Table of Contents
Vision, Mission and Strategic
Goals
ORHP Overview
Financial Data
Policy Activities
REGULATIONS AND KEY POLICY ISSUES
SPECIAL PROJECTS AND PARTNERSHIPS:
Provider-Focused Technical
Assistance
Health Information Technology
Healthcare Workforce
Rural Health Policy
Best Practices & Emerging
Issues in Rural Health
Women's Health Issues
Frontier Health
Collaboration with the
National Rural Health Association (NRHA)
Border Health
Grant Programs
Medicare Rural Hospital
Flexibility Grant Program (Flex)
Small Rural Hospital Improvement
Grant Program (SHIP)
Rural Health Outreach
Grant Program
Delta States Rural Development
Network Grant Program
Network Development Grant Program
Network Development Planning
Grant Program
State Offices of Rural Health
Grant Program
Rural Access to Emergency
Devices (Rural AED)
Public Access to Defibrillation
(PADDP) Demonstration Projects
Rural Health Research Centers
Rural Emergency Medical Service
Training and Equipment Assistance Program
Federal Extended Stay Clinics
ORHP Staff
Vision,
Mission and Strategic Goals
ORHP Vision
ORHP's vision is to improve the health of Americans by providing
national leadership in increasing access to quality health care
in rural America.
Mission
The mission of the ORHP is to sustain and improve access to quality
health care services for rural communities. In addition, the office
coordinates access to quality health care activities along the U.S.-Mexico
border.
Goals
In order to measure its accomplishments, the office has established
the following three long-term goals:
Goal 1: Improve the health and
wellness of people living in rural communities and in the U.S.-Mexico
border region
Goal 2: Improve the financial
viability of small rural hospitals, rural health clinics, and other
rural providers
Goal 3: Sustain and improve access
to outpatient, inpatient, pharmaceutical and emergency room care
for rural communities and along the U.S.-Mexico border
ORHP Overview
The Office of Rural Health Policy (ORHP) coordinates
rural health policy issues within the U.S. Department of Health
and Human Services. In FY 2005, ORHP administered 13 grant programs
with a focus on capacity building at the community and State levels.
While located within the Health Resources and Services Administration,
the office has a department-wide responsibility to analyze the impact
of departmental policy on rural communities.
ORHP is both a policy and programmatic resource
for rural communities. The office's policy role is created by Section
711 of the Social Security Act, which charges the office with advising
the Secretary on rural health issues. In that role, the office examines
issues such as the effects of Medicare and Medicaid on rural citizens'
access to health care, specifically on the viability of rural hospitals
and the availability of rural physicians.
The office's programs also provide funding at
both the community and State levels to support improved rural health
care delivery. Through its community-based programs, the office
supports projects that improve access to health care services, encourage
network development among rural health care providers, enhance delivery
of emergency medical services and place and train people in the
use of automatic external defibrillators.
In addition, the office assumes responsibility
for managing HRSA's border health activities. Much of the 2,100-mile
U.S.-Mexico border is rural and the urban regions face health care
delivery challenges similar to rural areas, such as limited health
workforce capacity and a fragile infrastructure.
Authorizing Legislation for
ORHP Activities:
Rural Access to Emergency Devices Grant Program
Authorization: P.L. 106-505, Title IV - Cardiac Arrest Survivial
Act, Subtitle B, section 413 of the Public Health Improvement Act
42 U.S.C. 254c.
Public Access to Defibrillation Demonstration
Projects
Authorization: Section 313 of the Public Heatlh Service Act 42 U.S.C.
245 as amended by section 159(c), P.L. 107-188 of the Public Heath
Security and Bioterrorism Preparedness and Response Act of 2002.
Rural EMS Training and Equipment Assistance
Program
Authorization: Section 330J of the Public Health Service Act 42
U.S.C. 254b as amended by section 221, P.L. 107-251 of the Heatlh
Care Safety Net Amendments of 2002.
Rural Health Research Centers Program
Authorization: Section 711 of the Social Security Act 42 U.S.C.
912 and Section 301 of the Public Health Service Act 42 U.S.C. 241
as amended by section 432, P.L. 108-173 of the Medicare Prescription
Drug, Improvement and Modernization Act of 2003.
Policy Oriented Rural Health Services Research
Program
Authorization: Section 711 of the Social Secutiry Act 42 U.S.C.
912 and Section 301 of the Public Health Service Act 42 U.S.C. 241
as amended by section 432, P.L. 108-173 of the Medicare Prescriptioni
Drug, Improvement and Modernization Act of 2003.
Frontier Extended Stay Clinics Demonstration
Authorization: Section 301 and 330A of the Public Health Service
Act 42 U.S.C. 241 and 254c.
Medicare Rural Hospital Flexibility Grant Program
Authorization: Section 1820(j) of the Social Security Act 42 U.S.C.
1395 as amended by section 4201(a), P.L. 105-33 of the Balanced
Budget Act and section 405(f), P.L. 108-173 of the Medicare Prescription
Drug, Improvement and Modernization Act of 2003.
Small Rural Hospital Improvement Grant Program
Authorization: Section 1820(g)(3) of the Social Security Act 42
U.S.C. as amended by section 4201(a), P.L. 105-33 of the Balanced
Budget Act and section 405(f), P.L. 108-173 of the Medicare Prescription
Drug, Improvement and Modernization Act of 2003.
Rural Health Outreach Grant Program
Authorization: Section 330A of the Public Health Service Act 42
U.S.C. 254c as amended by section 201, P.L. 107-251 of the Health
Care Safety Amendments of 2002.
Delta States Rural Development Network Grant
Program
Authorization: Section 330A of the Public Health Service Act 42
U.S.C. 254c as amended by section 201, P.L. 107-251 of the Health
Care Safety Amendments of 2002.
Network Development Grant Program
Authorization: Section 330A of the Public Health Service Act 42
U.S.C. 254c as amended by section 201, P.L. 107-251 of the Health
Care Safety Net Amendments of 2002.
State Offices of Rural Health Grant Program
Authorization: Section 338J of the Public Health Service Act 42
U.S.C. 254r as amended by section 301, P.L. 105-392. The program
was first authorized in 1991 and awarded its first grants in 1992
Network Development Planning Grant Program
Authorization: Section 330A of the Public Health Service Act 42
U.S.C. 254c as amended by section 201, P.L. 107-251 of the Health
Care Safety Net Amendments of 2002.
Financial Data
Labor-Health
and Human Services-Education and Related Agencies
(Amounts in thousands)
Rural
Health Programs |
FY
2004 Final Appropriation |
FY
2004 Amount to Program |
FY
2005 Final Appropriation |
FY
2005 Amount to Program |
Rural
Outreach grants |
39,601 |
38,397 |
39,278 |
38,005 |
Rural
Health Research |
8,902 |
8,827 |
8,825 |
8,751 |
Rural
Hospital Flexibility Grants |
39,499 |
39,167 |
39,180 |
39,180 |
Rural
and Community Access
to Emergency Devices
|
10,933 |
10,841 |
8,927 |
8,852 |
Rural
EMS Training and Assistance Equipment Program |
497 |
482 |
496 |
480 |
State
Offices of Rural Health |
8,391 |
8,136 |
8,321 |
8,044 |
Denali
Commission |
34,793 |
34,793 |
39,680 |
39,680 |
Total,
Rural Health Programs |
142,616 |
140,643 |
144,707 |
142,992 |
Chart 1.
D
Chart 2 - Total number of ORHP grants and
amounts by State, in FY 2005.
State |
# Grants Awarded |
FY 2005 Funding |
AK |
7 |
$1,382,481 |
AL |
7 |
$1,869,934 |
AR |
8 |
$2,557,735 |
AZ |
6 |
$1,284,805 |
CA |
10 |
$2,254,120 |
CO |
8 |
$2,074,835 |
CT |
3 |
$449,238 |
DE |
3 |
$406,091 |
FL |
13 |
$2,671,343 |
GA |
13 |
$2,998,538 |
HI |
4 |
$734,060 |
IA |
13 |
$3,198,800 |
ID |
6 |
$1,408,119 |
IL |
11 |
$2,761,183 |
IN |
6 |
$1,466,719 |
KS |
5 |
$1,933,249 |
KY |
11 |
$2,710,553 |
LA |
11 |
$2,799,906 |
MA |
6 |
$692,051 |
MD |
7 |
$1,283,385 |
ME |
7 |
$1,864,798 |
MI |
16 |
$3,211,774 |
MN |
12 |
$3,398,934 |
MO |
11 |
$2,812,174 |
MS |
7 |
$2,552,848 |
MT |
9 |
$2,370,735 |
NC |
8 |
$2,316,071 |
ND |
8 |
$2,563,383 |
NE |
9 |
$2,946,884 |
NH |
6 |
$1,148,969 |
NJ |
2 |
$258,531 |
NM |
9 |
$1,629,220 |
NV |
7 |
$1,535,217 |
NY |
8 |
$1,544,933 |
OH |
4 |
$1,187,642 |
OK |
4 |
$1,544,766 |
OR |
7 |
$1,532,270 |
PA |
6 |
$1,069,843 |
RI |
1 |
$145,753 |
SC |
8 |
$1,773,599 |
SD |
7 |
$1,937,950 |
TN |
6 |
$1,745,615 |
TX |
7 |
$2,586,660 |
UT |
4 |
$792,804 |
VA |
11 |
$1,907,100 |
VT |
7 |
$1,182,235 |
WA |
10 |
$2,747,795 |
WI |
7 |
$1,929,478 |
WV |
6 |
$1,283,895 |
WY |
4 |
$816,023 |
Guam |
1 |
$72,842 |
Puerto Rico |
1 |
$9,340 |
Total |
378 |
$91,357,226 |
Policy Activities
Project Coordinator: Emily Cook
Rural Health Policy Analyst: Carrie Cochran
REGULATIONS AND KEY POLICY ISSUES:
In its policy role, the office focuses on issues related to access
to care for residents of rural areas. Because many of the policy
levers at the Federal level are related to the Medicare program,
Medicare policy review and analysis comprise much of the office's
policy work. However, significant time and attention are also devoted
to other policy areas including Medicaid, the State Children's Health
Insurance Program, workforce and quality.
The specific Medicare regulations that come through
ORHP for review vary somewhat from year to year, however the major
Medicare payment system regulations generally come through for review
during both the proposed rule-making and final rule-making cycles.
Recently, regulations relating the Medicare Advantage, Medicare
Drug Benefit and various quality reporting programs also have been
received in the office and reviewed for comment.
Medicaid and SCHIP are State-based programs and
much of the discretion for these programs is left to the States.
However, ORHP does participate in the departmental review of Medicaid
and SCHIP waiver proposals to assure that the interests of rural
Medicaid beneficiaries are considered. Our role in workforce policy
encompasses a wide variety of issues including Graduate Medical
Education, J1-Visa Waivers, the National Health Service Corps and
Title VII programs that provide support to rural providers. Quality
issues are relatively new to the office, as they are to Federal
programs in general, but review and input into quality measurement
and reporting programs has become a regular and important activity.
Key Policy Accomplishments
During Fiscal Year 2005, the policy staff in ORHP reviewed more
than 44 draft Federal regulations and policies to determine how
they might affect rural providers and the individuals they serve.
Of these regulations only six included provisions ORHP staff felt
had the potential to adversely affect rural providers or for which
staff felt additional language should be added to benefit rural
providers.
The creation of the Medicare Advantage Regional
Preferred Provider Organizations by the Medicare Modernization Act
(MMA) was intended to give a beneficiary living in a rural area
the advantage of having a choice of methods through which he or
she can receive Medicare benefits. As such, we felt it was important
to assure that the regulations for the new program allowed this
goal to be met. Through the comment process, we worked with the
Centers for Medicare and Medicaid Service (CMS) to revise some proposed
restrictions on "essential hospitals," assure that rural
providers without access to the Internet could receive important
documents from Medicare Advantage Plans, and revise language concerning
cost-based providers.
During the establishment of the Medicare Prescription
Drug Benefit, ORHP provided multiple comments to CMS regarding how
their proposed regulations might better account for the needs of
rural providers and beneficiaries. We were successful in obtaining
a change in the network access standards that allows for certain
closed-access pharmacies, including those operated by Rural Health
Clinics, to count toward meeting the required access standards in
areas that lack a sufficient number of open-access pharmacies.
ORHP often identifies issues of particular concern
to rural providers during its review of the Medicare payment system
regulations. We had many concerns about a proposal in the FY 2006
IPPS regulations to restrict the circumstances under which Critical
Access Hospitals (CAH) could relocate their facilities and retain
their CAH designation. We submitted multiple comments explaining
our concerns and the potential affects that the proposed policy
might have on rural communities. CMS ultimately revised the regulations
and we supported its final policy. During the FY 2006 IPPS regulations
process, we also worked closely with CMS to revise several definitions
of rural used for both CAHs and other rural hospitals. These revised
definitions will assure that hospitals in areas considered rural
under several different definitions will continue to be considered
rural for purposes of Medicare payment.
The CY 2006 Outpatient Prospective Payment System
(OPPS) regulations offered us the opportunity to provide assistance
to CMS in developing a payment add-on for certain rural hospitals.
We worked with CMS to review data and payment policies that ultimately
resulted in a payment add-on for a subset of rural hospitals that
were determined to have the most need.
SPECIAL PROJECTS AND PARTNERSHIPS:
One of the unique aspects of the Office of Rural
Health Policy is its entrepreneurial nature. Since its inception,
the office has put an emphasis on working with key partners and
organizations to develop projects to address long-standing rural
health problems. The office uses a portion of its funding in the
Policy/Research line to support these activities. The emphasis of
these special projects is either to highlight an issue or work with
key rural partners to develop services or resources that fill an
identified need.
Some of these "special projects" are
focused on the needs of all rural communities, such as the need
for general information on rural health. Others may focus only on
a specific issue such as the recruitment and retention of health
workforce or the role of economic development in health care. Still
other activities focus on a particular type of health care providers.
In each case, however, the projects and initiatives supported by
the office meet an identified rural health care need.
The Rural Assistance Center (RAC) is one
of the best examples of this investment. In its authorizing statute,
the office was charged by Congress with establishing and maintaining
"a clearinghouse for collecting and disseminating information
on rural health care issues, including rural mental health, rural
infant mortality prevention, rural occupational safety and preventive
health promotion, research findings relating to rural health care
and innovative approaches to the delivery of health care in rural
areas.1 The need for such a resource was further
heightened by the findings of "One Department Serving Rural
America," a report by the Rural Task Force of the U.S. Department
of Health and Human Services to the Secretary.2
This report identified the need for a single coordinated point of
contact on rural issues for all the HHS programs that affect rural
communities. The RAC was established in December 2002 as a rural
health and human services "information portal." RAC helps
rural communities and other rural stakeholders access the full range
of available programs, funding and research that can enable them
to provide quality health and human services to rural residents.
Services provided include RAC's Web site (www.raconline.org),
electronic mailing lists, and customized assistance. The site has
had 586,589 hits since inception and has an average turnaround time
of less than 24 hours for individual requests. In FY 2005, the RAC
continued to expand the level and breadth of information and services
for rural residents. In addition, the project also added new sites
and information resources related to border health issues and health
disparities in the Delta region of the country.
Another long-standing effort of the office examines
the important link between economic development and health care
in rural communities. The health sector is often one of the top
employers in a rural economy, a role and relationship that often
is not fully understood. The Center for Rural Health Works
(RHWks) is an ongoing program that works to strengthen local systems
of health. As the national focal point, it provides technical assistance,
tools and training to help States measure the economic impact of
the health-care sector on local, regional and State economies. It
also develops feasibility studies for new health care services.
During FY 2005, Center for RHWks activities included conducting
two regional workshops, responding to more than 300 requests for
technical assistance, developing models for measuring the economic
impact of a CAH and a FQHC on local communities and sharing the
results of their studies/activities at 16 regional and national
conferences.
The National Association of Counties (NACo)
has established a partnership with Center for Rural Health Works
to help county elected officials take the lead in conducting a comprehensive
community engagement process for health and economic development.
The purpose of this project is to help communities recognize that
improving their health care system has a direct and positive impact
on local economic growth. This is a new initiative for FY 2005.
During this first year of the program, the NACo Project produced
three county-level reports on economic impact, community need, health
services directory and data/information. The reports were provided
to each county and placed on the NACo website. NACo also disseminated
information about this project through workshops at its Western
Regional and Annual Conferences and through articles in NACo's publication
"County News."
The provision of emergency medical services in rural areas represents
a particular challenge. Toward that end, the office in 2005 provided
funding support for the final year of a contract that created the
Rural EMS and Trauma Technical Assistance Center (REMSTTAC).3
This center served as the focal point for the dissemination of information
on rural emergency medical services and trauma care. Through the
provision of technical assistance, this continuing program promotes
local and regional integration of rural EMS within existing EMS,
trauma, healthcare, mental health, public health, public safety
and disaster responses systems.
With FY 2005 funds, REMSTTAC was able to conduct
a wide range of activities. The center provided technical assistance
to rural communities relating to EMS and trauma systems. It also
represented and provided a rural voice for EMS and trauma in various
meetings sponsored by national associations, State governments and
Federal agencies. Funding supported the development and dissemination
of the "Rural EMS Agenda" for the future. REMSTTAC sponsored
a Town Hall Meeting in Park City, Utah. In addition, it began the
development of written products that will assist EMS and trauma
rural providers.
Provider-Focused Technical Assistance
ORHP works to develop and provide technical assistance
and information sharing for rural health care providers to strengthen
and expand their ability to provide quality health care. ORHP's
provider-focused TA and information sharing efforts in 2005 involved
Rural Health Clinic TA Conference Calls, 340B TA for Rural Hospitals,
the Delta Rural Hospital Performance Improvement Project and the
Alaska Rural Hospital Performance Improvement Project.
New in FY 2005, Rural Health Center TA Conference
Calls focused on providing Rural Health Clinics (RHCs) with
four national technical assistance conference calls each year. These
calls were the only federally funded technical assistance provided
specifically to RHCs. The topics were determined about one month
before each call by an advisory group comprised of experts in the
area of RHCs. FY 2005 funds supported the cost of phone lines, speakers
and administration of four to six hour-long calls. The topics covered
included billing and coding, shortage designation application, health
information technology and cost reporting, among others. The calls
attracted an average of 175 participants each.
As a result of a change in the law in 2003, more
than 250 rural hospitals may now qualify to participate in the 340b
Discount Drug purchasing program. To assist these facilities in
signing up for the program, the ORHP provided supplemental funding
to the HRSA Pharmacy Services Support Center (PSSC) in FY 2005 to
assist rural hospitals in understanding and applying for participation
in the 340b discount drug purchasing program. The PSSC is a resource
established in 2002 to assist HRSA grantees and eligible health
care sites to optimize the value of the 340B Program and provide
clinically and cost effective pharmacy services that improve medication
use and advance patient care. The PSSC operates under a contract
between the American Pharmacists Association (APhA) and the Office
of Pharmacy Affairs (OPA), in the HRSA Healthcare Systems Bureau.
To date, 140 rural hospitals are taking part in the 340b program
as a result of this assistance.
The Delta Rural Hospital Performance Improvement
Project (RHPI) is designed to increase access to quality health
care services in the Mississippi Delta by improving the financial,
operational and clinical performance of its small rural hospitals.
On-site technical assistance is available to 122 hospitals in eight
States. This project is also developing and implementing a performance
improvement strategy based on the Balanced Scorecard (BSC) technology.
In 2005, the Delta RHPI Project carried out a range of activities.
It delivered TA to 17 unique hospitals, including 11 Performance
Improvement Assessments (PIAs), 10 Targeted Consultations and Balance
Scorecard (BSC) consultations in three hospitals. Additionally the
project made tools available through the project Web site, conducted
sustainability meetings in four States, surveyed all assisted hospitals
regarding project success and made numerous presentations about
this project. The project has conducted both process and outcomes
evaluations.
The Alaska Rural Hospital Performance Improvement
Project, new in FY 2005, provided on-site technical assistance
to hospitals in Alaska that request assistance. The TA was targeted
at helping these hospitals improve their financial, clinical and
operational performance. FY 2005 money funded three on-site TA visits
to Alaska hospitals, as well as follow-up services to provide assistance
during the implementation of recommendations made during the site
visits.
Health Information Technology
There is an established link between the benefits
of health information technology (HIT) adoption and quality improvement.
There also is an emerging need for support for rural providers to
make informed decisions about their HIT futures, as well as processes
and business tools to help them make decisions. Therefore, in an
effort to work toward rural equity of HIT adoption, ORHP will hold
a national rural HIT meeting, Health Information Technology: A Provider's
Roadmap to Quality, in September 2006. This meeting will provide
an opportunity for rural providers to learn about the basic components
of HIT, focus on the initial steps of strategic planning for HIT
investments and share best practices and lessons learned about HIT
implementation. The meeting will bring together 300 rural providers
to discuss strategic planning for HIT investments.
In planning for the 2006 meeting, the HIT External
Planning Team, made up of a group of 13 rural HIT experts, met in
Washington, D.C., on Nov. 7-8, 2005.
In other efforts to further the adoption and implementation
of HIT by rural providers, ORHP provided funding to the Technical
Assistance and Services Center to develop key expertise, partnerships
and tools for critical access hospitals (CAHs) to consider as they
look to invest in HIT. This is an ongoing project. With 2005 funding,
the Technical Assistance and Services Center for the Rural Hospital
Flexibility program (TASC) will deliver tools and a customized portal.
The tools will identify key areas of expertise needed to assist
CAHs in their clinical, financial, leadership and staffing domains,
most likely in the form of a primer on HIT. The portal will be a
customized space for knowledge sharing, access and workspace on
the AHRQ HIT portal site for the CAHs and other rural health care
providers.
Health Care Workforce
The Office of Rural Health Policy also sponsors two projects meant
to support improved access to quality health care services by supporting
the Nation's health care workforce.
The National Rural Recruitment and Retention
Network (3RNet) works to increase the number of providers practicing
in rural America. The project consists of 43 State-based, not-for-profit
organizations that encourage and assist physicians and other health
professionals in locating practices in underserved rural communities.
Members include State Offices of Rural Health, Primary Care Offices,
Primary Care Associations and Area Health Education Centers and
other not-for-profit entities.
During FY 2005, 3RNet helped States improve their
retention and recruitment (R&R) activities especially for primary
care physicians, RNs, dentists, pharmacists and mental health professionals.
Members placed 715 medical professionals in 622 communities and
568 of those were in HPSAs and MUAs. 3RNet also maintained a toll-free
phone line to assist providers interested in serving rural America.
The Network continues conducting workshops, training, and presentations
for those interested in recruiting and keeping providers in rural
communities. In addition, 3RNet is working with HRSA programs to
promote effective R&R into areas served by these programs.
A new project, J1 Visa Report WWAMI (Washington,
Wyoming, Alaska, Montana and Idaho) focuses on analyzing data to
determine the contribution of J1-visa waiver physicians to the rural
physician workforce. There have been multiple changes to the various
programs that approve these waivers. These changes have influenced
those applying for waivers in certain programs. This has led to
confusion over the actual aggregate numbers of physicians applying
for waivers in exchange for agreeing to practice in rural areas.
This project seeks to analyze existing data sources to better understand
the supply of J1-visa waiver physicians and determine placement
trends. With FY 2005 funding, the University of Washington Rural
Health Research Center, which has a heavy focus on rural workforce
issues, will analyze various data sets to determine where J1 visa
waiver physicians are practicing in rural communities.
Rural Health Policy
The ORHP funds a number of projects in its efforts
to influence rural health policy to make quality, affordable health
care accessible in rural areas.
One of these endeavors, the ongoing Policy
Analysis Cooperative Agreement, supports the performance of
research and analysis on key policy issues affecting rural communities.
The 2005 funding supported several activities. This includes working
with rural community colleges on health workforce issues. The cooperative
agreement also supports ongoing work of the Rural Policy Research
Institute (RUPRI) Rural Health Panel. The RUPRI Rural Health Panel
provides science-based, objective policy analysis to Federal policy
makers. Panel members come from a variety of academic disciplines
and create documents that reflect the consensus judgment of all
panelists. The grant also provides staff support to the Rural Hospitals
Issues Group, a panel of small rural hospital administrators and
rural hospital finance experts from across the country to discuss
issues such as the MMA, Medicare Advantage, and other policy issues
affecting small rural hospitals.
A new project, the CAH/Hospice Financial Report,
was created to analyze and predict the financial impact that providing
general inpatient and respite hospice services will have on Critical
Access Hospitals (CAHs). FY 2005 funds supported the development
and analysis of a financial model that depicts the likely financial
impact of the provision of hospice services on CAHs with various
cost structures.
Funding for the National Conference of State
Legislatures (NCSL) supports an existing cooperative agreement
through the Bureau of Primary Health Care which provides funding
support to the NCSL for an annual meeting focusing on a key rural
health issue of interest to rural State legislators. With 2005 funds,
NCSL convened a day-long conference to examine the relationship
between health care and economic development in rural areas, and
identify strategies and resources available to help rural communities
thrive.
Best Practices and Emerging Issues in Rural
Health
The ORHP also funds public health efforts and
a program of all-inclusive care for the elderly as part of its work
on communicating best practices and addressing emerging issues in
rural health.
This ongoing Public Health funding supports
an existing cooperative agreement with the National Association
of County and City Health Officials (NACCHO) through the Bureau
of Primary Health Care which provides technical assistance to community
and migrant health centers. The Office of Rural Health Policy supplements
this cooperative agreement to ensure that key rural issues are addressed
in the public health arena and information on rural activities is
communicated. Fiscal year 2005 funds supported several activities
including: the creation and maintenance of a rural listserv; an
issue brief on workforce development; rural sessions at the NACCHO
Annual Conference; six scholarships for rural Local Public Health
Agencies (LPHAs) to attend the NACCHO Annual Conference; two skills
building scholarships for rural LPHAs to attend a social marketing
public health conference; the creation of an internal NACCHO Rural
Health workgroup and updates on rural health resources and issues
in the NACCHO Exchange and the Public Health Dispatch.
The purpose of the Program of All-inclusive
Care for the Elderly (PACE) model, a Medicare demonstration
project, is to expand community-based long-term care options for
seniors through comprehensive coordination of preventive, primary,
acute, and long-term care services. It is a unique capitated managed
care benefit for the frail elderly provided by a not-for-profit
or public entity that features a comprehensive medical and social
service delivery system. There is little or no penetration of this
model into rural areas. What is not known is how many rural providers
are interested in the PACE model and how viable this model might
be for meeting the needs of frail elderly in rural communities.
FY 2005 funds supported a range of activities
related to PACE. The project offered consultation with potential
providers and a two-day meeting for all PACE Providers to determine
progress in the development of rural PACE sites. Discussion between
ORHP and the National PACE Association (NPA) has begun on evaluation
component. In addition, NPA provided technical assistance to providers
on ways to receive start-up PACE site funding.
Women's Health Issues
The ORHP created a new project in FY 2005 to
address women's health issues. The mission of the Bright Futures
for Women's Health and Wellness Initiative is to plan, develop,
implement and evaluate a variety of culturally competent consumer,
provider, and community-based products to increase awareness and
use of preventive health services for all women across their lifespan.
The objectives of this project are to aid rural women and adolescent
girls in the following ways: 1) providing information to rural women
on recommended preventive health services so that they seek care
based on their individual needs and share in the decision-making
about their health services and 2) providing tools for rural practitioners
to use in making all health care visits an opportunity to offer
preventive care. FY 2005 funding used to modify an existing set
of physical activity and healthy eating tools for consumers and
health care providers in rural settings. The final version of these
materials is expected on Aug. 30, 2006
Frontier Health
Funding for a frontier health project supports
the Frontier Education Center, which provides technical assistance
to individuals seeking information on frontier health care issues
and produces 3-4 issue papers on frontier health-specific topics.
Funding supported papers focusing on topics including the use of
health information technology for public health activities in the
U.S.-Mexico Border region, the applicability of the Frontier Extended
Stay Clinic model to sites in the "lower 48," and developing
baseline information to analyze the impact of the Medicare drug
benefit on frontier communities with a sole pharmacy.
Collaboration with the National Rural Health
Association (NRHA)
The Office of Rural Health Policy collaborates
with the National Rural Health Association (NRHA) on several fronts
to identify, analyze and address rural health needs.
The purpose of one of the collaborative efforts,
the Rural Medical Educators' Conference and Technical Assistance,
is to share innovative ways to get more medical professionals into
rural areas as well as discuss new issues in rural health education.
This is an ongoing program. FY 2005 funds supported the planning
and execution of the Rural Medical Educators Annual Conference in
May 2006. The conference will bring together about 50 physicians,
students, residents and professors who strive to bring medical professionals
(including doctors and nurses) into rural environments.
Additionally, in response to issues brought to
the forefront by the Institute of Medicine's 2005 rural health quality
report "Quality Through Collaboration," a new Rural
Hospital and Community Technical Assistance project seeks to
improve quality of health care in rural communities. Funding supports
in-depth technical assistance through three to five site visits.
These visits are designed to promote health care quality in rural
areas. In addition, funds are used to collect best practices and
rural needs in quality improvement as well as create a rural quality
focus group.
Another Quality project, new in FY 2005,
was funded to support several activities including planning a quality
conference, writing a rural health quality best practices manual
and bringing in four speakers to the Quality Conference in July
2006. In addition, funds will provide National Quality Forum Membership
for the National Rural Health Association to provide input and have
a "rural vote" in the forum.
The Office of Rural Health Policy also collaborates
with the NRHA to hold several policy forums throughout the year
for key stakeholders to discuss various issues, such as Medicare,
acute care, etc. The forums educate participants about rural community-based
health models and begin developing reports on best practices.
Another joint endeavor by ORHP and the NRHA, the
Cooperative of Health Networks, will develop a series of
performance measures in order to measure progress of the Rural Health
Network Grants. In FY 2005, the first year of funding, money was
used to identify possible measures.
The Regional Meetings - Best Practices
is a new project meant to improve rural health quality and promote
the use of best practices by working with State Rural Health Associations.
Technical assistance will be delivered through a series of presentations
and site visits. In addition to technical assistance, this program
will collect quality improvement models that work. This collection
of best practices will be distributed nationally.
Further, an ongoing Annual Meeting Support
project supports various parts of the National Rural Health Association's
annual meeting. The annual meeting brings together the broad rural
health community for continuing education and networking. FY 2005
funding was provided to support eight sessions on topics such as
rural Health Information Technology, the National Advisory Council,
Rural Voices, mental health and substance abuse, a committee on
rural health and human services, improving systems collaboration,
updates from ORHP and BPHC and a Medicaid update.
Another collaborative effort between ORHP and
NRHA brought about State Rural Health Association Grants to support
the rural health community at the State level through a variety
of different activities. It is a continuing project. With FY 2005
funding, 34 grants of $9,500 were administered to support activities
such as rural health newsletters, conferences, educational activities,
skill building, etc. In 2005, 20 of the State Rural Health Associations
(SRHAs) devoted portions of their annual meeting to educating rural
citizens about the findings in the Institute of Medicine's "Quality
Through Collaboration" report on rural health quality issues.
Other SRHAs used their meetings to share information about the new
Medicare drug benefit while others focused on issues such as health
information technology.
Other collaborative efforts with the NRHA resulted
in the Ag Health program that provides technical assistance in order
to raise awareness of health and safety issues associated with agriculture,
decrease the number of related accidents and illnesses, and improve
treatment. It is a new program in FY 2005. The Ag Health program
provided agriculture health training, such as farm safety, to health
professionals who have patients working in agriculture.
Border Health
ORHP also facilitates intra-agency border health
activities that cut across the Bureaus and Offices of HRSA.
In FY 2005, funds supported the Border Health
Clearinghouse in the Rural Assistance Center, which aims to
develop a border Website within the RAC (www.raconline.org) for
health and human services information. This bilingual site serves
as a clearinghouse for information on border health issues. The
border health website was launched on schedule in January 2006.
ORHP also supported the U.S.-Mexico Border
Health Association Meeting to further educate clinicians and
community workers about HRSA programs and the progress toward achieving
U.S.-Mexico Border 2010 Health Objectives. ORHP supported the annual
U.S.-Mexico Border Health Association Meeting in Laredo, Texas,
through the provision of logistical support for educational seminars
for providers.
The purpose of the Pan-American Health Organization
Immunizations program is to further educate clinicians and community
workers in the appropriate use of vaccines and to facilitate the
vaccination of children and adults in local clinics and community
health centers along the US-Mexico border. FY 2005 funding provided
logistical support for Immunization in the Americas Week.
In FY 2005, ORHP supported a new Border Environmental
Coordination Research Program is to fund research to test the hypothesis
that environmental education and training is an effective intervention
tool for improving public health. The target population is lay community
health workers, or promotoras, residing along the U.S.-Mexico
border and the communities they serve. This project, jointly sponsored
by EPA and HRSA, supports larger border health efforts including,
but not limited to, the U.S.-Mexico Border 2012 program (www.epa.gov/usmexicoborder).
Funding from FY 2005 supported the development of a research protocol
to examine pesticide exposure in rural border areas by Texas A&M
University.
Grant Programs
Medicare Rural Hospital Flexibility Grant Program
(Flex)
Project Officer: Steve Hirsch, MSLS
The Rural Hospital Flexibility Program is a Federal
initiative that provides funding to State governments to stabilize
rural hospital economics, integrate emergency medical services (EMS)
into the health care system and improve quality of care. Flex funds
support the conversion of small rural hospitals to Critical Access
status, which allows them to receive cost-based reimbursement from
Medicare for inpatient and outpatient services. Flex funding to
the States also encourages the development of collaborative systems
of care in rural areas, including the CAHs, EMS providers, clinics
and other providers of high-quality, necessary health care services.
The CAH program requires participating States
to develop rural health plans, and funds the States to support and
implement community-level outreach and technical assistance. Although
focused on very small, rural hospitals, this complex intervention
operates on the national, State, community and facility levels and
covers a broad range of health service issues.
Changes to the Program
There were no significant changes to the Flex Program.
Key Program Accomplishments
Since the inception of the Flex Program, more than 1,200 hospitals
have converted to Critical Access status. Most of these hospitals
have seen an improvement in their financial status. Most hospitals
have offered new, needed services to their communities. More than
80 percent of CAHs report engaging in activities to improve the
quality of care provided to patients.
The Program has also stimulated the development
of dozens of rural health networks in the participating States.
Network types have ranged from small, hospital-based networks to
Statewide networks involving all CAHs to multi-State networks devoted
to improving quality of care.
At A Glance Amount Awarded:
2004: $ 22.4 million
2005: $ 22.2 million
2006: $ 22.3 million (anticipated)
Grants Awarded:
2004: 45 continuing awards
2005: 45 continuing awards
2006: 45 continuing awards
States:
ORHP awarded 45 grants to 45 states in FY 2005 |
Small Rural Hospital Improvement Grant
Program (SHIP)
Project Officer: Keith J. Midberry, MHSA
The purpose of the SHIP grant program is to help
small rural hospitals do any or all of the following: 1) pay for
costs related to implementation of prospective payment systems (PPS);
2) comply with provisions of the Health Insurance Portability and
Accountability Act (HIPAA) of 1996; and 3) reduce medical errors
and support quality improvement (QI) efforts.
State Offices of Rural Health help rural hospitals
to participate in the program. In FY 2005, $14.7 million was awarded
to 1,523 eligible hospitals in 46 States and Puerto Rico and each
hospital received approximately $9,700.
Changes to the Program
Since FY 2002, the first year of the program, the number of participating
hospitals has increased by 73 hospitals or 4.8 percent.
The use of SHIP funds for reduction of medical
error and quality improvement activities increased from 49 percent
in FY 2003 to 53 percent in FY 2004 while the use of SHIP funds
for HIPAA activities decreased from 46.5 percent in FY 2003 to 39.5
percent in FY 2004. The use of grant funds for PPS activities remains
relatively constant at 6 percent.
Key Program Accomplishments
Key program accomplishments for FY 2005 have yet to be evaluated.
The project period, Sept. 1, 2005 to Aug. 31, 2006, began too late
in the year for the information to be available from the consultant
who provides the report at the end of the period.
During FY 2004, 53 percent of the funds ($7.8
million) were expended for projects and initiatives related to quality
improvement. HIPAA activities received 40 percent of the funds ($5.9
million) and PPS activities received 7 percent ($1 million) of the
funds. Of the 1,523 participating SHIP hospitals, 1,095 or 72 percent
used some or all of their grant funds to invest in health information
technology (HIT). Seventy percent (771) of the hospitals used SHIP
funds to secure new or upgrade existing hardware and software infrastructure
that serve as the foundation for business office, security and quality
improvement functions. Twelve percent (127) of the hospitals expended
funds on hardware or software related to business office functions
such as coding, billing or accounting software. Forty percent (436)
identified their HIT expenditures as specific to compliance with
the HIPAA security rule and 58 percent (634) invested in HIT for
quality improvement activities.
At A Glance Amount
Awarded:
2004: $ 14.7 million
2005: $ 14.8 million
2006: $ 14.5 million
Grants Awarded:
2004: 49 continuing awards
2005: 47 new awards
2006: 47 continuing awards
States:
ORHP awarded 47 grants to 46 states and Puerto Rico in FY
2005 |
Rural Health Outreach Grant Program
Project Officer: Eileen Holloran
The purpose of the Rural Health Care Services
Outreach (Outreach) Grant Program is to provide funds to expand
the delivery of health care services in rural communities. The history
of rural health care in the United States is one of underserved
people and under-resourced providers. Many factors contribute to
the story: geographic isolation, low incomes, lack of insurance
and too few caregivers, to name a few. The Outreach Grant Program
encourages the development of new and innovative health care delivery
systems in rural communities that lack essential health care services.
Programs funded vary greatly and have brought care that would not
otherwise have been available to at least 4 million rural citizens
across the country.
The emphasis of the grant program is on service
delivery through creative strategies requiring the grantee to form
a consortium with at least two additional partners. The consortium
should include local providers and other organizations that support
the delivery of health care. The Outreach projects are based on
demonstrated community needs. The population to be served should
be included in identifying and planning for the services that will
be provided. All projects need to be responsive to the unique cultural,
social, belief and linguistic needs of the target population.
Applicants may propose to deliver different types
of services, including primary care, dental care, mental health
services, home health care, emergency care, health promotion and
education programs, outpatient day care and other services not requiring
inpatient care.
In fiscal year FY2005, 30 new and 72 continuing
grants (102 total grants) were awarded, totaling $18,821,464.
Changes to the Program
Through the FY 2005 grant cycle the maximum amount of grant funds
that could be requested by applicants was $200,000 per year for
up to three years. For the FY 2006 grant cycle, Outreach applicants
could request $150,000 in the first budget period, $125,000 in the
second budget period and $100,000 in the last budget period.
Key Program Accomplishments
Rural communities have managed to create hospice care, bring health
check-ups to children and provide prenatal care to women in remote
areas. The Outreach program projects allow rural populations to
receive a wide variety of health services. In FY 2005 some of the
project focuses were: primary care, 27 percent; mental health, 26
percent; diabetes, 12 percent; oral health, 8 percent; obesity,
5 percent; and others types of services, including health education
and disease prevention, totaled 24 percent of the projects emphasis.
The majority of the population served is made up of adults (51 percent),
but infants, children, adolescents and the elderly also receive
health services.
Outreach program grantees successfully expand
health services delivery each year, by increasing the number of
people served in rural communities. Two examples of Outreach grantees
that have received national recognition for projects that were conceived
and developed using Outreach Grant Program funds are the Sickness
Prevention Achieved through Regional Collaboration (SPARC), which
focused on breast cancer detection in older women in a contiguous
rural area at the junction of Connecticut, Massachusetts and New
York, as well as the Diabetes Lay Educator Program in Morehead,
Minn. that provided services for migrant Hispanic farm workers who
have diabetes.
At A Glance Amount
Awarded:
2004: $ 19.9 million
2005: $ 18.8 million
2006: $ 17.9 million
Grants Awarded:
2004: 96 continuing awards, 13 new awards
2005: 71 continuing awards, 30 new awards
2006: 43 continuing awards, 65 new awards (anticipated)
States:
ORHP awarded 102 grants to 39 states in FY 2005 |
Delta States Rural Development Network
Grant Program
Project Officer: Lakisha M. Smith, MPH
The purpose of the Delta States Rural Development
(Delta) Grant Program is to support community organizations in the
development and implementation of projects to address local health
care needs in the rural Delta Region. A single grant is awarded
to one organization within each of the eight Delta States (Alabama,
Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri and
Tennessee) collectively known as the Delta Regional Authority (DRA).
The eight states are comprised of 207 eligible counties.
ORHP provides support for the counties within
the DRA through activities designed to strengthen the safety net
and small rural hospital performance, demonstration projects for
improving collaboration across counties among existing grant programs
and providing technical assistance and outreach funds to small rural
communities.
In fiscal year 2005, eight grants were awarded
to the DRA totaling $5,090,751.
Changes to the Program
In FY 2005, the program implemented a major shift for grantees from
single-county networks to multi-county consortia. This will help
to achieve greater financial impact across the Delta counties/parishes
for the program.
Key Program Accomplishments
Each of the eight Delta grantees is unique as is its accomplishments.
The Alabama Delta grantee has garnered the buy-in
of two counties, which previously opted to not be involved in the
grant program, to become active participants in the Delta grant
and have received funding for health implementation projects. Alabama's
partnership with the Southern Rural Access Program has provided
an opportunity for the grantee to engage in the practice management
model by providing technical assistance to primary care providers
throughout the region. This represents the first multi-county effort
ever initiated by Alabama's Delta States project.
Through TA, several grantees, including Arkansas
and Lousiana, were able to leverage additional grant funds in excess
of $1.35 million to assist in other initiatives within the various
Delta States.
Local projects in Illinois were able to develop
school based health centers in three sites and a coordinated referral
service for patients of an established volunteer free clinic.
Kentucky initiated a pharmaceutical access program
assisting low-income adults to take advantage of low cost pharmaceuticals
in 10 Delta counties. Grantees in Kentucky and Missouri have also
been involved in pilot project targeting to the ARC and DRA region
regarding a new pharmaceutical web-based pharmaceutical system.
At A Glance Amount
Awarded:
2004: $ 5.1 million
2005: $ 5.1 million
2006: $ 5.1 million (anticipated)
Grants Awarded:
2004: 8 new awards
2005: 8 continuing awards
2006: 8 continuing awards
States:
ORHP awarded 8 grants to 8 states in FY 2005 |
Network Development Grant Program
Project Officer: Erica Molliver, MHS
The purpose of the grant is to "expand access
to, coordinate and improve the quality of essential health care
services, and enhance the delivery of health care in rural areas."
These grants support rural providers who work together in formal
networks, alliances, coalitions or partnerships to integrate administrative,
clinical, technological and financial functions across their organizations.
The funds provided through this program are not used for the direct
delivery of services. The ultimate goal of the RHND Grant Program
is to strengthen existing health care networks in order to achieve
business (network partner return) and social (community return)
competencies that increase access and quality of rural health care
and, ultimately, the health status of rural residents.
Nine new grants and 28 continuing grants were
funded in FY 2005 (37 total grants) totaling $6,974,893.
Changes to the Program
There were 10 new awards made in FY 2005. There were no changes
to the program in FY 2005.
Key Program Accomplishments
Agrisafe Network in Iowa began a series of distance continuing
education courses for local providers. Network members initiated
discussions with the Iowa Farm Bureau Federation and Wellmark Blue
Cross Blue Shield of Iowa regarding the coverage of preventive health
services for farmers. They also developed protocol referral guidelines
to measure changes in clinical outcomes in four different content
areas.
The Upper Peninsula Health Care Network
in Michigan adopted and endorsed a cooperative pharmacy formulary
management system. The network then used the combined volume of
their 15 hospitals to leverage Performance Discount/Rebate Agreements
in the purchase of prescription drugs. In the case of one particular
drug, the network expects annual net savings for the network hospitals
to be as much as $74,000 from this drug alone.
In addition to continuing grant-funded work in
the adaptation and implementation of a web-based information management
software program to link rural safety net providers, the East
Texas Health Access Network (ETHAN) was able to provide significant
aid to victims of hurricanes Katrina and Rita. Network members provided
direct patient care and medication assistance to hundreds of evacuees,
obtained donations of insulin, food, clothing and hygiene supplies,
and conducted door-to-door search and rescue activities in two eastern
Texas counties. Two days after Rita hit, network staff reopened
the ETHAN Office using a generator, and kept updated information
on the location of open hospitals, food distribution sites, etc.
for evacuees.
North Country Health Consortium in New
Hampshire leveraged additional funds to support the Molar Express,
the network's mobile regional public health dental clinic, which
provided screenings to over 500 Medicaid-eligible North Country
children between April and December of 2005.
Grand Traverse Regional Health Care Coalition
of Michigan signed a contract with the State to operate the Adult
Benefit Waiver I (ABWI) program in three target counties. The network's
participation in this program allows access to Federal matching
dollars for other local programs.
At A Glance Amount
Awarded:
2004: $ 6.6 million
2005: $ 7 million
2006: $ 4 million (anticipated)
Grants Awarded:
2004: 29 continuing awards, 5 new awards
2005: 27 continuing awards, 10 new awards
2006: 15 continuing awards, 23 new awards (anticipated)
States:
ORHP awarded 37 grants to 22 states in FY 2005 |
Network Development Planning Grant Program
Project Officer: Michele L. Pray-Gibson, MHS
The purpose of the Rural Health Network Development
Planning Grant Program is similar to the Network Development Grant
Program in that it seeks to "achieve efficiencies; expand access
to, coordinate and improve the quality of essential health care
services; and strengthen the rural health care system as a whole."
These grants support rural communities needing assistance in planning,
organizing and developing a health care network. Funds cannot be
used for direct delivery of health care services. The grant supports
one year of planning to develop a network and help them become operational.
Nineteen new grants were awarded in fiscal year
2005 totaling $1,563.49.
Changes to the Program
In FY 2004, the grant cycle began on Dec. 1. For FY 2005, the cycle
was changed to March 1.
Key Program Accomplishments
Hopi Regional Health Care Network, Kykotsmovi, AZ
The Hopi Tribe received grant funding in 2004. The goal of the network
was to "develop a formal networking system that would foster
true partnership and collaboration between the two major hospitals
which provide medical health services to our Native American population."
As a result of the grant, the network developed and adopted bylaws
and a governing board. Two additional hospitals, Flagstaff Medical
Center and the Northern Arizona VA Hospital, have requested to join
the network.
Alaska Small Hospital Performance Improvement
Network (ASHPIN), Juneau, AK
The Alaska State Hospital and Nursing Home Association received
grant funding in 2004. It was a network of 10 small frontier hospitals
focusing on three things: (1) network development; (2) strategic
planning to address network member clinical and operational communications
issues, including a telehealth/telemedicine system; and (3) performance
improvement. This network was successful in securing a Network Development
Grant in fiscal year 2005 to continue its activities and is still
operational.
Planning Equals Access for Louisiana (PEAL),
Napoleonville, LA
The Louisiana Rural Health Association received funding in 2004.
The goal of PEAL was ultimately to identify strategies to increase
adult immunizations and adult vaccinations while addressing chronic
illness. The network proposed to develop a strategic plan addressing
the health needs of twenty-nine parishes. As a result of the grant
funds the network grew into an emerging coalition called Progress
Equals Access for Louisiana (PEAL) and network membership increased
to include the regional CMS Office and the LA Department of Insurance,
Senior Health Insurance and Information Program. This network was
successful in securing a Rural Health Outreach Grant in fiscal year
2006 to address the access issues identified during the planning
grant process.
Collaborative Action for TAOS County Health
(CATCH), Taos, NM
The Taos Health System (Holy Cross Hospital) received funding in
2005. The goal of CATCH is to evolve from a horizontal to a vertical
network. The project proposed to create a single point of entry
to existing services and develop a Promotoras program. As a result
of the grant, the network is now a vertical network that includes
emergency medical services, a community foundation and an herb company.
The network secured a Rural Health Outreach Grant for fiscal year
2006 to continue the development of a single point of entry and
the lay Promotora Program. The focus is on providing education on
diabetes, linking patients to appropriate programs and securing
prescription assistance.
At A Glance Amount
Awarded:
2004: $ 1 million
2005: $ 1.6 million
2006: $ 1.1 million (anticipated)
Grants Awarded:
2004: 12 new awards
2005: 19 new awards
2006: 13 new awards (anticipated)
States:
ORHP awarded 19 grants to 16 states in FY 2005 |
State Offices of Rural Health Grant Program
Project Officers: Jennifer Riggle, JD & Jennifer Chang,
MPH
The purpose of the State Offices of Rural Health
(SORH) Grant Program is to assist States in strengthening rural
health care delivery systems by creating a focal point for rural
health within each State. The program provides an institutional
framework that links small rural communities with State and Federal
resources to help develop long term solutions to rural health problems.
There are three core functions of the SORH: (1)
to serve as a rural health clearing house of information and innovative
approaches to the delivery of services; (2) to coordinate State
activities related to rural health in order to avoid duplication
of efforts and resources; and (3) to identify Federal, State, and
nongovernmental programs regarding rural health and provide technical
assistance to public and nonprofit private entities regarding participation
in such programs.
In fiscal year 2005, 50 non-competing continuation
grants were awarded for a total of $7,401,171. The maximum level
of funding awarded was $150,000, which 46 of the 50 States requested
and received. Each State is also required to match the SORH Federal
funding at a minimum 3:1 ratio; a unique leveraging component for
the program.
Changes to the Program
The program continued its performance improvement initiative at
the programmatic and grantee level. The Government Performance and
Results Act (GPRA) measure for the program was updated and the peer-to-peer
mentor program was used to improve the effectiveness of strategy
implementation and planning at the State level.
Key Program Accomplishments
The three core functions of the SORH program were well illustrated
during the response to the devastation caused during the 2005 hurricane
season. The SORHs in the afflicted and neighboring States were key
partners in information gathering, coordination of activities and
in providing technical assistance after the immediate crisis. Given
the rapidly changing nature of the crisis, there was an urgent need
to share information and the SORH served as a valuable asset to
ORHP and HRSA in determining the magnitude of the effect on rural
areas.
The program encourages each State to promote rural
recruitment and retention efforts of health professionals. The SORHs
are the primary dues-paying members to the Rural Recruitment and
Retention Network (3RNet) which in 2005 recruited 742 health professionals
of which 450 of these were primary care physicians.
State Offices continue to leverage significant
partnerships with the goal of improving rural health. In 2005, an
example of the impact of these partnerships is seen through the
Rural Hospital Performance Improvement project (RHPI). SORHs in
MS, LA, AR, AL, TN, IL, KY, and MO are worked collaboratively with
their State Hospital Associations (SHAs) to provide input and expertise.
In particular, the SORHs worked with the contractor to ensure that
the on-site technical assistance was well-managed and appropriate
to the needs of each hospital. The SORHs and SHAs also continue
to follow up with the hospital after technical assistance is rendered.
The SORHs are continuously working with Federal,
State and local partners to improve the collaboration among safety
net providers in rural areas of their States. In particular, 18
SORHs applied with their State partners to an ORHP initiative to
"Improve Collaboration Between Critical Access Hospitals (CAHs)
and Federally Qualified Health Centers (FQHCs)." Funding was
available to provide technical assistance to four of the States;
those were Louisiana, Texas, New Hampshire and Arkansas. In each
of these States, the SORH took the lead in bringing together the
State-level partners (PCO, PCA, SHA). The technical assistance was
provided through consultants to the State teams to assist them in
better understanding the roles and relationships between CAHs and
FQHCs. As a result of the leadership from the SORHs, each of the
States has developed plans and strategies for improved collaboration
between the CAHs and FQHCs in their States.
At A Glance Amount
Awarded:
2004: $ 7.4 million
2005: $ 7.4 million
2006: $ 7.2 million (anticipated)
Grants Awarded:
2004: 50 continuing awards
2005: 50 continuing awards
2006: 50 continuing awards
States:
ORHP awarded 50 grants to 50 states in FY 2005 |
Rural Access to Emergency Devices
Project Officer: Sheila Warren
The purpose of the Rural Access to Emergency Devices
(RAED) Grant Program is to provide funding to rural community partnerships
to purchase automated external defibrillators (AEDs) that have been
approved, or cleared for marketing by the Food and Drug Administration;
and provide defibrillator and basic life support training in AED
usage through the American Heart Association, the American Red Cross,
or other nationally recognized training courses. The legislation
that created this program states that awards will be made to community
partnerships. A community partnership is composed of local emergency
response entities such as community training facilities, local emergency
responders, fire and rescue departments, police, community hospitals
and local non-profit entities and for-profit entities.
Forty-eight non-competing continuation grants
were awarded in FY 2005 totaling $7,252,903.
Changes to the Program
No changes to the program in 2005.
Key Program Accomplishments
In 2005 approximately 8,110 AEDs were placed and approximately 24,830
lay persons and first responders were trained in their utilization.
There were approximately 1,500 AEDs uses, which resulted in approximately
850 patients having their cardiac rhythm restored. AEDs have been
placed in colleges, universities, community centers, local businesses,
law enforcement and ambulance vehicles, fire trucks, 911 dispatch
centers and offices to name a few. The grant creates opportunities
to educate the public on AEDs via advertisements, news media, schools,
churches, shopping malls, restaurants, home owner associations,
businesses, local government bodies, security firms, etc. The RAED
Program has resulted in an increased public awareness, increased
number of AEDs available and an increase in persons, first responders
and lay persons trained in their utilization in the event of sudden
cardiac arrest.
At A Glance Amount
Awarded:
2004: $ 9.2 million
2005: $ 7.4 million
2006: $0.3 million (anticipated)
Grants Awarded:
2004: 49 continuing awards
2005: 48 continuing awards
2006: 3 new awards (anticipated)
States:
ORHP awarded 48 grants to 47 states and 1 territory in FY
2005 |
Public Access to Defibrillation Demonstration
Projects
Project Officer: Sheila Warren
The purpose of the Public Access to Defibrillation
Demonstration Project (PADDP) is to award grants to political subdivisions
of States, Indian tribes and tribal organizations to develop and
implement innovative, comprehensive, community-based public access
defibrillation demonstration projects that provide cardiopulmonary
resuscitation (CPR) and automated external defibrillation (AED)
to cardiac arrest victims, provide training to community members
in CPR and AED usage, and to maximize community access to AEDs.
In fiscal year 2005 four non-competing continuation
grants were awarded totaling $930,663.
Changes to the Program
No changes to the program in 2005.
Key Program Accomplishments
In 2005 approximately 1,077 AEDs were placed and approximately 7,593
lay persons and first responders were trained to use them. AEDs
have been placed in colleges, universities, community centers, Indian
reservations, local businesses, law enforcement and ambulance vehicles,
fire trucks, 911 dispatch centers, sporting events, major tourist
attractions and offices. The grant has created methodologies to
educate the public on AEDs via advertisements, news media, schools,
churches, shopping malls, restaurants, home owner associations,
businesses, local government bodies, security firms, etc.
The PADDP Program has resulted in increased public
awareness, increased number of AEDs available and an increase in
persons, first responders and lay persons, trained in the utilization
of AEDs in the event of sudden cardiac arrest.
At A Glance Amount
Awarded:
2004: $ 0.9 million
2005: $ 0.9 million
2006: $ 0.9 million
Grants Awarded:
2004: 4 new awards
2005: 4 continuing awards
2006: 4 continuing awards
States:
ORHP awarded 4 grants to 3 states in FY 2005 |
Rural Health Research Centers
Project Officer: Joan Van Nostrand, DPA
The Rural Health Research Centers (RHRCs) Program
is designed to help policy makers understand the problems that rural
communities face in assuring access to health care for their residents.
The RHRCs study issues facing rural communities in their quest to
secure adequate, affordable, quality health services for their residents.
This is the only Federal program that is dedicated entirely to producing
policy-relevant research on health care in rural areas. The work
done by the Centers is also critical to helping the Office play
its policy role within the Department. The research done by the
RHRCs help provide important data and findings to the office's policy
staff which they bring to bear in their annual review of key Departmental
regulations.
Eight Centers in eight States were competitively
awarded cooperative agreements for the period FY 2005-2008.
The eight RHRCs conducted 25 research projects
and wrote 25 policy briefs and technical reports about their results.
All RHRCs have websites which highlight their rural research results.
Key Program accomplishments
Research Centers create policy briefs that provide clear, simple
summaries of legislation affecting rural areas, e.g., the Medicare
Modernization Act, and possibilities for effective implementation,
e.g., the new prescription drug benefit. The following are examples:
- A report on the impact of Medicaid cuts on
rural communities, especially on the disabled and the elderly
- A report on rural teens that found that rural
teens are just as likely to be exposed to violence and more likely
to use illicit drugs than urban or suburban teens
- Policy briefs that showed the benefit of Federal
loan repayment scholarship, and special recruitment programs to
staffing rural Community Health Centers
- A report on certification and training of Community
Health Workers to study the certification activities in States
with formal programs
- Program changes in FY 2005 included increasing
the number of RHRCs from six to eight and having each RHRC identify
a topic of concentration for its rural research.
At A Glance Amount
Awarded:
2004: $ 4 million
2005: $ 4.4 million
2006: $ 4 million
Grants Awarded:
2004: 8 new awards
2005: 8 continuing awards
2006: 8 continuing awards
States:
ORHP awarded 8 grants to 8 states in FY 2005 |
Rural Emergency Medical Service Training
and Equipment Assistance Program
Project Officer: Blanca Fuertes, MPA
The purpose of the Rural Emergency Medical Service
Training and Equipment Assistance Program (REMSTEP) is to assist
entities to develop improved emergency medical services (EMS) in
rural areas by improving the recruitment, training, certification
and retaining of volunteer and paid EMS personnel with a special
emphasis in the use of technology-enhanced education methods. The
grant also funds the purchase of EMS and personal protective equipment.
The office provides support to these grantees
through the EMS and Trauma Technical Assistance Center and by requiring
the use of community partnerships and the involvement of the grantee's
State Office of Rural Health program.
In fiscal year 2005 three grants were awarded
as continuation grants to the REMSTEP program totaling $356,313.
Fiscal Year 2006 the Congress chose not to fund this program. Grantees
will complete the current funded year and will be instructed on
how to close the program.
Changes to the Program
No changes were made to the program.
Key Program Accomplishments
Arizona: Northland Pioneer College (NPC) in partnership with
the authorized State EMS council for Northern Arizona, 14 Northern
Arizona fire departments, 12 hospitals and two other community colleges
created Project ROPE (Rural Outreach Paramedic Education). The project
provides high-quality, accessible and cost-effective training opportunities
for certification and recertification of paramedics, and continuing
education for EMS providers in Northern Arizona using a mobile hand-on
critical care skills lab, using NORMAN, a human patient simulator.
Washington: Inland Northwest Health Services
(INHS) in collaboration with Spokane County EMS and the Spoke County
Medical Director, created EMS Live At Night! (EMS Live). EMS Live
provides monthly education forum using interactive video conferencing
broadcasts to rural communities throughout eastern Washington. The
grant funds have been utilized to expand the program to more than
300 EMS agencies not only in the State of Washington, but also to
Northern Idaho, North Central Oregon, and the Eastern Aleutian Tribes
of Alaska. The success of the program prompted the State of Montana
to request, and was accepted as a partner State.
Wisconsin: In partnership with six hospitals,
four are CAHs, 10 ambulance services from Sandusky and Huron counties,
the Sanilac Medical Services in Sandusky, Michigan developed an
EMS program to increase access to EMS training, reduce barriers
when accessing EMS training or services, increase awareness of the
value and importance of EMS volunteers, and increase the incentives
to increase EMS volunteers.
At A Glance Amount
Awarded:
2004: $ 3.8 thousand
2005: $ 3.6 thousand
2006: $ N/A
Grants Awarded:
2004: 3 new awards
2005: 3 continuing awards
2006: N/A
States:
ORHP awarded 3 grants to 3 states in FY 2005 |
Frontier Extended Stay Clinic Program
Project Officer: Emily Cook
The purpose of the Frontier Extended Stay Clinic
(FESC) Cooperative Agreement Program is to examine the effectiveness
and appropriateness of a new type of provider, the FESC, in providing
health care services in certain remote locations.
In remote, frontier areas of the country, weather
and distance can prevent patients who experience severe injury or
illness from obtaining immediate transport to an acute care hospital.
For residents in some of those communities, providers offer observation
services traditionally associated with acute care inpatient hospitals
until the patient can be transferred or is no longer in need of
transport. Provision of these services requires the staffing, equipment
and quality assurance programs of an acute care hospital. However,
extended stay services are not currently reimbursed by Medicare,
Medicaid or other third-party payers. For several years, officials
in the State of Alaska and several State Offices of Rural Health,
Primary Care Offices and Primary Care Associations have explored
the development of a new provider type, or other mechanism, that
would enable reimbursement of these services through the FESC model.
The Medicare Prescription Drug Improvement and
Modernization Act of 2003 (MMA) authorized the Centers for Medicare
and Medicaid Services (CMS) to conduct a demonstration program in
which FESCs would be treated as Medicare providers. Under MMA, FESCs
are defined as clinics that are: 1) located in communities which
are at least 75 miles away from the closest hospital or are inaccessible
by public road and 2) designed to address the needs of patients
who are unable to be transferred to an acute care facility because
of adverse weather conditions or who need monitoring and observation
for a limited period of time.
In a separate recognition of the extended care services provided
by some frontier clinics, an additional demonstration program to
be administered by the Health Resources and Services Administration
(HRSA) was established by the Consolidated Appropriations Act of
2004.
Changes to the Program
The ORHP Frontier Extended Stay Clinics Cooperative Agreement was
the catalyst for a significant increase in the availability of quality
health care in four frontier communities in Alaska and Washington.
The Cooperative Agreement provided funding to the Alaska FESC Consortium
for additional provider staff, equipment and facility upgrades.
Each site meticulously recorded every extended stay via a detailed,
web-based encounter log. In addition, the Alaska FESC Consortium
worked closely with state and federal partners to craft standards,
policies and procedures, regulations, and conditions of participation.
They qualified the conditions under which patients can safely be
monitored and observed, and when they must be transferred to a higher
level of care.
Key Program Accomplishments
Preliminary results of the first year of data collection indicate
that the four clinics recorded 631 extended stays (two hours or
greater duration). Only 7 percent of the stays were over 24 hours;
48 percent of the extended stays resulted in being discharged home,
without further referral; 41 percent resulted in emergency transfer
to a higher level of care; 12 percent were referred on a non-emergent
basis.
At A Glance Amount
Awarded:
2004: $ 1.5 million
2005: $ 1.5 million
2006: $ 1.5 million
Grants Awarded:
2004: 1 new award
2005: 1 continuing award
2006: 1 continuing award
States:
ORHP awarded 1 grant to 1 state in FY 2005 |
ORHP Staff
|
Budget,
personnel, Government relations, operations oversight, legislation,
policy and administration issues, Secretary's Rural Initiative,
tribal health, oral health |
|
Budget, personnel,
National Advisory Committee on Rural Health and Human Services,
policy and research coordination, administrative issues |
|
Grants Program
Director (program oversight), guidance preparation, re-Authorization,
Division of Independent Review liaison, liaison to Grants Management
and Division of Grants Policy and Grants Tracking, State-based
activities |
|
Delta Health
Initiative Grant Program, Delta Small Rural Hospital Performance
Improvement Initiative, SOUTHEAST REGION LIAISON (Project Officer
for Southeast States in FLEX, SHIP, and State Office of Rural
Health) |
|
Rural Health
Care Services Outreach Grant Program Coordinator. Issue Areas:
women's health, maternal and child health, domestic violence,
school-based programs |
|
Single-Year
Rural Research Grant Program. Rural health policy issues including:
workforce, health information technology, Medicare payment policy,
Medicaid payment policy, rural health clinics, HHS Rural Task
Force, National Advisory Committee on Rural Health and Human
Services. |
|
Rapid Response
for Requests of Rural Data Analysis Cooperative Agreement. Rural
health policy issues, including: Medicare and Medicaid payment
policy, critical access hospitals, rural hospitals, rural health
clinic regulations, National Advisory Committee on Rural Health
and Human Services, rural Medicare demonstrations including
the Frontier Extended Stay Clinic model. |
|
Issue Areas:
Rural Recruitment and Retention Network liaison, Access to Capital
-MIDWEST REGION LIAISON |
|
Small Health
Care Provider Quality Improvement Grant Program Coordinator.
Issue Areas: health information technology, case management
services, public health, dietary/ metabolic syndrome issues |
|
Issue Areas:
clinical advisor/evaluation, quality (especially hospital and
primary care), nursing issues, influenza pandemic, State Hospital
Team Leader. NORTHWEST REGION LIAISON |
|
Rural Hospital
Flexibility Grant Program coordinator, Rural Assistance Center
Cooperative Agreement. Issue Areas: definitions of Rural (including
Rural Urban Commuting Areas) NORTHEAST REGION LIAISON |
|
Grant Program
Coordinator. Issue Areas: transportation (mobile clinics), chronic
disease and Alzheimer's |
|
Black Lung
Clinics Program, Coordinator Rural Health Outreach Grants
Issue area: mental health and substance abuse. |
|
State Offices
of Rural Health Grant Program Coordinator, Small Hospital Improvement
Program Coordinator and Human Resources Coordinator |
|
Network
Development Grant Program coordinator. Issue Areas: pharmacy
issues (coordination, prescription drugs and medication management) |
|
Rural Health
Care Services Outreach Grant Program Coordinator. Issue Areas:
cardiovascular health, diabetes, nutrition, obesity and elder
care |
|
Executive
Officer Liaison to the Office of the Administrator, Budget Coordinator,
National Advisory Committee on Rural Health and Human Services
logistics, SOUTHWEST REGION LIAISON |
|
Border Health
Initiative, U.S.- Mexico Border Health Commission liaison, SOUTHWEST
REGION LIAISON |
|
Issues Areas:
Rural EMS, Pharmacy, and Medicaid
Project Officer for Network, Outreach, Black Lung, and RESEP
Grants. |
|
Grants Program
Assistant, Electronic Handbook liaison, File Master. Issue Areas:
earmarks grants, health professions education, health literacy
and oral health. |
|
Delta Network
Development Grant Program Coordinator, Issue Areas: HIV/AIDS,
minority health, Indian/Tribal liaison, agricultural health
and safety, safety net collaboration, school-based programs,
and health education/promotion and disease prevention (general) |
|
Acting Intergovernmental
Affairs Coordinator (State Organizations: NGA, NACO, ASTHO,
NCSL, NRHA, NACCHO, Commissions, Technical Assistance Coordination)
and NHRA Liaison. |
|
Administrative
Team Coordinator, Inter/Intra Agency Agreements Coordinator,
contracts backup. Issue Areas: primary care access (general) |
|
Rural Health
Research Centers Grant Program Coordinator. Issue Areas: aging,
disability, long-term care and palliative care |
|
Rural Access
to Emergency Devices/Public Access to Defibrillation Demonstration
Grant Program Coordinator and Contracts Coordinator. Issue Areas:
health education/promotion and disease prevention (general) |
Support
Staff |
Mary
Collier |
|
April
Ward |
|
Footnotes
1. Section 711 of the Social
Security Act.
2. "One Department Serving
Rural America," February, 2003.
3. This activity had received
funding through the Trauma/EMS line in the annual budget due to
a rural 10 percent set aside in this line item in the budget line
authorized under Title XII of the Public Health Service Act. However,
the funding in this line item was eliminated in the FY 2006 budget.
|