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

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.........