RHC TA Conference Call Transcript

CAPITOL ASSOCIATES

Moderator: Bill Finerfrock
May 13, 2008
1:00 p.m. CT

Operator: Good day and welcome to Rural Health Clinic technical assistance call. Today's call is being recorded.

At this time, I'd like to turn the conference over to Mr. Bill Finerfrock. Please go ahead, sir.

Bill Finerfrock: Thank you, operator and welcome to today's Rural Health Clinic technical assistance call on Rural Health Resources, “What's Available to the RHC Community.”

Our presenters today will be (Kristine Sande) from the Rural Assistance Center, (Erica Molliver) from the Federal Office of Rural Health Policy, and (Karen Madden), who is with the New York State Office of Rural Health representing the National Organization of State Offices of Rural Health.

My name is Bill Finerfrock and I'm the executive director of the National Association of Rural Health Clinics and I will be the moderator for today's call. (NOSORH Karen) will be talking about the organization but more specifically State Offices of Rural Health and what resources you may be able to find available at your State Offices of Rural Health. Erica will discuss the Federal Office of Rural Health Policy and how her office can be of help to the RHC community. And (Kristine), with the Rural Assistance Center, will talk to us about the RAC and what resources they have that can be of benefit to the RHC community.

Today's program is scheduled for one hour. First 45 minutes will consist of our speakers' presentations, with the remaining 15 minutes dedicated to questions and discussions. You should have received a copy of (Kristine's) presentation previously via our LISTSERV. (Erica's) presentation, her slides, are in the process of still being approved by the federal folks and so those will have to be posted after the call. And I believe that (NOSFOR) will have some slides posted after the call as well.

This series is sponsored by the Federal Office of Rural Health Policy in conjunction with the National Association of Rural Health Clinics. The purpose of the series is to provide RHC staff with valuable technical assistance and some RHC specific information. Today's call is the 24th in this series and it began in late 2004. And as you all know, there is no charge to participate in this conference call series. We encourage you to refer others to this projects if you think that they would benefit. If individuals would like to sign up for the LISTSERV to get information, they can go to www.ruralhealth.hrsa.gov/RHC.

During the question and answer period of the call we would ask that you identify yourself by name and the location that you're calling from, city and state. In the future if you have questions or topics that you'd like to refer to us, you can send those to info@narhc.org and put RCH Teleconference Question Topic in the subject line. I want to remind callers when we get to (Kristine’s) that you can follow along if you have her PowerPoint presentation.

At this point I'd like to turn the call over to our first speaker, who will be (Kristine Sande) on behalf of the Rural Assistance Center. Thanks, (Kristine), for being with us today.

(Kristine Sande): Thanks, Bill. I appreciate the opportunity to let people know about the services that we have available here at the Rural Assistance Center.

By way of background, the Rural Assistance Center has been in existence for about five years now. It was a product of the U.S. Department of Health and Human Services Rural Initiative where the department was looking at what resources were available for rural America. They identified over 200 programs within HHS that rural communities could apply for or be part of.

And they decided that there needed to be a central location for people to find information about those programs as well as information about – that can advantage rural communities more broadly. So we were started in December 2002 to be that rural health and human services information portal. So as an information portal, our charge is to help rural communities access that full range of available programs, funding and research as well as to gather and streamline the information from all kinds of sources and provide easy access to that information.

The Rural Assistance Center is operated as a partnership of the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences and the Rural Policy Research Institute. And the Center for Rural Health here in Grand Forks, North Dakota is the lead partner and the operation center. So our staff is very familiar with rural issues, many of us from a rural background, which is really helpful in what we do. And RAC is also funded by the Federal Office of Rural Health Policy, who is tremendously supportive of our efforts.

The services provided through the Rural Assistance Center are all free to the users and to the communities because they're paid for through the federal grant that we receive. And those services include Web-based services that are available at raconline.org, electronic updates and customized assistance. And I'll be talking about those three services more throughout my presentation.

RAC has a very diverse audience, which includes anyone interested in improving and maintaining Health and Human Services delivery systems in rural communities. So this includes people working at the community level on up to national organizations or reporters for national publications.

Some examples of users might include local clinic administrators who possibly are interested in information about regulations or reimbursement, community-based organizations or local government officials possibly looking for information on funding, rural community advocates looking for solutions to problems in their communities or even congressional offices and federal employees.

So you can see a very wide range of users. And we really try to target the information that we make available to the community level, but it's also very useful for people at other levels looking for information about rural communities.

As far as our Web site, it acts as a virtual library for rural health and human services information. So it allows our users to find publicly available information at their convenience and it contains information on the entire spectrum of rural health and human services issues and includes links to thousands of external resources as they exist elsewhere on the Web. And the Web site is very widely used. We had over 650,000 visits to the Web site in 2007.

So, really, the point of the Web site is to find as much information as we can that's available across the Internet on the issues that affect rural healthcare and rural human services providers and to make that all available in one location so you can easily find it and use that information. We're all kind of living in an information overload world, so to be able to find the specific information that you need can be very valuable.

The first section of our Web site that I'd like to discuss is our funding area and users can browse our 54 funding topics or browse the funding opportunities by sponsors such as the Office of Rural Health Policy or HUD or specific foundations or they can browse by state. And they can also do a search for funding opportunities from federal, state and foundation sources as well.

The funding summaries will give information to help users to determine if the funding opportunity might fit their needs and also tells them where to get more information. And that information includes the program Web site, the sponsor, what the program does, what are the eligibility requirements, how much funding is available and how do you apply or who do you contact for more information.

And we generally have over 200 active funding opportunities in that section. So a lot of funding opportunities are in there. And we also have RSS feeds in that section of the site where you can get real-time information about the funding opportunities that we've added so you can watch what's being added on a daily basis because a lot of times the turnaround on those opportunities is pretty quick. And we want to give our rural communities as much notice as possible about those to level the playing field for them.

The next section of our Web site is the information guides. These are pages on specific rural health and human services topics. Currently there are over 70 information guides on the site. And those information guides contain an overview paragraph, frequently asked questions, contacts, links to news items, documents, tools, events and organizations. We have the help of content experts such as folks from national organizations or federal agencies and they contribute to and review the information on the guides to make sure that the information is accurate and as complete as possible.

I think you'll find that these information guides are excellent sources of some of the basic information for people who want to become familiar with a topic as well as are very useful for people who might already be familiar with the topic but are looking for additional information, such as possibly news or research. And one of the most used guides on the site is the rural health clinic guide. Bill Finerfrock, who introduced me, happens to serve as the content expert on that guide and provides us with some really useful information for that guide.

In fact, one of CMS's regional representatives told me at a conference that she thinks that the page is so good that she sends people there when they call her asking how do they become a rural health clinic. Because it's so much easier for her if they go there and become familiar with the topic and what is a rural health clinic and some of the rules and regulations and then come back to her and they can really talk about the details then.

Some other popular information guides on the site include federally qualified health centers, critical access hospitals, what is rural, health education, financial aid, J1 visa waivers, methamphetamine and we also have a new information guide on medical homes. So you might be hearing a lot about that concept recently and if you want to learn more, that guide would be a good place to go.

The news and events section of the Web site helps users to stay up to date on the latest developments in rural health and human services. For instance, we go through the Federal Register on a daily basis to find funding opportunities, comment requests, new rules and regulations, things that might be of interest to our rural stakeholders. And those notices are then linked from our Web site and this allows our users to stay up to date on what's been posted in the Federal Register without having to sift through that information themselves every day because that can be a kind of a cumbersome process.

In the news section also features things like press releases and media coverage on rural issues. And the calendar of events is a very comprehensive listing of events that might be of interest to our users and includes all the particulars about those events.

The experts and organization section of our site allows users to identify and contact experts and organizations in rural health and human services, including national organizations and federal agencies as well as state offices of rural health and state rural health associations and that sort of information.

The publications and maps section of our Web site list things like key rural publications, rural health research center publications, state rural health publications, important publications that we've run across in the last 30 days. And it also has access to our electronic publications, which include the Rural Monitor, which is a quarterly publication that features stories and columns on rural health and human services issues. The Rural Monitor is sent by e-mail to over 5,000 subscribers and is also available in an archive on our Web site.

We also send out health updates and human services updates or LISTSERV postings and those go out by e-mail bimonthly and monthly respectively. Those include news items that have been – or new items that have been added to our database, so some of the things that are contained in those LISTSERV postings or news, new funding opportunities, new documents, tools that we've indexed, as well as events that are coming up within the next 60 days.

We receive a lot of comments from our subscribers telling us that our LISTSERVs are really invaluable to keep them up to date on important information and opportunities. And you can sign up for any of those publications on our Web site.

We also have maps on our site. Those allow users to access a series of national maps on a variety of health and human services and demographic issues. It also includes a feature where users can create a custom map so it allows them to limit the area to a state, to add town names, roads, all of those sort of things, which can be really helpful. For instance, is you're writing a grant and you need a map of your particular location, that's a very useful tool.

We also have success stories on the Web site. And that section contains links to both a variety of publications and Web sites that contain those success stories but also a database of rural success stories. And those success stories can serve as model projects or spark ideas for communities. So if any of you have a success story that you'd like to share that you think would be helpful for other communities, I would encourage you to submit them using the form available on the Web site or by sending an e-mail to our staff. We'd really like to get more of those success stories from you.

The state resources section of the Web site is very similar to the information guides except that the information is organized by state rather than by topic. And this section of the site was developed in response to our user's needs. We found that a lot of people were asking for state specific information, so we wanted to make it as easy as possible for people to access information that way. And in developing these pages, our information specialists have worked with State Offices of Rural Health and other contacts within states to ensure that we have high quality information and complete information on those pages.

Another feature on the Web site is the Am I Rural? feature that can be accessed off of the homepage. And it's been fairly popular and we hope to expand it even more in the future. To use this feature the user enters the street address with their city, state and zip code and the Am I Rural? feature generates a custom report that tells them if the location is considered rural by various definitions and programs.

For instance, rural-urban commuting areas or RUCAs, core-based statistical areas, rural-urban continuum codes, the (FCC) definition and urban influence codes. And these rural definitions were selected as those that are most commonly used for programmatic determinations as well as for research on rural issues.

Our resource database has access to over 8,500 resources, including documents, tools, news, events and funding opportunities. And there are multiple search options that can be used to access that information.

And lastly, we provide customized assistance whereby people throughout the country can receive free personalized information services by phone or e-mail from our information specialists. We do have four information specialists on staff and they are all Masters-prepared librarians. And they have expertise in rural health and human services issues as well as in search techniques. So they're all experts at finding information on the Internet as well as by other means.

And in addition to using tools such as the Internet and information databases, they rely on experts across the country to assist them in finding the requested information, such as the staff at the partner organizations, ORHP, and State Offices of Rural Health. And in addition they have a lot of contacts within the federal government such as the HRSA bureaus, CMS, and HUD, as well as national organizations such as the National Rural Health Association or the National Association of Rural Health Clinics.

And the information specialists are also very good at finding contacts through the Internet and they're not afraid to cold call numerous contacts to track down appropriate information for our clients. So the types of information they can provide, one of the most commonly requested types of information would be funding opportunities. And they can search from various sources. They'll search things like the RAC database and grants in other publicly available sources.

But in addition to that, they can also search the Foundation Directory. So they can look for foundations that say they fund the type of project that you might be interested in undertaking. And then we'd feed you those foundations and you could follow up on that information.

They can also help find statistics, maps and documents. So, for instance, if you're looking for rural health research they can search article databases such as PubMed. Another really valuable service that they provide is that they can assist you to find appropriate contacts and experts within the field and that includes within the federal government.

We found that sometimes the information doesn't exist in writing anywhere, but it is in someone's head so we try to help you to track down that person who has the information in their head. Also sometimes it can be really difficult to find the right contact within the government so we can help you do that and eliminate some of the frustration that you might experience.

Bill Finerfrock: Kristine if you could wrap it up …

(Kristine Sande): Yes.

(Kristine Sande): Yes, that is my last slide and then we have our contact information is on the last slide as well.

Bill Finerfrock: Great. Thank you very much, Kristine That was a lot of really great information and I hope all of you can learn about some of the things. I know there'll probably be a lot of hits on the funding section of your Web site in the next 24 hours.

Our next speaker is (Erica Molliver), who is with the Federal Office of Rural Health Policy. And (Erica) is going to talk to us about some of the resources and services that are available through the Federal Office of Rural Health Policy. (Erica)?

(Erica Molliver): Hi. Thank you, Bill. Yes, my name is (Erica Molliver) and I've been with the Office of Rural Health Policy for about three and a half years now.

And just by way of overview also, the office is so if you can go from larger to smaller, there's a Department of Health and Human Services and then within HHS you have HRSA, which is Health Resources and Services Administration. HRSA is one of several agencies within HHS. And then our office, ORHP, is located within HRSA.

And the office was created back in 1987 primarily to address problems that arose from the implementation of the inpatient prospective payment system, which led to the closure of several hundred hospitals. And our office has kind of a unique position within HRSA because it is legislatively mandated to provide advice and recommendations to the secretary on rural health policy and rural health issues in general.

So one of our functions is policy and then we also have a number of grant programs. And so because there's such a strong emphasis on grant administration, we are located within HRSA. And then we also have a number of research functions as well. So the three big ones are grants, research and policy.

And within the office we, a couple of years ago, moved kind of towards a team-based structure so we have most of the grant programs are separated into state-based grants versus community-based grants. And I'll talk mostly about the community-based grants because I think that those are probably what's most relevant for the rural health clinics.

But first, just within the state-based grants, I just wanted to call attention to one of them, which is the State Office of Rural Health Grant. And so ORHP funds a State Office of Rural Health in each state across the country and the state offices are great resources for providers throughout the state. They know what the issues are and have connections. I know they vary in terms of staffing a great deal, but they have always been a wonderful resource.

So if folks have questions, we have a directory on the ORHP Web site of all of the state office director names and contact information if you want to get in touch with them. And we actually for most of our grant programs recommend that applicants at least send a copy of their application to their State Office of Rural Health director so that they can either provide technical assistance or at least have a better feel for what's going on within the state.

We have approximately eight community-based grants within ORHP. The number keeps growing. We just recently acquired two new ones within the last year. And I will touch on what those are a little bit. But just wanted to mention that we have a new funding strategy within the office. Previously, all of our community-based grant programs were awarded every single year, which was good because folks that weren't successful one year could reapply the following year.

But it created a lot of confusion and lack of coordination across the different classes of grantees. So starting this year we are staggering the grant programs so that they're awarded every two or three years. So, and I can – I will tell you about those. There are two of them that are coming up and will be competitive in fiscal year '09 that rural health clinics would be eligible to participate in.

And one of those is the network planning grant program. It's a one-year grant and it provides, I believe it's up to $85,000 for three or more organizations to come together to create a rural health network. And the three organizations don't have to be actual providers but they can be. So, for example, you could have a network of three rural health clinics or you could have one rural health clinic and a faith-based organization and then a social services organization. And the planning grant is basically kind of the formative stages for identifying your partners and coming up with an idea of how you would coordinate and improve the quality of healthcare services within the area.

And then the – there's a – sorry about that. We have a rural health outreach grant as the other grant program that is available and will be competitive in fiscal year of '09. And that – the outreach program is really based on providing healthcare services. So it has a similar format in that its applicants would be consortiums of three or more different entities. Again, they could be – all three could be providers or it could be a mix of different types of providers.

And it's focused on improving local healthcare delivery systems by providing new sources of clinical care or improving access to service within that area. And some of those services, just for example, that previous grantees have focused on were mental health issues, dental health, obesity and diabetes, access to care for diabetes and obese patients. And the rural health outreach grant program is a three-year program as opposed to network planning, which is just for the one year.

Some of the other areas that our office works with in terms of providing services to rural areas are – so we have the funding programs and then we have policy elements. So the policy team focuses on primarily reviewing regulations. Most of our work has to do with Medicare regulations. So, for example, the physician fee schedule, hospital inpatient, the various prospective payment systems that come through from CMS.

Our office has a legislative mandate to review those kind of with an eye towards rural to make sure that rural issues are addressed or that rural providers are not inadvertently affected. Some people call our office the Office of Unintended Consequences. So we try to make sure that regulations that go through don't inadvertently impact rural providers.

And then in addition, beyond our office, the department has several cross-cutting rural efforts, policy-wise, and one is National Advisory Committee on Rural Health and Human Services. And that's kind of an external body to the federal government. And it's a panel of 21 members with expertise in various areas having to do with rural health and human services. And at the end of each year they put together a final report that addresses generally – has three chapters and addresses three major rural health policy issues.

And actually this past year was the office's 30th anniversary and so the annual report for 2008 should be coming out soon. It's in clearance. And addresses – has a retrospective, so a look back of rural health and human services issues over the last 20 years and how things have changed and then what's coming for the future.

And then in addition, we have our research function and there's – we have two research grant programs and just in terms of putting together, if you all were considering applying for a community-based grant, a lot of times it's helpful to go onto our research centers’ Web site and just take a look and get some background information on what the issues are that are going on. We have a Web site called the Research Gateway where all of the publications and policy briefs from our research centers are posted and you can download them from there.

I have Web sites for that as well as for where to find information about our actual grant programs. And unfortunately, I apologize, I wasn't able to get the slides to Bill and to you all online. But I can send an e-mail to Bill right after the call with at least just the Web sites of information.

And then beyond that, I would just encourage folks to check out the CMS (Centers for Medicare and Medicaid Services) who we – our office also works closely with, partially in reviewing regulations and just in meeting in general to address rural health issues. If you're not aware, they have what are called open door forums pretty regularly. And two of them that would be relevant to rural health clinics are there's a rural health open door forum and then a low income access open door forum.

And the forums are where they have CMS folks on the call who give updates on policy and regulation issues that are coming up and then open question and answer series. So you can call in and ask questions about absolutely anything and try to get answers to questions that way. And let's see, the next rural health open door forum is coming up on May 21st and the next low income healthcare open door forum is this Thursday, so May 15th. And again, I'll send Bill the link for you guys to see how to sign up for information about that.

And that is pretty much it. I will just do that brief summary so that we can squeeze everyone else in.

Bill Finerfrock: Thank you, (Erica). That was very helpful.

Our last speaker will be (Karen Madden), who is the president of the National Organization of State Office of Rural Health. She's also the director of the New York State Office of Rural Health. She's going to talk to us about the role of the State Office of Rural Health and what resources and opportunities there are for rural health clinics and working with State Office of Rural Health. (Karen), you're up.

(Karen Madden): Thanks, Bill, and thank you for giving us this opportunity to be on your call today.

If I could see all of you and we were in a room together, I would ask how many of you are aware and know your State Office of Rural Health. But since we can't do that, I would hope that most of you are raising your hands, although my fear is that you're not.

First I'll talk a little bit about NOSORH, the National Organization of State Offices of Rural Health. And we represent each of the 50 state offices. There is – there is an office in every state. And NOSORH's role really is to promote a healthy rural America through state and community leadership and to assist all of our members into filling the missions of their individual offices.

As I mentioned, each state has a State Office of Rural Health. And inasmuch as we have similar goals of promoting health and services in rural areas and creating access to high quality services, we are also all very different in the way that we approach that. There are 50 of us. The majority of us, I think it's somewhere up around 34 or 35 of us are located in state health departments, like we are in New York. Some of us are located in universities and three offices are not-for-profits. So that kind of gives you a little bit of an idea of the range of activities and the range of the way that we're organized.

The purpose of each state office is to help their individual rural communities build healthcare delivery systems. And as I mentioned, we're all very different. Some offices have very big budgets and very big staffs and some have very small budgets and very few staff. But we all receive a grant from the Federal Office of Rural Health Policy through the State Office of Rural Health grant program.

And with that grant we each have five goals that we are to pursue. And they are to collect and disseminate information to rural communities in our states, coordinate rural health resources and activities statewide, provide technical assistance, encourage recruitment and retention of health professionals, and strengthen state, local and federal partnerships.

Some of us are located in the same offices as our primary care offices in our states. And if we're not located in the same office, we work very closely with them. So many of you might be aware of the primary care office program, but that's probably a topic for a different call.

I mentioned those five goals that we pursue and within our states we do that differently. But basically, and I can speak mostly about what we do in New York, but I think that it's probably not that much different, at least in terms of those goals. We provide information about federal and state legislation and regulations to our communities on a pretty regular basis, provide technical assistance to determine the impact of the various legislations and regulations.

I know that lately everybody's been very concerned about the changes to the HIPSA and medically underserved area rules. And I know that we've been working very closely with our workforce group in this department on how that will be impacting our rural communities. And I would expect that that's happening in all of your states as well.

Some of the other work that we do, data collection and analysis on a county or community level, resource identification including grants. We let our communities know when grants are available. So the grants that (Erica) just mentioned, we're working very closely with communities in our states that are pursuing those grants. Some state offices actually offer grant writing assistance and workshops.

And of particular interest to most of the people on this call are that some state offices offer specific services to rural health clinics, including billing services and designation services. I know that two of the states that do that are North Carolina and South Carolina. But I would encourage you all, if you're not aware of your State Office of Rural Health, to go to our Web site, which is www.nosorh.org, or you can find us either on the RAC Web site or on the federal offices Web site.

And just get on there and look to see where your office is located and who the director is and give them a call just to find out what they can – what services they have and what they can help you out with.

We all – those of us who have (state health associations) in our states work very closely with them and help them put on statewide conferences. In New York we've done a statewide conference for I think six or seven years now. And we've also done conferences and different types of workshops around different areas, including quality. We did one last fall that was all about quality improvement and we targeted rural health clinics as part of that group when we did that conference.

As I said, I encourage you to check out our Web site and to get in touch with your state office if you don't know who they are so that you can find out more of what they – more of the services that they have to offer you.

And we don't – we didn't have slides available for today, but we will get them out to Bill so that he can post them for you. That's all I have, if there are any questions.

Bill Finerfrock: OK. Thank you very much, (Karen). We're going to move to the questions in just a second.

I just want to thank everybody for the time you've taken and the information. And for those of you who are listening, I hope that one of the things that you come away with is that you know that you have – you have allies and resources out there. The State Offices of Rural Health are really tremendous resources for you at an individual state level.

They're going to be very familiar with a lot of the issues, a lot of the policy things that are going on at your state. They're going to have very state specific perspective and advocacy roles and I hope you all will, if you didn't before today, know who your State Offices of Rural Health is, find out their contact information and reach out and begin a dialog with them.

The Rural Assistance Center as well is a tremendous resource in terms of the information they have available. The concept of one-stop-shopping covering a broad range of areas is just a tremendous source of information, particularly I think what (Kristine) talked about in terms of what is available in the philanthropic and the foundation community in terms of financial resources, technical assistance to you as rural health clinics.

We often always look to say is there a federal grant and it can help me do something and quite often there may be private foundation philanthropic money that's available that you're overlooking. And RAC can be a very valuable resource when it comes to finding those areas.

And then finally, the Federal Office of Rural Health Policy, which is a tremendous advocate for rural health clinics and rural providers in general within the federal bureaucracy. And having them there has just been such a valuable addition to the – to the rural community and our efforts to try and make sure that Washington doesn't forget about rural. And you also heard a out some of the grant programs that they run that some of you may want to take a look at.

So when we get the slides out, all of the contact information will be there. (Kristine's) slides have already been distributed and then this will all be posted up onto the Office of Rural Health Policy's Web site so you can go and check it there or refer others to the presentation and get that information.

Operator, at this time I'd like to open it up for questions and again remind everyone, if you would just to give us your name and where you're calling from prior to asking your question. We like to get a sense of where people are calling in from as part of this series. So, operator, go ahead.

Operator: Thank you. The question and answer session will be conducted electronically. To ask a question, please press star one on your telephone keypad at this time. We'll take as many questions as time permits and proceed in the order that you signal us. A voice prompt on your phone line will indicate when the line is open to ask a question. Please state your name and city and state location before posing your question. Once again, please press star one if you'd like to ask a question. And we'll pause for just a moment to signal the queue. And again, that is star one if you'd like to ask a question.

Bill Finerfrock: We may not get any questions. I will – in terms of the State Office of Rural Health, (Karen), you mentioned that they are different. Many of them are in the health departments, some are not-for-profit, others are university-based. Does that, the structure there, affect the kinds of services that they're able to provide in terms of you mentioned, for example, one state provides assistance for billing and cost reporting. Is that a function of the type of organizational structure they operate under or is that something that all 50 state offices could at some point envision doing?

(Karen Madden): I don't think it's necessarily a function of how they're organized because the South Carolina office does that and they're not-for-profit. And the North Carolina office does it as well, but they're located within part of their state government. So I think that it's something that probably everyone could do. I don't know.

I think it really depends on where you're located. I know that for us to do that in New York would be – would be kind of difficult because of our state bureaucracy. But that doesn't mean that just because an office is located in state government that they couldn't do it because their states might not be quite as bureaucratic. And then the universities are probably the same way.

Bill Finerfrock: OK. I mean, that was really what I was looking for, that there are – there are different models out there, as you said, and we have the state-based that does that, you have a not-for-profit. I suspect, too, there's an issue of critical mass. For example, in your state in New York, the number of rural health clinics may be as – is relatively small and therefore it would perhaps be difficult to justify.

But it's something that other folks might want to think about in terms of approaching their state of these are the kinds of things that could be occurring at your state level. And there are examples that you could point to in other states to say, hey, this is something worth taking a look at in our state.

(Karen Madden): And those are – I should – those aren't the only two that do that.

Bill Finerfrock: Right.

(Karen Madden): I'm just not quite certain which others do exactly. I know that the Colorado office does a lot of services for rural health clinics. I don't think that they do billing, though.

Bill Finerfrock: OK. In terms of the RAC, Kristine,I guess I wasn't aware and I should have been, I apologize, but the Am I Rural? function, can you explain a little bit more how that works?

(Kristine Sande): OK. Well, I guess the user just would go onto the homepage and you can enter your address complete with your zip and your state and then it generates a report that tells you based on that location whether you are – would be eligible for different federal programs based on just the rural component. Some of them have other eligibility criteria as well. But this service just looks at whether you would be considered rural for those particular programs. And then also it'll tell you whether you're considered rural based on the definitions themselves.

Bill Finerfrock: So when I put it in, it'll automatically tell me all these programs. I wouldn't go in, for example, and specifically query, "Am I rural,” and only ask for rural health clinic. You're asking, "Am I rural,” and the report itself will automatically tell you your status with regard to all of these programs?

(Kristine Sande): Right. And you can say if you just want to look at one particular program or select all if you want to see for everything.

Bill Finerfrock: OK.

(Kristine Sande): It allows you to do that. And we do tell people that it's a good idea still to verify that information with the funding agencies as well.

Bill Finerfrock: That was a question I had, then, is not the accuracy so much but – I guess it is, but how often is that updated? I don't think that we change designations that frequently. But is there – is there any – is that part of the verification process that yours may be a year old and that's part of it or how …

(Kristine Sande): Well, I guess we try to update it as often as we can. And the other thing is in some of these programs there are some subtle nuances as to how they determine the – whether something is rural or not. And so that's just to be extra safe. We do encourage people to check with the funder. But it can give you a quick idea of whether you're eligible or not.

Bill Finerfrock: Any plans to add an Am I Underserved (section) to that as well?

(Kristine Sande): Dealing with HIPSAs and MUAs?

Bill Finerfrock: Yes.

(Kristine Sande): Well, I don't know that that's specifically what we were thinking of, but that's a good point that that might be a good add on that.

Bill Finerfrock: OK. (Erica), I think it'll be in your slides, but in terms of the grants, does – when they go to the Web site, does that provide information on the deadlines and timing and things of that nature?

(Erica Molliver): Yes. And actually for all of our grant programs, you can look up the general information on the program on our – the ORHP Web site and then for grant programs that are open and competitive right now, you would go to www.grants.gov because all federal applications now are required to be submitted online. So, once the application – once the funding cycle is open, you would go to the grants.gov Web site.

Bill Finerfrock: And once there you would just do a word search, rural, or how would you …

(Erica Molliver): Yes, I would …

Bill Finerfrock: … because it is a government-wide, how would they get to the specific grant programs, do you know?

(Erica Molliver): You can search either – there's a search function when you go to the main page and then you can search either by keyword or by the funder, so you could search by ORHP or whatever office or bureau you're looking for. You can also search by CFDA number, but that's a pretty tricky thing to do if you're just doing a basic search. So I'd recommend putting in either rural health or ORHP.

Bill Finerfrock: OK. Operator, do we have any calls or any questions from the callers?

Operator: Yes, we do. We'll take the first question.

Bill Finerfrock: Thank you. Go ahead, caller.

(Charlene Pontoriero): Yes, my name is (Charlene Pontoriero) and I'm out in Montana. I was wondering, this one's for (Erica), where is – where can we get a copy of the report that's coming out from this National Advisory Committee for '08?

(Erica Molliver): That's a great question. That's one of the Web sites that I'm actually e-mailing to Bill right now. There is a Web site for the National Advisory Committee and all of their previous reports are archived on the Web site so you can read them and download them from there. The 2008 report hasn't been released yet, but as soon as it is, it will be posted on that Web site as well.

Bill Finerfrock: I will go ahead and send that out. I'm not at my computer right now, but as soon as I get that and get to my desk, we'll send that out LISTSERV so you'll have that link.

(Charlene Pontoriero): Great. Thank you.

Bill Finerfrock: next question?

Operator: At this time, there are no further questions, sir.

Bill Finerfrock: OK. Well, in that case, I think we're up pretty close to 3 o'clock, if there are no other questions. If there were any last comments that anybody wanted to make, otherwise we can go ahead and close this out. Any last comments anybody wanted to make that you didn't have an opportunity and you felt like you needed to finish up sooner than you wanted?

(Erica Molliver): This is (Erica). I just have one quick comment. Just for details, the two grant programs that are going to be available this coming year, I have the specific dates for. The network planning, which is the one-year grant program, the grant guidance for that program will be available on June 30th. And then applications will be due September 15th, I believe. And they're planning to fund between 15 and 20 of those one-year network planning grants.

And then for the rural health outreach, the guidance will be available on July 15th and applications will be due August – I'm sorry, October 17th. And they're planning to fund about 90.

Bill Finerfrock: Great. Thank you very much.

I want to thank all of our presenters today as well as all of our participants and the Office of Rural Health Policy for sponsoring this teleconference series. A transcript and an audio recording of today's presentation will be available on the ORHP Web site, hopefully within a week to two weeks, depending on how quickly we can get it turned around. I want to encourage the – remind everyone to encourage others who may be interested in registering for the technical assistance call series to visit the Rural Health Policy Web site address that I gave you earlier.

I also do want to mention our next call is scheduled for July 8th 2008. However, as many of you know, the Centers for Medicare and Medicaid Services is in the final stages of developing proposed changes, very significant proposed changes in the rural health clinics rules and regulations. In the event that those rules are released within the next 30 days, we will be scheduling a teleconference call with representatives from the Centers for Medicare and Medicaid Services to talk about those proposed changes.

And given the number of changes and the magnitude, in all likelihood those will be probably two – we'll need two calls in order to cover all of the information there. These will be proposed rules that are available for public comment. Much has been done currently with the shortage area of proposed changes. So while we have always tried to keep to a bimonthly schedule and we have tentatively scheduled our next call for July 8th, it is possible that we will be doing calls out of that cycle because the public comment period, once the proposed rule is issued, will be a 60-day public comment period that we'll have to have our call during the public comment period. So just be on the lookout for information about that and it may be out of cycle.

Again, I want to thank the Office of Rural Health Policy for their support of this series. And the slides that were not available prior to the call will be made available, along with the links that our speakers have mentioned today. Again, thank you all for participating. Look forward to talking to you in the very near future. Thank you.

Operator: That does conclude today's conference. Thank you for your participation today.

END

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