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OFFICE
OF RURAL HEALTH POLICY
Summary
of the Request
|
FY
2007 Actual |
FY
2008
Enacted |
FY
2009
Estimate |
FY
2009 +/-
FY 2008 |
BA |
$160,071,000 |
$167,100,000 |
$16,878,000 |
-$150,222,000
|
FTE |
2 |
4 |
--- |
-4 |
The
purpose of the Office of Rural Health Policy is to
serve as a focal point for rural health activities
within the Department. The Office meets that charge
by serving as a policy and research resource on rural
health issues. In addition, the Office administers
several grant programs that focus on supporting and
enhancing health care delivery in rural communities.
Created in 1987, ORHP advises the Secretary and other
components of the Department on rural health issues
with a particular focus on working with rural hospitals
and other rural health care providers to ensure access
to high quality care in rural communities. The Department
has maintained a significant focus on rural activities
for 20 years. Historically, rural communities have
struggled with issues related to access to care, recruitment
and retention of health care providers and maintaining
the economic viability of hospitals and other health
care providers in isolated rural communities.
The administration requests $16,878,000 for Rural
Health Activities, including:
-
$8,737,000 for Rural Health Policy Development which
reflects an increase of $153,000. Funding will support
activities such as the rural health research center
grant program as well as policy analysis and information
dissemination activities on a range of rural health
issues.
-
There is no FY 2009 request for Rural Health Outreach,
Network Development and Quality Improvement Grants,
which reflects a reduction of $48,031,000. The reduction
in support for these activities will be offset through
other existing programs within HHS that can meet
the same need.
-
There is no FY 2009 request for Rural Hospital Flexibility
Grants, which reflects a reduction of $37,865,000.
The Rural Hospital Flexibility Grants have supported
grants that assist small rural hospitals including
Critical Access Hospitals (CAHs). The reduction
in support for these activities will be met through
other existing programs within HHS.
-
The reduction in support for these activities will
be offset by enhanced reimbursement for rural hospitals
as a result of the Medicare Modernization Act of
2003 that included more than $25 billion in rural
health payment improvements.
- $8,141,000
for State Offices of Rural Health Grants, which
reflects an increase of $142,000. The State Offices
of Rural Health Grants provide matching grants to
States to ensure the existence of a focal point
for rural health activity within each of the 50
States.
-
There is no FY 2009 request for Rural Access to
Emergency Devices Grants, which reflects a reduction
of $1,461,000. The Rural Access to Emergency Devices
Grants provide funds to rural communities for the
purchase of automatic external defibrillators (AEDs)
and the training of first responders in their use.
The reduction in support for these activities will
be met through other existing programs within HHS.
Previous federal investments have largely met the
need.
-
There is no FY 2009 request for the Denali Commission,
which reflects a reduction of $38,597,000. The Denali
Commission, an Agency of the Department of Commerce,
supports the planning, designing and construction
of health care facilities in Alaska. The reduction
in support for these activities is offset by previous
Federal investments which have largely met the need.
This activity has already received more than $300
million in funding since 2000.
-
There is no FY 2009 request for the Delta Health
Initiative, which reflects a reduction of $24,563,000.
The purpose of this grant is to meet health care
needs in the rural Delta region of the State of
Mississippi with an emphasis on improving access
to rural health care services, increased rural training
of health care professionals, implementation of
electronic health records, and the construction
of healthcare facilities. Other programs in HRSA
address many of these needs
The ORHP programs have two annual performance measures.
The Rural Health Care Services Outreach program served
627,120 individuals in 2006, the most recent year
for which data are available. The Rural Hospital Flexibility
Grant program has helped improve operating margins
for Critical Access Hospitals (CAHs) with these facilities
reporting a -8.8 operating margin in 2006, an improvement
from 2005 when CAHs had an average operating margin
of -9.6 percent. This reflects a continued improvement
trend as the targets have been exceeded each year
since the benchmark margin of -14.05 operating margin
was set based on 1999 data. There is no request to
support these rural activities in the 2009 budget
so there is no target for performance measures.
The ORHP programs went through the PART process as
a single entity (Rural Health Activities) in 2003.
The program received a rating of Adequate. The review
noted that some of its programs may be duplicative
of other programs within HHS and that one of the primary
challenges for the programs comes from flaws in the
program’s various program authorizations, which
are fragmented. As a result of the review, ORHP is
developing new health and quality-related annual performance
measures to further demonstrate program accomplishments.
Funding History
FY
2004 |
$142,119,000
|
FY
2005 |
$144,210,000
|
FY
2006 |
$184,985,000 |
FY
2007 |
$160,071,000 |
FY
2008 |
$167,100,000 |
Budget
Request
The FY 2009 request of $16,878,000 will support the
Rural Health Policy Development program and State
Offices of Rural Health. This will continue funding
for activities such as the rural health research center
grant program as well as policy analysis and information
dissemination activities on a range of rural health
issues. The Budget reduces funding for smaller scale
activities that have fulfilled their intended purpose
or are duplicative of one of the hundred of HHS activities
that focus on rural health care activities. Additionally,
support for the State Offices of Rural Health Grants
will provide matching grants to States to ensure the
existence of a focal point for rural health activity
within each of the 50 States.
# |
Key
Outcomes |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007; |
FY
2008 Target
|
FY
2009
Target |
Out-Year
Target |
Target |
Actual |
Target |
Actual |
Long-Term
Objective: Focus resources and services on diseases
and conditions with the greatest health disparities |
27.1 |
Reduce
the proportion of rural residents of all ages
with limitation of activities caused by chronic
conditions (Baseline-2000: 14.67%) |
|
|
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|
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|
2010:
13% |
# |
Key
Outputs |
FY
2004 Actual |
FY
2005 Actual |
FY
2006 |
FY
2007 |
FY
2008 Target/Est. |
FY
2009 Target/Est. |
Out-Year
Target/Est. |
Target/Est. |
Actual |
Target/Est. |
Actual |
Long-Term
Objective: Focus resources and services on diseases
and conditions with the greatest health disparities |
27.
IV. A.1 |
Increase
by 1% annually the number of people served through
Outreach Grants |
655,257 |
776,880 |
675,300 |
627,120 |
777,000a |
Oct-08 |
785,000 |
NA |
NA |
Long-Term
Objective: Increase collaborative efforts to improve
the capacity and efficiency of public health and
health care systems |
27.2 |
Increase
the proportion of critical access hospitals with
positive operating margins (Baseline-1999: 10%) |
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2010:
35% |
27
V.B.1 |
Increase
by 0.5 percentage point annually the average operating
margin of critical access hospitals |
-10.20% |
-9.60% |
0.5
% point over FY 05 |
-8.80% |
0.5%
point over FY
06 a |
Sep-08 |
0.5%
over FY 07 |
NA |
NA |
Efficiency
Measure |
27.E |
Increase
the return on investment of funds by the Rural
Hospital Flexibility (FLEX) grant program, as
measured by change in total operating margin of
critical access hospitals in relation to FLEX
dollars invested |
23.36% |
14.80% |
24.50% |
Sep-08 |
25%
a |
Sep-09 |
26% |
NA |
NA |
|
Appropriated
Amount ($ Million) |
142.119 |
144.21 |
|
159.985 |
|
160.071 |
167.1 |
16.878 |
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Notes:
a |
The
FY 2007 target in the FY 2008 Congressional Justification
was changed to reflect a full-year continuing
resolution for FY 2007. |
NA = For FY 2009: Not applicable as no funding is
requested. Rural Health programs were reduced due
to the
investment contained in the rural provisions of the
Medicare Modernization Act of 2003.
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