Rural Health Care Services Outreach, Network and Quality Improvement Grants

Authorizing Legislation -Section 330A of the Public Health Service Act.

Program Description and Accomplishments
The Rural Health Care Services Outreach, Network and Quality Improvement Grants are a subcomponent of ORHP. The purpose of the grants is to improve access to care, coordination of care, integration of services and to focus on quality improvement. The grants began as a demonstration program in 1993 and were formally authorized in 1996. There are multiple grant programs administered under this authority. All of the grants support collaborative models to deliver basic health care services to the 55 million Americans living in rural areas.

The Rural Health Care Services Outreach grant program, which began in 1993, focuses on supporting community efforts to increase access to primary health care services for rural Americans. The program supports a wide range of services, including primary medical and dental care, mental health treatment, health promotion and health education services, and hospice care. The program awarded 122 grants in FY 2007.
The Rural Health Network Development grant program, which began in 1997, helps rural health providers develop community-based, integrated systems of care. This program has three separate competitions.

• The first is the Rural Network Development grants which support building regional or local partnerships among local hospitals, physician groups, long-term care facilities and public health agencies to improve management of scarce health care resources. The program awarded 38 grants in FY 2007.
• The second program under this authority, which began in 2001, provides network development grants to the eight States in the Mississippi Delta for network and rural health infrastructure development. The program awarded 12 grants in FY 2007.
• The third program in this authority supports Network Planning grants, which began in 2004. These grants provide small start-up funding to groups of rural health care providers who seek to work together in a more formal network to increase access to services and/or the viability of the local rural health care delivery system. The program awarded 10 grants in FY 2007.

The Small Health Care Provider Quality Improvement Grants began in 2006 and their purpose is to help small health care providers focus on specific interventions to improve health care quality in specific chronic disease areas. The program awarded 15 grants in FY 2007. In FY 2006, the Outreach program served 629,120 individuals, just below the target of 675,300.

This program was covered in OMB’s combined PART assessment of HRSA’s Rural Health Activities during 2003. The rural health activities received a rating of Adequate. (See earlier Office of Rural Health Policy Summary Request.)

Funding includes costs associated with grant reviews, processing of grants through the Grants Administration Tracking and Evaluation System (GATES) and HRSA’s electronic handbook, and follow-up performance reviews.

Funding History

Budget Request
There is no FY 2009 Budget request for this program. The need for this program has decreased as the result of rural provisions within the Medicare Modernization Act of 2003 (MMA). The MMA contained several provisions to support rural health, for example by increasing Medicare Critical Access Hospital (CAH) payments to 101 percent of costs and broadening eligibility criteria for CAHs. The number of CAHs receiving enhanced Medicare payments has grown significantly since the passage of the MMA. In addition, the HHS administers approximately 225 other health and social services programs that provide resources to rural areas. There is no target for the performance measures for FY 2009 as there is no request for this program.