The National Advisory Committee
on Rural Health and Human Services
U.S. Department of Health and Human Services
Office of Rural Health Policy
National
Advisory Committee WASHINGTON,
D.C. Meeting
Summary The 46th meeting of the National
Advisory Committee Sunday, February 22 Other members present were:
Mr. James R. Agras; Mr. David L. Berk; Governor Beasley asked if
there were any changes to the minutes of the previous meeting. There were
none and the minutes were approved. He then asked for comments on the
annual report to the Secretary. Ms. Sally Richardson praised the report
and asked that West Virginia be cited as one of the states providing mental
health training to primary care physicians. Staff will make this change.
Senator Rawson asked for clarification of some oral health data in the
report. Mr. Morris will review the data and make any changes that are
necessary. The Committee voted to adopt the report. STAFF UPDATES Mr. Dudley presented a review
and update of programs at the Administration on Aging. He described the
AoA partnerships with State Units on Aging and the designated Area Agencies
on Aging located throughout the country. AoA programs are closely coordinated
through these agencies. He briefly described programs authorized by the
Older Americans Act of 1965. They encompass transportation, services for
low-income minority elders, health promotion, caregiver support, and others.
Mr. Dudley highlighted the Assistant Secretary's priorities in health
and the National Eldercare Locator system that helps seniors find services
in their communities. He spoke about programs to help older people to
remain at home and provided information on the National Family Caregiver
Support Program. Ms. Owen distributed an organization
chart for the ACF and spoke about focus groups that have been conducted
with rural grantees. A report on the focus groups will be available in
a few months. Ms. Owen stated that the Assistant Secretary for ACF would
be speaking later in the day and would provide more details on ACF activities. CROSS SECTOR POLICY: A
RURAL OPPORTUNITY Mr. Fluharty spoke about the
unique mission of the Advisory Committee and how it is well placed to
be a voice on rural health and human services issues. The Committee's
work establishes linkage between rural health and human services with
emphasis on community-based and cross-sectional approaches. COMMITTEE DISCUSION Mr. Size commented on the
difficulty of differentiating and coordinating health and human services
issues. He spoke about bureaucratic impediments to collaboration. Mr. Otis used the example
of teenage pregnancy as a crosscutting issue and commented that community
development must precede economic development in rural areas. Ms. Richardson commented that
separate funding streams for health and human service programs make coordination
and collaboration very difficult. Mr. Gallegos talked about
building and maintaining infrastructure in rural communities. Dr. Mueller stated the need
to address structural problems in rural health programs and suggested
the possibility of community impact statements tied to Federal funds.
He called for more flexibility in programs. Dr. Brand mentioned the greater
flexibility now available in Federal block grants to the states. Mr. Otis talked about the
reluctance of health care leaders to engage in community development activities.
Ms. Freeman-Watson stated
that Federal guidelines for rural programs need to be reviewed with the
aim of affording greater flexibility. Mr. Size expressed hope that
the Committee would choose a children/family issue to pursue this year.
Monday, February 23 2005 REPORT PLANNING Mr. Size suggested that the
Committee focus on the new Medicare Modernization Act. Mr. Morris responded
that the bill includes hundreds of provisions and there are many issues
that could be addressed. Dr. Edwards and Dr. Glenn
suggested that the Committee include health care quality issues in its
agenda. Dr. Mueller and others advocated
issues regarding the availability and use of health information technologies
in rural areas. Mr. Otis, Dr. Kaye, Ms. Freeman-Watson
and others talked about community development and collaboration issues. RURAL HUMAN SERVICES PRIORITIES
OF THE DEPARTMENT Mr. Dillard described a transportation
program for children in Alabama that involved the private sector. Governor
Beasley had seen the system first-hand and attested to its success. Mr. Nelson described contract
issues that prohibit for-profit organizations from working with non-for-profit
groups in rural communities. He further stated that schools were the most
likely places to reach rural children. Dr. Horn acknowledged the importance
of this issue, but also mentioned that in the human services area non-profit
groups are not always active in rural places. He agreed on the need to
connect children with human services agencies and mentioned an Agency
program that mentors young people to work with Head Start children. Mr. Agras described programs
in Pennsylvania to help young people develop employment skills and cited
examples of governmental regulations that get in the way of such programs. Dr Horn closed by thanking
the Committee for its work and emphasizing the need for a holistic approach
to health and human services in rural areas. RURAL HEALTH SERVICE PRIORITIES
OF THE DEPARTMENT Dr. Enright asked if the expansion
of the National Health Service Corp would involve increases in mental
health provides. Dr. Duke responded that there would be an increase and
promised to furnish additional information to the Committee. Mr. Nelson asked if there
were any studies on retention of J-1 Visa providers. Dr. Duke said that
no studies have been conducted to date, but that HRSA's involvement with
the program was just underway and studies of retention might be appropriate
in the future. Mr. Dillard voiced concern
about the disruption that occurs when J-1 Visa providers and National
Health Service Corp provides leave a community. Dr. Duke replied that
Corp retention is over 55% and that the methodology to derive that data
may be applicable to the J-1 Visa retention issue. Mr. Otis asked about the effects
of Community Health Center expansion in communities. Dr. Duke said that
expansion has fostered community needs assessments, encouraged networking
among health care providers, and strengthened community participation
in health care. Dr. Montgomery asked about
HRSA's role in the J-1 Visa Program. Dr, Duke explained that HRSA matches
providers with communities that need them. Mr. Size asked about the potential
for collaboration between Community Health Centers and hospitals given
issues related to the composition of their respective boards. Dr. Duke
spoke about a study now underway to examine this issue. It will examine
ways to improve access to primary care in underserved communities with
a Critical Access Hospital. It will identify and promote models that improve
collaboration between two of HRSA's major safety-net programs, Critical
Access Hospitals and the Federally Qualified Health Centers. Five sites
in five different states will be studied. The study should be completed
by the end of the summer. OVERVIEW OF THE MEDICARE
PRESCRIPTION DRUG BILL Dr. Steele mentioned the challenge
of building an infrastructure for information technology in rural areas.
He said that the biggest barrier was not money, but the lack of technical
assistance for providers. Ms. Bell suggested that broad band could be
a useful tool in areas where it is available. Mr. Nelson said that the cap
on payments to Rural Health Clinics remains an important issue. The speaker
agreed that it must be addressed. Dr. Kaye offered that information
dissemination is a big issue in rural areas. Ms. Bell agreed that this
would be a challenge and that providers may be a source of information.
Mr. Dillard asked if there
would be attempts to dismantle the bill or reduce its impact. Ms. Bell
replied that legislation to change the bill has already been introduced,
but the current focus is on implementation. EMERGING HEALTH CARE ISSUES COMMITTEE DISCUSSION Dr. Steele reiterated his
support for the topic of information technology. Governor Beasley suggested
that the widespread and growing problem of obesity would be a timely and
important topic. Dr. Mueller stated that malpractice
expenses might create a crisis for OG/GYN services throughout the country.
Mr. Morris added that the issue has major implications for access to care
in rural areas and data is available. Several members talked about
workforce issues and managed care. Dr. Mueller and Dr. Rawson
spoke to the issue of uninsured populations. Mr. Size talked about the
need for leadership development in rural communities. PANEL DISCUSSION: EMERGING
ISSUES Mr. Morgan also mentioned
workforce shortages as a major issue. Malpractice insurance is also a
big issue and is closely linked with workforce shortages. He also cited
problems of the uninsured and the need for rural providers to gain greater
access to information technologies. Ms. Markwood spoke about the
need for home and community-based services in rural areas and the problems
faced by caregivers in the home. Problems related to stress, hypertension
and burnout are significant human services issues for caregivers in rural
areas. The need for health promotion and prevention programs is a major
issue for rural communities. Ms. Markwood also raised the issue of physicians
who are not trained in geriatrics. 2005 WORKPLAN: COMMITTEE
DISCUSION The Committee members proposed
a wide range of topics for the 2005 report. After lengthy discussion,
the Committee voted to select the following four topics: (1) Options for
improving health and human service program collaboration in rural communities;
(2) Rural technical assistance to needy families (TANF); (3) Obesity in
rural communities: impact on families; and (4) Access to obstetrical care
in rural communities. Governor Beasley appointed
chairpersons and members of the four subcommittees that will handle these
issues. He reiterated that all members would have opportunities to be
involved with each issue. Tuesday, February 24 Governor Beasley convened
the meeting and requested comments on the letter to the Secretary. The
letter will summarize the meeting and thank the Secretary for the presentations
by Departmental officials. There were no comments on the letter. The Governor distributed information
on subcommittee assignments and restated the process for preparing the
2005 report. Mr. Morris announces that
staff would gather information for the subcommittees and schedule conference
calls. The goal is to have a working document for the June meeting and
a rough draft for the meeting in September. Governor Beasley asked Dr.
Mueller about the June meeting in Nebraska City. Dr. Mueller will arrange
site visits for the Committee that will inform its work on the four new
topics. The meeting will be held at the Arbor Lodge and members should
plan to arrive Saturday night. The four subcommittees met
separately to discuss their respective topics for the 2005 report. There were no public comments
and the meeting was adjourned.
on Rural Health and Human Services
February 22-24, 2004
on Rural Health and Human Services was held on February
22-24 at the Grand Hyatt Hotel in Washington, D.C.
Mr. Evan S. Dillard, FACHE; Joellen Edwards, Ph.D., NP; Michael Enright,
Ph.D.; Ms Bessie Freeman-Watson; Mr. Joseph D. Gallegos; Lenard Kaye,
D.S.W.; Arlene Jaine Jackson Montgomery, Ph.D.; Keith Mueller, Ph.D.;
Ron L. Nelson, P.A.; Sister Janice Otis; The Honorable Larry Keith Otis;
Ms. Sally K. Richardson; Glenn D. Steele, M.D., Ph.D.; and Mr. Tim Size.
The two members unable to attend were Stephanie Bailey, M.D., MSHSA, and
Susan Birch, RN, BSN, MBA. Present from the Office of Rural Health Policy
were: Marcia Brand, Ph.D.; Tom Morris, MPA; Ms. Michele Pray Gibson, MHS;
and Jennifer Riggle, J.D. Present from the Administration on Aging was
Mr. Dennis Dudley. Present from the Administration for Children and Families
was Ms. Rachel Owen.
Ms. Jennifer Riggle, Office of Rural Health Policy (ORHP)
Mr. Dennis Dudley, Administration on Aging (AoA)
Ms. Rachel Owen, Administration for Children and Families (ACF)
Mr. Chuck Fluharty, Director, Rural Health Policy Research Institute
Wade Horn, Ph.D., Assistant Secretary for Children and Families, Department
of Health and Human Services.
Dr. Betty James Duke, Administrator, Health Resources and Services Administration
(HRSA)
Ms. Jennifer Bell, Senate Finance Committee Majority Staff
Dr. Marcia Brand, Director, Office of Rural Health Policy
Mr. Gary Cyphers, Director of Member Services, American Public Human Services
Association
Mr. Alan Morgan, Vice President, National Rural Health Association
Ms. Sandy Markwood, Executive Director, National Association of Area Agencies
on Aging
Governor Beasley called for public comments. There were no comments and
the meeting was adjourned for the day.