Vote No on Proposition 101, Amendment 60, and Amendment 61

As Colorado gears up for elections this November, the Colorado Rural Health Center has decided to oppose a trio of ballot initiatives that would severely impact Colorado's fiscal situation: Proposition 101, Amendment 60 and Amendment 61. If you think the past few years have been tough (keep in mind, our state isn't even close to being finished with budget cuts and I know all of us have been impacted by the current cuts that have occurred) these three ballot measures would severely cripple state and local services.

We encourage all of our members to get the word out and vote no on these! Tell your friends! Contact your elected officials! Vote NO on Proposition 101, Amendment 60 and Amendment 61!!!

During the next few months, CRHC will be providing you more information on these measures or you may visit the Looking Forward website to learn more. You can find county specific data as to how much your county will lose if any of these three passed. You may also sign on to oppose these measures, along with a host of other organizations including our rural partners Club 20, Action 22, and Progressive 15 by visiting Don't Hurt Colorado. I will be providing continued information about these ballot initiatives in the upcoming months in efforts to ensure these do not pass this November.

Below is a quick synopsis of what these three measures would do to local & state services.

Proposition 101 would eliminate taxes and revenue collected from car registrations and vehicle fees. This revenue helps fund local school districts, emergency medical services, and maintenance of roads & bridges. If passed, the state would lose about $2 billion a year (approximately $600,000 of that would impact local communities). This would greatly impact healthcare services by eliminating the ability of communities to have ambulance and emergency services.

Amendment 60 would overturn prior local election decisions regarding taxes & fees, cut local support for schools and charge new taxes on public services. This measure would greatly impact local funding for school districts who would expect to lose about 50% of their propery tax revenue. In total, A60 would cut over $1 billion of local funding. It would also charge new taxes on public universities & colleges, water authorities, and the Division of Wildlife.

Amendment 61 would bar the state from borrowing money, including short term loans, which are used for construction projects, roads, universities, and hospitals. Basically, the state of Colorado would freeze once this was enacted as the state would be unable to upgrade, build, or improve any infrastructure in the state.

All together these three measures would cause the state to lose about $6.3 billion annually from state and local goverment. This means that healthcare services would be greatly impacted as the state would not be able to completely fund Medicaid, reimburse providers (who have already been cut by 5.5% the past two years) and greatly diminish emergency medical services in the state. Colorado cannot afford any of these measures to pass.

Stay tuned for more information about these three and how you can mobilize your communtity, friends, and family members to vote NO!!!!

Safety Net Clinic Week: Aug. 30th - Sept. 3rd

In efforts to raise awareness of Colorado's healthcare safety net providers and clinics, ClinicNET in partnership with the Colorado Rural Health Center (CRHC), is declaring August 30th - September 3rd as Safety Net Clinic Week. The week will be devoted to educating the public and policy makers about Community Funded Safety Net Clinics and federally certified Rural Health Clinics. While there is a plethora of entitites that comprise the healthcare safety net, this week will focus on the often overlooked clinics that are affiliated with ClinicNET and CRHC.

There are currently 26 identified Community Funded Safety Net Clinics (CSNCs) in Colorado. These clinics tend to be non-profit, rural & urban, privately funded and provide primary care services to uninsured and underinsured individuals.

Colorado has 52 federally certified Rural Health Clinics (RHCs) that provide primary care services in some of the most rural and remote areas of Colorado. During 2009,CSNCs and RHCs collectively provided services to approximately 250,000 inidividuals in Colorado.

If you are a CSNC or an RHC and are interested in participating in Safety Net Clinic Week by hosting a site visit with policy makers, please contact Terri Hurst at: th@coruralhealth.org.

Doctors for America Health Reform Conference Call with Mary Wakefield

On Tuesday, July 27th, Doctors for America will be holding a conference call with Mary Wakefield, HRSA Administrator, to discuss health reform implementation. HRSA plays a large role in healthcare workforce programs and rural healthcare services. Participants on the call are encouraged to submit questions about healthcare provisions and how they will impact your community.

As most of you know, federally certified Rural Health Clinics and Community Funded Safety Net Clinics, providers of primary care services in rural and underserved areas that are an essential part of the healthcare safety net, were largely overlooked in healthcare reform. This is a great opportunity to ask HRSA what support and resources will be available for these rural healthcare safety net providers as health reform is implemented.

For more information and to register for the call, please visit Doctors for America.

Centura Health: Rural Health Video

Centura Health just created a Rural Health Video about the programs and services they offer to improve access to healhcare services in rural Colorado, such as Flight for Life, which provides critical care transport services, and Connected Care , which is expanding specialty care to four rural communities through the use of telemedicine.

Health Insurance Exchange Forum: Friday July 23rd

The Colorado Coalition for the Medically Underserved (CCMU), the Colorado Consumer Health Initiative (CCHI), and the state's Health Reform Implementation Board will be holding community forums regarding Colorado's efforts to create health insurance exchanges. Under the Affordable Care Act, states are responsible to develop health insurance exchanges – virtual marketplaces -where thousands of currently uninsured Coloradans will seek information to select and purchase health insurance. Many of these individuals and families will be eligible for federal subsidies to help them pay their insurance premiums.

The community forums will give stakeholders and the public an opportunity to learn more about health insurance exchanges and provide input as Colorado begins moving forward on health reform implementation efforts. The first forum will be held on Friday, July 23rd from 9a-11a in Denver at the National Jewish Hospital (1400 Jackson Street) in the Molly Blank Center.

New High Risk Pool: GettingUSCovered

Beginning July 6th, the state began accepting applications for Colorado's new federally funded high-risk pool to cover uninsured individuals who have pre-exisitng conditions. GettingUSCovered is administered by Rocky Mountain Health Plans and Cover Colorado. GettingUSCovered stems from the Accountable Care Act and will cover apporoximately 4,000 Coloradans who have been denied access to insurance due to their health status. To be eligible for GettingUSCovered, you must have been uninsured for 6 months prior to enrolling into the program. GettingUSCovered will become effective on September 1, 2010.

Director of Colorado's Primary Care Office Appointed to National Rulemaking Committee

Health & Human Services Secretary Kathleen Sebelius announced the 24-member negotiated rulemaking committee that is tasked to review criteria & methodology for designating Health Professional Shortage Areas (HPSA) and Medically Underserved Areas (MUA). Congratulations to the Director of Colorado's Primary Care Office, Steve Holloway, who will be serving on the committee!!

HPSA and MUA methodologies date back to the 1970's and have not been updated since. HPSA and MUA designations allow clinics, hospitals, and healthcare providers access to a host of incentives, which include: loan forgiveness programs, Medicare bonus payments, increased reimbursement rates, and the ability to be designated as a Rural Health Clinic, just to name a few. Fifty-seven (57) out of Colorado's 64 counties have been designated for primary care health professional shortage.

For more general information on HPSAs and MUA, please visit the Health Resources & Services Administration website.

Click on the following to learn more about Colorado's Primary Care Office and HPSA & MUA desingations in Colorado.

Did you know........

Medicare payments to hospitals with 50 beds or fewer represent less than 2% of the overall Medicare budget?!?!?

For more facts on rural healthcare, visit our national partner organization the National Rural Health Association.

The White House Project - CO Rural Go Lead 2010

The White House Project is a non-profit agency that seeks to advance women's involvement in the political process. On Saturday, July 31st, The White House Project will be holding an event in Montrose, Colorado entitled: Colorado Rural Go Lead 2010. It will be held from 10a - 4p at the Montrose Pavillion. Cost is $25.

Rural Go Lead participants can expect to learn more about The White House Project, hear from other women in the community about their paths to leadership, and to dispel some of the myths about running for office.

The Magnitude of Underinsurance in Colorado

The Colorado Trust recently published an issue brief entitled The Magnitude of Underinsurance in Colorado. The brief discusses the current state of Coloradans who are underinsured and how the underinsured experience similar problems faced by those who are uninsured. Underinsurance is defined as, "having public or private insurance coverage that does not adequately cover the costs of medically necessary services relative to family income, resulting in out-of-pocket expenses that exceed an insured individual's ability to pay."

Approximately 13% of the state's population is considered underinsured. Unfortunately, a majority of the underinsured reside in rural counties. Using the 21 Health Disparities Regional Profiles established by CDPHE, 13 of the regions reported an underinsurance rate higher than 13%. Seven of those regions were rural counties with Region 5 (Cheyenne, Elbert, Kit Carson, Lincoln) reporting 23.2% of the population being underinsured.

State Loan Forgiveness Program Accepting Applications

Starting tomorrow, July 1st, the Primary Care Office will open up the next opportunity of funding for the Colorado Health Service Corps (CHSC). CHSC is the state's health professions loan repayment program, which provides funding to primary care physicians, nurse practitioners, physician assistants, certified nurse midwives, licensed mental health professionals and oral health professionals who agree to practice in a rural or underserved area of our state. Applicants are eligible to receive up to $105,000 in loan forgiveness for a committment of two or three years of service. Eligible health professionals must be employed or seeking full-time employment in an outpatient practice in an area of Colorado with a health professional shortage.

For more information on the CHSC or to learn how to apply, please visit the CHSC website.

July 7th - Rural Hospital Webinar on 340B Enrollment

With the passage of federal health reform, a number of new catagories of hospitals are eligible for the 340B drug discount program. Newly eligible hospitals include Critical Access Hospitals, Sole Community Hospitals, and Rural Referral Centers. Safety Net Hospitals for Pharmaceutical Access along with the National Rural Health Association is holding a free webinar next Wednesday, July 7th from 11a - 12:30p MST. Registration is limited to hospitals and non-profit organizations that work with hospitals. Click here to be taking to the registration page.

Comment on State Policy Recommendations for Disabled Citizens

The Colorado Department of Health Care Policy & Financing (HCPF) is seeking comment on a document entitled Olmstead: Recommendations and Policy Options for Colorado. This report recommends policy options for the state in regards to disabled citizens and people with long term care needs who wish to live in community based settings. You have until 5p on Saturday, July 17th to submit comments.

Temporary SGR Fix Extended Until November 30th

On Friday, President Obama signed into law the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010. Whew! That's a mouthful. What this means is that Medicare claims will now be processed with a 2.2% increase (retro to June 1st). This slight bump in reimbursement will be in effect until November 30, 2010. It is assumed that Congress will come up with a permanent fix to the Medicare SGR rate in the interim, though if history repeats itself, we will be scrambling again in November to try and avoid major cuts to physicians who care for Medicare patients.

The Center for Medicare & Medicaid Services (CMS) released a statement stating that all Medicare claims are on hold temporarily until the 2.2% increase can be tested to ensure that claims will be processed correctly and paid at the new rate. They expect to begin processing claims with the increase no later than July 1st.

Rural Health Research & Policy Center: Rural Health Care & Health Reform

The Rural Health Research & Policy Center just released an 85 page document summarizing the impact of federal health reform on rural healthcare delivey called: The Patient Protection and Affordable Care Act: A Summary of Provisions Important to Rural Health Care Delivery.

HHS Announces $250 Million for Primary Care Workforce

With all the doom and gloom in regards to the state budget and reimbursement delays & cuts, I am happy to share with you the following news. Kathleen Sebelius, Secretary of Health & Human Services, along with the Health Resources & Services Administration (HRSA) announced the availability of $250 million over the next 5 years to strengthen the primary care workforce. RFPs have already been released for some of the following:

Creating additional primary care residency slots: $168 million for training more than 500 new primary care physicians by 2015;

Supporting physician assistant training in primary care: $32 million for supporting the development of more than 600 new physician assistants, who practice medicine as members of a team with their supervising physician, and can be trained in a shorter period of time compared to physicians;

Encouraging students to pursue full-time nursing careers: $30 million for encouraging over 600 nursing students to attend school full-time so that they have better odds of completing their education;

Establishing new nurse practitioner-led clinics: $15 million for the operation of 10 nurse-managed health clinics which assist in the training of nurse practitioners. These clinics are staffed by nurse practitioners, which provide comprehensive primary health care services to populations living in medically underserved communities.

Encouraging states to plan for and address health professional workforce needs: $5 million for states to plan and implement innovative strategies to expand their primary care workforce by 10 to 25 percent over ten years to meet increased demand for primary care services.

June 2010 State Economic Forecast

Ladies & Gentleman. The moment we've all been waiting for.......The offical first day of summer! And for policy wonks like myself, the June Revenue Forecast (listed under Budget Balancing News in the middle of the page).

An initial glance does not look promising. Even with the delay in Medicaid payments, the state is approximately $74 million short for FY09-10, which ends June 30th. With this updated forecast, it appears that the FY10-11 budget is close to $215 million short. I would imagine an official announcement of the June revenue forecast and what sort of cuts our state can expect will occur shortly.

21% Physician Medicare Cuts in Effect

The Senate passed a temporary fix to the Medicare SGR on Friday, but the House still needs to vote on the bill before it can become law. The Centers for Medicare and Medicaid (CMS) has been holding Medicare claims since June 1st waiting to see if Congress would stop the 21% cut. Beginning today, CMS will be processing claims as of June 1st with the 21% cut.

The temporary SGR extension passed by the Senate would postpone the 21% cut until November 30 2010. It would also give a 2.2% increase for Medicare reimbursement retroactive to June 1st. The House is expected to vote on the bill this week. If the House does pass the Senate fix, Medicare claims will be processed with the enhanced 2.2% Medicare increase, but in the meantime, physicians will be scrambling to cover costs of providing care to seniors.

In other words, welcome to a total administrative mess. If the House passes this 2.2% increase and postpones the 21% cut until November 30th, CMS will be processing claims twice (once with the 21% cut and then again with the 2.2% increase) and we will be back here in November talking about a 21% Medicare cut to physicians. And this will be right after elections. Again......what a mess!

Originally, the Medicare SGR fix was going to be included in the tax extenders bill that has been in the Senate for the past few weeks. That bill is still being debated and is trying to extend unemployment & COBRA benefits, as well as extend the FMAP increase that states have been receiving to help with Medicaid caseloads.

Senate to Scale Back Tax Extender Bill

The Senate has been debating what is known as the tax extender bill for the past few days and it looks like they are going to have to cut back on what they initally hoped to achieve. The bill includes a temporary fix to the Medicare SGR, which expired June 1st. Without any sort of extension to the SGR, Medicare reimbursement to physicians will be cut by 21%. Originally, the Senate had hoped to extend the Medicare SGR through 2011, though there is talk that it may only be extended through 2010. If this, in fact, is what passes in the bill; we will be right back here having this same conversation at the end of 2010. I know there is no easy answer. I certainly don't have the answer, but how many times can Congress temporarily fix Medicare payments?!?!? Physicians are already exhausted as this is the 3rd time this year they have been worried about being cut by 21%. In the meantime, Medicare patients may be thinking they can't find a doctor to see them because of healthcare reform, which is not the case. Congress needs to decide how to provide a sustainable Medicare reimbursement rate that will allow providers to see patients without continually having to worry of a large impending cut. Now that would be real healthcare reform.......

Similarly, the FMAP bump that has been helping states with the unprecedented growth in Medicaid caseloads may not be extended out in the tax extenders bill. A large number of states created their FY10-11 budget with the expectation that the FMAP bump would be extended to June 2011. Without any additional action by Congress, the FMAP bump will end December 2010. We shall see what the Senate is able to pass....

Wating on Congress........again........

Well, the Center for Medicare & Medicaid Services (CMS) is holding Medicare payments until Friday (6.18) to see if Congress acts this week to stop the 21% Medicare reimbursement cuts to physicians that was expected to begin today. The Senate is wrapping up debate on the tax extenders bill, which will hopefully include provisions that will stop the Medicare cuts. The tax extenders bill may also possibly extend an increased FMAP bump that Colorado has been receiving to help with the increased Medicaid caseload.

Welcome to The Rural Voice!

Welcome to The Rural Voice! I know some of you have been subscribed and reading my policy rants for quite some time now, but for those of you who've never received this before......Aloha!

If you're really not interested in reading about policy or already get too much email, no problem! Just click unsubscribe at the bottom of the page.

For those of you who have previously signed up for my postings , you should still be getting this in your inbox at the regular schedule of your choice. For those who've never seen my postings before and you'd like to continue to receive them, you can decide if you'd like to receive this in your inbox on a daily, weekly, or monthly basis. Just click on your preference!

Thanks to everyone for your continued support of the Colorado Rural Health Center and helping us to ensure that rural Coloradans have access to afforable, quality healthcare services!

Small Businesses & Healthcare Reform

The following article is from the Center for Rural Affairs regarding federal healthcare reform and what it means for small businesses:

Small Businesses & Health Care Reform
June 2010

Small businesses dominate the rural economy. In fact, they dominate the American economy in terms of the number of business firms. So it’s important to know, understand, and accurately portray the effects of the newly adopted health care reform law, on small businesses.

First though, we need to understand what the new law - the Patient and Affordable Care Act - means by “small business.” In many respects, “small employer” is a more accurate term. In fact, Section 1421 (Credit for Employee Health Insurance Expenses of Small Businesses) uses that term.

Self employed sole proprietors who are not employers (non-employers in statistical parlance) and their immediate family members do not qualify for the small business tax credit benefits described below. They will qualify for the individual credits and premium assistance beginning in 2014 and the more immediate health insurance reforms.

Do small businesses have to provide health insurance to their employees or face penalties?

No. The law has a general requirement that employers provide health insurance. But it specifically exempts from this employer responsibility any business with 50 or few¬er employees (Section 1513). The result is that nearly all businesses in the nation, including those in rural areas, are exempt from any health insurance requirements or mandates and are free from any penalties for not doing so.

According to the U.S. Census Bureau’s County Business Patterns, 95 percent of all business establishments in the nation have fewer than 50 employees. The House of Representatives Small Business Committee estimates the employer mandate will apply to less than two percent of businesses.

How do small businesses afford health insurance under the law?

In many respects the health insurance reform law is all gain and no pain for small businesses, particularly at first. Section 1421 of the law establishes a Small Business Tax Credit for those businesses who do provide health insurance for their employees. The initial credit exists for tax years 2010 through 2013. A second credit exists for any two years beginning in 2014 when the Health Insurance Exchanges begin.

To be eligible for the tax credits, a small business must have fewer than 25 full-time equivalent employees, have average annual wages less than $50,000, purchase health insurance for employees, and contribute at least 50 percent of the cost of the premium.

The Small Business Tax Credit provides both immediate and longer term health insurance premium assistance for small businesses, especially the smallest businesses that dominate rural economies. The immediate tax credit beginning in 2010, and lasting through four tax years, acts as a bridge to the Health Insurance Exchange system that begins in 2014. The exchange system will act as large insurance pool for the nation’s small businesses (more on that below).

The longer term two year credits also allow the exchange system to be fully operational and for the pooling and risk spreading aspects of them to take effect. The Congressional Budget Office estimates that with the law’s small business tax credits, the average premiums per person in the small group market will decline by up to 8 to 11 percent in 2016 relative to the current law.

Can small businesses pool together to purchase insurance?

Yes. In fact, the Health Insurance Exchange concept is based on the pooling idea. The health reform law mandates the creation of exchanges in every state by 2014, and allows businesses of up to 100 employees to participate (Sections 1304 and 1311).

The result is the creation of a health insurance pool of small businesses, their employees and the self-employed. When fully implemented the exchange will allow for more attractive insurance as a result of lower administrative costs (costs will be spread across the larger pool) and the spreading of risk across the larger pool. A larger pool will also allow annual premium volatility to moderate and enhance competition (more potential customers in the larger pool).

The law also allows states to create the Small Business Health Options Program (SHOP), a special exchange for small businesses, either within the larger state exchange or as a separate exchange. The SHOP Exchange is designed to assist small business employers in enrolling their employees in small group health plans.

The law also enables other insurance alternatives within the exchanges that could result in small business pools or groups. It makes possible establishment of state-based nonprofit health insurance cooperatives and funds such efforts with loans. Regional, interstate or multistate exchanges may also exist if the states involved permit and they are approved by the federal government.

Will the health reform law cause my taxes to go up?

Probably not. The health reform law imposes some new taxes and increases others. But the real question is who is responsible for those taxes. While each individual and business has unique circumstances that will determine tax liability, it is clear that most rural small businesses will not be affected by the tax changes contained in the law. Some of those changes are:

A new 10 percent excise tax on indoor tanning services (for services provided after June 30, 2010). This excise tax will obviously be paid only by those businesses providing indoor tanning services.

A 0.9 percent Medicare surcharge on the wages of single taxpayers earning more than $200,000 per year and couples earning more than $250,000 per year (starting in 2013). In addition, these taxpayers would incur a special Medicare tax of 3.8 percent on unearned income (interest, dividends, capital gains, annuities, royalties and rents). While some rural small business taxpayers may earn enough income to activate these taxes, that case will be extremely rare. The non-partisan Tax Policy Center finds that less than two percent of taxpayers with small business income are in the federal income tax brackets that include the $200,000/$250,000 income levels.
An excise tax beginning in 2018 on insurance companies providing “high-cost” employer sponsored health plans, defined as those with values exceeding $10,200 for individual coverage and $27,500 for family coverage. The tax is equal to 40 percent of the value of the plan exceeding the threshold amount. This tax will likely not apply to many health plans offered by rural small businesses as the 2008 average value of health plans offered nationally by businesses with 10 or fewer employees ranged from $4,536 (individual) to $11,952 (family) and for businesses with 11 to 25 employees ranged from $3,984 (individual) to $1,051 (family).

Fees assessed on businesses that do not provide health insurance to employees will only be charged to businesses with 50 or more employees— a small fraction of businesses nationwide and even fewer in rural areas.

As we have written before, many circumstances related to health insurance act as barriers to creating a strong rural economy based on entrepreneurial development. The Patient and Affordable Care Act will begin to lower these barriers for many rural small businesses.

While exempt from mandates requiring insurance coverage for employees, the tax credits provided by the law will make health insurance more affordable for businesses and provide an incentive to help insure employees. Over time as the primary features of the law are implemented and take effect, particularly the Health Insurance Exchanges, rural small employers will reap the benefits of pooling and larger group coverage that provides comprehensive, affordable, and continuous health care coverage for their business and their employees.

Contact: Jon Bailey, jonb@cfra.org or 402.687.2103 x 1013 for more information. This is the second article in our new series on what health reform means for rural Americans.

Delayed Medicaid Payments

Due to a lower than expected state budget revenue forecast, which will be made public June 21st, the Department of Health Care Policy & Finance is required to delay Medicaid payments for the last two weeks of June.

YOU MUST SUBMIT MEDICAID CLAIMS BY THIS FRIDAY, JUNE 11TH TO RECEIVE PAYMENT IN JUNE. CLAIMS NOT IN THE SYSTEM BY JUNE 11TH WILL NOT BE PAID UNTIL JULY 9TH.

If you have any questions about the delayed payments, please contact Eric Wolf at 303-866-5963 or eric.wolf@state.co.us

CO FY10-11 budget will be short if no FMAP extension

According to a report published by the National Conference of State Legislatures, almost 30 states, including Colorado, balanced their budgets relying on Congress to extend the Federal Medical Assistance Percentages (FMAP) enhancement that has been in place since the American Recovery and Reinvestment Act (ARRA) was passed. The FMAP is the amount of Medicaid support the federal government provides to states. Prior to ARRA, Colorado received a 50:50 match. With the ARRA bump, Colorado has been receiving about a 60:40 match. This FMAP boost to states is set to expire December 2010. As previously stated, close to 30 states believed Congress would extend the FMAP bump through June 2011, since most state budget cycles are from July 1 - June 30.

Prior to the Memorial Day recess, the House passed the Tax Extenders bill, which orignially included extention of the FMAP, but due to political pressure and not wanting to add to the federal deficit, the bill that was passed did not include extending the FMAP increase. The Senate is expected to debate and vote on the bill this week. If the Senate does not include an FMAP extension, Colorado will be approximately $130 million short for FY10-11 as the budget was balanced including the increased FMAP. What sort of cuts this would mean for our state is unknown. Stay tuned to see what the Senate does this week.......

Authorized vs. Funded Provisions in Federal Health Reform

As our state & country move forward on implementing provisions in the federal healthcare reform bill that was passed in March, it should be mentioned that certain provisions were funded while others were merely authorized. Provisions that are authorized will have to wait, beg, and/or plead to be funded by the Appropriations Committee. While I don't have a timeline to share with you as to when this may or may not happen, I do have a list from the Congressional Budget Office (CBO) of the provisions that were only authorized by Congress. Unfortunately, a large portion of these authorized provisions are focused on rural and healthcare workforce issues. As implementation moves forward, I will be encouraging all of us to contact our Congressional leaders and implore them to fund the following critical pieces of healthcare reform that would dramatically increase access to healthcare services in rural & underserved areas.

Title V
5102 - State Healthcare Workforce Development: Planning Grants & Implementation
5103 - Workforce Assessment: National Center; State & Regional Centers
5203 - Healthcare workforce loan repayment program: Pediatric Medical & Surgical; Pediatric Behavioral
5204 - Public Health Workforce Loan Repayment Program
5208 - Nurse Managed Health Clinics
5403 - Area Health Education Centers: Continuing Educational Support for Health Professionals in Underserved Communities
5601 - FQHC Grants

Congress on Vacation until June 7th - Medicare Claims on Hold

For the third time this year, physicians face a 21% cut in Medicare reimbursement rates due to inaction by Congress. The House passed an amendment included in the tax extenders bill prior to the Memorial Day recess that would temporarily patch Medicare cuts for 19 months. The SGR amendment postpones the 21 percent Medicare physician payment cut an additional 19 months until Jan. 1, 2012. It provides a 2.2 percent increase on June 1, 2010 and an additional 1 percent increase on Jan. 1, 2011. However, in 2012 physician Medicare reimbursement would be cut by a reported 33 percent as the payment methodology reverts to the current SGR formula. The Senate is expected to begin debate on this bill and amendment when they return from recess June 7th.

The Centers for Medicare & Medicaid have instructed contractors to hold Medicare claims for 10 days; giving the Senate a few days to pass the House amendment without disrupting Medicare reimbursement. If the Senate makes any changes to the amendment, it will have to go back to the House to be voted on again before being sent to the President. In the meantime, physicians will be struggling to provide care to Medicare patients while Medicare patients will struggle to find physicians willing to accept them. Let's hope the Senate acts quickly when they return next week.

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.