move forward. Still a lot of talk of using the reconciliation process. Here is a link to an article on Time Magazine online that discusses how the reconciliation process works.

Have a great weekend!

Medicare Payments Extended 30 Days

Last night the Senate was able to pass the Temporary Extension Act of 2010, which will delay the 21.2% Medicare cut to physicians. In addition to postponing Medicare physician payment cuts, the bill extended a variety of other expiring programs including unemployment insurance and premium subsidies for COBRA continuation coverage for those whose employment was involuntarily terminated.

This now means that Congress has a month to either approve another short-term fix to the Medicare SGR or to finally address this payment methodology so that physicians are not constantly faced with the threat of substantial Medicare reimbursement cuts. With President Obama pushing healthcare reform, the SGR formula fix may be tied into that bill or we may see something completely seperate emerge.

Stay tuned as the fun never seems to stop!!!!

Call to Action: Contact the JBC!

The Joint Budget Committee (JBC) will be figure setting (creating the budget) for FY10-11 for the Department of Health Care Policy & Finance (HCPF) on Thursday, March 11th. Due to the budget shortfall, there will inevitably be cuts to the HCPF budget. Some of the proposed HCPF cuts for FY10-11 include:

A 4-week delay in Medicaid payments (meaning Medicaid providers will most likely get paid the first week of June 2011, but won't be paid again until after July 1, 2011);

$25.7 million cut from Amendment 35 funds, which will leave $17.3 million for prevention, early detection, and treatment programs; tobacco education; and health disparities programs;

Medicaid reimbursement cut of 1%; and

10% Medicaid cuts to Advance Practice Nurses(APN) and Physician Assistants(PA).

It is this last proposed cut that CRHC is urging the JBC to reconsider. Targeting APNs and PAs for reimbursement cuts would greatly impact rural healthcare delivery. APNs, in particular, practice independently in rural Colorado. In addition to the 5.5% Medicaid cuts that have taken place the past 2 years, an additional 10% cut to their reimbursement would cause many APNs and PAs to reduce or stop accepting Medicaid patients altogether. The state estimates that a 10% rate cut to APN/PAs will save the state approximately $600,000. Instead of targeting specific provider types, CRHC, along with some of our partner organizations, are asking for an additional .1% across the board cut for all providers. According to the Colorado Nurses Association, adding a .1% across the board cut to all providers would save the state approximately $900,000. This means more cost savings for the state and a more fair and equitable way to address the budget shortfall. It is unfortunate that healthcare providers are being targeted at all in helping to balance the state budget, but targeting provider types as a reason to reduce reimbursement rates is not fair nor good public policy.

CRHC encourages you to contact members of the JBC and ask them to avoid cutting APNs and PAs by 10% and instead spread the cuts across all providers by adding a .1% Medicaid reduction.

JBC Members:

Representative Jack Pommer: 303-866-2780
jack.pommer.house@state.co.us

Representative Mark Ferrandino: 303-866-2911
mferrandino@yahoo.com

Representative Kent Lambert: 303-866-2937
rep.kent.lambert@comcast.net

Senator Moe Keller: 303-866-2585
moe.keller.senate@state.co.us

Senator Abel Tapia: 303-866-2581
abel.tapia.senate@state.co.us

Senator Al White: 303-866-2586
al.white.senate@state.co.us

Medicare Rate Cuts for Physicians

Starting today, the Center for Medicare & Medicaid Services (CMS) will hold Medicare claims for 10 days in anticipation that Congress will act to avoid a 21.2% reimbursement cut to physciains. If Congress fails to address the Sustainable Growth Rate (SGR), which is the methodology used to determine Medicare payments, Medicare patients will be greatly impacted as physicians will inevitably stop accepting Medicare patients. These Medicare cuts will greatly impact rural residents as there is a larger portion of elderly living in our rural communities who are already faced with a provider shortage.

Now is the time to contact Colorado's Congressional leaders and encourage them to fix the SGR and avoid these cuts!

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

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

Updated CRHC Bill Tracking Tool

Enjoy!

House Passes Markey-Perriello Bill to End Monopoly Protections for Health Insurers

Key bi-partisan health care reform bill passes 406-19

WASHINGTON—The U.S. House of Representatives today voted 406-19 to pass H.R. 4626, the Health Insurance Industry Fair Competition Act, introduced by Congresswoman Betsy Markey and Congressman Tom Perriello. The two-page bill repeals the special anti-trust exemption that health insurance companies have enjoyed since 1945, and will restore competition to the health insurance market to promote affordability, improved quality, and greater consumer choice in health plans.

“I’m proud of my colleagues on both sides of the aisle for standing up for a common sense bill,” said Rep. Markey. “Long ago, the insurance industry got a special deal from Washington. Big health insurance companies could conspire with each other to fix prices, divide territories and never be punished for it. It's wrong, and this bill fixes it–once and for all.”

“Today, Washington finally took a stand for patients, for the free market, and for common-sense, bipartisan principles of fairness. Today, we sent a simple message: health insurance companies must compete for business like everyone else,” said Rep. Perriello. “Working and middle-class families are sick and tired of getting nickel and dimed by these companies while they rack up billions in profit and enjoy their monopoly protection. I applaud my colleagues for standing on the side of consumers over the health insurance companies.”

Under the legislation, health insurers will no longer be protected from liability for antitrust practices like price fixing, dividing up market territories, or bid rigging. In the last 14 years, there have been 400 mergers among health care insurers so that 95% of health insurance markets are “highly concentrated,” which means consumers have little or no choice between insurers. During the past decade while this concentrated market has enjoyed its exemption from antitrust regulation, health insurance premiums have doubled.

Repealing the anti-trust exemption for health insurance companies has been endorsed by the American Hospital Association, the American Dental Association, the American Academy of Pediatrics, the National Association of Attorneys General, and the National Farmers Union, among others. The Obama Administration also released a strong statement of support yesterday saying, “This bill will benefit the American health care consumer by ensuring that competition has a prominent role in reforming health insurance markets throughout the nation.”

Watch Representative Markey on the floor of the House

President Obama's Healthcare Summit

As most everyone has heard by now, President Obama will be holding a televised healthcare summit tomorrow, Thursday, Feb. 25th. It will air at 8am MST on C-SPAN3.

Your guess is as good as mine as to what is going to transpire during this summit. All I can say is, get your popcorn ready! Here's to hoping our Government can act like adults and discuss healthcare reform in a rational and reasonable way.......

List of Senators expected to attend:

Harry Reid, D-Nev., majority leader
Richard J. Durbin, D-Ill., majority whip
Charles E. Schumer, D-N.Y., Democratic Caucus vice chairman
Patty Murray, D-Wash., Democratic Caucus secretary
Max Baucus, D-Mont., Finance Committee chairman
Christopher J. Dodd, D-Conn., Banking Committee chairman
Tom Harkin, D-Iowa, HELP Committee chairman
John D. Rockefeller IV, D-W.Va., Finance Subcommittee on Health Care chairman
Kent Conrad, D-N.D., Budget Committee chairman
Jon Kyl, R-Ariz., minority whip
Lamar Alexander, R-Tenn., Republican Conference chairman
Charles E. Grassley, R-Iowa, Finance Committee ranking member
Michael B. Enzi, R-Wyo., HELP Committee ranking member
John McCain, R-Ariz., HELP Committee member
Tom Coburn, R-Okla., M.D., HELP Committee member
John Barrasso, R-Wyo., M.D.

List of Representatives expected to attend:

Nancy Pelosi, D-Calif., Speaker of the House
Steny H. Hoyer, D-Md., majority leader
James E. Clyburn, D-S.C., majority whip
Charles B. Rangel, D-N.Y., Ways and Means Committee chairman
Henry A. Waxman, D-Calif., Energy and Commerce Committee chairman
George Miller, D-Calif., Education and Labor Committee chairman
John D. Dingell, D-Mich., Energy and Commerce Committee chairman emeritus
Robert E. Andrews, D-N.J., Education and Labor HELP Subcommittee chairman
Xavier Becerra, D-Calif., Democratic Caucus vice chairman
Jim Cooper, D-Tenn., Blue Dog Coalition member
Louise M. Slaughter, D-N.Y., Rules Committee chairwoman
John A. Boehner, R-Ohio, minority leader
Eric Cantor, R-Va., minority whip

Support Rural Health - Protect Rural Medicare!

The following is from our partners, the National Rural Health Association:

On December 31, 2009, a number of rural Medicare add-on payments expired. Although extenders of these provisions were included in both the Senate and House versions of health reform legislation, these payments have lapsed, jeopardizing access to care for rural Medicare beneficiaries, while health reform lingered.

As you well know, rural health care providers operate on a very thin margin and these payments allow them to remain in business and providing care to patients in their communities. Email your Representatives today and urge them to sign on to the Rural Health Care Coalition's letter supporting the extension of these important provisions as part of any current legislation.

CLICK HERE TO TAKE ACTION & EMAIL YOUR REPRESENTATIVE

FY10-11 Proposed Healthcare Cuts

Please note: The CO Rural Health Center has not taken a formal position on any of these proposed cuts.

Get ready for FY10-11 budget fun under the dome as the Joint Budget Committee (JBC) will be figure setting for the Health Care Policy & Finance (HCPF) Department on March 11th. What this means is that funding and budget proposals regarding Medicaid and other healthcare services will be set during this time as the JBC prepares the long bill (aka our state budget). Public testimony is not allowed during figure setting or for the long bill, but members of the JBC may be contacted via email or phone if you are concerned by any of the proposed cuts that are planning to make up the HCPF figure setting. FY10-11 will begin July 1, 2010 and runs through June 30, 2011.

Some of the proposed HCPF cuts for FY10-11 include:
A 4-week delay in Medicaid payments (meaning Medicaid providers will most likely get paid the first week of June 2011, but won't be paid again until after July 1, 2011);

$25.7 million cut from Amendment 35 funds, which will leave $17.3 million for prevention, early detection, and treatment programs; tobacco education; and health disparities programs;

Medicaid reimbursement cut of 1%; and

10% Medicaid cuts to Advance Practice Nurses(APN) and Physician Assistants(PA).

This last cut, in particular, will greatly impact rural healthcare providers and services. Cutting reimbursement to APNs and PAs to 90% of what a physician receives for providing the same service will very much be felt in many rural communities and counties where APNs and PAs serve as the primary healthcare provider.

If you are concerned about these proposed cuts and/or would like more information, please contact Terri Hurst, CRHC Policy Analyst, or call 303-407-2031.

2.18.10 Bill Tracker Update

Here's the latest and greatest from CRHC.

Health Policy Update

We're five weeks into the 2010 Legislative Session and the exhaustion is already starting to show! There are approximately 84 bills that have been introduced dealing with healthcare issues alone. CRHC is actively supporting four bills and all of them seem to be sailing through without many issues (hooray!). I'll be giving an update on those bills and more in the next couple of days.

I'm finally getting my head above water and will be able to keep all of you up to speed as to what is going on under the gold dome! It has been a whirlwind of a month so far......

I'm sure most of you have heard, the President is holding a Healthcare Summit next Thursday, Feb. 25th, which will supposedly be televised. Stay tuned for more information on this as well in the upcoming days.....

Protect Rural Medicare Beneficiaries & Providers

The following is a call-to-action from our partners, the National Rural Health Association:

Extend Rural Medicare Add-on Payments

On December 31, 2009, a number of rural Medicare add-on payments expired. Although extenders of these provisions were included in both the Senate and House versions of health reform legislation, these payments have lapsed, jeopardizing access to care for rural Medicare beneficiaries, while health reform lingered.

As you well know, rural health care providers operate on a very thin margin and these payments allow them to remain in business and providing care to patients in their communities. Email your Senators today and urge them to, retroactively to the date of their expiration, extend these important provisions as part of any current legislation, along with preventing the 21 percent cut in Medicare physician payments expected at the beginning of March.

Please click on the title of this posting to contact Senator Udall and Senator Bennet to urge their support of these rural provisions.....

Bill Tracking Tool 2.9.10

The madness continues at the Capitol! The Senate continues to work on the revenue enhancement measures proposed by the Governor's office and we can expect next week to focus on the FY10-11 budget. In the House, the first Committee deadline is approaching this Thursday, which means all Committees (except Appropriations) must report out bills that were introduced in the beginning of the session.

As always, stay tuned for more fun in the upcoming weeks!

Hospice Bills

The 2010 Legislative session is zooming along! CRHC has officially taken positions on three bills that seem to be moving through the legislative process fairly easily. That being said, there are two bills that will directly impact the scope of Advance Practice Nurses (APNs), in particular, those that work in hospice and palliative care. While CRHC has not taken an official position on either of these bills, these bills will directly impact the ability of APNs to provide healthcare in rural Colorado.

HB10-1024: Declaring Patients Terminally Ill, explicitly removes the ability of an APN to declare a patient terminally ill in order to begin end-of-life care. APNs have had the ability to declare a patient terminally ill since January 1, 2009. If HB10-1024 passes, APNs would still have the ability to enter declarations of medical treatment into a patient's record and participate in end-of-life care, but would lose the ability to declare a patient as terminally ill.

HB10-1025: Colorado Medical Treatment Act Updates, is written in a way that would remove the ability of an APN to declare a patient as terminally ill to begin end-of-life care. This bill reenacts the Colorado Medical Treatment Decision Act, which affirms the right of each patient to accept or reject medical treatment and creates a procedure to make such decisions in advance through a written declaration. While HB10-1025 has many good provisions in it, if it passes it will accomplish the goal of HB10-1024.

Both of these bills are to be heard by the House Committee of the Whole tomorrow.
If you would like contact information for your Representative, please click HERE.
If you do not know who your Representative is and would like to learn, click HERE.

Health Reform?????

Since federal healthcare reform is stalled for the moment, I thought I'd post another picture from the NRHA Policy Institute. This is a picture of the group of Coloradans who took over the Hill last week along with Senator Udall and his healthcare staffer, Jake Swanton.

Wish I had more to tell you about what's going on with healthcare reform, but it sounds like the Democrats are still trying to figure out what to do. The clock is ticking though. I think that if something doesn't occur in the next few weeks, we can add another failed attempt at healthcare reform to our history books. Ugh......

1.28.10: Bill Tracking Tool

There are a handful of new bills added since last week. You'll see the Nurse Educator Loan Repayment bill passed the Education Committee, but was amended slightly. There are also a couple of bills that have been introduced that deal with donating prescription medications to healthcare facilities. We also see the repeat introduction of allowing the state to purchase insurance across state lines (3rd year in a row). As always, everything in this document is subject to change and those bills without a CRHC position mean that the Policy & Legislative Council have not formally discussed them.

More fun to come......

National Rural Health Association Policy Institute Recap

Welcome back to Colorado!
I spent the past 4 days in Washington D.C., participating in the National Rural Health Association's (NRHA) Policy Institute. It was an amazing experience! Monday was spent learning about key rural health provisions that have lapsed for rural providers (bonus Medicare payments), in addition to learning about other important issues impacting rural healthcare entities. One issue in particular that CRHC will be providing comment on involves the Center for Medicare and Medicaid (CMS) ruling on "meaningful use" in regards to HIT funds. The comment period will close on March 1st and we may be asking some of you for your input and feedback to submit to CMS. Stay tuned for more information about this proposed rule.....

Tuesday consisted of Hill visits with a delegation of Coloradans who educated healthcare staffers and some of our congressional leaders on rural healthcare concerns. I tell you what folks, we have some amazing champions on our side in Washington. Senator Udall and his healthcare staffer were extremely savvy and aware of the needs and issues surrounding rural Coloradans having the ability to access healthcare services. Big thanks to the Senator and his office for drafting the Rural Physcian Pipeline Act, which would provide grants for Rural Training Track programs in medical schools in efforts to improve the healthcare workforce practicing in rural areas. Senator Bennet and his healthcare staffer were also very knowledgable about rural healthcare needs and have also drafted a bill with some extrememly important rural provisions that will hopefully be passed regardless of healthcare reform.

Our group also met with Congressman Lamborn's staff, Congresswoman Markey's staff, and Congressman Salazar's office (see pic above). Our message focused on the importance of Rural Health Clinics to our healthcare safety net and providing equity in reimbursement rates for rural providers.

Now that I'm back home (thank goodness! loved lobbying on Capitol Hill, but D.C. is an odd, odd city) I'm catching up on all the fun that is happening at our state capitol and will be updating the CRHC bill tracker as soon as I can. Enjoy!

1.21.10 Bill Tracking Tool Update

I'm leaving for Washington D.C. this weekend, so thought I'd update the bill tracking tool one more time before I leave. Next update will occur next Thursday. Keep in mind, the hearing dates/times are subject to change and you can always listen to the hearings online by visiting the audio/video section of the Colorado General Assembly website.

You may access the bill tracking tool by clicking on the title of this post.

1.21.10 - Federal Healthcare Reform Update

Politics has always been a bit exhausting to watch, but the next few weeks are going to challenge even the most ardent political fans. With Scott Brown winning the Senate seat this week in Massachusetts, the future of federal healthcare reform is up in the air and the stories of what is to come change from minute to minute. The Speaker of the House, Nancy Pelosi, came out today and said the House would not pass the Senate's healthcare reform proposal as is, which would be the easiest and fastest way for Congress to get health reform passed. Since the Senate proposal has already passed the Senate, it would not need to be re-voted on in that chamber, but it would have to pass a vote in the House. With the Speaker of the House saying that is not an option, at least right now, stay tuned for more political madness in the upcoming weeks.

CRHC Bill Tracking Tool

We are already a week into the 2010 Legislative Session! CRHC is currently following 10 bills; nine of which will impact access to healthcare in rural Colorado (one of the bills will impact non-profit organizations). I will be updating this bill tracking list at least on a weekly basis and will post updates here. My goal is to keep the Tool as current as possible. Also, you'll see CRHC has taken positions on certain bills, while others are blank. This means that we are currently considering taking a position on that piece of legislation or are remaining neutral on the bill. A position of monior merely means that we are tracking the progress of the bill and will decide to take a more active role if it appears necessary.

To access the Bill Tracking Tool, click on the title of this blog or this link.

CRHC will also be doing calls to action once bills that we are actively involved with are up for hearing. I will be posting that information here. We also now have a service that should allow you to easily send an email to your elected officials.

Stay tuned as we move forward during the 2010 Legislative Session and work to improve access to healthcare services for rural Coloradans!

Federal Health Reform Update

All eyes are on Massachusettes today as the state is holding a special election to fill Senator Ted Kennedy's seat. Early polls were showing that the Republican candidate, Scott Brown, was ahead of the Democratic candidate, Martha Coakley. The significance of this election comes down to if the Senate will continue to have a supermajority of 60 votes. If Brown wins, the Republicans would have enough members in the Senate to successfully filibuster future legislation, including the healthcare reform bill. This does not mean that healthcare reform is dead, but it would put a big wrinkle in Democrats plans.

It is important to note that it is still possible to pass healthcare reform. The most viable way is to utilize the Senate bill as the base bill. The House would be required to pass the Senate bill without any amendments. The Senate, since it already passed this bill, would not need to act again and would therefore not need to overcome a likely future filibuster. If the identical Senate bill is passed in the House, it could then be sent to the President’s desk for signature. Would the House accept the Senate bill as-is? Still uncertain, but with pressure from the White House, and the “it’s this or nothing” ultimatum - - it’s a likely scenario.

If the House rejects the Senate bill as-is, Democratic leaders will likely try to woo a moderate Republican such a Olympia Snowe to be the 60th vote. (This may prove to be a little tough.) Additionally, there is a possibility that the MA Democratic Governor may wait several weeks to certify the election results if Brown wins, that is, not certify the election results until after health care reform is signed into law. (This avenue would subject the Democrats to significant criticism and is likely not the path many want to take).

The fun continues! Stay tuned........

Democrats Hope to Have Health Care Deal by Friday

CQ TODAY MIDDAY UPDATE – HEALTH
Jan. 14, 2010 – 2:04 p.m.

Democrats Hope To Have Health Care Deal by Friday

Congressional leaders hope to reach a deal on the broad outlines of a final health care bill by Friday, and they are looking to President Obama to sell it — not only to their members but also to the public.

Democratic leaders and committee chairmen from both chambers planned to return to the White House at mid-afternoon Thursday for more negotiations on the major sticking points between the House and Senate bills.

Click HERE to read this article in its entirety.

The 2010 Colorado State Legislature Begins!

Today kicks off the 67th Colorado General Assembly. Our state is facing a budget shortfall of over $1 billion, which is sure to make the next few months an extremely challenging yet interesting session. The fun begins this morning at 10am and you can watch the opening comments & speeches online at The Colorado Channel.

The Colorado Rural Health Center will be tracking and following healthcare bills throughout the session and are working on providing you with an easy way to contact your elected officials to let them know how potential legislation will impact you. A legislative bill tracking matrix will be posted here and on our website.

CRHC's priorities for the upcoming session will focus on educating policy makers about the importance of Rural Health Clinics and Critical Access Hospitals as part of the healthcare safety net, working to protect clinics and providers from experiencing further provider rate cuts, and advocating on behalf of rural Coloradans to ensure everyone in the state of Colorado has access to healthcare services.

Rural Detoxification Services - Policy Brief & Full Report

The Rural Health Research & Policy Centers has published a policy brief and full report describing the lack of detoxification services in rural areas. Conducted by the Maine Rural Health Research Center, the data collected shows that few detox providers (n=235) serve rural America and that 82% of rural residents live in a county without a detox provider.

To read the policy brief and full report in its entirety, please click HERE.

Colorado Broadband Access Map

Listed below is a press release from the Governor’s Office of Information Technology announcing the online broadband access map. This mapping project was mandated by the passage of SB08-215 in recognition of the importance of broadband for economic development, and begins the process of expanding broadband access by first identifying those communities which do NOT have such access.

This map will provide the basis for securing additional federal funding (ARRA stimulus funding and otherwise) to deploy broadband in Colorado’s rural communities. To that end, it is important that you take time to view the initial map which has just been posted and provide input as to its accuracy and your personal perspective on the availability of broadband in your area.

Please visit the Connect Colorado webpage and do TWO things:
1) Click on the “Mapping” tab and view the “Interactive Map” by clicking on the link at the bottom of the page. You can ZOOM in with this map to view how much broadband access is attributed to YOUR area. (Refer to the legend in the left-hand margin to interpret the color codes associated with the various broadband carriers.)
2) From either the “Home” page of the “Mapping” page, click on the 4 ‘bubbles’ on the right side and provide your first-hand perspective about the availability of broadband in your area and the importance of it to you and your community. Your input will help refine the map (which will be continuously updated every 6 months) and will help Colorado in its efforts to secure more federal funding to expand broadband access throughout the state.

You may also send a copy of your comments to Dara Hessee in the Office of Information Technology at: dara.hessee@state.co.us

Case Study: Project ECHO Expands Access to Specialty Care for Rural Patients

Summary: An innovative project in New Mexico uses telemedicine, case-based learning, and disease management techniques to expand access to care for patients with hepatitis C and other chronic, complex conditions. Specialty providers based at the University of New Mexico help guide rural community providers in applying best practices to manage care. The community providers build their knowledge of particular conditions and serve as expert consultants in their regions.

To read the article in its entirety, click HERE.

Compare the Senate & House Health Reform Proposals

The Kaiser Family Foundation has an online tool where you can look at a side-by-side comparison of the final Senate and House healthcare reform proposals. Once Congress convenes in January, these two proposals will have to be meshed before a final version is sent to the President to sign.

Click on the title of this blog to visit the Kaiser Family Foundation website.

Health Reform Update 12.28.09

The Senate voted for passage of the Patient Protection and Affordable Care Act at 7am on December 24 by a party-line vote of 60-39. Upon returning from recess in January, Congress will have to reconcile the differences between the House and Senate bills. The final healthcare reform bill will most likely resemble what is in the Senate bill. The tentative goal is to have a final bill to the President's desk by the State of the Union (mid to late January), though the White House has acknowledged that Congress has many priorities to tackle early in the year.

The National Rural Health Association has been working hard to ensure there are strong rural provisions in any healthcare reform proposal. Please visit the NRHA website to see specifics of what is included in the Senate and House proposals.

Health Reform Update 12.22.09

Well, it appears that the Senate will be voting on the Patient Protection and Affordable Care Act before Christmas. As of right now, the Senate is expected to vote at 8am on Christmas Eve. Senate Majority Leader Harry Reid has a Manager's Amendment that is 383 pages long and adds some important rural provisions to the bill. As soon as details come forth of what is included in the Manager's Amendment, I will be sure to post that information here.

Once the Senate passes their bill, a conference committee will occur between select House and Senate members to reconcile differences between the two healthcare reform bills coming from each respective chamber. It is believed a final healthcare reform bill will resemble the Senate's version since once a final bill is produced from the conference committee, the Senate will need 60 votes to ensure the bills passage before it can be sent to President Obama to sign.

The fun continues........stay tuned.......

Health Reform would Reduce Uninsured in Rural America from 8.1 Million to 3.2

As Congress continues to analyze and debate key details of health reform, the numbers of people covered under the current plans is receiving increased attention. According to a new analysis by the Rural Policy Research Institute (RUPRI), if fully implemented, the approach to covering the uninsured presented in H.R. 3590, the Patient Protection and Affordable Coverage Act, would reduce the number of uninsured from 8.1 to 3.2 million in rural areas. This increase in coverage would lead to a slightly higher coverage rate for people living in rural areas than for their urban counterparts (93.4% compared to 92.7%), largely because a lower proportion of rural persons are non‐citizens who would not be covered under any of the proposed reform approaches but also because the reform proposal reaches more low‐income persons who are more represented among the rural uninsured.

The report also provides state-by-state estimates of the effects of the legislation on overall health insurance coverage rates (for both rural and urban persons), as well as estimates of how the previously uninsured would be covered under the provisions of the legislation.

Please click HERE for the report in its entirety.

Healthcare Reform Update & Colorado State Revenue Forecast

Federal Healthcare Reform:
At 1 a.m. this morning, the Senate voted 60-40 to invoke Cloture on Majority Leader Reid's manager's amendment to health reform, limiting debate to 30 hours and ensuring its up or down vote. Monday morning's cloture vote was a procedural one that allowed Reid to make certain changes to the bill. It wasn't the big cloture vote, or even the last of the procedural votes that will be held -- there are four more to come, with the last scheduled for Christmas Eve. But the outcome of those is now not in doubt.

There is one big test remaining, of course -- after the Senate passes its version of the bill, it will have to iron out its differences with the House. That could mean more wrangling.

State Budget Revenue Forecast:
The most recent budget revenue forecast shows the state is $40 million short of what was projected in September. Revenue available for spending in the General Fund is $600.6 million below the amount budgeted for expenditure in FY 2009-10. It is already projected that the state is $1.5 billion short for FY10-11.

The upcoming legislative session will be tackling the FY10-11 budget. The General Assembly convenes Wednesday, January 13th.

Healthcare Update 12.18.09

The fun continues!

The House voted this week to pass an amended defense appropriations bill (H.R. 3326), that temporarily delays the scheduled 21.2% Medicare physician payment cut that was set to occur January 1st. Congress now has until Feb. 28th to come up with a plan to keep these cuts from happening. The bill provides a 0 percent update to the Medicare physician payment formula to allow Congress to establish a new permanent Medicare physician payment system upon returning in the new year. The Senate is poised to approve the defense spending bill in the coming days. Both the House and Senate tried to include a permanent fix in their healthcare reform proposals to the Sustainable Growth Rate (SGR), which is the reason these Medicare cuts were set to occur in the first place, but due to the fiscal impact of fixing the SGR, neither healthcare reform proposal addresses this issue.

The Senate will begin working on the healthcare reform bill again this weekend and there is still talk that something will be voted on by Christmas. What that "something" is remains to be seen.......
Stay tuned......

Senate Health Reform Vote by Christmas in Doubt....

Kaiser Health News has pulled together news articles from across the country regarding the issues that the Senate still faces in trying to get a vote on healthcare reform prior to Christmas next week.

Please click HERE to read up on the obstacles the Senate is facing in reaching its deadline.

Senate Healthcare Reform Update - 12.16.09

Senate Majority Leader Harry Reid (D-Nev.) and the White House are still negotiating with key senators to reach agreement on outstanding issues so a manager's amendment can be finalized this week. This amendment is being designed to garner the 60 votes needed to pass H.R. 3590, the "Patient Protection and Affordable Care Act," before the holidays. So far, more than 430 proposed amendments to the bill have been submitted, although only a handful will be presented for a vote on the Senate floor.
A proposal circulated last week that would have allowed uninsured individuals between the ages of 55 and 64 to purchase Medicare coverage has been abandoned after generating opposition from centrist Sens. Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.), as well as from a group of Democrats representing states with relatively low Medicare payment rates.

It remains to be seen if there will be a vote before Christmas as originially planned. Stay tuned.......

Some Rural Communities Concerned Reform Provisions Could Hurt Medicare Services

Newspapers in Alaska and Washington state explore how health reform provisions might affect Medicare services in rural areas, while a Colorado newspaper looks at one senator's efforts to increase the number of doctors in rural areas.

Please click HERE to read these stories in their entirety.

12.9.09 - Healthcare Reform Update

The fun continues as the Senate moves into its 10th day of the healthcare reform debate. As of this writing, Senate Majority Leader has pulled the public option and has offered a compromise instead. The compromise consists of offering a private plan that is similar to the Federal Employee Health Benefit plan, which is the plan offered to members of Congress. The compromise also would allow those who are uninsured and between the ages of 55 - 64 years old to buy into Medicare. Even with this compromise being offered, there are some Senators who are still talking of allowing a "trigger" for a public option that would come into effect by a certain date if this compromised plan does not alleviate healthcare costs and reduce the number of uninsured.

There are still numerous amendments, including rural provisions, that have been officially filed, but not yet brought to the floor. There is no distinct timeline as to when the rural amendments will be offered, though Senator Reid is still claiming the Senate will have a complete bill before Christmas. Stay tuned.........

Critical Access Hospitals and Healthcare Reform

Critical Access Hospitals not only play a vital role in providing healthcare services to our rural and frontier counties, but they are also a main ecomonic driver in rural communities. The Patient Protection and Affordable Care Act does not adequately address some key provisions that would help increase the ability of CAHs to offer quality, comprehensive healthcare services. Now is the time to contact your Senators to ensure all of the following are addressed:

Reinstate "Necessary Provider" for Critical Access Hospitals - This would allow states to once again waive the 35-mile requirement and deem a hospital as a "necessary provider" based on unique conditions often only realized by local and state entities.

Allow Critical Access Hospitals flexibility in their bed count - CAHs currently are limited by a hard 25-bed cap. Allowing CAHs to maintain an average bed count of 20 improves patient access, especially in the case of seasonal or other unexpected influxes of patients.

Ensure Rural Access to Anesthesia Services - CAHs frequently use certified registered nurse anesthetists to provide anesthesia services in a cost-effective way. However, Medicare reimbursement is currently unreliable due to a lack of clarity in current legislation. Current legislation (S. 1585) would solve this problem and must be included in the final health reform bill. Additionally, H.R. 3151 seeks to close current loopholes and ensure that Critical Access Hospitals (CAHs) are properly reimbursed for their anesthesiology services.

Eliminate CAH "Isolation Test" for Ambulance Reimbursement - Under current law, CAHs can only receive cost reimbursement for ambulance services if they are the only provider of ambulance services within a 35-mile drive. This provision would eliminate the 35-mile requirement, ensuring that CAHs are appropriately reimbursed for providing emergency medical services.

To contact Senator Bennet click HERE or call: 202-224-5852
To contact Senator Udall click HERE or call: 202-224-5941

Senate Healthcare Reform Update

The Senate is currently debating H.R. 3590, the Patient Protection and Affordable Care Act. As of Sunday evening, a total of 165 amendments had been formally submitted, the vast majority of which will not be voted upon. There are many rural provisions that have been submitted, though it is unknown when or if these amendments will be voted on. Colorado's Senator Bennet has submitted an amendment entitled the Rural Health Access and Improvement Act, which would prioritize Critical Access Hospitals to receive grants to implement Health Information technology, expand participation in Drug Pricing Agreement program under Section 340B of PHS Act, provide for a study and report on Pharmacy Dispensing Fees under Medicaid, and provide continuing funding for the State offices of Rural Health. Colorado's Senator Udall also plans to submit an amendement that would create a grant program for medical schools to offer Rural Training Tracks, which encourages and trains medical students to practice medicine in rural areas.

Stay tuned for more updates as the Senate is expected to continue debating the healthcare reform proposal and the plethora of amnedments throughout the next few weeks. You can also visit the National Rural Health Association to stay on top of current healthcare reform news.

Senate to Begin Debating Healthcare Reform on Monday, November 30th

After months and months of waiting, the Senate finally has a healthcare reform proposal, The Patient Protection and Affordable Care Act, that will begin being debated on Monday, November 30th. The Senate voted this past Saturday to invoke cloture and had the magic number of 60 votes, which means there is no opportunity for those opposed to the legislation to filibuster. It also means there will eventually be a floor vote in the Senate. When that will occur and how the bill will look by the time a floor vote comes; remains to be seen.

There are many rural provisions and amendments that our national partner organization, the National Rural Health Association, hope are added to the Senate bill. For a specific list of these rural provisions, please click HERE.


Now is the time to contact Senator Udall and Senator Bennet and urge their support for these rural amendments.

I'd like to contact Senator Udall.
I'd like to contact Senator Bennet.

House Passes Medicare Fix for Physicians

The House of Representatives passed HR 3961 yesterday (11.19.09). This bill eliminates the 21% cuts to Medicare Payments that would have started in January and provides a long term fix for the Sustainable Growth Rate formula. The bill passed by a vote of 243 to 183. Colorado's Democratic Representatives voted in favor of this legislation, while the two Republican Representatives (Lamborn & Coffman) voted no.

Even though this legislation has passed in the House, its outlook in the Senate remains in doubt. Though the Senate's most recent health reform bill holds off the 21% cut from this year, it offers no long-term solution to this problem; but rather simply prevents cuts from taking place this January.

Stay tuned......

Senate Bill is finally (maybe) Moving Forward

Finally, the wait is over. The long-anticipated Senate health reform bill (a bill blended from the two bills reported from the Finance Committee and Senate HELP Committees) has been filed. The bill number is HR 3589. It is over 2,000 pages, so not a quick & easy read! It is believed that most of the rural provisions that were gained during the Senate Finance Committee debate are still included. Preliminary discussions of the bill have begun on the Senate Floor - - but there will be a few procedural hurdles that must be overcome before we get to the actual debate where amendments will be offered.

The bill has been scored by the Congressional Budget Office (CBO) at $849 billion over ten years, ie, within the target that the Democrats were shooting for. CBO indicates that the bill will actually reduce the deficit by $127 billion over ten years and $650 billion over the following ten years. The bill is also projected to insure 94% of the population.

As of right now, it looks like the Senate will work on procedural maneuvers through the weekend. Majority Leader Reid will file a procedural motion know as “cloture” today. The purpose of the vote is to end current debate and allow a motion to proceed to the health reform bill -- the first of these two procedural votes will be Saturday and the second will be Sunday. However, this is very fluid and may change. One current roadblock that may delay this strategy is that Senator Baucus (D-MT) is in Montana due to a family matter - - if he is unable to return for the weekend votes, it will be delayed.

If 60 votes can be gained in the motion to proceed, the Senate rules then require the Clerk to read the bill. It is standard operating procedure that this perfunctory move is waived - - however, because we anticipate a Republican filibuster, the motion to waive the reading of the bill is expected to fail. This will require the Clerk to read out loud the full 2000+ page bill - - which could easily take until next Wednesday. The Senate will then be in recess on Thursday and Friday for Thanksgiving. This means that actual debate will not begin until the following Monday (November 30).

Thanks to our friends at the NRHA for providing this information. Stay tuned for more up to the minute information as it becomes available to us!

Center for Rural Affairs - Health Reform Reports

The Center for Rural Affairs recently highlighted some reports that specifically address how health reform will impact rural America. Please click HERE to access the reports in full.

H.R. 3962 - How Will the House Reform Bill Impact My Community?

The Committee on Energy and Commerce prepared, for each House member, a district-level analysis of the impact of House Bill 3962: Affordable Health Care for America Act. This analysis includes information on the impact of the legislation on small businesses, seniors in Medicare, health care providers, and the uninsured. It also includes an estimate of the impacts of the surtax that will help to pay for the legislation.

You may access this information by clicking HERE.

House Passes Health Care Reform Bill

On Saturday, the House passed the Affordable Health Care for America Act (H.R. 3962) with a vote of 220-215. Even with the passage of the House bill, overall healthcare reform has some hurdles to clear. The Senate bill is still awaiting a score (cost) from the Congressional Budget Office (CBO). Once the CBO provides its analysis, the Senate will have a floor vote, which will most likely be contentious. If and when the Senate passes its reform bill, the House and Senate reform proposals will have to be merged before anything is sent to the President to sign.

To learn about the key points of the Affordable Health Care for America Act, please visit The Kaiser Family Foundation.

Stay tuned......

Health Reform Update 11.4.09

National health reform is still moving along, though where it is going to end up still reamins to be seen. Here is a quick update on both the House and Senate side as to where the two proposals stand......

House: The House has merged the three committee proposals that were passed this summer and the total price tag of the compiled House bill is close to $1 trillion dollars, according to the Congressional Budget Office. There are still some sticky issues in the House proposal that are being worked out and a floor vote is expected this Saturday, November 7th. Some key rural health provisions are not included in the House bill and it is unlikey that there will be many (if any) floor amendments offered. This means the Senate is the key focus of adding any rural health provisions. Some of these provisions include: improving reimbursement for Rural Health Clinics, allowing Critical Access Hospitals more flexibility with their bed count (currently capped at 25 occupied beds per day), and allowing CRNAs to be reimbursed at cost through Medicare.

For a complete list of the rural health amendments that are hoping to be addressed on the floor of the Senate, please visit the National Rural Health Association Health Reform page.

Senate: The Senate has compiled both proposals that were passed this summer/fall and have sent their bill to the Congressional Budget Office (CBO). The CBO will analyze the bill and provide a price tag to the proposed reforms. It is still unknown when the Senate will have a floor vote on their reform bill and there is talk it may be pushed into 2010.

Keep checking back regularly for updates!

Expanding Health Insurance Coverage for Rural Residents through Health Reform

The Rural Policy Research Institute recently released a report entitled "Assuring Health Coverage for Rural People," which was funded by the Robert Wood Johnson Foundation. The Health Reform brief suggests that the challenges that rural people face in obtaining health insurance are partly due to the structure of the rural economy: 64 percent of adults working in rural are employed in jobs where health insurance is provided, compared to 71 percent of their urban counterparts. At the same time, rural workers are far more likely to be self-employed. Rural businesses also pay higher premium costs than urban businesses for similar health insurance plans.

Please click HERE to access the report.

The Commonwealth Fund: Comprehensive Congressional Health Reform Bills of 2009

The Commonwealth Fund has relased a report that provides an overview of the key provisions in the health reform bills currently being considered in Congress.

Please click HERE to access The Commonwealth Fund website and report entitled: The Comprehensive Congressional Health Reform Bills of 2009: A Look at Health Insurance, Delivery System, and Financing Provisions.

Senate Health Bill Could Come This Week, 'Compromise' Public Option Now Seems Likely

The following is from Kaiser Health News.

Senate Democrats will need to move quickly if they want to pass some version of health overhaul legislation by the end of the year.

The Associated Press: With "time growing short," Senate Democratic leaders "still face key decisions..." In the Senate, that "means deciding whether legislation will give the government a role in the marketplace at all, and if so, what rights individual states would have in deciding whether to participate." The Senate is weighing its final choices as negotiators work to merge the bills from Senate Finance and from Health, Education, Labor and Pensions Committees. The latest talks have focused around getting rid of any mandate on businesses to provide health insurance for their employees (Espo, 10/26).

The Wall Street Journal reports that the Senate's finalized health bill could be ready as soon as early this week, when the leaders will submit the bill to the Congressional Budget Office for scoring. Senate Majority Leader Harry Reid "spent the weekend shoring up support for the bill from Democrats in the chamber. But some key moderate Democrats signaled Sunday that they remain uneasy about main planks of the legislation." Although some details could change, the "broad outlines are becoming more clear" (Adamy and Hitt, 10/26).

Politico reports that Sen. Chuck Schumer also believes 60 votes are within sight. But "Senate Minority Leader Mitch McConnell said that Democrats still have work to do in rallying support within their ranks, pointing to last week’s overwhelming vote to strike down a so-called doc fix to Medicare physician reimbursement that would have added nearly $250 billion to the deficit. A group of Democrats crossed party lines on the vote" (Isenstadt, 10/25).

The New York Times: "Several Democratic senators voiced optimism on Sunday that Congress would pass a health care bill containing at least the germ of a government-run insurance program. Their expectations were grudgingly seconded by Senator John McCain, the Republican presidential candidate in 2008. 'I think the Democrats have the votes, and in the House, Blue Dogs bark but never bite,' Mr. McCain said on CBS’s 'Face the Nation,' using the nickname for conservative Democrats."

Democrats who said they see a public plan passing include Sens. Claire McCaskill, of Missouri; Chuck Schumer, of New York; and Russ Feingold, of Wisconsin. Sen. Ben Nelson, D-Neb., said he was willing to look at the proposal if the Senate allows states to opt out of that part of the plan (Berger, 10/25).

Senate Fails to Pass Permanent Fix to Medicare Physician Payments

On Thursday, October 22nd, the Senate voted to limit debate and bring S. 1776, the Medicare Physicians Fairness Act of 2009 to the floor for a full vote, but failed to get the 60 votes needed to do so. The final vote tally was 57 no votes to 43 yes votes. Both Senator Bennet and Senator Udall voted yes on the bill.

The cost of the bill, the reason it was defeated, was $245 billion over the next ten years and did not provide any offsets. This means that the Finance Committee’s Health Reform bill (S 1796), which included a temporary “fix” to the 21.5 percent payment cut via the sustainable growth rate (SGR) formula for Medicare physician pay, will most likely be included in the final bill brought to the Senate floor.

Colorado Backseat Budgeter

If given the opportunity, how would you go about balancing the state budget? With our state approaching a $1.8 billion deficit for Fiscal Year 2009-2010, state budget cuts are imminent. Due to certain constitutional mandates, balancing Colorado's state budget is no easy task; especially if you'd like to raise revenue. Colorado's Backseat Budgeter is a great tool to use to better understand Colorado's fiscal situation. Please visit the site by clicking HERE and enjoy!

Health Bills in Congress Won't Fix Doctor Shortage

Health Bills In Congress Won't Fix Doctor Shortage

By Phil Galewitz, KHN Staff Writer
Oct 12, 2009

Even as Congress moves to expand health insurance coverage to millions of Americans, it's doing little to ensure there will be enough primary care doctors to meet the expected surge in demand for treatment, experts say.

The American Academy of Family Physicians predicts that the shortage of family doctors will reach 40,000 in the next 10 years, as medical schools send about half the needed number of graduates into primary care medicine. The overall shortage of doctors is expected to grow to nearly 160,000 by 2025, according to the Association of American Medical Colleges.

Click HERE to read this article in its entirety.

Provide Feedback about Medicare to the Center for Medicare & Medicaid

On Thursday, October 29th, the Center for Medicare & Medicaid (CMS), Medicare Provider Feedback Group will be holding a town hall meeting that you can participate in via teleconference. You must register by 3pm (MST) on Friday, October 23rd.

For more information and to register please click HERE.

Call Senator Bennet & Senator Udall Today!

The U.S. Senate is finally moving on a bill (S.1776) that would eliminate Medicare's sustainable growth rate (SGR) formula. The SGR formula essentially cuts Medicare payment rates. For more information on SGR and S.1776 click HERE.

The Senate was set to vote on the bill today (Monday, October 19th) but the vote has been delayed for at least 24 hours.

Because the Senate's first vote could occur as early as tomorrow, Tuesday, Oct. 20, please call Sen. Mark Udall and Sen. Michael Bennet NOW and urge them to VOTE YES on S. 1776. You may use the American Medical Association's (AMA) hotline to contact them by calling: (800) 833-6354.

Never called a congressional office before? Check out the AMA guide to "Communicating with Congress."

To see how the cuts impact patients and physicians in Colorado, click HERE.

Health Reform Update

After receiving a final “score” from the Congressional Budget Office, the Senate Finance Committee has scheduled a meeting to vote on the America’s Healthy Future Act on Tuesday, October 13. The bill will likely pass out of the Committee, then move into a conference between Finance and HELP Committee leadership to bring one single version of the bill for the Senate floor.

Given the controversial issues surrounding health reform from either side of the aisle, there will likely be considerable action on the Senate floor. Here are a few of the rural amendments that NRHA expects to be offered on the floor during debate:

S. 307 – Wyden – Allows flexibility in the CAH bed count
S. 1355 – Barasso/Wyden – Raises the RHC Cap to $92
S. 1171 – Pryor – Would waive the 35-mile rule for CAH designation

For copies of both Finance and HELP Committee bills, please see below:

Senate Finance Committee Links

Senate HELP Committee Bill (S.1679 – The Affordable Health Choices Act)

You may also click here to read the House's proposal (H.R. 3200: America's Affordable Health Choices Act of 2009)

Gov. Ritter to hold Town Hall Meetings - Oct. 8th - 10th

Governor Ritter will be holding public town hall meetings in Idaho Springs, Alamosa, San Luis, Antonito, Saguache and Monte Vista the next few days, and he's inviting you to attend and participate.

Thursday, October 8, 2009 - 11:30 a.m.
City Hall, 1711 Miner St., Idaho Springs

Friday, October 9, 2009 - Noon
Adams State College, Student Union Building, Banquet Room A-130,
Corner of 1st Street and Stadium Drive, Alamosa

3 p.m.
Centennial High School, 901 Main Street, San Luis

5 p.m.
Dos Hermanas Restaurant, 435 Main St., Antonito

Saturday, October 10, 2009 - 9:30 a.m.
Saguache Community Building, 525 7th Street, Saguache

11:30 a.m.
Gov. Ritter will visit veterans and community members at the Colorado State Veterans Center at Homelake and host a town hall meeting, 3749 Sherman Ave., Monte Vista.