U.S. Supreme Court Does Not Act on ACA

The U.S. Supreme Court deferred taking action on a bid by Virginia’s attorney general for fast-track consideration of the state’s challenge to the Affordable Care Act (ACA). The Court will have another opportunity this month to decide whether to take up the ACA for early consideration. While the Supreme Court is ultimately expected to decide the constitutionality of the ACA, several appeals courts will be hearing challenges to the law throughout 2011. Federal trial judges across the nation have upheld the law but others have declared it unconstitutional. Read more. 

1099 Provision in Health Reform Repealed

President Obama signed a bill repealing a tax-compliance mandate, known as the 1099 Provision, in the Affordable Care Act. The repealed provision, under which companies would have had to report more transactions to the Internal Revenue Service, was to have taken effect in 2012. Read more.

FY 11-12 State Budget Update

The Colorado Senate and House passed the FY 11-12 budget Long Bill and several related bills this week. Although still contingent upon the state declaring a fiscal emergency, funding for Primary Care Fund was included with $1.72 million for the Special Distribution Fund and $10.75 million (eligible for a federal match) for the Health Care Services Fund. These amounts are reductions over last year’s levels. A Senate amendment that would have added an additional $1.8 million to the Health Care Services Fund was not picked up in the House. The final package also adds monthly premiums to the Child Health Plan Plus (CHP+) program for children over 205% of the federal poverty level, cuts Medicaid provider rates by 0.75%, and reduces Medicaid funding for family medicine residency programs.

As each chambers passed different versions (including the Primary Care Fund amendment), the Long Bill now moves to conference committee, consisting of members of the Joint Budget Committee, to work out the differences. Once the committee completes its work, the budget returns to both houses for final passage. Read more.

Federal Budget Update

In Washington, Congress will be voting today on a budget compromise reached last weekend on the FY 11 budget. This agreement cuts $38.5 billion and includes an across-the-board 0.2% reduction in all non-defense discretionary accounts. Specific cuts include $600 million from community health centers and $35 million to eliminate the rural Delta Health Initiative.

While wrapping up FY 11, attention is shifting to work on the FY 12 budget and considering long-term deficit reduction plans. The House is debating a GOP budget resolution that would reduce domestic discretionary spending to below 2008 levels for 5 years, convert Medicaid into a block grant to the states, and shift Medicare into a voucher-like program in which future retirees purchase private insurance plans. In addition to his original FY 12 budget proposal, the President responded yesterday with recommendations, including streamlining Medicaid payments to states in a single rate for both Medicaid and Children’s Health Insurance Plans, strengthening a payment advisory board that would recommend cuts to reimbursement rates if Medicare costs grow too fast, and placing dual-eligible Medicare/Medicaid beneficiaries in Medicaid managed care and extending Medicaid drug rebates to this population.

The House will be debating the GOP budget resolution this week and, while it may not represent the final budget decision, this proposal does create a blueprint that could have significant negative impacts on rural healthcare providers and access to healthcare for rural communities. Please call Congress this week at 202.224.3121 and ask to be transferred to your Representative’s office to leave this message: “Please vote against Rep. Ryan’s budget resolution which will hurt critical healthcare programs for rural communities including Medicaid and Medicare.” Click here to find out who represents you. We will continue to monitor the federal budget situation and post updates. Also stay tuned for a state budget report.

2011 Report from National Advisory Committee on Rural Health & Human Services

The National Advisory Committee on Rural Health & 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 2011 report to the Secretary examines three key topics in health and human services and their effects in rural areas: rural childhood obesity, place-based initiatives for rural early childhood development, and the rural implications of Accountable Care Organizations and payment bundling.

Bighorn Leadership Program Seeking Applicants from Roaring Fork Valley & Colorado Springs

The Bighorn Leadership Program presented by Engaged Public and in collaboration with Colorado State University are seeking individuals to participate in The Bighorn Health Care Policy and Project Lab. The program will be taking place simultaneously in two locations: The Roaring Fork Valley & Colorado Springs. The  Lab will include public leadership curriculum with an additional component allowing participants the opportunity to focus on the actual implementation of a health related policy or project. Individuals who live in the Roaring Fork Valley or Colorado Springs and who have a specific interest in developing their own public leadership skills, health care policy and healthy living in order to better serve their communities and constituencies are encouraged to apply. The application deadline is April 15. Download the application and more information.

Webinar on Accountable Care Collaboratives in Colorado

Bringing Health Home is hosting a webinar on Thursday, April 14 from 12:00-1:00 pm titled "Accountable Care Collaboratives--what is happening in Colorado?". Accountable Care Collaboratives are a framework within which other health care initiatives can potentially thrive, such as the medical home, health information technology, and payment reform.  This webinar will introduce folks to the ACC model, the pilots underway in the Colorado Medicaid program, and how it fits with national healthcare reform. Space is limited, click here to register and learn more. 

Plan to Reduce Health Disparities Announced

In a first-of-its-kind report, the U.S. Department of Health and Human Services is recommending steps that states and communities can take to reduce health disparities. Read more.

Impact of a Federal Government Shutdown

Today's Denver Post features an article that describes the local effects of a federal government shutdown and how members of Colorado's congressional delegation are responding.

FY 11-12 Budget Updates

Colorado Senate and House leaders and the Governor have agreed on a budget for FY2011-12, to be introduced this week in the Senate as the Long Bill. The delayed Long Bill and other budget balancing efforts, including action on the Primary Care Fund, were delayed due to disagreements regarding the cuts to K-12 education, the sales tax vendor fee, and the amount of money in the state’s reserves. The bipartisan agreement includes a $250 million cut to K-12 and maintains a 4% general fund reserve. Read more about the proposed budget.

U.S. House and Senate leaders are still negotiating around the nation's FY 11 budget, facing a deadline of April 8 to avoid a government shutdown. House Republicans released their FY 12 budget proposal earlier this week, calling for significant changes to Medicare and Medicaid programs. Read more about the House proposal's impact on healthcare.  

Updated Bill Tracker Available

CRHC's bill tracker is current as of April 1, 2011. Enjoy!

Colorado CRNA Opt-Out Upheld

On March 31 in a verbal ruling, the Denver District Court found that Governor Ritter's September 2010 opt-out from the Medicare requirement that a CRNA must practice under physician supervision in rural communities and Critical Access Hospitals was consistent with Colorado law. A written order is expected to be issued soon. The ruling comes in response to a lawsuit filed against Governor Ritter's opt-out decision.


CRHC thanks the Colorado Hospital Association, Colorado Nurses Association, and the Colorado Registered Nurse Anesthetists who worked diligently to see the opt-out decision upheld. CRHC has long-supported an opt-out of CRNA supervision requirements to improve access to healthcare in rural communities and will continue to keep our readers updated on any new developments.

Accountable Care Organization Rules Now Available

The U.S. Department of Health and Human Services (HHS) today released proposed new rules for Accountable Care Organizations (ACOs). According to the HHS press release, ACOs create incentives for health care providers—including doctors, hospitals, and other providers—to work together to treat an individual patient across care settings such as doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower health care costs while meeting performance standards on quality of care and putting patients first.  Patient and provider participation in an ACO is purely voluntary. Read the full rules and get more information. 

CRHC will be working closely with our national partners including the National Rural Health Association and the National Organization of State Offices of Rural Health regarding the implications for rural providers and communities and on public comment. We will keep you informed with information, analysis, and opportunities to weigh in as they become available.

National Quality Strategy Released

The U.S. Department of Health and Human Services (HHS) released the National Strategy for Quality Improvement in Health Care. The strategy is the first effort to create national aims and priorities to guide local, state, and national efforts to improve the quality of health care in the United States. This report describes the initial Strategy and plan for implementation. The Strategy pursues three broad aims: better care, healthy people/healthy communities, and affordable care. Read more. 

Check Out County Health Rankings

The University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation have published online a new set of reports that compare health factors and health outcomes in counties within each state. The rankings use data from vital statistics and government health surveys. Visit the website to learn more and check out information on your county. 

Colorado's Budget Negotiations

Check out an article published today in The Pueblo Chieftain about Colorado’s ongoing budget negotiations. 

Editorial on the ACA and Rural America

Today's Denver Post features an editorial titled "A health care law for rural America" by U.S. Health and Human Services Secretary Kathleen Sebelius and Agriculture Secretary Tom Vilsack about provisions of the Affordable Care Act that assist rural communities.

FY 11-12 Primary Care Fund Update

As reported in earlier posts, the Joint Budget Committee was considering significant cuts to Primary Care Funds, including eliminating the Special Distribution Fund that assisted 16 community-funded safety net clinics and rural health clinics. CRHC, ClinicNET, and many affected clinics worked diligently in recent days to educate JBC members about Colorado's diverse healthcare safety net and the need to support these clinics. Earlier this week, the JBC voted to restore funding for the Special Distribution Fund by $1.7 million and add additional monies to the Health Care Services Fund (for community health centers and other indigent care clinics) for a total of $21.5 million in federal and state funds. While these amounts still represent cuts, the funds provide some relief for these clinics. Please contact Sara for more information and we will post additional updates as the FY11-12 budget negotiations unfold.

Health Insurance Exchange Bill Introduced

On Monday, March 21, Colorado Senator Betty Boyd (D-Lakewood) and Representative Amy Stephens (R-Colorado Springs) introduced the Colorado Health Benefit Exchange Act, SB 11-200. The bill establishes the governing structure of the nonprofit public health insurance exchange, or marketplace where individuals and small businesses can shop for and purchase health insurance. The bill also creates a governing board and a legislative oversight committee. The board will consist of 9 voting members and 3 non-voting ex-officio members, with all voting members needing to have expertise in one of several specified skill sets (including healthcare delivery). Appointments shall be coordinated to provide broad geographic representation. Click here to read the bill.

CRHC is currently reviewing the bill and has not yet taken an official position. We will post additional information to the bill tracker and please contact Alicia Haywood at ah@coruralhealth.org for more information or with any questions. 

The Forum 2011: Essential Perspectives for Safety Net Providers, April 20-21

The Forum is a two-day conference that will bring together participants from across Colorado and surrounding states. Presented by CRHC and ClinicNET, The Forum is an essential educational, training, and networking event for all safety net clinics, members of the clinical team, and other interested parties. Scheduled agenda topics include federal and state policy updates, patient centered medical homes, a funders panel, and Colorado’s health insurance exchange. Opportunities for sponsorships are now available. Learn more about The Forum and register online. 

March Revenue Forecast

The Governor’s Office of State Planning and Budgeting (OSPB) and Legislative Council presented their March 2011 revenue forecasts to the Joint Budget Committee (JBC) this afternoon. The findings indicate higher than expected tax revenues and, combined with budget cuts already approved, the projected budget shortfall for FY11-12 has been revised from $1.0 billion to $450 million. Modest economic growth is expected for the near future, requiring the state to still make difficult budget cuts.  Read the OSBP and the Legislative Council reports for more information.

CRHC’s Role in NRHA’s Rural Health Congress

National healthcare issues directly impact rural providers and communities. Several CRHC staff currently serve on the National Rural Health Association’s (NRHA) Rural Health Congress and constituency groups and are committed to advocating on behalf of the interests of rural healthcare providers in Colorado and nationally to ensure NRHA policy positions are strategically designed to promote providing high quality healthcare services to rural areas.

CRHC has a long-standing, 20 year history as an organization with active membership in NRHA. CRHC founder and former Executive Director, Denise Denton, served as NRHA President in 1993. CRHC staff have held leadership roles in NRHA’s Constituency Groups (CG) which ultimately advise the Rural Health Congress in taking positions on key advocacy and policy positions for rural healthcare. Lou Ann Wilroy, CRHC CEO, has served for ten years on the Frontier Constituency Group, addressing healthcare issues in the nation’s most sparsely populated communities.  Michelle Mills, CRHC’s Program Director for Critical Access Hospitals and Rural Health Clinics, has been a member of the Rural Health Clinics Constituency Group since late 2010. Michelle is also the RHC CG representative on the Rural Health Congress. Cari Fouts, Communication & Development Director for CRHC, is a member of the State Association Council CG for NRHA and was appointed a position on the Rural Health Congress in January 2011 to represent the needs of all rural communities and state rural health associations across the nation.

Specific topics that are being addressed by the Rural Health Congress this year include:

• Health reform implementation
• Accountable Care Organizations
• Medicaid Payments
• CAH, RHC, Frontier Stay Extended Stay Clinics– discussion of potential development of new certification and payment methods (spearheaded by Tom Henton, CEO of Conejos County Hospital in Colorado; also a member of the Congress)
• Primary Care Shortages
• Rural General Surgeon Shortages
• EMTALA & Telehealth
• Mental Health in Rural America (expand to include substance abuse)
• Deleterious Impacts on Rural Multiracial & Multicultural Populations due to decrease in Welfare Programs
• Network Neutrality
• Broadband – Rural Access
• Tobacco Use in Rural America

As the Rural Health Congress moves forward in adopting positions, CRHC will seek input from our members to ensure the policy briefs meet the needs of our constituents. CRHC’s Policy & Legislative Council (PLC) guides and informs CRHC’s state and federal policy activities. If you would like more information about the PLC or are interested in participating, please contact Sara Schmitt at ss@coruralheatlh.org. If you have any questions about the Rural Health Congress, please contact Michelle Mills, mm@coruralhealth.org, or Cari Fouts, cf@coruralhealth.org. Learn more about NRHA’s Rural Health Congress.

CRHC, CCMU and ClinicNET – In Search of Health Stories to Create a Shared Statewide Vision

Got a health story to tell? The Colorado Rural Health Center, Colorado Coalition for the Medically Underserved, and ClinicNET are ready to hear it.

CRHC, CCMU, and ClinicNET will hit the road in April in search of Colorado health stories. “The purpose of Colorado HealthStory is to create an appreciation of our shared experiences of health, one conversation at a time,” said Alicia Haywood, policy analyst with the Colorado Rural Health Center. “We invite Coloradans to tell their own health stories to begin a dialogue about access to health in our communities.”

The three-year project was made possible through funding from The Colorado Trust and the Colorado Health Foundation. Over the next three years, Colorado HealthStory collaborators will engage existing and new partners to identify 250 storytellers and capture their stories. Personal health stories will be audio recorded with a family member, a friend, a care provider, a mentor or HealthStory collaborator. Each storyteller will be provided a CD of their story recording, and a second copy will be retained in the Colorado HealthStory archive.

Stories will be available on the Colorado HealthStory Web site, blog and other social media outlets, and news and media outlets will receive periodic project updates. In addition, once a body of stories is collected from each participating community, Colorado HealthStory will convene community forums known as “listening sessions.” Using information gathered from collected stories, listening sessions and local health data, the HealthStory team will create “community health profiles” for each participating community.

“Sharing your own health story is a great way to start, but there are lots of other ways you can help your family, friends and neighbors share their story,” Haywood said. “You can host a ‘HealthStory Day’ at your organization, co-author an op-ed in your local newspaper that encourages others to share their stories or link to the Colorado HealthStory site, (coloradohealthstory.org, but not yet launched) from your Web site.”
 

For more information on Colorado HealthStory, contact Alicia Haywood of the Colorado Rural Health Center at ah@coruralhealth.org or by calling 720.248.2748.

Implementation Brief: Primary Care Physician Workforce

Federal health reform legislation contains dozens of provisions related to health care workforce issues, including strengthening primary care, national workforce policy development, and increasing the supply of health care workers. A new Implementation Brief from George Washington University and Robert Wood Johnson Foundation focuses on those provisions that specifically target the strengthening of the primary care physician workforce.

2010 Colorado Health Report Card

The Colorado Health Foundation released its 2010 Colorado Health Report Card. The report card includes detailed information about 38 health indicators to provide a comprehensive picture of the health of Colorado's residents. The state's overall health grades have not improved significantly since the first report card in 2006. The only grade that improved from 2009 was "healthy aging", which moved from a B+ to an A- this year. Read more.

Updated CRHC Bill Tracker

Bill tracker is updated through March 9, 2011.

JBC Makes 2011-2012 Budget Recommendations for HCPF

Yesterday the Joint Budget Committee (JBC) conducted “figure setting” for Health Care Policy & Finance, setting budget numbers for many healthcare programs that will go into the FY 2011-2012 Long Bill, or the state’s budget. The state has an estimated $1 billion deficit for 2011-2012 and deep cuts are being made in many government services and programs. The JBC recommended several Medicaid program reductions, including a 0.75% medical provider rate cut and reduced oral health benefits, but did not recommend a provider payment delay at this time. Additional cuts included $19.2 million in Amendment 35/Primary Care Funds and reduced payments to family medicine residency programs. The JBC’s actions do not represent the final budget, as House and Senate members need to approve the Long Bill. However, further cuts may be needed if the March revenue forecast (due out later this month) is dismal. If you would like more information or have questions or concerns, please contact Sara Schmitt at ss@coruralhealth.org or 303.468.3498. 

Issue Brief: Insurance Coverage and Access to Care in Primary Care Shortage Areas

An issue brief by the Kaiser Family Foundation examines insurance coverage and access to care among the nonelderly who live in geographical primary care health professional shortage areas (HPSA). The analysis found that when compared with those who live outside geographical HPSAs, these individuals were more likely to be uninsured or be covered by government insurance and to have a chronic condition. The authors discuss the need to address healthcare workforce shortages to meet both current and future demand for services in these areas and suggest several policy options to consider. The brief is a concise summary of many issues familiar to The Rural Voice readers and rural communities. Download the report. 

Participate in Creating Colorado's Economic Development Strategy

Colorado’s “bottom up” economic development planning continues, with several meetings scheduled throughout the state in the coming days. CLICK HERE to find the meeting in your region. Please consider attending and serving as a voice for healthcare in this discussions. 

Attend the Rural Economic Development Summit in Greeley on March 14. Click here for the schedule and more information.

Please attend these events and underscore the importance of healthcare as a rural economic driver.  Consider these facts: 

• Many healthcare providers are self-employed entrepreneurs; 
• Assuming the same ratio of providers to overall population, Colorado will add 5,000 new healthcare jobs per year for the foreseeable future; 
• On average, one in eight Colorado jobs is in the healthcare sector. In rural counties, the average is closer to one in six jobs; 
• Taking into account multiplier effects, each healthcare job supports about two additional jobs. 

·         As a powerful economic engine across Colorado, healthcare must be at the table during economic development talks. For more information, contact Clint Cresawn at 720.248.2745 or 800.851.6782, ext. 255, or by email at ccr@coruralhealth.org. 

CRHC Updated Bill Tracker

Bill tracker is updated through March 3, 2011.

State Budget Primer

As Colorado works to balance its current budget and plan for the upcoming year, a resource from The Colorado Fiscal Policy Institute provides helpful information and background. The Colorado Budget Primer is a detailed explanation of how the state’s budget is formed, the major players in the process, terms for understanding the state budget, and state and federal limits on revenue and spending.

Define Rural Before You Budget for It

How many times have you been asked to define rural? Timothy Collins, assistant director of the Illinois Institute for Rural Affairs, was asked to address this issue before the U.S. House Agriculture Subcommittee on Rural Development, Biotechnology, and Foreign Agriculture last month. A quick answer for Collins, and for many of us in a pinch, typically is ‘you know rural when you see it’ but he suggests that “this approach doesn’t fly when it comes to policy implementation and the distribution of billions of dollars for rural development projects.” Read his post in Daily Yonder. 

2010 Colorado Health Insurance Report Available

The 2010 Colorado Health Insurance Report contains information about the cost of health insurance and the factors that drive the cost of health insurance premiums on an individual and group basis in the state. Released by the Division of Insurance annually, the report includes financial information on health carriers and how Colorado’s health coverage and options compare nationally. Read the report. 

Congress and the Affordable Care Act

A new Health Policy Brief from Health Affairs and Robert Wood Johnson Foundation looks at the current congressional fight over derailing implementation of the Affordable Care Act.

CRHC's Bill Tracker

The bill tracker is updated through February 25. Enjoy!

Impact of Health Reform on Colorado’s Economy

A new Colorado Trust issue brief titled “The Future of Colorado Health Care: An Economic Analysis of Health Care Reform and the Impact on Colorado’s Economy” sheds light on what the budgetary impacts of federal healthcare reform may be on Colorado families, businesses, and the state. The findings of the study project lower growth in healthcare costs and increases in economic activity and jobs due to national health reform efforts. Read more. 

Participate in Local Economic Development Survey

Make sure healthcare has a voice while participating in an innovative approach to economic development planning! Colorado is undergoing a new “bottom-up” approach to economic development planning by involving people at the local level. Check out the brief survey associated with this effort and make sure healthcare is heard! Your participation in the survey will add local voices to this process that will help chart our state’s direction as we move forward. Consider these facts:

• Assuming the same ratio of providers to overall population, Colorado will add 5,000 new healthcare jobs per year for the foreseeable future
• On average, one in eight Colorado jobs is in the healthcare sector. In rural counties, the average is closer to one in six jobs
• Taking into account multiplier effects, each healthcare job supports about two additional jobs
• Many healthcare providers are self-employed entrepreneurs

As a powerful economic engine across Colorado, healthcare must be at the table during economic development talks. For more information, contact Clint Cresawn at 720.248.2745 or 800.851.6782 ext. 255 or by email at ccr@coruralhealth.org. 

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.