NEBRASKA RURAL HEALTH ASSOCIATION
ORHP Grant Deadline Approaching

The federal Office of Rural Health Policy (ORHP) has released the application guidance for the Rural Health Outreach Services grant program. Applications are due Oct. 16. These grants received a $10 million increase in their funding line in 2008.

The outreach grants are demonstration projects to test out good ideas to improve access to health care services in rural communities. ORHP is hoping to make as many as 90 awards by March. Awardees will receive up to $375,000 over the three years of the grant ($150,000 in year one, $125,000 in year two and $100,000 in year three). 

The announcement number is HRSA-09-002.  Click here for the synopsis and application process. Important tips:

•Applicants must be registered in Grants.gov to apply. Applicants must be in a rural area to apply (check ORHP's web site to determine if you eligible.)

•Grants need to be community-driven and reflect a broad consortium of at least two independent entities rather than one single entity in charge.

•The lead applicant needs to be a not-for-profit entity. Health care is fairly broadly defined so this can be used for what some might consider human services.
This program will not be competed again until 2012 (next year's primary emphasis will be the Small Health Care Provider Quality Improvement Program).





Nebraska Rural Health Association 
October 2008

In This Issue :


•   FEATURED MEMBER

•    FEDERAL UPDATE 

•   APPROPRIATIONS UPDATE

•    PHYSICIAN FEE SCHEDULE

•   FUNDING OPPORTUNITY

•   CAM SERVICES INCREASED
 

 





Why did you join the Association?

To have the support and connections that are always so helpful and necessary in our positions.  The growth and development of the association over the years is so evident in the actions and accomplishments.   Each of us working in rural health should be a member of a group that can have such an aggressive plan.

List one goal that you would like to see NeRHA accomplish.

I'm so happy to see the clinic constituency starting and anxious to see how beneficial it can be to the rural health clinic members.  Through managing the rural health clinics for our facility it was such a challenge to find resources.  I want this group to feel like they have a unified voice and a collaborative effort among the membership.  


What do you feel is the biggest rural health issue Nebraskans face today?

Workforce is becoming such a big challenge.  We have seen this through our physician recruitment efforts recently and as this problem grows we are going to see it in so many positions that we recruit. 


What would you like other members of the Nebraska Rural Health Association to know about you? 

That it has and continues to be a pleasure to be a part of this group. 

Briefly describe your past and current responsibilities/activities relating to rural health.

I have worked for Community Hospital in McCook since 2002, managing the clinics when I first joined the facility and now through more departments.   Growing up in rural Nebraska and working for a clinic while I was in high school rural healthcare has always been where I have wanted to work.
FEATURED MEMBER

Karen Kliment
FEDERAL UPDATE 

Rural Health Clinic Victory!
Language to correct a technical issue impacting most Rural Health Clinics (RHCs) has been included in the Health Care Safety Net Act (S 901).

The bill passed in the Senate by unanimous consent and is expected to pass the House.  Language in this bill addresses a discrepancy in the timeline for de-certification review in the Centers for Medicare and Medicaid Services' ( CMS) proposed RHC and Federally Qualified Health Center (FQHC) rule. This important legislative victory will make a small technical correction that will benefit hundreds of RHCs, protecting access to health care in the most underserved rural communities.


However, we still need your help. Even with the legislative fix, CMS' proposed rule still threatens to close the doors of many RHCs. The new rule would change the conditions of participation for RHCs with the following changes:

Create an exception process that will allow RHCs that do not meet the requirements that they are located in a currently designated rural shortage area to apply for an exception through additional criteria. 

Payment methodology for RHCs and federally qualified health centers (FQHCs) under the  Medicare system, which had been in place unchanged for the last three decades. This change  will cut payments to RHCs and FQHCs that have costs higher than Medicare per-visit payment limits and for provider-based RHCs that have costs above Medicare reasonable costs.

Improved staffing requirements by allowing a non-physician provider to be contracted and strengthened quality improvement activities.

APPROPRIATIONS UPDATE
On Sept. 27, the Senate passed the Continuing Resolution (CR), H.R. 2638 by a vote of 78-12. The House had previously passed the CR by a vote of 370-58 and the president is expected to sign the bill. The bill includes full FY 2009 appropriations for military construction and the departments of Defense, Veterans Affairs and Homeland Security. The rest of the government will be funded at FY 2008 levels through March 6.



The next Congress and administration will have to finish the remaining nine FY 2009 appropriations bills, including the Labor, Health and Human Services and Education appropriations bill. This is what the NeRHA expected, and we will be working to ensure rural America is not forgotten when the new Congress crafts the appropriations bills in March.
PHYSICIAN FEE SCHEDULE

Study of alternative payment localities under the Medicare physician fee schedule available, comments due Oct. 20
Medicare is statutorily required to adjust payments for physician fee schedule services to account for differences in costs due to geographic location. There are currently 89 different localities which have not been revised since 1997. The CY 2009 Physician Fee Schedule notice of proposed rulemaking, which was released on June 30, indicated the CMS web site would include a preliminary study of several options for revising the payment localities. The report, "Review of Alternative GPCI Payment Locality Structures," was produced by Acumen LLC under contract to CMS and is available here.



The study of possible alternative payment locality configurations is in the early stages of development. At this time CMS is not proposing to make any changes to the payment localities.  CMS encourages interested parties to submit comments on the options presented in the report as well as suggestions for other options. These comments will be considered in the development of possible future notice and comment rulemaking. When CMS is ready to propose any changes to the locality configuration, they will provide extensive opportunities for public comment (for example, a town hall meeting or open door forum) on specific proposals before implementing any change.


Electronic comments on the interim report may be submitted to CMS_MPFS@cms.hhs.govuntil Oct. 20.

FUNDING OPPORTUNITY
CAM SERVICES INCREASED
Hospitals across the nation are responding to patient demand and integrating complementary and alternative medicine (CAM) services with the conventional services they normally provide, according to the results of a new survey released today by Health Forum, a subsidiary of the American Hospital Association (AHA).  

The survey shows that more than 37 percent of responding hospitals indicated they offer one or more CAM therapies, up from 26.5 percent in 2005.  Additionally, hospitals in the southern Atlantic states led the nation in offering CAM services to the patients they serve, followed by east north central states and those in the middle Atlantic.   CAM is not based solely on traditional western allopathic medical teachings, and can include acupuncture, chiropractic, homeopathy, diet and lifestyle changes, herbal medicine, massage therapy and more. CAM services also reflect hospitals' desire to treat the whole person-body, mind and spirit.



"Complementary and alternative medicine has shown great promise in supporting and stimulating healing," said AHA President and CEO Rich Umbdenstock.  "It's one of the many tools hospitals look to as they continue to create optimal healing environments for the patients they serve."
According to the survey, 84 percent of hospitals indicated patient demand as the primary rationale in offering CAM services and 67 percent of survey respondents stated clinical effectiveness as their top reason.  


"Today's patients have better acces s to health information and are demanding more personalized care," said study author Sita Ananth.  "The survey results reinforce the fact that patients want the best that both traditional and alternative medicine can offer."


Other survey results include:
Massage therapy is in the top two services provided in both outpatient and inpatient settings; The majority of hospitals that offered CAM were urban hospitals (72 percent) and were medium-sized (100-299 beds); and Most CAM services are not reimbursable by insurance and are paid for out-of-pocket by patients. The third biannual survey was mailed in November 2007 to 6,439 U.S. hospitals.  The report is available online at www.healthforumonlinestore.com (click on the Data Products tab in the right upper corner) or by calling 800-242-2626.