Skip Navigation HRSA - U.S Department of Health and Human Services, Health Resources and Service Administration U.S. Department of Health & Human Services
Home
Questions
Order Publications
 
Grants Find Help Service Delivery Data Health Care Concerns About HRSA
FY 2009 Budget Justification
 
PDF FY 2009 Budget Justification
(PDF – 2.69 MB)

HEALTH RESOURCES AND SERVICES ADMINISTRATION

SIGNIFICANT ITEMS IN HOUSE, SENATE AND CONFERENCE APPROPRIATIONS COMMITTEE REPORTS

The following section represents FY 2008 Congressional requirements for reports and significant items derived from House Report 110-231, Senate Report 110-107 and Conference Report 110-424

FY 2008 House Appropriations Committee Report Language (House Report 110-231)

ITEM 1
Expansion of Community health centers -- The Committee supports continued efforts to expand the health centers program into those areas of the country without current access to a health center. The Committee urges HRSA to implement such an expansion to address the lack of access in the neediest communities of the country, and not to limit new funding to certain geographic areas, such as counties. The Committee has rejected bill language requested by the Administration setting aside $26,000,000 for high-poverty counties. Further, the Committee urges HRSA to make funding available to increase capacity at existing centers, and for service expansion awards adding or expanding mental health services, dental services, and pharmacy services at community health centers. HRSA should also use a portion of the increased funding to provide planning grants to help communities develop their plans for future applications. The Committee expects HRSA to implement any new expansion initiative using the existing, and statutorily-required, proportionality for urban and rural communities, as well as migrant, homeless, and public housing health centers.

Action taken or to be taken
HRSA recognizes the importance of providing funds to expand health centers in areas without access to primary care services, to increase health centers’ capacity and to add or expand mental health, dental services, and pharmacy services. For FY 2008, HRSA has announced a funding opportunity targeting expansion in areas of high need under a New Access Point funding opportunity. HRSA has also announced funding opportunities for Expanded Medical Capacity and Service Expansion in mental health, dental services and pharmacy services. All awards in FY 2008 will be consistent with existing statutory requirements for urban/rural and proportionate distribution of funds.

ITEM 2
Community health centers - increasing information technology -- This loan authority is important to give centers access to capital for infrastructure improvements. The Committee recognizes the importance of increasing the use of health information technology (IT) at health centers. Health centers have demonstrated improved access to services, improved quality of care and improved patient outcomes by utilizing electronic health records and other health information technology (HIT) tools through their participation in health center controlled network initiatives, and other quality improvement initiatives such as the health disparities collaboratives. Given this success, the Committee urges HRSA to ensure that health centers have adequate resources to establish and expand health IT systems in order to further enhance the delivery of cost-effective, quality health care services.

Action taken or to be taken
In FY 2007, the Health Resources and Services Administration (HRSA) provided $31.4 million in grants to help health centers prepare to adopt and implement Electronic Health Records (EHR) and other health information technology (HIT) innovations.

  • There were twenty-five grants totaling more than $27 million to support implementation of EHRs at health centers and in networks that link multiple health center grantees.
  • Eight grants worth almost $1 million awarded to help health centers in planning activities that prepared them to adopt EHR or other HIT innovations were awarded.
  • Thirteen grants worth more than $3 million to help health center networks implement HIT other than electronic health records were also awarded. Other HIT advances included electronic prescribing, physician order entry, personal health records, community health records, health information exchanges, smart cards, and creating interoperability with outside partners such as health departments and other HRSA grantees.

In addition to grants, HRSA has also provided a great deal of technical assistance to health centers to adopt HIT. In collaboration with its sister agency, AHRQ, HRSA implemented and launched a technical assistance web portal designed to serve the HIT needs of health centers. The portal disseminates lessons learned, model practices, basic information, and also includes an HIT Toolkit with modules designed to answer grantee questions about HIT adoption. In less than one year, over 2000 users requested and received login names and passwords to the health center portal.

HRSA sponsored its first all HRSA HIT grantee meeting in November 2007. Registration exceeded HRSA’s goal of 500 attendees. In addition, HRSA began sponsoring a series of HIT Technical Assistance calls and two calls have been held so far. Each call attracted approximately 200 callers. Additional calls are scheduled on a monthly basis for 2008.

ITEM 3
Community health centers- training and technical assistance initiatives -- The Committee recognizes the important role of CHCs in caring for people living with or at risk for hepatitis C (HCV). The Committee encourages the Bureau of Primary Care to increase health centers’ capacity for delivery of medical management and treatment of HCV by implementing training and technical assistance initiatives, so that health centers are able to increase hepatitis C counseling, testing, medical management, and treatment services to meet the healthcare priorities of their respective communities.

Action taken or to be taken
Health Centers provide Hepatitis C related services as an integral component of comprehensive primary health care. Hepatitis testing, treatment, and counseling are also part of HRSA’s Bureau of Primary Health Care (BPHC) quality improvement strategy for health centers. As part of this strategy, HRSA/BPHC will work with its National, regional and State training and technical assistance training partners to expand health center capacity in these areas.

ITEM 4
National Health Service Corps in health centers -- The Committee is pleased by the increasing proportion of NHSC assignees being placed at community, migrant, homeless, and public housing health centers. The Committee encourages HRSA to further expand this effort to ensure that health centers have access to a sufficient level of health professionals through the NHSC, especially given recent efforts to expand the health centers program.

Action taken or to be taken
The NHSC has historically had a strong partnership with the health centers. Currently, 50 percent of NHSC clinicians practice in health centers across the Nation. For the last three years the percent of NHSC field strength serving in health centers has been at least 50 percent. The FY 2008 NHSC Opportunities List contains 4,888 vacancies, 2,704 (55 percent) of which are in health center facilities. The NHSC works closely with health centers on recruitment; including training in recruitment strategies and encouraging health centers’ participation in job fairs held in conjunction with NHSC Scholar Conferences. The NHSC also assists health centers to retain clinicians after their service commitment has been fulfilled; the Program’s success can be measured by the large cadre of NHSC alumni that continue to practice in health centers, providing strong, experienced clinical and administrative leadership to those facilities. The NHSC expects to continue to support health center expansion by helping to increase access to dental care through targeting the requested funding increase to loan repayment contracts for dentists, especially those in high-need health centers.

ITEM 5
Nursing faculty loan program -- The Committee recognizes that the growing nurse faculty shortage is directly linked to the nationwide shortage of registered nurses. According to the American Association of Colleges of Nursing’s 2006-2007 survey, almost three quarters of the nursing schools offering baccalaureate and graduate nursing programs pointed to faculty shortages as a major reason for turning away nearly 43,000 qualified applicants. In addition, the average ages of doctoral-prepared nurse faculty holding the ranks of professor, associate professor, and assistant professors are 59, 56, and 52 years, respectively. A wave of nurse faculty retirements is projected for the next ten years that will only worsen the crisis. The Committee urges the Secretary of Health and Human Services to continue efforts to address the nurse faculty shortage as well as the impending retirements of nurse faculty.

Action taken or to be taken

The Nurse Faculty Loan Program (NFLP), implemented in FY 2003, seeks to increase the number of qualified nursing faculty. The program supports the establishment and operation of a loan fund within participating schools of nursing to assist nurses in completing their graduate education to become qualified nurse faculty. In FY 2008, it is estimated that 1,201 participants will receive loan support through the Nurse Faculty Loan Program.

There are currently 119 schools that participate in the NFLP (This number reflects new awards and awards based upon participating schools with excess cash). Thus far, the NFLP has supported 162 students qualified to fill nurse faculty positions. In FY 2007, approximately 418 continuing students received NFLP loan support. Each year has seen an increase in the number of participating schools coupled with an even greater increase in the number of new students requesting NFLP support.

ITEM 6
Oral health -- The Committee directs HRSA to strengthen its support of the oral health infrastructure within the agency and to appoint a chief dental officer.

Action taken or to be taken

As an extension of his role as the head of the Oral Health Workgroup, HRSA’s Administrator named, Stephen R. Smith as HRSA’s Oral Health Coordinator and chair of the HRSA Oral Health Work Group. The Administrator designated Dr. Jay Anderson as HRSA’s Chief Dental Officer. In carrying out the duties of Chief Dental Officer, Dr. Jay Anderson will report directly to HRSA’s Oral Health Coordinator. Duties of the Chief Dental Officer include: assisting the Oral Health Coordinator in coordinating oral health activities across all HRSA programs; and advising the Oral Health Coordinator and HRSA on the recruitment, assignment, deployment, retention, and career development of dentists and other oral health professionals. Dr. Anderson will serve as the principal dental consultant for all HRSA oral health programs and as advisor to the Administrator of HRSA on all matters concerning oral health.

ITEM 7
Oral health -- The Committee is aware that dental disease disproportionately affects our Nation’s most vulnerable populations. New ways of bringing oral health care to underserved populations are needed to address geographic and other challenges that exist. The Committee encourages HRSA to explore innovative programs for delivering preventive and restorative oral health services, including State and community proposals and programs that seek to improve access to care in accordance with State licensing laws.

Action taken or to be taken
HRSA has been committed to providing access to and otherwise addressing the disproportionate incidence of dental disease among populations in health professional shortage areas (HPSAs) and medically underserved areas (MUAs).

Through its Grants to States to Support Oral Health Workforce Activities program (HRSA-06-134), States have made available HRSA funding to public and non-profit eligible organizations to reduce health barriers and health disparities. Funded under Section 340G of the PHS Act, the program requires community-based collaborative proposals to address oral health access issues. This is accomplished through the establishment of community-based dental clinics as well as dental health coordinators in HPSAs to provide community, evidence-based dental prevention programs. This program is designed to be as flexible as possible for States to address specific dental workforce needs of underserved urban and rural populations comprising, in many cases, large groups of ethnic/racial minorities. In FY 2007, this program provided funding of $1,980,000 for 18 grants. The average amount awarded was $100,000 (range $80,000 -120,000) per grantee.

HRSA has collaborated with dental professionals through the Bureau of Health Professions participation in meetings with the ADA, American Dental Education Association (ADEA), American Academy of Pediatric Dentistry (AAPD), National Dental Association (NDA), Hispanic Dental Association (HDA), Academy of General Dentistry (AGD), American Association of Public Health Dentistry (AAPHD), Association of State and Territorial Dental Directors (ASTDD), Special Care Dental Association, (SCDA), and the APHA Oral Health Section. The Agency has given $100,000 to the Institute of Medicine to embark on a study of oral health workforce needs to include convening a major workshop on oral health workforce issues.

The NHSC offers recruitment incentives, such as scholarship and loan repayment support to health professionals, including dentists, committed to service to the underserved. To date, more than 28,000 have served by participating in either the scholarship or loan repayment program. NHSC clinicians have expanded access to high quality primary medical, dental, and mental and behavioral health care to the Nation’s underserved. In 2006, 486 dentists and 65 dental hygienists served as NHSC clinicians. In FY 2007, 29 new scholarships were awarded to dental students, and 88 new loan repayment contracts were awarded to dentists, with 12 new contracts awarded to dental hygienists.

ITEM 8
Newborn screening -- The Committee commends HRSA for convening the Secretary’s Advisory Committee on Heritable Disorders and Genetic Diseases in Newborns and Children to develop National recommendations for standardizing newborn screening programs in the U.S. and for funding the Regional Genetic Service and Newborn Screening Collaborative to address the maldistribution of genetic services and resources to bring services closer to local communities. However, the Committee is aware that wide disparities continue to exist among States in the number of conditions for which newborns are screened and in the service infrastructure for infants who test positive. The Committee encourages HRSA and the Secretary’s Advisory Committee to consider developing written guidance for parents on the availability of additional screens that may not be required under State law. (Page 74)

Action taken or to be taken
HRSA’s Maternal and Child Health Bureau (MCHB) has produced both parent and professional educational materials about newborn screening. These materials have been endorsed by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology and distributed to their membership for use with parents in their practices. In addition, the HRSA/MCHB funded National Newborn Screening and Genetics Resource Center has established a link on its homepage to Commercial and Non-Profit Organizations offering Expanded Newborn Screening Tests.

ITEM 9
Vision screening -- The Committee understands that States currently conduct childhood screening programs through their MCH block grant. The Committee recognizes that vision disorders are the leading cause of impaired health in childhood, and that one in four school-age children has a vision problem significant enough to affect their learning. The Committee urges the States to strengthen their vision screening programs and to broaden the programs’ geographic reach. In this effort, States are encouraged to take maximum advantage of the ongoing vision screening program conducted by the Centers for Disease Control and Prevention, which is increased by 40.6 percent to $3,466,000 in the bill.

Action taken or to be taken

HRSA will Conduct a review of the Title V Information System to determine the extent to which State Maternal and Child Health ( MCH) programs are engaged in and can report on childhood vision screening including the vision screening program conducted by the Centers for Disease Control and Prevention. In addition to this review, HRSA will analyze the findings to determine promising models that could contribute to a Statewide/universal childhood vision screening program.

Following this review and analysis, HRSA will conduct a preliminary meeting of relevant stakeholders to discuss such things as:

the best age at which to conduct screening;
the existence of screening tools;
the feasibility of a Statewide versus a universal childhood vision screening program; and
the existence of promising models

ITEM 10
Thalassemia -- The Committee reiterates its long-standing support for the continuation of funding for comprehensive thalassemia treatment centers under the SPRANS program. The Committee strongly encourages HRSA to continue this program and to coordinate closely its activities with the thalassemia clinical research network and the related voluntary organizations.

Action taken or to be taken
HRSA’s Maternal and Child Health Bureau (MCHB) continues to support the comprehensive thalassemia treatment centers under the SPRANS program.

ITEM 11
Hemophilia --The Committee urges HRSA to maintain its funding support of the network of hemophilia treatment centers, which provide comprehensive disease management services to men and women with bleeding and clotting disorders.

Action taken or to be taken
Through the SPRANS program, HRSA’s Maternal and Child Health Bureau (MCHB) continues to support the network of hemophilia treatment centers, our National Hemophilia Program, to provide comprehensive disease management services to men and women with bleeding and clotting disorders.

ITEM 12
Universal newborn hearing screening --The Committee is concerned that even though approximately 90 percent of babies are now screened for hearing loss before one month of age, about one-third of those who are referred for screening do not receive diagnostic evaluations by three months of age. Moreover, only about half of the infants and toddlers diagnosed with permanent hearing loss are enrolled in appropriate early intervention programs by six months of age. To avoid duplication, the Committee encourages HRSA to coordinate projects funded with this appropriation with projects related to early hearing detection and intervention by the National Center on Birth Defects and Developmental Disabilities, the National Institute on Deafness and Other Communication Disorders, the National Institute on Disability and Rehabilitation Research, and the Office of Special Education and Rehabilitative Services.

Action taken or to be taken
HRSA’s newborn hearing screening program is highly coordinated with related efforts in other Federal agencies as well as the American Academy of Pediatrics and such parent support groups as Family Voices and Hands and Voices.

ITEM 13

Hepatitis C Virus -- The Committee encourages HRSA to provide guidance to grantees to encourage them to proactively address HCV care and treatment among their HIV/HCV coinfected patient populations and provide more education and training to medical providers treating HIV/HCV coinfected persons. The Committee also encourages State AIDS Drug Assistance Programs (ADAP) to provide coverage of therapies approved by the Food and Drug Administration for the treatment of HCV in HIV/HCV co-infected patients.

Action taken or to be taken
HRSA continues to be aware of the significant morbidity and mortality of HCV among people living with HIV in the United States. HRSA has worked closely with State ADAPs to maximize their efficiencies in order to expand their formularies to provide more life saving treatments to greater number of people. The TA document published by HRSA in June, 2006, Care and Treatment for Hepatitis C and HIV Coinfection: Expanding Access Through the Ryan White CARE Act, specifically addresses concerns of State ADAPs. In January, 2007, HRSA hosted a National TA call on HIV/HCV co-infection for State ADAPs.

ITEM 14
HIV drug resistance -- The Committee is concerned about the increasing incidence of HIV drug resistance among Americans living with HIV/AIDS. New, active HIV therapies are being developed that treat patients with HIV resistance. Current, National HIV treatment guidelines require that each patient’s treatment regimen be individualized and include two or more active agents. CMS, in developing regulations for Medicare Part D plans, recognized the importance of making new HIV antiretrovirals available to providers and patients as soon as possible by requiring Part D plan pharmacy and therapeutics review committees to conduct expedited reviews of new HIV treatments within 90 days of FDA approval. Therefore, the Committee urges HRSA to ensure that State AIDS Drug Assistance Programs provide immediate access to all new antiretroviral therapies for their eligible clients.

Action taken or to be taken
HIV treatments have improved considerably in the last few years for patients with multi-drug resistant virus. HRSA continues to provide technical assistance to States to assist them in prioritizing life-saving HIV therapies and will continue to do so as instructed in the Ryan White HIV/AIDS Treatment Modernization Act of 2006, which requires the Secretary to develop a list of drug classes, based on the DHHS Clinical Practice Guidelines, for inclusion in ADAP formularies. HRSA has worked closely with the DHHS Clinical Practice Guidelines Committees to assure rapid integration of new therapies into the guidelines. HRSA has provided technical assistance to the ADAP grantees regarding this new requirement and its implementation.

ITEM 15
Early intervention program -- The Part C, . . . early intervention services program, . . . . Funds are used for discretionary grants to community health centers, family planning agencies, comprehensive hemophilia diagnostic and treatment centers, Federally-qualified health centers, county and municipal health departments and other non-profit community-based programs that provide comprehensive primary care services to populations with or at risk for HIV disease. . . The Committee urges HRSA to direct funding increases above the fiscal year 2007 level to existing Part C service areas rather than to expand the overall number of Part C programs. The number of Part C sites has continued to expand even in the absence of funding increases; existing programs are experiencing significant strains. There is already strong geographic diversity in the Part C program.

Action taken or to be taken
All currently anticipated increases in funding for the Part C Early Intervention Services program will be directed to existing Part C grantees.

ITEM 16
Pulmonary hypertension (PH) -- The Committee commends HRSA for its leadership in promoting increased organ and tissue donations across the Nation and encourages the Division of Transplantation to expand its partnership with the pulmonary hypertension community in this important area. In addition, the Committee commends UNOS for working with the pulmonary hypertension community to address concerns regarding the allocation of lungs for transplantation in PH patients. The Committee encourages UNOS to continue its dialogue to monitor any concerns regarding the methodology used to determine transplant eligibility for PH patients.

Action taken or to be taken
HRSA will continue to work with the Organ Procurement and Transplantation Network to assure that all interested stakeholders in the OPTN policy development process have an opportunity to present their views, opinions and concerns. In addition to the normal public comment process, the OPTN and HRSA have met with organizations representing patients with specific diseases for which transplantation may be an appropriate therapeutic intervention. These dialogs are encouraged and help to shape policies that are as fair and equitable as possible.

ITEM 17
340B prices -- In January, 2007, HRSA issued proposed guidelines that would make significant changes to the traditional definition of the term “patient” under the drug discount program authorized by Section 340B of the Public Health Service Act. The Committee has heard concerns about numerous aspects of the proposed guidelines, including the limitations to prescriptions resulting from outpatient services and requirements regarding patient health record information. The Committee urges HRSA to consider the concerns raised by the external community as it reviews the guidelines before publication in final form.

Action taken or to be taken
With respect to comments on the proposed guidance “Regarding Section 602 of the Veterans Health Care Act of 1992 Definition of ‘Patient” published in the Federal Register at 72 Fed. Reg. 1543 on January 12, 2007, HRSA is in the process of reviewing all of the comments which will be carefully considered prior to publication of final guidance in the Federal Register. HRSA is mindful of the dual need to provide guidance to best ensure compliance with the law and the need to provide flexibility and minimal burden upon covered entities in their essential efforts to provide care to their patients. HRSA intends to publish a final guidance after completing the review process.

ITEM 18
Prevention and treatment of heart disease, stroke and other cardiovascular diseases in women
-- The Committee is concerned that there is a widespread lack of awareness among health care providers that cardiovascular disease is the leading killer of women in the United States. The Committee encourages HRSA to conduct an education and awareness campaign for physicians and other health care professionals relating to the prevention, diagnosis, and treatment of heart disease, stroke and other cardiovascular diseases in women.

Action taken or to be taken
The HRSA Office of Women’s Health coordinates women’s health-related activities across all of HRSA’s Bureaus, and works closely with the Bureau of Health Professions and the Bureau of Primary Health Care to ensure evidence-based information and educational materials are made available to public service providers in contact with women across their lifespan. Since 2001, the National Heart, Lung, and Blood Institute, in partnership with other Federal and non-Federal partners, has coordinated “The Heart Truth Campaign,” an excellent National education and awareness campaign for women, their health care providers, and their communities focused on heart disease. Targeted provider materials include extensive lecture materials and slides, problem-based learning cases, clinical tools, and self-study modules with CME/CEU credits, and can be found at http://www.womenshealth.gov/hearttruth/

The HRSA Office of Women’s Health relies on information provided by the NHLBI effort to further heart disease education and awareness.

ITEM 19
Health center program expansion --The Committee supports continued efforts to expand the Health Centers program into those areas of the country with high poverty and no current access to a health center. The Committee urges HRSA to implement such an expansion to address the lack of access in the neediest communities of the country, and that eligibility for new funding not be limited to certain geographic areas, such as counties. The Committee directs HRSA to expedite awards to new access points by funding sufficiently high-scoring applications from the fiscal year 2007 cycle that were left unfunded.

Action taken or to be taken
HRSA recognizes the importance of expanding the Health Center Program into areas of high poverty with no access to a health center. For FY 2008, HRSA has announced a New Access Point funding opportunity which will support health centers in high need areas across the country. New Access Point applications that were not selected for funding in FY 2007 are eligible for funding for up to one year from notification from HRSA.

ITEM 20
Expansion of existing centers -- Further, the Committee urges HRSA to make funding available to increase capacity at existing centers, and for service expansion awards adding mental health services, dental services, and pharmacy services at community health centers. The Committee expects HRSA to implement any new expansion initiative using the existing, and statutorily-required, proportionality for urban and rural communities, as well as migrant, homeless and public housing health centers.

Action taken or to be taken
HRSA recognizes the importance of providing funds to increase health centers’ capacity and to add or expand mental health, dental services, and pharmacy services. For FY 2008, HRSA announced funding opportunities for Expanded Medical Capacity and Service Expansion in mental health, dental services and pharmacy services. All awards in FY 2008 will be consistent with existing statutory requirements for urban/rural and proportionate distribution of funds across special populations.

ITEM 21
Rural health center expansion -- The Committee strongly urges HRSA to assist rural communities in high-need areas of the country that have not fully participated in the Health Center expansion effort in recent years. Despite documented need, many eligible counties have not received health center grants. The focus on financial viability and regionally specific criteria, such as homeless populations and migrant workers, has sometimes held back communities outside of the targeted demographic. The Committee notes that very high poverty and extremely underserved rural areas experience significant challenges in getting resources together to form a successful application. The Committee urges HRSA to provide technical assistance and consider funding planning grants to potential new access point grantees to enable them to better compete for health center awards.

Action taken or to be taken
HRSA understands the special challenges that some areas may face in competing for funding. The FY 2008 application guidances have been developed to include special consideration for sparsely populated areas in the administration of the grant opportunities supported under the Health Center Program. Currently, 53.0 percent (569) of Health Center grantees serve rural populations. In 2006, grantees served over 6,688,356 people in rural areas providing 20.5 million encounters. HRSA provides technical assistance to potential applicants in rural and urban areas across the country via direct communication, web-based information, interactive conference calls and local, State, and National meetings.

ITEM 22
Services to persons living with hepatitis C -- The Committee recognizes the important role of the consolidated health centers in caring for people living with or at risk for hepatitis C. The Committee encourages HRSA to increase health centers' capacity for delivery of medical management and treatment of HCV by implementing training and technical assistance initiatives, so that health centers are able to increase hepatitis C counseling and testing, and medical management and treatment services to meet the healthcare priorities of their respective communities.

Action taken or to be taken

Health Centers provide Hepatitis C related services as an integral component of comprehensive primary health care. Hepatitis testing, treatment, and counseling are also part of HRSA’s Bureau of Primary Health Care (BPHC) quality improvement strategy for health centers. As part of this strategy, HRSA will work with its National, regional and State training and technical assistance training partners to expand health center capacity in these areas.

RURAL – ITEM 23
Review of regulations in effort to better reach remote communities -- The Committee continues to be concerned that community health center funds are often not available to small, remote communities because the population base is too small. Many of these communities have no health service providers and are forced to travel long distances by boat or plane even in emergency situations. The Committee recommends that HRSA examine its regulations and applications procedures to ensure they do not unduly burden small communities and are appropriately flexible to meet the needs of these communities. . . . The Committee applauds the agency for its Frontier Health Plan initiative, and encourages the agency to continue and expand its efforts with this program.

Action taken or to be taken
Through its community-based rural grant programs, HRSA makes special efforts to reduce administrative burdens in applying for these funds. This requirement recognizes that rural communities struggle to achieve economies of scale and therefore rely on partnerships and collaboration to address health issues.

HRSA remains committed to frontier health issues and will continue and expand its work in this area in the coming year by continuing its work on the Frontier Extended Stay Clinic demonstration, continued expansion of community health center grants and through dissemination of information about frontier health issues through the Rural Assistance Center (RAC).

Currently, 53.0 percent (569) of Health Center grantees serve rural populations. In 2006, health center grantees served over 6,688,356 people in rural areas providing 20.5 million encounters. Since the start of the President’s Initiative (2002) through FY 2007, the following awards have been made for health centers serving rural populations:
- 364 New Access Point Grants
-Including 55 High Poverty New Access Point Grants
-20 High Poverty Planning Grants
-216 Expanded Medical Capacity Grants

For sparsely populated communities, HRSA recognizes that the recommended level of staffing and/or services may not be supportable in sparsely populated areas. Therefore, alternative methods of providing necessary support for isolated providers, including participation in rural service delivery networks may be considered appropriate. For example, applicants that by themselves may not be able to meet the staffing recommendations and/or service requirements may, through formal agreements regarding clinical and referral arrangements or strong collaborative relationships with other local providers, be considered to have met the staffing level recommendations and/or service requirements.

In addition, HRSA provides a funding preference for sparsely populated area applicants. As a consequence, since the beginning of the President’s Initiative, a total of 80 sparsely populated area health centers have been funded.

ITEM 24
Health information technology at health centers -- The Committee recognizes the importance of increasing the use of health information technology [IT] at health centers. Health centers have demonstrated improved access to services and improved patient outcomes by using electronic health records and other IT tools through their participation in various networks, projects, systems, and collaboratives. The Committee urges HRSA to ensure that health centers have adequate resources to establish and expand health IT systems to further enhance the delivery of cost-effective, quality health care services.

Action taken or to be taken

On August 27, 2007, the Health Resources and Services Administration (HRSA) Administrator Elizabeth M. Duke announced $31.4 million in grants to help health centers prepare to adopt and implement Electronic Health Records (EHR) and other health information technology (HIT) innovations.

  • There were twenty-five grants totaling more than $27 million to support implementation of EHRs at health centers and in networks that link multiple health center grantees. They are accessible on the HRSA News Room Web site: http://newsroom.hrsa.gov/releases/2007/HITgrantsAugust.htm.
  • Eight grants worth almost $1 million awarded to help health centers in planning activities that prepared them to adopt EHR or other HIT innovations were awarded.
  • Thirteen grants worth more than $3 million to help health center networks implement HIT other than electronic health records were also awarded. Other HIT advances included electronic prescribing, physician order entry, personal health records, community health records, health information exchanges, smart cards, and creating interoperability with outside partners such as health departments and other HRSA grantees.

In addition to grants, HRSA has also provided a great deal of technical assistance to health centers to adopt HIT. In collaboration with its sister agency, AHRQ, HRSA implemented and launched a technical assistance web portal designed to serve the HIT needs of health centers. The portal disseminates lessons learned, model practices, basic information, and also includes an HIT Toolkit with modules designed to answer grantee questions about HIT adoption. In less than one year, over 2000 users requested and received login names and passwords to the health center portal.

HRSA sponsored its first all HRSA HIT grantee meeting in November 2007. Registration exceeded HRSA’s goal of 500 attendees. In addition, HRSA began sponsoring a series of HIT Technical Assistance calls and two calls have been held so far. Each call attracted approximately 200 callers. Additional calls are scheduled on a monthly basis for 2008.

ITEM 25
Integrated Health Centers and Nurse-Managed Health -- Centers in new public-private safety net partnerships] --The Committee recognizes the service to the uninsured by Integrated Health Centers [IHCs] and Nurse-Managed Health Centers [NMHCs]. These nonprofit hospital-affiliated or university-based health centers provide much needed primary care to a diverse and disadvantaged population. These health centers are frequently the only source of primary care to their patients. The Committee encourages HRSA to explore options to include IHCs and NMHCs in new public-private safety net partnerships thereby increasing access for the medically underserved and increase the clinical education sites to increase nurse education. Specifically, the Committee encourages HRSA to explore granting these health centers the ability to apply for FQHC Look-Alike status.

Action taken or to be taken
HRSA recognizes that Integrated Health Centers (IHCs) and Nurse-Managed Health Centers (NMHCs) serve an important role in improving the overall access to care for the Nation’s underserved populations. IHCs and NMHC’s are eligible to apply for the funding opportunities supported under the Health Center Program and for designation under the Federally Qualified Health Center Look-Alike Program. HRSA provides technical assistance to potential applicants for funding and for FQHC Look-Alike designation via direct communication, web-based information, interactive conference calls and local, State, and National meetings.

ITEM 26
Providing administrative competency curriculum to Native Hawaiians -- The Committee is pleased with the administration’s response and recognition of the island designation and seeks continued support in meeting the unique health care access challenges innate to clinics, Federally qualified health centers or hospitals located on these islands. The Committee recognizes there are still few Native Hawaiian health care administrators working in Federally qualified health centers. The Committee directs that a portion of the funds appropriated for Native Hawaiian Health Care Act programs be used to develop administrative competency curriculum to prepare Native Hawaiians with the expertise necessary to succeed in these positions.

Action taken or to be taken
There are currently no Native Hawaiian chief executive officers (CEOs) in Federally Qualified Health Centers or in the Native Hawaiian Health Care (NHHC) program in Hawaii. About $60,000 was earmarked from the NHHC program last year for a certificate program and a master’s degree program to support the educational development of future Native Hawaiian CEOs. About $50,000 to $60,000 will be earmarked for similar efforts this year.

ITEM 27
Health Center access to National Health Service Corps --The Committee is pleased by the increasing proportion of National Health Service Corps assignees being placed at Community, Migrant, Homeless, and Public Housing Health Centers. The Committee encourages HRSA to further expand this effort to ensure that health centers have access to sufficient numbers of health professionals through the Corps.

Action taken or to be taken
The NHSC has historically had a strong partnership with the health centers. Currently, 50 percent of NHSC clinicians practice in health centers across the Nation. For the last three years the percent of NHSC field strength serving in health centers has been at least 50 percent. The FY 2008 NHSC Opportunities List contains 4,888 vacancies, 2,704 (55 percent) of which are in health center facilities. The NHSC works closely with health centers on recruitment; including training in recruitment strategies and encouraging health centers’ participation in job fairs held in conjunction with NHSC Scholar Conferences. The NHSC also assists health centers to retain clinicians after their service commitment has been fulfilled; the Program’s success can be measured by the large cadre of NHSC alumni that continue to practice in health centers, providing strong, experienced clinical and administrative leadership to those facilities.

ITEM 28
Health Professional Shortage Area (HPSA) scoring process -- The Committee is concerned that the current Health Professional Shortage Area [HPSA] scoring process used by HRSA disadvantages many health centers located in medically underserved areas of the country. The Committee urges HRSA to apply the same placement criteria to physicians seeking J-1 Visa Waivers and NHSC Scholars as are currently applied to NHSC Loan Repayment recipients. The Committee is concerned that the recent decline in J-1 Visa Waiver applicants is due to systemic obstacles, including HPSA scoring minimums, rather than diminishing needs in underserved communities. To ensure that the number and location of the placements meets the needs of the underserved, the Committee urges HRSA to expand eligibility for the J-1 visa waiver program.

Action taken or to be taken
The current placement criteria for NHSC Scholars reflects the program’s compliance with Section 333A(d)(2)(B)of the Public Health Service Act, which limits the number of entities offered as assignment choices for scholars to no more than twice the number of NHSC Scholars available for assignment in the program year.

In April 2006, the scoring minimum for entities to apply for a J-1 Visa waiver physician through HHS was reduced from 14 to 7, thus expanding eligibility. However, it should be noted that the total number of J-1 physicians receiving waivers through all Federal and State agencies is declining, an indication that the issue is less one of programmatic obstacles than one of a shrinking pool of J-1 physicians overall.

ITEM 29
Building nursing faculty -- The Committee recognizes that the current nursing shortage has reached a crisis state across America. The situation only promises to worsen due to a lack of young nurses in the profession, an aging existing workforce, and inadequate availability of nursing faculty to prepare future nurses. The Committee urges HRSA to support programs aimed at increasing nursing faculty and encouraging a diverse population's entry into nursing.

Action taken or to be taken
In FY 2007, the Nursing Workforce Development Programs provided a comprehensive approach to addressing the faculty shortage. Undergraduate nursing programs supported by the Nurse Education, Practice and Retention Program, specifically the 31 career ladder program grants and 21 expanding baccalaureate program grants produced graduates who represent the future faculty pipeline. The Advanced Education Nursing Program supported a total of 25 masters and doctoral programs that focused on preparing graduate students for faculty roles. The Nurse Faculty Loan Program supported 119 participating institutions that had a total of 418 participants receiving loans to support their education to become faculty. In FY 2008, it is estimated that 1,201 participants will receive loan support through the Nurse Faculty Loan Program.

HRSA’s Nursing Workforce Diversity program is the only nursing program primarily focused on increasing diversity and improving cultural competency in the workforce. In FY 2007, 25,392 minority K-12, pre-college, pre-nursing, and nursing students, participated in grant related activities to interest students from diverse backgrounds to become nurses. To reduce the financial barrier to education for disadvantaged students 618 scholarships were awarded. Diversity in the nursing workforce is essential to improve the quality of care. It has been found that minority and disadvantaged nurses are more likely to serve in areas with a high proportion of underrepresented racial and ethnic groups and to practice in or near designated health care shortage areas. Numerous studies have documented that increasing the number of minority health professionals is a key strategy to eliminating health disparities. Diversity in the health workforce will strengthen cultural competence throughout the healthcare system. Cultural competence profoundly influences how health professionals deliver health care.

ITEM 30
Nurse Education, Practice, and Retention --The Committee encourages HRSA to incorporate innovative methods, such as competitive grants for competency-based distance learning technologies, to increase the number of trained nurses in the field.

Action taken or to be taken
The Nurse Education, Practice, and Retention (NEPR) program is a broad authority with targeted purposes under each of the education, practice, and retention priority areas, which addresses the growing nursing shortage. The NEPR program provides grant support for academic, service and continuing education projects designed to strengthen the nursing workforce and improve nurse retention and quality of patient care. There are three major priority areas which include education, practice and retention. Within the Education Priority applicants can apply for funding to provide education in the area of new technologies, including distance learning methodologies. In FY 2007 the NEPR program funded 10 programs in this area, including 4 faculty development technology programs. Given the broad authority of the NEPR legislation, accredited nursing programs may apply using innovative teaching and learning methodologies including competency based distance learning technology.

ITEM 31
Motherhood demonstration program -- As stated above, the Committee also provides $1,536,480 for a first-time motherhood demonstration program, equally divided between urban and rural settings. . . . . Rural areas represent a unique challenge in supporting first-time mothers, particularly around the area of lactation support and services. Funding for the rural portion of the demonstration should be focused on the best ways of delivering supportive services, including delivery outside the hospital setting both before and after the birth of the child. Priority should be given to applications which emphasize breastfeeding initiation and retention.

Action taken or to be taken
The First-time Motherhood demonstration program will provide grants to urban and rural communities to support community-based doulas. Doulas, who have specialized knowledge and experience in perinatal care and support, are utilized by pregnant/postpartum women to provide continuous physical, emotional and informational support during the prenatal, childbirth, and/or postpartum periods. Doulas spend numerous hours with the families they serve providing: pregnancy and childbirth education, early linkages to appropriate healthcare and other services, encouraging parental attachment, breastfeeding promotion counseling, and parenting education. HRSA will award up to 12 competitive, one-year grants: up to six grants to will be awarded to urban communities while up to six additional grants will go to rural community projects; priority will be given to projects that emphasize breastfeeding.
In addition, HRSA will offer outreach, training, technical assistance and evaluation services to doula grantees in order to maximize project effectiveness and care quality across all projects. These services will be provided by an organization with expertise in replicating community-based doula programs.

ITEM 32
Pediatric dentistry -- The Committee recognizes the key role that Maternal and Child Health Centers for Leadership in Pediatric Dentistry Education provide in preparing dentists with dual training in pediatric dentistry and dental public health. The Committee encourages HRSA to provide incentives to the Centers to leverage resources and seek matching funds to strengthen center activities.

Action taken or to be taken
Maternal and Child Health currently funds three programs in Leadership Education in Pediatric Dentistry. The programs are grants for five years (2007-2012) and are located at the University of Washington in Seattle, Columbia University in New York and the University of California in Los Angeles. The programs currently receive $200,000 per grant year. In the current program guidance the pediatric dentistry programs were asked to disclose other forms of budget resources to demonstrate leveraging of funds. MCHB actively encourages grantees to leverage funds during site visits and program meetings.

ITEM 33
Thalassemia treatment centers -- The Committee reiterates its long-standing support for the continuation of funding that the Maternal and Child Health Block Grant has provided to comprehensive thalassemia treatment centers under the SPRANS program. The Committee urges HRSA to continue this program.

Action taken or to be taken
HRSA’s Maternal and Child Health Bureau (MCHB) continues to support the comprehensive thalassemia treatment centers under the SPRANS program.

ITEM 34
Hemophilia treatment centers -- The Committee recognizes the critical role of hemophilia treatment centers in providing needed comprehensive care for persons with bleeding disorders and the expanded role of these centers in addressing the needs of persons with bleeding disorders and clotting disorders. The Committee urges HRSA to continue its support of this model disease management network.

Action taken or to be taken
Through the SPRANS program, HRSA’s Maternal and Child Health Bureau (MCHB) continues to support the network of hemophilia treatment centers, our National Hemophilia Program, to provide comprehensive disease management services to men and women with bleeding and clotting disorders.
ITEM 35 Services to co-infected individuals -- The Committee is concerned that at least 25 percent of persons living with HIV are coinfected with HCV, and that HCV-related complications are the leading cause of death among persons with HIV/AIDS. The Committee requests that HRSA provide additional guidance to grantees on providing services to coinfected individuals, and more education and training to medical providers treating HIV/HCV coinfected persons. (Page 56) Action taken or to be taken HRSA continues to be aware of the significant morbidity and mortality of HCV among people living with HIV in the United States. HRSA has worked closely with State ADAPs to maximize their efficiencies in order to expand their formularies to provide more life saving treatments to greater number of people. The TA document published by HRSA in June, 2006, Care and Treatment for Hepatitis C and HIV Coinfection: Expanding Access Through the Ryan White CARE Act, provides guidance to grantees on this topic and in January 2007, HRSA hosted a National TA call on HIV/HCV co-infection for State ADAPs. HRSA provides further technical assistance at the biannual All Grantee Meeting and annual clinical conference to educate medical providers on HCV care, treatment, and capacity building around HCV services. In addition, the AIDS Education and Training Centers play a vital role in ensuring the highest quality of care among medical providers.

ITEM 36
New HIV treatment therapies -- The Committee is aware of the success HIV therapies have had on prolonging and enhancing the quality of life for those infected with HIV/AIDS. As the infected population lives longer and becomes increasingly resistant to current treatment regimens, there is a growing need to focus on access to newer therapies for treatment experienced or “later stage” patients. The Committee encourages HRSA and State ADAPs to prioritize coverage of treatments for later stage patients so that there is parity of access to effective treatments for patients across the HIV disease spectrum. The Committee further encourages State ADAPs to provide coverage of therapies approved by the FDA for the treatment of HCV in HIV/HCV co-infected patients.

Action taken or to be taken
HIV treatments have improved considerably in the last few years for treatment experienced patients, with an undetectable viral load the goal of treatment for most patients. The Ryan White HIV/AIDS Treatment Modernization Act of 2006 requires the Secretary to develop a list of drug classes, based on the DHHS Clinical Practice Guidelines, for inclusion in ADAP formularies. HRSA has worked closely with the DHHS Clinical Practice Guidelines Committees to assure rapid integration of new therapies, most of which are specifically indicated for treatment experienced patients, into the guidelines. HRSA’s HIV/AIDS Bureau has provided technical assistance to the ADAP grantees regarding this new requirement and its implementation. Given this new provision of the Ryan White statute, ADAPs are required to have many of the important drugs for salvage therapy on their formularies.

ITEM 37
Organ and tissue donations -- The Committee commends HRSA for its leadership in promoting increased organ and tissue donations, however the Committee is concerned with recent funding reductions for research and demonstration projects that have historically led to increased organ donation and encourages HRSA to restore these programs.

Action taken or to be taken
-- Since the passage of the Organ Donation and Recovery Improvement Act (ODRIA) in April 2004, the Program has worked towards implementing its requirements and new provisions. In doing so, the Program has had to change funding priorities. This change necessitated reducing the number of new awards for research and demonstration grants.

The Program has supported the following ORDIA-mandated and -authorized activities with funds redirected from the research and demonstration grants:

  • grants to provide support to OPO and hospital-based organ donation coordinators (42 U.S.C. § 274f-2);
  • grants to public and non-profit private entities to support public education activities (42 U.S.C. § 274f-1);
  • grants to States to assist in the development and improvement of State donor registries (42 U.S.C. § 274f-1(c));
  • a cooperative agreement to operate a National program to provide reimbursement to individuals for travel and subsistence expenses incurred towards living organ donation (42 U.S.C. § 274f); and
  • a contract with the Institute of Medicine (IOM) to examine the ethical implications of various proposals to increase cadaveric donation. The report of the IOM entitled ‘Organ Donation, Opportunities for Action,’ served as a major source of information for the findings and recommendations provided in the HHS report to Congress mandated in Section 8 of ODRIA.

HRSA plans to provide $5.6 million in funding for approximately 20 research and demonstration grants in FY 2008. This funding amount represents approximately 24 percent of the anticipated appropriation of $23.049 million for FY 2008.

ITEM 38
Frontier Extended Stay Clinic demonstration -- The Committee understands that many primary care clinics in isolated, remote locations are providing extended stay services and are not staffed or receiving appropriate compensation to provide this service. The Committee encourages the HRSA to continue its support for a demonstration project authorized in the Medicare Modernization Act to evaluate the effectiveness of a new type of provider, the “Frontier Extended Stay Clinic,” to provide expanded services in remote and isolated primary care clinics to meet the needs of seriously ill or injured patients who cannot be transferred quickly to acute care referral centers, and patients who require monitoring and observation for a limited time.

Action taken or to be taken
In FY07 the HRSA ORHP demonstration awarded a four-year cooperative agreement (FY07FY10) to the SouthEast Alaska Regional Health Consortium (SEARHC), the entity that serves as the consortium lead for the demonstration. HRSA funds pay for infrastructure development of additional staff, equipment and quality assurance programs to expand and improve extended care services in isolated clinics that currently cannot be reimbursed through Medicare, Medicaid or private insurers. Additionally, the HRSA demonstration actively involves a provider workgroup that works on the development of FESC clinical protocols with an emphasis on addressing quality assurance and sustainability for the FESC protocols and model. An evaluation component of the demonstration oversees the implementation, testing, and evaluation of the FESC clinical and administrative protocols, as well as documentation of FESC services provided, the costs associated with those services, and their impact on quality of care. HRSA demonstration cooperative agreement funds have added an additional focus area in this program cycle to provide technical assistance on an as needed basis. HRSA will also assist the participating clinics in developing health information technology and quality initiatives around FESC activities in the HRSA demo sites as well as the continued exploration of the FESC model in the lower 48 States including the relationship with Critical Access Hospitals.

ITEM 39
Coordination of Services to the Mississippi Delta -- Mississippi's Delta is a community in which residents disproportionately experience disease risk factors and children are significantly mentally and physically developmentally behind. The Committee recognizes that communities such as this show positive behavioral change when community-based programs and infrastructure are in place. The Committee believes that collaborative programs offering health education, coordination of health services and health-related research offer the best hope for breaking the cycle of poor health in underprivileged areas such as the Mississippi Delta. Therefore, the Committee recommends the continued funding of these activities (This language was requested by Senator Cochran). (Page 60)

Action taken or to be taken
HRSA will continue to support activities to improve access to health care and health care system improvement in the Mississippi Delta. The appropriation of funds in this project in FY 2006 continues to yield benefits as the grantee, Delta Health Alliance, has taken a collaborative community-based approach toward addressing unmet health care needs in the region. The Delta Health Alliance is currently in a no-cost extension status and its projects are progressing accordingly with significant investments in health information technology that will link health care providers from across the region together in a single electronic health record as well as an ongoing project focusing on improving outcomes for diabetic patients

ITEM 40
Denali Commission -- The Committee expects the Denali Commission to allocate funds to a mix of rural hospital, clinic, long-term care and social service facilities, rather than focusing exclusively on clinic funding. (Page 62)

Action taken or to be taken
Although planning and construction of primary care clinics continues to be the dominant use of funding, the Denali Commission did devote an increased amount of funds toward other providers in FY 07. This included the construction of five youth psychiatric facilities in Dillingham, Anchorage, Fairbanks and Eklutna as well as improvements in eight hospitals. HRSA will continue to work with the Denali Commission to ensure an appropriate mix of providers receive support through this funding.

ITEM 41
Distribution of title X funds -- The Committee remains concerned that programs receiving title X funds ought to have access to these resources as quickly as possible. The Committee again instructs the Department to distribute to the regional offices all of the funds available for family planning services no later than 60 days following enactment of this bill. The Committee intends that the regional offices should retain the authority for the review, award and administration of family planning funds, in the same manner and timeframe as in fiscal year 2006. The Committee intends that at least 90 percent of funds appropriated for title X activities be for clinical services authorized under section 1001 of the act. The Committee further expects the Office of Family Planning to spend any remaining year-end funds in section 1001 activities.

Action taken or to be taken
The Public Health Service (PHS) Regional Offices will receive their funding distribution for Title X family planning services within 60 days following enactment of this bill. At least 90 percent of the funds appropriated for Title X activities will be distributed to Title X service grantees for the provision of clinical services authorized under section 1001 of the Act. Additionally, any year-end fund will support section 1001 activities.

ITEM 42
Health Care-related Facilities -- The Committee has included bill language to terminate after 5 years the Federal interest in buildings and equipment funded in this line item. The Committee is aware of situations in which HRSA has had to track obsolete pieces of equipment, such as old medical equipment, for years after the useful life of the equipment has ended. The Committee is also aware of situations in which HRSA has had to track Federal interest of less than 2 percent of total value of a building for years after the completion of construction. The bill language should alleviate these unintended consequences of the grant process.

Action taken or to be taken
This language was not included in the final Consolidated Appropriations Act, P.L. 110-161.

ITEM 43
Establish nurse grant program -- The Committee encourages the Division of Nursing [DON] to use existing authority under the Nurse Reinvestment Act to consider establishing a grant program that will assist nurse practice arrangements commonly referred to as nurse-managed health centers in securing an alternative means of prospective payment reimbursement for their Medicare and Medicaid clients.

Action taken or to be taken
Nurse managed centers commonly experience self-sustainability issues due to financial challenges in serving underinsured and uninsured populations. Many are faced with threats to their existence after the Division of Nursing funded project period has ended due to lack of adequate financial reimbursement for primary care services. The Nurse Reinvestment Act supports nurse practice arrangements in securing expertise related to the development of financial systems that will help them address challenges related health care reimbursement. In addition, several nurse-managed health centers have applied to the Bureau of Primary Health Care for recognition as a Federally Qualified Health Center Look-Alike as a means to increasing revenue and to support self-sustainability.

BPHC – ITEM 44
Waiver authority -- The Committee encourages CMS to use existing waiver authority under the Public Health Service Act to issue waivers of the governance requirements for Federally Qualified Health Centers [FQHC] look-alike centers to nurse practice arrangements commonly referred to as nurse-managed health centers.

Action taken or to be taken
HRSA recognizes that nurse-managed health centers (NMHCs) serve an important role in improving the overall access to care for the Nation’s underserved populations. NMHC’s are eligible to apply for the funding opportunities supported under the Health Center Program and for designation under the Federally Qualified Health Center (FQHC) Look-Alike Program. There are NMHCs that receive grant funding and that have been designated as FQHC Look-Alikes.

Although the Secretary of the Department of Health and Human Services, acting through the Health Resources and Services Administration (HRSA), has the authority to grant time limited waivers to organizations receiving grants under section 330 of the Public of Health Service Act (PHSA), the HRSA does not have this authority for organizations seeking designation under the Federally Qualified Health Center (FQHC) Look-Alike Program. Per section 1905(l)(2)(B) of the Social Security Act, HRSA reviews FQHC Look-Alike applications for compliance with the requirements for grants funded under section 330 of the PHSA and makes recommendations to the Centers for Medicare and Medicaid Services (CMS) regarding designation of an applicant. Final authority for designating an organization as an FQHC Look-Alike resides with CMS which will only designate organizations that fully comply with all section 330 requirements. Furthermore, it should be noted that from 1990-2003, waivers were allowable in the FQHC Look-Alike Program; however, in 2003, when the Omnibus Budget and Reconciliation Act amended the Social Security Act, it eliminated waivers of section 330 requirements in the FQHC Look-Alike Program.
FY 2008 Conference Appropriations Committee Report Language (Conference Report 110-424)

HSB – ITEM 45
340B drug purchasing program--The conferees are aware that HRSA has issued proposed regulations revising the requirements for the 340B drug purchasing program. While there are important elements in the regulations that target abuses of the program, the conferees believe there are legitimate concerns regarding the implementation of the proposed rule's definition of patient eligibility. The questions of eligibility and the means by which eligibility is determined are important and should be carefully considered. Therefore, the conferees urge HRSA to move quickly to implement the portions of the regulation that enjoy wide support and consider reopening the patient eligibility question for an additional public comment period. The House and Senate included similar report language.

Action taken or to be taken
The proposed guidance “Regarding Section 602 of the Veterans Health Care Act of 1992 Definition of ‘Patient” was published in the Federal Register at 72 Fed. Reg. 1543 on January 12, 2007. HRSA is in the process of reviewing all comments which will be carefully considered prior to publication of final guidance in the Federal Register. HRSA is mindful of the dual need to provide guidance to best ensure compliance with the law and the need to provide flexibility and minimal burden upon covered entities in their essential efforts to provide care to their patients. HRSA intends to publish a final guidance after completing the review process.

OHIT – ITEM 46
Digital technologies --The conferees note that many rural hospitals are working to implement systems to transmit medical information electronically to help deliver efficient and effective health care services to their patients. The conferees hope that HRSA will continue to examine ways to help such hospitals implement digital technologies, such as picture archiving communications systems and other digital technologies.

Action taken or to be taken
HRSA, through its telehealth grants, has extensively funded telehealth networks in rural communities that foster the use of digital technologies to support health care. In 2007, HRSA supported 54 telehealth programs that involved over 350 rural hospitals. In addition, its five regional Telehealth Resource Centers provide technical assistance to rural hospitals and other providers who wish to start or expand their telehealth programs. HRSA also awarded 16 grants totaling $24 million to support the implementation of health information technology. The grants were designed to connect Critical Access Hospitals and other health care providers in their community on a shared electronic health record. In addition, HRSA’s Rural Network Development grants currently include 10 projects focusing on health information technology applications.