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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.
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