2011 Colorado Capital Conference, June 15-17

Senator Mark Udall has partnered with Mesa State University to co-host the Colorado Capital Conference in Washington D.C. on June 15-17. The Conference will be a chance for Coloradans to learn about the political process, hear directly from national leaders, and take home ideas about how you can effect political change. Applications must be submitted online or postmarked by March 15, 2011, and attendees will be announced on April 18, 2011. Learn more and submit your application.  

CRHC Bill Tracker and Budget Update

Check out the current bill tracker for updated information on health-related legislation moving through the General Assembly. CRHC has taken official positions on four bills and is monitoring several others.

We are also watching budget activities closely. Supplemental bills to balance an additional $145 million for the rest of this fiscal year (ending on June 30) have passed the House and Senate, with final issues being worked out by the Joint Budget Committee (JBC). Governor Hickenlooper released his FY 11-12 budget proposal earlier this week, which calls for difficult and painful cuts in state spending to balance a projected $1 billion deficit. While few areas of the budget were spared, significant cuts in K-12 education were proposed along with several health-related measures including Medicaid benefit reductions and a 0.5% provider rate cut. The Legislature will now begin their work to set the budget, beginning with JBC figure-settings. The Department of Health Care Policy and Financing hearing is scheduled for March 8. Another important day is March 20, when the next revenue forecast will be released. This forecast will indicate if further cuts are needed or if things are starting to pick up. Stay tuned.

Rural Medicare Beneficiary Access to Primary Care

A policy brief by the RUPRI Center for Rural Health Policy Analysis assesses U.S. primary care physician and general surgeon willingness to accept Medicare patients and the reasons for not accepting these patients. The study finds that overall rural physicians are more likely than urban physicians to accept all new Medicare patients.

Because it is critical that rural America’s elderly have physicians willing to accept new Medicare patients, how Congress addresses the temporarily-resolved Medicare physician payment issue will be of great concern to rural providers and communities. Read more about the President’s two year plan for the Medicare “doc fix” included in his recent budget proposal.

Governor Hickenlooper Releases Budget Proposal

Today Governor Hickenlooper submitted his budget proposal for FY 11-12 to the Joint Budget Committee. Read the report and other documents. This proposal now moves to the General Assembly, where the proposal will be debated and may be changed. Several healthcare-related cuts have been proposed, including $13.2 million in Medicaid program reductions and a 0.5% Medicaid provider rate reduction. We are continuing to review the proposal and will be providing additional information. 

Repealing the 1099 Provision

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation describes efforts to repeal the so-called 1099 provision in the Affordable Care Act. The provision was designed to help finance the expansion of health insurance coverage by ensuring that businesses reported and paid tax on certain income. President Obama has called for repealing this provision; the Senate has voted to do so; and the House is likely to do so in coming weeks. Read more. 

Updated CRHC Bill Tracker Posted

Enjoy!

Boosting the U.S. Healthcare Workforce

A new article in Health Affairs by John Iglehart discusses the challenge of addressing the nation’s healthcare workforce shortages, suggesting that any efforts will require federal funding and creative solutions from Congress and the White House.

Stories Needed in Support of Insurance Expansions

As posted on CRHC’s bill tracker, HB11-1025 is a bill to repeal the Hospital Provider Fee. The Colorado Hospital Association is leading efforts, in collaboration with other organizations including CRHC, to oppose HB11-1025. Since its passage two years ago, the Provider Fee has helped increase access to healthcare for medically underserved Coloradans and reduced the amount of uncompensated care provided by hospitals without drawing on Colorado’s General Fund. To protect the Provider Fee, as well as current and future coverage expansions, please share your story if you have benefitted from expanded coverage (or will benefit from future expansions) by emailing Alicia Haywood at ah@coruralhealth.org.  As a reminder, the expansions include: increase Medicaid eligibility for parents from 60% to 100% of the federal poverty level (FPL); increase CHP+ eligibility for children and pregnant women to 250% FPL; option for people with disabilities to buy into the Medicaid program up to 450% FPL; and allow eligibility for adults without dependent children up to 100% FPL. 

Updated Bill Tracker Now Available

Click to read CRHC's updated bill tracker.

Update on federal health reform

In March 2010 the Patient Protection and Affordable Care Act (ACA) became law. Since that time, states began planning for implementation and some also filed lawsuits challenging ACA’s constitutionality. 

The 112^th Congress that convened in January has weighed in. Last month, the US House of Representatives voted to repeal ACA and has charged several committees with working on a replacement bill. The US Senate will also vote on repealing ACA, as early as this week. The repeal vote in the Senate is not expected to pass and the President has pledged to veto repeal legislation. Both political parties do agree that certain provisions in ACA, specifically a tax-filing requirement on small businesses, should be eliminated but disagree on how to pay for the fix.

Despite Congressional votes, it seems that the U.S. Supreme Court may ultimately decide the ACA's final outcome. In response to lawsuits filed against ACA, two federal judges have already ruled it partially or wholly unconstitutional, but two others have upheld the law. These lawsuits have been appealed and it could take 1-2 years before the cases reach the Supreme Court. Many states, including some that filed lawsuits, are continuing their implementation efforts (read about Colorado’s work to date) while others are re-evaluating their efforts. In the meantime, ACA provisions continue to roll out.   

What happens next? We’ll find out together…

Impact of health reform on uninsured Coloradans

The Colorado Health Institute’s new issue briefs highlight the impact of health reform on reducing the number of uninsured Coloradans and identify groups that may not readily benefit from efforts to expand health insurance coverage, specifically “medically vulnerable” Coloradans and families with mixed insurance status. 

Strong rural representation among Hickenlooper’s senior staff

An article in today’s Pueblo Chieftain details that more than half of Governor Hickenlooper’s senior staff come from rural Colorado, including Department of Health and Public Environment Executive Director Dr. Chris Urbina from Pueblo and Health Care Policy and Finance Executive Director Sue Birch from Steamboat Springs. 

Update to state bill tracker

CRHC's bill tracker has been updated for the week. Please let us know if you have any questions, comments, or feedback.

2011 Policy Institute Update

A group of Coloradans traveled to Washington DC this week to attend the National Rural Health Association’s Policy Institute to learn more about the federal health policy landscape and how it impacts rural Colorado. Seven members hit the Hill on Tuesday to meet with our two Senators and seven Representatives (including new members Scott Tipton and Cory Gardner), educating our lawmakers about issues facing rural healthcare providers and consumers in their districts and asking for their support in sustaining critical programs. While funding levels are still being negotiated, all Colorado lawmakers expressed support for rural health providers and programs and understand the need for programs that promote a strong healthcare workforce and ensure access to care for our rural residents. They also asked for help in keeping their district and DC offices updated on local issues and concerns (check out CRHC’s website for how to contact your elected officials). A very special thanks to the Policy Institute participants who took these important messages to our lawmakers on behalf of rural Colorado.

CRHC Bill Tracking Tool

The 2011 Legislative Session is in full swing. CRHC is getting its bill tracking tools in place for the session, focusing on legislation that impacts access to healthcare in rural Colorado. Click here to read a bill summary. We will be updated this list as often as possible and will post updates to The Rural Voice. As in previous years, CRHC will take positions on certain bills, may be in the process of considering a position, or remain neutral. We may also be monitoring bills, tracking its progress and reserving the option of taking a more active role at a later time.

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, promoting efforts that support and better identify the healthcare workforce, and advocating on behalf of rural Coloradans to ensure everyone in the state has access to healthcare services. Read CRHC’s 2011 Policy Priorities. Stay tuned to The Rural Voice for opportunities to weigh in on these issues, including attending hearings and contacting your legislators.

U.S. House votes to repeal Affordable Care Act

Late this afternoon the House of Representatives voted to repeal the Affordable Care Act. The Senate leadership has indicated they will not take up the measure. Read a summary of news reports on the vote by Kaiser Health News. 

An editorial by former rural state governors Kathleen Sebelius (current Health and Human Services Secretary) and Tom Vilsack (Agriculture Secretary) highlights some of the rural-focused provisions of the Affordable Care Act. 

Health Insurance Exchange Governance Brief

Colorado’s Health Reform Implementation Board with Colorado Coalition for the Medically Underserved and the Colorado Consumer Health Initiative hosted ten community forums across the state to share information on health insurance exchanges and gather input from stakeholders. A new report lays out the most consistent perspectives shared during the forums about governance and authority in creating an exchange in Colorado.

Colorado’s 68th General Assembly has begun

The Colorado State Legislature began the first day of the 2011 session on Wednesday, January 12. The Colorado Rural Health Center will be tracking bills throughout the session and providing you with opportunities to contact your elected officials to let them know how legislation may impact our rural communities. We will also be providing a bill tracking chart on our website in the coming days. Don’t forget that you can also visit the Colorado General Assembly website for audio/video broadcasts of proceedings. 

How the Affordable Care Act Strengthens Primary Care

A new brief by The Commonwealth Fund looks at the provisions in the Affordable Care Act that improve primary care. Initiatives including expanding and training the primary care workforce, improving provider reimbursement and patient incentives for primary care services, and supporting innovative approaches to delivering care. 

National advisory committee reports on rural health and human services issues

The National Advisory Committee on Rural Health and Human Services is a 21-member citizens' panel of nationally recognized rural health experts that provides recommendations on rural issues to the Secretary of the Department of Health and Human Services. The Committee’s 2010 report examines home and community based care for rural seniors, rural primary care workforce, and rural health care provider integration.

Participate in a Webinar on Engaging with Policymakers on Thursday, January 13

The National Organization of State Offices of Rural Health is hosting a free webinar “Preparing to Engage with Legislators and Policymakers” on Thursday, January 13 from 12:00-1:00 pm. The webinar will provide instruction on communicating with elected officials and assist those planning to attend the Policy Institute in Washington DC later this month. Click here to register online or contact Stephanie Hansen at steph@nosorh.org for additional information.

Hickenlooper appoints cabinet members

In recent days, Governor-elect Hickenlooper announced several appointments to his cabinet. Sue Birch was named executive director of the Department of Health Care Policy and Financing. Ms. Birch is currently the CEO of the Northwest Colorado Visiting Nurse Association in Steamboat Springs. Other key health-related appointments include Dr. Chris Urbina as executive director of the Colorado Department of Public Health and Environment and Reggie Bicha as executive director of the Department of Human Services. Read more about these and other appointees. 

Healthcare story project to launch in 2011

CRHC, in partnership with the Colorado Coalition for the Medically Underserved (CCMU) and ClinicNET, received funding from The Colorado Trust and The Colorado Health Foundation for a three-year public will building project. The project, Colorado HealthStory, is an effort to record and collect personal stories about individual's access to healthcare across Colorado. Read the Public News Service's interview with Gretchen Hammer, Executive Director of CCMU, about the project.

Whether a painful experience, a journey of healing, or even details about managing a chronic condition, Colorado HealthStory wants to record it. The storytellers will receive a CD of their stories for their personal records, and copies will be retained in the Colorado HealthStory archives. Recording will begin in Spring 2011. Contact Alicia Haywood at ah@coruralhealth.org with questions.

New year, new healthcare provisions

Several components of federal health reform go into effect on January 1, 2011, including prescription drug discounts for Medicare Part D beneficiaries and a temporary increase in Medicare payments for primary care services and to general surgeons in health professional shortage areas. Read about the 2011 provisions.

$13.7 million bonus to state for increased Medicaid enrollment

Colorado will receive a $13.7 million performance bonus from the Department of Health and Human Services for increasing children's enrollment in Medicaid. To qualify for the bonus, Colorado had to show it implemented at least five of eight recommended enrollment simplification policies and that it met a target for increasing enrollment. Read more about the performance bonuses and Colorado's efforts.

Work on health insurance exchange in Colorado continues

One component of federal health reform is the development of health insurance exchanges, organizations that individuals and small businesses can use to shop for insurance plans and to access federal subsidies. A recent Denver Post article provides an overview of Colorado's efforts to develop an exchange and the steps that lie ahead in 2011.

Securing High Quality Health Care in Rural America: The Impetus for Change in the ACA

The Affordable Care Act calls for the development of a National Health Care Quality Strategy and Plan that will affect millions of healthcare consumers and providers in rural areas and across the country. A new report by the Rural Policy Research Institute, Securing High Quality Health Care in Rural America: The Impetus for Change in the Affordable Care Act, focuses on rural considerations that should be addressed in this quality strategy to ensure full participation by and inclusion of rural providers and communities.

Study maps need for kids’ doctors in rural areas

Today’s Denver Post highlights a recent study that shows the need for pediatricians and family practitioners in rural areas. The study found that while the number of pediatricians and family physicians have outpaced increases in the U.S. child population, the distribution of primary care doctors for children is uneven. Using national data to calculate the per-child supply of working pediatricians and family physicians in geographic regions, low-supply regions were mostly rural. Read the article.

December Revenue Forecast

The Office of State Planning & Budgeting  and the Colorado Legislative Council Staff released their budget revenue forecasts today. Both forecasts indicate that Colorado’s economy is recovering slowly and neither report indicate much change from the September forecast. Revenues are forecast to increase slightly, providing enough General Fund revenue to fully fund budgeted appropriations in FY 2010-11, but revenue will be $137.0 million short of the amount needed to fully fund the 4.0 percent reserve required by law. The loss of one-time federal stimulus funds, particularly $67.2 million in Medicaid funds, may increase this amount to $204.2 million. FY2011-2012 continues to present significant fiscal challenges, with estimates up to a $1 billion shortfall due to increased enrollment in state programs and reduced federal stimulus funds. Read the OSPB and CLCS reports. 

Register for NRHA’s Rural Health Policy Institute in Washington DC, January 24-26

Join rural healthcare providers and advocates in Washington DC at NRHA’s Rural Health Policy Institute from January 24-26. Meet Colorado’s Congressional members and learn about important federal issues that will impact rural health. Discount registration ends on December 27. Learn more and register online.

President signs bill to delay Medicare cuts

President Obama signed legislation that delays for one year a cut in Medicare payments to physicians that was scheduled to take effect on January 1, 2011. Advocates and lawmakers hope to take advantage of the one-year delay to develop a sustainable solution to the Medicare payment formula.

State releases health reform implementation road map

The Governor's Office has prepared an initial assessment of the work completed and the tasks ahead as Colorado addresses health reform and the Affordable Care Act. Implementing Health Care Reform: A Roadmap for Colorado identifies key issues and opportunities for Colorado and provides information for all Coloradans to better understand the many pieces of federal health reform legislation and the state's role in implementing them.

Congress approves 12-month Medicare ‘doc-fix’, rural provisions extended

Today the House approved the Senate’s plan to avoid a scheduled 25% cut in physician Medicare payments, extending current payment rates until January 1, 2012. The approved legislation also extended several provisions in Medicare that benefit rural providers. Read NRHA’s report on the agreement and rural provisions.

Congress reaching agreement on avoiding Medicare cuts

Republican and Democratic Senate leaders have announced a plan that eliminates the 25% cut in Medicare physician payments that is scheduled for January 1 and extends current rates for a year, giving Congress time to work on a sustainable solution. The plan still needs to be approved by Congress and signed by the President. Lawmakers are proposing a tightening of the rules on tax credits in the healthcare law to finance this measure. Read more.

Colorado drops to 13th in health rankings, high geographic health disparities found

As reported in today’s Denver Business Journal, Colorado fell five places to 13th among states in the latest edition of America’s Health Rankings. The annual rankings, published jointly by the United Health Foundation, the American Public Health Association and Partnership for Prevention, placed Colorado ahead of most other states for its low rates of cancer, obesity, cardiovascular death, and preventable hospitalizations but found the state to be lagging behind others in immunization coverage and with high geographic health disparities. Check out the state rankings and learn more about the measures. 

CMS Hosting Listening Session on December 10: Health Care Delivery System Reform

The Centers for Medicare & Medicaid Services (CMS) is hosting a listening session on Friday, December 10 from 9:00-11:00am on Health Care Delivery System Reform, co-hosted by Health and Human Services Regional Director Marguerite Salazar and CMS Regional Administrator Jeff Hinson. The session will be at The Children’s Hospital in Aurora and will highlight three areas: The Accountable Care Organization Shared Savings Program; The Center for Medicare and Medicaid Innovation; and The Federal Coordinated Health Care Office. Participants will learn what CMS is doing in these three areas and also have an opportunity to make oral statements. 

Seating is limited and will be based on a first come, first served basis. Those interested in attending must register no later than close of business on Wednesday, December 8th. Click here to register. For more information go to CMS's website or contact the CMS Denver office at 303.844.7130.

House approves one-month Medicare payment extension

This afternoon the House approved a bill passed by the Senate earlier this month that postpones a 23 percent cut in Medicare physician payments that was scheduled to take effect December 1. The president is expected to sign the bill. The legislation freezes current rates for services provided through December 31, giving Congress additional time to craft a longer-term solution to the formula used to determine Medicare physician payments.

Colorado's rural ambulance services under pressure

Today’s Denver Post highlights ambulance services in several rural counties and how they are trying to address falling revenue and budget cuts while also providing critical emergency services for their communities. Read the article. 

Join the National Summit on Advancing Health through Nursing webcast on November 30

The Colorado Center for Nursing Excellence and AARP invite you to attend a special meeting on Tuesday, November 30 for a facilitated webcast of the National Summit on Advancing Health through Nursing. The meeting will provide more information about the Institute of Medicine and Robert Wood Johnson Foundation recommendations on the “Future of Nursing” and will allow leaders across Colorado to discuss the recommendations and their implications. The program is from 8:00-11:30am and will be held at AARP's Denver office at 303 E. 17th Avenue Suite 510. For more information and to RSVP, contact Wendy Krzeczowski at Wendy@coloradonursingcenter.org or 303.715.0343 x18.

Colorado Health Professions Workforce Policy Collaborative releases 2011 policy agenda

Read and download the recently released 2011 policy recommendations of the Colorado Health Professions Workforce Policy Collaborative. Created in 2008 through support by The Colorado Trust and convened by the Colorado Rural Health Center, the Collaborative brings together a multidisciplinary group of policy leaders, health care providers, educational institutions, economic development, and workforce planning authorities to better understand the complex nature of healthcare workforce policy and to develop and support effective changes. This year’s policy recommendations “Addressing Colorado’s Primary Care Provider Shortage” span across healthcare professions and provide evidence-based and actionable steps that state policymakers can take to ensure Colorado will have the healthcare workforce that it needs.

Senate approves one-month Medicare rate extension

On Thursday, November 18 the U.S. Senate passed a one-month extension of the current Medicare physician payment rates in an effort to avert a 23 percent cut scheduled to take effect Dec. 1. Now the U.S. House must approve the extension, which is intended to give lawmakers additional time to work out a longer-term solution. The House should take up the measure on November 29. Stay tuned for more news and thanks to all who contacted their elected officials last week on this important issue.

Challenges facing Colorado's nurse practitioners

An article in today's Denver Post highlights the challenges that Colorado's advance practice nurses face in being credentialed and reimbursed by insurance companies.

Calls needed to stop looming Medicare cuts

Congress is back in session and needs to act now to avoid a 23 percent Medicare payment cut that is scheduled for December 1 (with another 2 percent cut following on January 1). These cuts will greatly impact rural residents, as there is a larger portion of elderly living in our rural areas already dealing with provider shortages, and rural healthcare providers who are struggling to cover their costs and care for our communities. The American Medical Association (AMA) and the U.S. Health and Human Services Department are supporting a 13-month halt to any cuts while Congress works on creating a more permanent solution to Medicare funding for physicians.

Please consider contacting Senator Udall, Senator Bennett, and your 2010 member of Congress this week and ask them to avoid these Medicare cuts!

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

Representative Diana DeGette: 202-225-4431; 303-844-4988
Representative Jared Polis: 202-225-2161; 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

You can also use the AMA’s Patient Action Network by calling 888-434-6200 (you will need to submit your zip code). Not sure who represents you in Congress? Click here.

Medicare Updates: 2011 OPPS Final Rule, Physician Payments and the SGR

Earlier this month, the Centers for Medicare and Medicaid (CMS) issued final rules updating Medicare policies and rates for 2011, including several changes relating to physician supervision that impact rural providers. Read more about these changes as well as other components of the final rule. Some of the highlights include:

• Delayed the enforcement of supervision requirements for outpatient therapeutic services in both critical access hospitals (CAHs) and small rural hospitals through calendar year 2011
• Changed definition of “immediately available”
• Finalized a proposal for 16 services requiring direct supervision by a physician or non-physician practitioner during an initiation period, followed by ‘general’ supervision for the reminder of the service
• Announcement that CMS will convene a panel in 2012 to review supervision requirements for all outpatient services

While we’re on the topic of Medicare, as Rural Voice readers recall from last week’s post, Medicare physician payments will be cut by 23% beginning December 1 without congressional action. Why so high? In very oversimplified terms, the formula used to determine Medicare payments, the Sustainable Growth Rate (SGR), ties Medicare physician payments to factors related to the overall national economy. Put another way, SGR says the growth in payments per Medicare beneficiary cannot grow more than the economy as a whole…and slower economic growth requires lowering physician payments to control Medicare costs. Reimbursements were cut in 2002 but since that time payment reductions have been postponed (and been accumulating) while SGR remains in place. Many organizations and individuals will be calling on Congress next week to take action to avert these cuts and create a more stable, sustainable method for determining physician payments. Stay tuned for opportunities to contact your congressperson next week to share your concerns about potential Medicare cuts and what they will mean for rural communities and providers. 

Want to learn more about SGR and how Medicare pays physicians? Check out this policy brief by Health Affairs that summarizes the issues and possible solutions.

Share your ideas and priorities on rural public health for Rural Healthy People 2020

Complete a brief, online survey to assist rural health policy makers and researchers in identifying the most important health issues facing rural residents. The project, Rural Healthy People 2020, is designed to identify the most significant preventable threats to the health of rural people and to establish goals for reducing these threats. The survey should take 5-10 minutes to complete and does not require a professional background in health issues.

Rural Healthy People 2020 is an important companion document and resource to Healthy People 2020, a national framework for health and prevention. You can find a good article on the 2020 initiative written by Kim Krisberg in the American Public Health Association's The Nation's Health.

Federal Health Reform Accounts for Less than 5% of Rate Increases in Colorado

In response to speculation about the effects of federal healthcare reform on health insurance premiums in Colorado, the Division of Insurance, lead by Insurance Commissioner Marcy Morrison, conducted an analysis of recent rates and found that “while federal changes have minimally affected premium costs, numerous other factors are more significant across the board”. Read the news release from the Division of Insurance and learn more about factors which are driving healthcare insurance rate increases.

Looking ahead...but not too far

By now most of us have probably learned about the outcomes of yesterday’s election. In Washington, the House of Representatives will be Republican-controlled beginning January 2011 and Democrats will have a narrower margin in the U.S. Senate. Colorado voters will send Michael Bennett (D) back to the Senate for another term. Re-elected Representatives Mike Coffman (R), Diana DeGette (D), Doug Lamborn (R), Ed Perlmutter (D), and Jared Polis (D) will be joined in January by the newly elected Cory Gardner (R) and Scott Tipton (R).

But there’s work left to be done this year in Washington. Lawmakers will return to D.C. later this month for a post-election “lame duck” session and they will have a lot on their plates. On the agenda are spending bills for most government programs (including important rural and workforce provisions) and addressing a 23.6% Medicare payment cut for physicians that is scheduled to begin on December 1. National organizations are already mobilizing and we will keep you informed of opportunities to contact your member of Congress about these important healthcare issues.  

Back here in Colorado, voters rejected several tax cutting initiatives including Amendment 60, 61, and Proposition 101 as well as Amendment 63. Republicans appear to have taken a majority in the State House, the Democrats have maintained their majority in the State Senate, and John Hickenlooper (D) is the Governor-elect. With our state facing significant revenue shortfalls, FY 2011-12 budget briefings and hearings are scheduled to begin later this month.

Read a complete list of Colorado’s election results. And thanks for voting!

Governor Ritter’s FY2011-12 proposed budget released

In the midst of election activities (more to come on that later), Governor Ritter released his proposed budget plan for fiscal year 2011-2012.  Addressing a shortfall of over $714 million, the proposal includes targeted reductions in Medicaid and Children’s Basic Health Plan (CHP+), payment delays for Medicaid providers, and also a reduction in scheduled provider fee payments to hospitals. No direct cuts to Medicaid provider rates were proposed, however the payment delays and other proposed reductions will negatively impact Medicaid providers. This proposal is not yet final, as the Legislature and Governor-elect John Hickenlooper can make changes to the budget. CRHC will continue to monitor the budget process for opportunities to advocate on behalf of rural healthcare and share updates as they unfold. I welcome your feedback on budget issues—send me an email at ss@coruralhealth.org. 

New report features Colorado clinics using non-physician clinicians

A new report by the Colorado Health Institute provides case studies of clinics throughout Colorado that utilize interdisciplinary collaborative models for the provision of primary care. Working under physician supervision or independently (depending on their training and practice setting), nurse practitioners, certified nurse midwives, and physician assistants are providing a range of primary care services to patients. Read the report "Collaborative Models of Primary Care: Case Studies in Colorado Innovation". 

Family Medicine Residency Training in Rural Locations

A survey of U.S. family medicine residency programs found that 33 rural programs account for over 80% of family medicine training occurring in rural sites. Published by the WWAMI Rural Health Research Center, the report includes responses from family medicine residency programs about their rural training programs and provides policy recommendations to encourage the growth of medical training that supports rural primary care. Read the full report.

Other health clinics need support, too

The Denver Post published Colorado Rural Health Center CEO Lou Ann Wilroy’s letter “Other health clinics need support, too” in response to an article on the state’s rural safety-net clinics.

Health Insurance Exchange Forums this week in Colorado Springs and Greeley

Public forums on health insurance exchanges will be held this week--on Tuesday, October 26 in Colorado Springs at the Pikes Peak Regional Development Center, located at 2880 International Circle and on Friday, October 29 in Greeley at the Panorama Room of the UNC University Center, located at 2045 10th Avenue. Both forums will be held from 10:00 a.m.-12:00 p.m. Information on these meetings as well as materials and minutes from previous forums are available on the state's Exchange Forums website.  

As part of the Affordable Care Act, states are responsible for developing health insurance exchanges. The exchanges will be virtual marketplaces where Coloradans will be able to obtain information to select and purchase health insurance plans and determine eligibility for federal subsidies and tax credits. The Colorado Coalition for the Medically Underserved, the Colorado Consumer Health Initiative, and the state's Health Reform Implementation Board have been hosting a series of community forums across Colorado to discus the options for our state and collect input from stakeholders and communities. 

Governor announces additional cuts to re-balance budget

Facing an shortfall of about $261.7 million in FY 2010-11, Governor Ritter released a budget re-balancing plan totaling $296.5 million. Proposed health-related items in the plan include a three week provider payment delay for fee-for-service Medicaid providers. More information on the proposed provider payment delay, including a provider payment schedule, is available on the Department of Health Care Policy and Financing website. 


More budget news is on the horizon. The Governor will present his FY 2011-12 balanced budget request on November 1, anticipating an estimated $1.1 billion shortfall for the year beginning July 1, 2011. Additional budget cuts for FY 2010-11 may be needed following December’s revenue forecast. 

Impact of Amendment 60, 61, and Proposition 101 on healthcare in rural communities

If passed, Amendment 60, 61, and Proposition 101 will have dire consequences for healthcare across Colorado, especially in rural communities. The Bell Policy Center has written an article on how these ballot initiatives will directly impact three rural hospital districts in Garfield, Huerfano, and Yuma counties, severely limiting their abilities to maintain facilities and provide services. Read the article and download fact sheets for these three counties. For information on how these initiatives will impact other Colorado counties, visit Looking Forward.  

Don't forget to cast your ballot--by early voting, by mail, or at the polls on November 2. Read the Secretary of State's 2010 Voter's Guide for more information. 

Health Reform Hits Main Street

Looking for an easy-to-understand source for learning more about the health reform law? The Kaiser Family Foundation has produced a short, animated movie that explains some of the concerns about the current healthcare system, the changes that are happening now, and the changes to come in 2014. 

California Court Approves CRNA Opt Out

The California Superior Court in San Francisco has upheld Gov. Arnold Schwarzenegger's June 2009 decision to opt out of the federal physician supervision rule for certified registered nurse anesthetists (CRNA).  The presiding judge ruled that California state law does not specifically require CRNAs to be supervised by physicians when administering anesthesia, and therefore Gov. Schwarzenegger was within his rights to opt out of the federal rule.

Colorado’s Governor Ritter opted-out of the CRNA Medicare supervision requirement in rural and Critical Access Hospitals in September, becoming one of fifteen states that have opted out of the requirement. The Colorado Society of Anesthesiologists and the Colorado Medical Society filed suit in Denver District Court to block Governor Ritter’s opt-out decision and this legal challenge is still pending.

CRHC congratulates California on this important victory and applauds the Colorado advocates of CRNA opt-out, including the Colorado Hospital Association, Colorado Nurses Association, Colorado Association of Nurse Anesthetists, and many individuals and healthcare providers who all support this effort. 

Denver Post Article Discusses Amendment 63

The Colorado Rural Health Center (CRHC) is mentioned in an article in today's Denver Post as one of several members of Colorado’s medical community that is opposed to Amendment 63. This confusing and costly amendment would alter the state’s constitution to block Colorado from adopting federal health reform legislation that requires individuals to have health insurance coverage. While not taking a position on the individual mandate issue, CRHC opposes Amendment 63 and does not believe a constitutional amendment is the appropriate way to address this issue. Read more about CRHC’s positions on the November ballot measures. 

CRNA Opt-Out Update

Last month Governor Ritter exercised the option to exempt Colorado’s Critical Access Hospitals and rural hospitals from the Medicare requirement that certified registered nurse anesthetists be supervised by a physician, joining 15 other states that have already opted-out of the requirement. Both the Colorado Board of Nursing and the Colorado Medical Board voted on and supported the CRNA opt-out and a study found that opting out of the oversight requirement did not diminish quality of care or threaten patient safety. The Colorado Society of Anesthesiologists and the Colorado Medical Society filed suit to block Governor Ritter’s decision and this legal challenge is still pending.

CRHC thanks the many individuals and organizations who support this effort to improve access to healthcare in rural Colorado and have worked tirelessly toward the opt-out decision, including the Colorado Hospital Association and the Colorado Nurses Association. The Rural Voice will continue to update readers on this important issue. 

Department of Insurance to Assist on Child-Only Policies

Colorado’s Department of Insurance announced yesterday that it will assist families with finding “child-only” health insurance policies. Federal health legislation that took effect on September 23, 2010 prohibits insurers from denying coverage to children based on pre-existing conditions. Read the Department’s updates on Child-Only policies.  

Navigating Health Reform Implementation

Confused about what is in the Patient Protection and Affordable Care Act of 2010 and how it will be implemented? While the Act’s four major components — market reforms, state health insurance exchanges, Medicaid expansions, and employer and individual responsibility provisions — do not take effect until January 1, 2014, other aspects of the legislation have already taken effect or will be soon. Two resources for information are the Kaiser Health Reform Gateway, sponsored by the Kaiser Family Foundation, and Health Reform GPS, a joint project of the Robert Wood Johnson Foundation and George Washington University's School of Public Health and Health Services. 

Know the Issues for November 2!

Coloradans will be heading to the polls (or mailing in their ballots) in just over a month—get ready. 

The Colorado Legislative Council has published The Blue Book, a detailed analysis of each of the ballot initiatives. CRHC is opposing Amendment 60, Amendment 61, and Proposition 101 along with a growing coalition of organizations. Please visit Don’t Hurt Colorado for more information. CRHC also opposes Amendment 63, Health Care Choice. To learn more about Amendment 63, go to www.NoOnAmendment63.com. 

Don't forget! Voter registration ends on October 4, be sure to register or update your voter registration.

Legal challenge issued in response to Governor Ritter’s CRNA opt-out

The Denver Post featured an article today about the Colorado Society of Anesthesiologists and the Colorado Medical Society filing a suit in Denver District Court on Tuesday, September 28 to block Governor Ritter’s decision to opt-out of the certified registered nurse anesthetist Medicare supervision requirement in rural and Critical Access Hospitals. 

Colorado awarded over $6.7 million to strengthen healthcare workforce

Congratulations to the Colorado recipients of recently-announced HHS grant awards to expand and support the state's healthcare workforce. Below is a listing of Colorado grantees, programs, and amounts awarded.

Expansion of Physician Assistant Training Program

University of Colorado Denver – Aurora: $855,360

State of Colorado for Red Rocks Community College – Lakewood: $399,495

Nurse Managed Health Clinics

University of Colorado Denver – Aurora: $1,498,206

Primary Care Residency Expansion

Regents of the University of Colorado – Aurora: $1,920,000

University of Colorado Denver – Aurora: $1,920,000

State Health Care Workforce Grants: Planning

Colorado Department of Public Health and Environment – Denver: $150,000

Governor Ritter Signs Opt-Out for CRNA Supervision

Today Governor Ritter took an important step in preserving and improving access to quality, safe, and affordable healthcare services in Colorado by opting-out of the certified registered nurse anesthetist (CRNA) Medicare supervision requirement in rural and Critical Access Hospitals. Read the Governor's press release.

CRHC has long supported the opt-out of the Medicare requirement for CRNAs to be directly supervised by the attending physician, dentist or podiatrist, which adds another barrier to accessing healthcare for rural residents. Opting-out also gives hospitals the flexibility to structure their anesthesia services around the needs of their communities and patients. With today’s action, Colorado joins 15 other states that have already opted-out of this requirement. CRHC applauds Governor Ritter for helping increase access to care for rural Coloradans. Thanks to everyone who took action in support of this important issue.

Getting Started...

Hello from CRHC's new Policy Analyst! A big thanks goes to Terri Hurst for her expert guidance and leadership in this role and I wish her well in her new position.

A little bit about myself...I came to CRHC in May as a recruitment coordinator with Colorado Provider Recruitment, assisting rural and underserved communities in recruiting and retaining healthcare professionals. Prior to relocating to Colorado with my family and joining CRHC, I worked in managed care and program planning at the University of Chicago Medical Center and earned my Master’s Degree in health administration and policy from the University of Chicago. I also served as policy/advocacy coordinator for several years with the AIDS Foundation of Chicago.

I welcome your feedback and input on The Rural Voice and look forward to working with you to ensure that every Coloradan has access to quality healthcare services. We have much to do in the year ahead and I'm excited to get started!

Are Rural Health Clinics Part of the Rural Safety Net?

A report that highlights the importance of Rural Health Clinics (RHCs) to the healthcare safety net was just released today. Published by the Maine Rural Health Research Center, this policy breif entitled, Are Rural Health Clinics Part of the Rural Safety Net? highlights the importance of RHCs in providing primary care services in rural areas. In particular, in communities without a Community Health Center (CHC), RHCs provide a majority of care to those insured by Medicaid & CHP. The report also highlights the lack of funding and resources for RHCs, as they have been left out of funding from both the stimulus bill and federal health reform. While there are measures in the federal health reform law to incentivize RHCs to collaborate with CHCs, RHCs in and of themselves have been largely overlooked as part of the healthcare safety net. Read the full report by clicking HERE.

September Revenue Forecast

The September Revenue Forecast was released today by both the Office of State Planning & Budgeting and the Colorado Legislative Council Staff. While the numbers vary slightly in both of the forecasts, one thing is certain.......Colorado state services will continue to experience cuts as the state is facing a shortfall from projected revenue. For our current fiscal year, FY10-11, Colorado is upwards of $257 million short, which means future cuts are on the horizon. The cuts may not tally as high as $257 million as there are many factors at play, though $257 million appears to be the ceiling, at least for now. For FY11-12, which doesn't even start until July 1, 2011, and for which the budget hasn't even been created yet; the state is expected to be upwards of $1.1 billion short. FY11-12 is going to be tough fiscally for the state as federal assistance through the stimulus package & FMAP extension will not be available anymore.

The next budget revenue forecast will be released in December. Even though it's only September, my wish for the upcoming holiday season (and next revenue forecast) is that our state does not have to continue cutting an already meager budget.

CRHC Opposes Amendment 63!

Coloradans will have 9 state ballot measures to vote on this November. CRHC has already taken a position of opposition and urges you to vote no on Amendment 60, Amendment 61, and Proposition 101. These anti-tax measures would end state funding for public schools, diminish funding for EMTS services, and basically stop any future infrastructure (roads, bridges, schools, etc) from happening. For more information on these measures, please visit Don't Hurt Colorado.

CRHC has now officially taken a position of opposition on Amendment 63, which is entitled Health Care Choice. This amendment would amend the state constitution to block Colorado from adopting federal legislation passed earlier this year through the Patient Protection and Affordable Care Act to require all U.S. citizens to get health insurance coverage. CRHC does not believe that a constitutional amendment is the appropriate solution to this issue. Colorado's constitution is four times longer than the U.S. Constitution and adding an amendment like Amendment 63 will not actually impact or override the federal law. CRHC has not taken a position of opposition or support regarding the individual insurance coverage mandate, but urges you to vote NO on Amendment 63 as it is not a substantive and constructive alternative!!!

The Colorado Legislative Council has published The Blue Book, where you can read each of the ballot initiatives, read the pros & cons of each side, and educate yourself on these issues prior to arriving at the voting booth in November. CRHC will be posting more information about these ballot measures and more as we get closer to the elections. Stay tuned......

My Aloha from CRHC......

It is with much sadness and excitement that this issue of The Rural Voice will be the last that is published by yours truly. After two and a half years, I am leaving CRHC and will be the Director of Public Policy at the Colorado Behavioral Healthcare Council. It has been an absolute pleasure working at CRHC and for all of you, as we have worked hard to improve access to healthcare services for those who call rural Colorado home. CRHC will continue to be the voice for rural Colorado to ensure that every Coloradan has access to quality healthcare services.

If you need further assistance or have any policy questions, please contact Cari Fouts, Director of Communication & Development, at cf@coruralhealth.org

Denver Post Supports CRNA Opt-Out

The Denver Post published an editorial today that supports Colorado opting-out of the CRNA Medicare supervision requirement. My previous two blog posts provide more information on this issue and I encourage you to read them if you are not familiar with this issue. In the meantime, we are anxiously awaiting Governor Ritter's decision, which will hopefully come in the next week or so.

NY Times Editorial: Who Should Provide Anesthesia Care?

Is this perfect timing or what!? The New York Times featured an editorial yesterday discussing the Certified Registered Nurse Anesthetist (CRNA) supervision opt-out issue (see my Sept. 2nd post for more information). The editorial highlights two reports that have concluded patient safety and quality has not been compromised in the 14 states that have opted-out of the Medicare supervision requirement (California chose to opt-out last year, making it 15 states altogether). In fact using CRNA's to deliver anesthsia services is more cost-effective and is a more feasible option for rural hospitals.

Let's hope Governor Ritter makes Colorado the 16th state to opt-out.

Urge Governor Ritter to Improve Access to Healthcare Services in Rural Colorado!

Governor Ritter needs to hear from you about opting-out of the certified registered nurse anesthetist (CRNA) Medicare supervision requirement. As you know, CRHC has long supported the opt-out of the Medicare requirement for CRNAs to be directly supervised by the attending physician, dentist or podiatrist, which adds another barrier for rural residents in accessing quality healthcare services. A recent study published in Health Affaris showed that there was no diminished quality of care or threat to patient safety in the 14 states (2005) that had opted-out of the supervision requirement. In fact, the study recommends that CRNA's in every state be allowed to work without the supervision requirement. As of July 2009, 15 states had chosen to opt-out of the supervision requirement.

Recently, both the state Board of Nursing and the Colorado Medical Board voted on and supported the CRNA opt-out. Both respective entities stated that opting-out is consistent with the Nurse Practice Act and the Medical Practice Act. It is now up to Governor Ritter to submit a letter to the Center for Medicare & Medicaid Services (CMS) requesting Colorado be exempted from the supervision requirement.

If you have minute, please call the Governor at (303) 866-2471 and urge him to opt-out of the CRNA supervision requirement.

There are 42 rural hospitals in Colorado. Of those 4 do not provide anesthesia services at all. Of the remaining 38 that provide anesthesia services:
• 5 provide anesthesia services using physician anesthesiologists ONLY
• 9 provide anesthesia services using a combination of part time anesthesiologists and part time CRNAs
• 24 provide anesthesia services using CRNA’s ONLY and do not have anesthesiologists on staff.

Opting-out of CRNA supervision will not harm patient safety. It will not diminish the need for physicians and anesthesiologists in the healthcare arena. It WILL help increase access to care for the 700,000 plus residents of our state that call rural Colorado home. Tell Governor Ritter to increase healthcare access for rural residents by opting-out of the CRNA supervision requirement!

Rural Community Hospital Demonstration Program

Health & Human Services Secretary Kathleen Sebelius has announced the expansion of the Rural Community Hospital Demonstration Program. The Demonstration Program began in 2005 as per the Medicare Modernization Act. The pilot originally funded 13 hospitals that were located in 8 sparsely populated states. There are currently ten hospitals still participating in the program. With the passage of the Affordable Care Act, 20 additional hospitals (in 20 additional states, which includes Colorado) may be eligible to participate in the Program. In order for a hospital to be eligible to apply and participate in the Program they must be located in a rural area, have fewer than 51 acute care beds, provide 24-hour emergency care, and not be eligible for nor currently be designated as a Critical Access Hospital. Approximately 3 hospitals in Colorado may have the potential to apply to participate in this Program.

The Demonstration Program tests the feasibility and advisability of providing reasonable cost reimbursement for small rural hospitals. Hospitals selected for participation in the Program will receive payment for inpatient services, with the exclusion of services furnished in a psychiatric or rehabilitation unit that is a distinct part of the hospital, using the following rules:
1. Reasonable cost for covered inpatient services, for discharges occurring in the first cost reporting period on or after the implementation of the program;
2. For subsequent cost reporting periods, the lesser amount of reasonable cost or the previous year’s amount updated by the inpatient prospective payment update factor for that particular cost reporting period.

Mental Health First Aid for Suicide Prevention Webcast 9.10

Did you know that the rate of suicide among rural men is significantly higher than urban men? The rate of suicide among rural women has also been increasing the past few years and research has shown that rural residents are more successful in their suicide attempts due to the prevelance of the use of guns. Join the National Council for Community Behavioral Healthcare on World Suicide Prevention Day for a Mental Health First Aid webinar geared toward suicide prevention on Friday, September 10th from 11a - 12p MST. Learn how you can recognize the symptoms and risk factors that can lead to suicide and tools that can be used to help prevent suicide from happening.

Open Meeting 9.14: CoverColorado Provider Fee Schedule Meeting

CoverColorado, one of Colorado's high risk insurance pools, is restructuring its fee schedule for providers. CoverColorado currently insures approximately 12,000 Coloradans who are unable to obtain insurance from other avenues. In order to ease some of the financial strain CoverColorado has been experiencing, legislation was passed during the 2010 session that allows CoverColorado to create a new fee schedule for reimbursing providers who provide services to those insured through CoverColorado.

CoverColorado is seeking input from providers in regards to the new fee schedule. A meeting is scheduled for Tuesday, September 14th from 4-6pm at the Molly Blank Auditorium at National Jewish Hospital in Denver. Interested individuals who cannot attend the meeting in person may also submit written comments to sbgamble@covercolorado.org.

Please visit the highlighted links for more information on CoverColorado or the Public Meeting set for September 14th.

Colorado Awarded Almost $800,000 for Rural Healthcare Priorities

On Monday, Health & Human Services Secretary, Kathleen Sebelius, announced the awarding of $32 million in grants to support rural health priorities. Congratulations to the Colorado Rural Health Center, which was awarded over $500,000 for the Rural Hospital Flex Program. The Rural Hospital Flex Program supports improvements in healthcare quality in communities served by Critical Access Hospitals (CAHs). CAHs are rural hospitals with fewer than 25 beds that provide critical care to rural and remote areas of our state. There are 29 CAHs throughout Colorado that will benefit from this funding.

Congratulations are also in order to the Plains Medical Center located in Limon, Colorado, that received close to $200,00 for Rural Health Workforce Development.

To see a list of all the awardees, please visit the Health & Human Services website or click here.

The Colorado Health Foundation Blog on 60, 61 and 101

Shepard Nevel, Vice President for Policy and Operations at the Colorado Health Foundation, published an excellent post on the negative impact Amendment 60, 61 and Proposition 101 would have on healthcare services in Colorado.

The Colorado Rural Health Center is one of many organizations opposed to these three ballot measures. Please visit Looking Forward Colorado to learn more about the impact these ballot initiatives would have on Colorado.

Safety-Net Facilities Improvement Grants

The Kresge Foundation, based in Michigan, is accepting grant applications on an on-going basis for safety-net facilities to improve their infrastructure. It is a challenge grant, so there are funding requirements (ex: raising a percentage of funding) in order to be eligible for these funds. This is a great opportunity for communities to come together and support Rural Health Clinics, Critical Access Hospitals, and Community Funded Safety Net Clinics since none of these entities received resources for infrastructure through the federal stimulus package.

Please read the following for more information and to link to the grant website:

Safety-net Facility Improvements

This grant opportunity extends Kresge’s long history of awarding challenge grants to organizations conducting capital campaigns for new building construction and facility renovation. In addition to facilities-capital challenge grants, we are increasing our investment in community-based health centers through a variety of funding methods, including program-related investments or below market rate loans.

Clinics that are expanding and/or improving their physical infrastructure in order to increase accessibility, availability, and the quality of services provided to disadvantaged, uninsured and under-insured populations are typically competitive applicants. Anchor organizations that assume a leadership role in facilitating meaningful and relevant community change by strengthening the safety-net or improving their ability to respond to priority community health issues are encouraged to apply. Consideration also is given to projects that are environmentally sustainable and adopt the Green Guide for Health Care.

To apply for facilities capital, visit the challenge grant page for complete information, including letter of inquiry requirements, and to apply online.

Conferences, Conferences, and More Conferences!!

With summer winding down, a large portion of our organizational partners are gearing up for their fall conferences. I've listed some of them below and included links for your convenience. Enjoy!

Progressive 15 - Fall Conference & Candidate Forum
September 16 - 17 at the Fountains of Loveland, Loveland

Action 22 - Annual Conference
September 24 - 25 at the Crowne Plaza Hotel, Colorado Springs

Club 20 - Fall Meeting & Debates
September 10 - 11 at Two Rivers Convention Center, Grand Junction

Colorado Coalition for the Medically Underserved - Annual Conference
Friday, October 8th at The Children's Hospital, Aurora

Federal Medicaid Extension Signed by President Obama

President Obama signed into law the $26 billion jobs bill, which contained funding for the FMAP extension. As previously written about here, the FMAP is the matching funds the federal government provides states to operate Medicaid. This means that Colorado lawmakers will not have to make an estimated $200 million in cuts that would have happened if the FMAP had not been extended. If and when the state will have to make future cuts will become more apparent as 2010 rolls along. The next budget revenue forecast will be released September 20th. With the passage of this bill, Congress is now on recess until the middle of September, so things should be relatively quiet at the federal level. That being said, with primary election results being decided yesterday, stay tuned for the campaigning fun to begin!

HHS Awards $159.1 Million to Support Health Care Workforce Training

Congratulations to all of the Colorado recipients of the Health & Human Services Health Care Workforce Training Grants! Colorado will receive a total of $1.4 million!
These funds will be used to expand training in nursing workforce. Here is a breakdown of who & what was funded in our state:

Advanced Education Nursing Grants
University of Colorado, Denver - Aurora: $315,433.00
University of Colorado, Denver - Aurora: $249,103.00
University of Colorado, Denver - Aurora: $293,049.00

Advanced Education Nursing Traineeship Grants
University of Colorado Health Sciences Center - Aurora: $80,543.00
Regents of The University of Colorado, Colorado Springs: $38,602.00
Regis University, Denver: $164,077.00
University of Northern Colorado, Greeley: $27,745.00

Nurse Education, Practice, Quality and Retention Grants
Chi Colorado Foundation (doing business as St. Mary-Corwin Health Foundation) Pueblo: $195,201.00

Senate Passes FMAP Extenstion - House Expected to Vote this Week

See what happens when I go on vacation.....the Senate finally voted on extending the FMAP! With a vote of 61-39, the Senate approved a slightly scaled back version of the FMAP extension. Beginning in January 2011, the FMAP extension will provide a 3.2%first quarter increase, which is reduced to 1.2% in the second quarter. There are exceptions for states with high unemployment rates (not sure what the definition of "high unemployment rates" is), which will continue to receive the enhanced FMAP without any decrease.

The House, which had began summer recess, has been called back to D.C. and is expected to vote on the bill this week. It is critical that the House pass this legislation or Colorado's current budget will be short approximately $200 million. If you have a minute, please consider calling your Representative and encouraging them to vote yes on extending the FMAP.

Representative Diana DeGette: 202-225-4431
Representative Jared Polis: 202-225-2161
Representative John Salazar: 202-225-4761
Representative Betsy Markey: 202-225-4876
Representative Doug Lamborn: 202-225-4422
Representative Mike Coffman: 202-225-7882
Representative Ed Perlmutter: 202-225-2645

Rural Provisions Appropriated, but still need Congress Approval

The Senate Labor, Health & Human Services, Education and Related Agencies marked up its draft appropriations bill and released a final version July 29th. The bill provides $169.9 billion in discretionary funds for a variety of programs, some of which would be very helpful for rural healthcare consumers & providers. In particular to note is the $5.1 million for the Rural Physician Pipeline program, which was introduced by Colorado Senator Udall. This program was included in the federal health reform bill, but did not receive appropriated funding through the bill. There are a host of other rural friendly & workforce provisions in the bill including funding for primary care training, nurse faculty loan forgiveness, and public health workforce training. You can read more about what was appropriated by clicking HERE.

The big pickle with this bill is that it is not likely to be voted on by Congress until after the elections in November. According to our partners at the National Rural Health Association, Senate Labor-HHS-Education Appropriations Subcommittee Chairman Tom Harkin (D-IA) was quoted as saying, "this bill probably won't see the light of day until December, maybe January." Not promising news........

FMAP Vote to Happen Before 5p Tomorrow

The Senate is expected to vote on the FMAP extension no later than 5p tomorrow. I will be out of town and not able to provide an update until Monday. Fingers crossed that the extension is approved!

FMAP Vote to take place ???????

Looks like the FMAP vote that was allegedly set to take place last night (Monday 8.2) was postponed. The Senate might vote on it tonight. Perhaps tomorrow. No one really knows. Isn't our political system fun!?!?!

On another note, the House is on recess until Tuesday, September 14th. This is a great time to try and meet with your district Representative. As part of Safety Net Clinic Week (Aug. 30th - Sept. 3rd) ClinicNET and CRHC will be reaching out to policy makers and scheduling site visits so that our elected officials learn about the often overlooked healthcare safety net providers: Rural Health Clinics and Community Funded Safety Net Clinics. Please feel free to contact me if you are interested in hosting a site visit.

TCT Video about Colorado Workforce Collaborative

New video features Colorado Workforce Collaborative
Click on the above link to watch a video from The Colorado Trust highlighting some of the issues faced in recruiting and retatining healthcare professionals in rural and underserved areas of Colorado and how the Colorado Health Professions Workforce Collaborative is working to address some of these issues.

Senate Expected to Vote on FMAP Extenstion

Details are foggy right now, but it sounds as if the Senate is expected to vote tonight on extending the FMAP bump to states. As has been previously mentioned here in The Rural Voice, the FMAP is the methodology used by the federal government to provide states funding for the Medicaid program. Prior to the stimulus bill, Colorado was a 50/50 state. For every dollar Colorado spent on Medicaid, the federal government matched that with a dollar. Since the stimulus package went into effect, Colorado's FMAP has been approximately 60/40, which has provided the state some relief. Currently, the big issue facing our state (as well as 20+ other states) is that Colorado crafted the state FY10-11 budget assuming our state would get the FMAP extension that is being voted on tonight. The increased FMAP bump is set to expire at the end of December 2010. If Congress fails to extend this FMAP increase, Colorado will be approximately $200 million short in our current fiscal year, which ends July 31, 2011. This will mean major cuts to state services as we move into 2011.

On a good note, this past weekend the Denver Post reported that revenues for the state are better than expected since last budget revenue forecast. This means the $75 million in cuts that Governor Ritter was set to address this month may not have to happen afterall. Keep your fingers crossed and as always, stay tuned for more budget fun as the next budget revenue forecast will come out in September.

Challenges for Improving Health Care Access in Rural America

Rural Health Research and Policy Centers, funded by the Federal Office of Rural Health Policy, recently released a compendium entitled Challenges for Improving Health Care Access in Rural America.

This compendium is a great tool to continue discussions surrounding healthcare reform and the challenges faced in rural communities as implementation moves forward. As previously stated in The Rural Voice, some of the rural and workforce provisions in federal healthcare reform were authorized, but not funded. This point must not be forgotten as Colorado and the rest of the country move forward with implementation efforts.

CCHI Seeking Healthcare Stories

The Colorado Consumer Health Initiative (CCHI) is seeking stories from rural residents who are having or have had a difficult time finding primary care services in your community. If you or someone you know has had trouble accessing primary care healthcare services and you would like to share your story, please contact Christina Yong at christina@cohealthinitiative.org