Office of Rural Health Policy

2009 Annual Report

U.S. Department of Health and Human Services

Health Resources and Services Administration

February 2011
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Table of Contents

ORHP OVERVIEW ......................................................................................................................................................2

ORHP BUDGET ...........................................................................................................................................................3

POLICY ACTIVITIES..................................................................................................................................................4

KEY REGULATORY REVIEW AND POLICY ACTIVITIES ...............................................................................................4

Rural Medicare Payment......................................................................................................................................4

Rural Health Care Quality....................................................................................................................................4

POLICY RELATED PROJECTS AND PARTNERSHIPS ......................................................................................................5

340B Drug Pricing Technical Assistance Program. .............................................................................................5

Flex Monitoring Team .........................................................................................................................................5

CAH Replacement Manual. .................................................................................................................................5

National Technical Assistance to Rural Communities.........................................................................................6

Rapid Response to Requests for Rural Data Analysis..........................................................................................6

Rural Assistance Center.......................................................................................................................................6

Rural Health and Economic Development...........................................................................................................6

Rural Health Clinic Technical Assistance............................................................................................................7

Rural Health Research Center Gateway...............................................................................................................7

Rural Hospital Performance Improvement Project (RHPI)..................................................................................7

Rural Policy Analysis Cooperative Agreements. .................................................................................................8

State Partnerships.................................................................................................................................................8

Technical Assistance Services Center..................................................................................................................8

Targeted Rural Health Care Outreach Services for Vermiculite Asbestos-Related Diseases Program................8

Workforce ............................................................................................................................................................9

GRANT PROGRAMS ................................................................................................................................................10

RESEARCH AND POLICY GRANT PROGRAMS............................................................................................................10

Frontier Extended Stay Clinic Program (FESC).................................................................................................11

Rural Health Research Centers Program ............................................................................................................12

Targeted Rural Health Research Grant (TRHR).................................................................................................13

HOSPITAL STATE DIVISION GRANT PROGRAMS.......................................................................................................14

Critical Access Hospital Health Information Technology Network Grant Program (CAH-HIT)......................15

Delta Health Initiative (DHI) .............................................................................................................................16

Medicare Rural Hospital Flexibility Grant Program (Flex) ...............................................................................17

Small Rural Hospital Improvement Grant Program (SHIP)...............................................................................18

State Offices of Rural Health Grant Program (SORH) ......................................................................................19

COMMUNITY-BASED GRANT PROGRAMS ................................................................................................................20

Black Lung Clinics Program (BLCP) ................................................................................................................21

Delta States Rural Development Network Grant Program (Delta) ....................................................................22

Radiation Exposure Screening and Education Program (RESEP) .....................................................................23

Rural Health Care Services Outreach Grant Program........................................................................................24

Rural Health Network Development Grant Program.........................................................................................25

Rural Health Network Development Planning Grant Program (Network Planning) .........................................26

Rural Access to Emergency Devices (RAED)...................................................................................................27

Small Health Care Provider Quality Improvement Grant Program (Rural Quality) ..........................................28

OTHER HRSA INITIATIVES ADMINISTERED BY ORHP...................................................................................29

BORDER HEALTH.....................................................................................................................................................30

DENALI COMMISSION ..............................................................................................................................................31

INTERGOVERNMENTAL AFFAIRS (IGA) ...................................................................................................................32

APPENDIX A: CONTRACTS....................................................................................................................................33
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ORHP Overview

The Office of Rural Health Policy (ORHP) coordinates activities related to rural health care within the U.S.

Department of Health and Human Services (DHHS). Part of the Health Resources and Services

Administration (HRSA), ORHP has department-wide responsibility for analyzing effects of DHHS policy on

62 million residents of rural communities. Created by Section 711 of the Social Security Act, ORHP

advises the Secretary on health issues within

these communities, including the effects of

Medicare and Medicaid on rural citizens’ access

to care, the viability of rural hospitals, and the

availability of physicians and other health

professionals.

In FY 2009, ORHP also administered 16 grant

programs designed to build health care capacity

at both the local and State levels.

These grants provide funds to 50 State Offices

of Rural Health (SORH) to support on-going

improvements in care, and to rural hospitals

through the Medicare Rural Hospital Flexibility

Grant (Flex).

Through its community-based programs, ORHP

encourages network development among rural

health care providers and upgrades in

emergency medical services, as well as places

and trains people in the use of automatic

external defibrillators. ORHP also oversees the

Black Lung Clinics grant program and the

Radiation Exposure Screening and Education

grant program. While these efforts are not

solely focused on rural health issues, many of

the populations affected reside in rural areas.

Finally, ORHP coordinates Agency-wide

enterprises: HRSA’s border health initiative

concentrates on improving care in the largely

rural, 2,100-mile-long, boundary lands between

the U.S. and Mexico. The program includes

urban centers in this zone, as they face

challenges similar to rural areas, such as fragile

infrastructure and difficulty attracting and

retaining an adequate healthcare workforce.

Authorizing Legislation

Office of Rural Health Policy

Section 711 of the Social Security Act

Black Lung

Section 427(a), Public Law 91-173 of the Federal Coal Mine Health and Safety Act of

1977 as amended by section 5(6), Public Law 92-303 of the Black Lung Benefits Act

of 1972 and amended by section 9, Public Law 95-239 of the Black Lung Benefits

Reform Act of 1977.

Delta Health Initiative Grant Program

Section 1820(j) of the Social Security Act 42 U.S.C. 1395

Delta States Rural Development Network Grant Program

Section 330A of the Public Health Service Act 42 U.S.C. 254c

Frontier Extended Stay Clinics Demonstration

Section 301 and 330A of the Public Health Service Act 42 U.S.C. 241 and 254c.

Medicare Rural Hospital Flexibility Grant Program

Section 1820(j) of the Social Security Act 42 U.S.C. 1395

Network Development Grant Program

Section 330A of the Public Health Service Act 42 U.S.C. 254c

Network Development Planning Grant Program

Section 330A of the Public Health Service Act 42 U.S.C. 254c

Public Access to Defibrillation Demonstration Projects

Section 313 of the Public Health Service Act 42 U.S.C. 245 as amended by section

159(c), P.L. 107-188 of the Public Heath Security and Bioterrorism Preparedness and

Response Act of 2002.

Radiation Exposure, Screening and Education Program

Section 417C of the Public Health Service Act as amended by section 4, Public Law

106-245 of the Radiation Exposure Compensation Act Amendments of 2000.

Rural Access to Emergency Devices Grant Program

P.L. 106-505, Title IV – Cardiac Arrest Survival Act, Subtitle B, section 413 of the

Public Health Improvement Act 42 U.S.C. 254c.

Rural Health Outreach Grant Program

Section 330A of the Public Health Service Act 42 U.S.C.

Rural Health Research Centers Program

Section 711 of the Social Security Act 42 U.S.C. 912

Small Health Care Provider Quality Improvement Grant Program

Section 330A of the Public Health Service Act 42 U.S.C. 254c

Small Rural Hospital Improvement Grant Program

Section 1820(g)(3) of the Social Security Act 42 U.S.C. as amended by section

4201(a), P.L. 105-33 of the Balanced Budget Act and section 405(f), P.L. 108-173 of

the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

State Offices of Rural Health Grant Program

Section 338J of the Public Health Service Act 42 U.S.C. 254r as amended by section

301, P.L. 105-392.

Targeted Rural Health Services Research Program

Section 711 of the Social Security Act 42 U.S.C. 912
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ORHP Budget

Chart 1 – Budget Summary for Programs, FY 2008 and FY 2009 (amounts in

thousands)

Rural Health Programs

FY 2008 Final

Appropriation

FY 2009 Final

Appropriation

Rural Health Outreach 48,031 53,900

Rural Health Research and Policy 8,584 9,700

Medicare Rural Hospital Flexibility 37,865 39,200

Rural and Community Access to

Emergency Devices

1,461 1,751

Delta Health Initiative 24,563 26,000

State Offices of Rural Health 7,999 9,201

Denali Commission 38,597 19,642

Radiation, Screening, Exposure and

Education Program

1, 884 1,952

Black Lung 5,788 7,200

CAH & SNF Federal Hospital Insurance

Trust Funds

942,123 0

Total $ 175,713 168,546

Note: Individual line items may include funding for more than one grant program. For example, the Rural Health Outreach line item includes

funding for the Rural Health Care Services Outreach, Rural Network Development, Network Planning, Small Health Care Provider Quality

Improvement, Frontier Extended Stay, and Delta Network grant programs. The Medicare Rural Hospital Flexibility Grant line includes funding for

the Flex, Small Hospital Improvement, and Delta Health Initiative grant programs. The policy line item includes funding for the Rural Health

Research Center grant program, as well as all of the Office’s policy activities. Also, the Flex Line for FY 2007 includes $25 million above the base

to fund the Critical Access Hospital Health Information Technology Network Grant Program.

Chart 2 – Total number of ORHP Grants and Amounts by State, FY 2009

Total number of Grants awarded: 465

Total amount Funding provided: $127,139,

State # Grants

Awarded

FY 2009

Funding

AK 9 1,845,190

AL 14 2,528,071

AR 13 2,603,413

AZ 8 1,484,999

CA 17 2,623,594

CO 8 2,009,216

CT 2 259,200

DE 3 417,200

FL 10 1,801,515

GA 12 2,428,814

HI 6 1,048,719

IA 8 2,026,853

ID 4 1,091,024

IL 10 3,409,175

IN 10 1,978,655

KS 8 2,170,017

KY 19 3,922,683

State # Grants

Awarded

FY 2009

Funding

LA 9 2,436,026

MA 4 628,418

MD 11 1,428,497

ME 12 2,339,069

MI 14 2,360,800

MN 10 3,010,817

MO 13 2,767,510

MS 8 27,632,643

MT 15 4,738,865

NC 11 2,420,030

ND 12 2,521,071

NE 11 3,014,308

NH 9 1,531,252

NJ 1 167,200

NM 9 1,778,668

NV 4 970,856

NY 11 1,739,207

State # Grants

Awarded

FY 2009

Funding

OH 12 2,797,349

OK 6 1,624,650

OR 10 1,883,766

PA 11 2,148,100

RI 1 150,000

SC 11 2,208,200

SD 10 1,828,725

TN 10 2,369,726

TX 11 3,185,014

UT 5 1,143,567

VA 12 2,275,405

VT 8 1,268,143

WA 12 3,245,577

WI 8 1,908,438

WV 7 2,595,430

WY 5 1,229,121

Puerto

Rico 1 144,362
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Policy Activities

Key Regulatory Review and Policy Activities

ORHP advises the Secretary on the effects of current policies and proposed statutory, regulatory,

administrative, and budgetary changes on rural communities. Because many of the policy levers at the

Federal level are related to the Medicare program, review and analysis of prospective changes to

Medicare comprise much of the ORHP’s policy work. Significant time and attention also are devoted to

other policy areas, including Medicaid, the State Children’s Health Insurance Program (CHIP), workforce,

quality, and health information technology (HIT).

Rural Medicare Payment

During Fiscal Year 2009, the policy staff in ORHP reviewed approximately 185 drafts of Federal

regulations and policies to determine how they might affect rural providers and the individuals they serve.

Of these regulations, 22 included provisions ORHP staff determined had the potential to adversely affect

rural providers or for which staff believed additional language should be added to provide adequate

protections. ORHP often identifies issues of particular concern to rural communities during its review of

the Medicare payment system regulations.

Rural Health Care Quality

CAHs continued to increase their participation in reporting quality measures to the CMS Hospital

Compare. For 2008 discharges, 70 percent of CAHs publicly submitted data for at least one

measure. Submission rates vary by State and by CAHs organizational characteristics. By state, the

percentage of participating CAHs ranged from 7.7 to 100 percent. In nine states, all CAHs were

participating. CAHs were more likely to report data on pneumonia and heart failure measures than on

Acute Myocardial Infarction (AMI), and surgical infection prevention measures. Participation in the

program is significant since CAHs submit data on a voluntary basis and do not receive any payment

update; unlike hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS) who are

required to participate in order to receive a full payment update.

In 2009 ORHP contributed funds to the HRSA Patient Safety and Clinical Pharmacy Services

Collaborative (PSPC) for a second PSPC Collaborative session that began in September, 2009. Seven

additional rural teams joined four rural teams who continued in the PSPC 2.0. The aim of the PSPC

collaborative is to eliminate adverse drug events and improve patient outcomes. There are 109 active

teams participating representing 350 organizations in 39 States and the District of Columbia and Puerto

Rico.

National Advisory Committee on Rural Health and Human Services (NACRHHS)

ORHP serves as primary staff for the National Advisory Committee on Rural Health and Human Services,

with assistance from the U.S. Department of Health and Human Services Administration on Aging.

NACRHHS is a 21-member citizens’ panel of nationally recognized rural health experts that provide

recommendations on selected issues in an annual report to the Secretary.

The 2009 Report was released in July and covers the following topics:

The Medical Home Model: Viability for Rural Communities

Treating “At Risk” Children in Rural Areas

Workforce and Community Development

The 2010 Report topics include:

Health Care Provider Integration

Home and Community Based Care for Rural Seniors

Rural Primary Care Provider Workforce
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Policy Related Projects and Partnerships

One of the unique aspects of the Office of Rural Health Policy is its entrepreneurial nature. Since its

inception, ORHP has put an emphasis on working with public and private organizations to develop

projects that address the long-standing problems in rural health. These “special projects” either highlight

an issue, sustain development of services or resources to fill an identified need.

These projects typically focus on the interests of all rural communities, such as the need for general

information and technical assistance. Others may pertain to a specific issue, such as the recruitment and

retention of clinicians or the importance of economic development to health care. Still, other activities

focus on particular types of health care providers and settings. In each case, however, the projects and

initiatives meet an identified need in rural health care.

• 340B Drug Pricing Technical Assistance Program – As a result of a 2003 change in the Medicare

Modernization Act of 2003, approximately 350 Rural Disproportionate Share Hospitals (DSH) became

eligible to participate in the 340B Drug Pricing Program. Each year ORHP provides supplemental funding

to the HRSA Office of Pharmacy Affairs to assist the HRSA Pharmacy Services Support Center (PSSC) in

providing technical assistance to rural DSH in securing 340B discount drug purchasing. Established in

2002, the aim of PSSC is to expand pharmacy services in eligible safety net health care providers. The

Center operates under a contract between HRSA and the American Pharmacists Association (APhA). To

date, it has helped almost 200 rural DSH enroll in the 340B program.

Observing that 75% of the eligible but non-participating rural DSH are in five states in the southeast,

including: Alabama, Arizona, Mississippi, Kentucky, and Louisiana; plus Texas and Oklahoma, ORHP

targeted these states by holding a one day free workshop to educate them on the 340B program and

assist them in enrolling in the program. Over 50 people from eligible hospitals and state organizations

(State Office of Rural Health and State Hospital Associations) attended. PSSC consultants were there to

assist the hospitals and provided follow up contact information for further technical assistance.

• Flex Monitoring Team – The Flex Monitoring Team (FMT) is a consortium of three rural health

research centers: Southern Maine University, University of Minnesota, and University of North Carolina

Sheps Center, whose purpose is to monitor and evaluate the Flex Grant Program and to make

recommendations for improving the program. Since its inception in 1997, an important body of

knowledge has been produced about rural health care, rural hospital financial issues, network

development, EMS, quality improvement, and community impact.

As the program has matured, the monitoring and evaluation process has focused less on the process of

converting hospitals to critical access status and more on development of rural organized systems of

care, financial performance, impact on access to and quality of care, disease management, community

role, and impact on health status of rural populations served by these emerging systems. Improving

clinical, financial and leadership performance of rural healthcare organizations, access to capital and

progress in acquisition and use of technology will be important future areas of evaluation.

In 2009, the FMT continued to track hospital participation on CMS Hospital Compare, Health Information

Technology (HIT) adoption rates in CAHs, and CAH performance improvement for 20 financial indicators.

Upcoming projects include HIT “meaningful use” adoption in CAHs, Changes in Obstetrical Services in

CAHs and Trends in Hospital Ownership of Skilled Nursing Facilities. The Flex Monitoring Team regularly

makes presentations on their work at national conferences as well as publishes in peer reviewed journals.

The FMT is also a valuable resource to ORHP regarding the Flex program and other rural hospital issues.

• CAH Replacement Manual – ORHP developed and has in publication a “Roadmap and Manual for

CAH Replacement,” containing step-by-step guidance, simple tools and successful strategies for

obtaining capital and building new facilities. Some CAHs are considering replacing their facilities, many

of which were built in the 1950s. These projects have proven to increase admissions and outpatient visits;

as well as improving staff recruitment and clinical performance, and boosting local economies. But

hospital CEOs and Boards in rural communities typically encounter serious technical hurdles. Few local

lenders (public or private), architects or builders have the requisite experience with hospital projects. The

manual will be available and distributed in 2010.
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• National Technical Assistance to Rural Communities – In 2009, ORHP joined with the National

Rural Health Association (NRHA) to identify and promote useful administrative and clinical practices for

rural providers, advance health quality initiatives, and increase leadership and skills development

training. Through teleconference and Webinar series, this initiative extends continuing education to

providers in remote communities, while affording ongoing technical assistance to entities like the State

Offices of Rural Health (SORHs) and State Rural Health Associations (SRHAs).

o Technical assistance was provided to the following states: Indiana, Colorado, California,

Tennessee, Mississippi, Oklahoma, West Virginia, Florida, and Virginia. Activities included

website redesign, fundraising, marketing, grant writing, membership recruitment, communications

and strategic planning. States completed an application process for this technical assistance and

funds were awarded on a first-come, first-serve basis. A record number of states applied for this

assistance, however, the review committee could only approve the 9 proposals listed above

based on the projects submitted.

Monthly conference calls were held to provide updated information related to technical assistance,

membership, regulations and each SRHA provided an update on their activities in an effort to share

information with their peers. NRHA staff members also provided onsite technical assistance to states.

Specifically, strategic planning technical assistance was provided for SRHAs in Alabama, Oklahoma,

Kentucky, and Oregon. NRHA also provided technical assistance for New York, Nebraska, Arizona and

Minnesota. The technical assistance included strategic planning, assistance with membership issues (i.e.

recruitment and retention), and role clarification of SRHAs at the national level.

• Rapid Response to Requests for Rural Data Analysis -- In 2009, ORHP funded the Rapid Response

to Requests for Rural Data Analysis to support quick turnaround requests for rural data analysis to assist

with policy making. Due to the nature of rural policy analysis and formulation, policymakers often require

information that is available only through specialized analysis of databases of information. In order to

acquire the information from the data sets needed to identify trends, problems and progress in rural

health care financing and access to care in rural areas, ORHP funds a consortium of research institutions

that have access to the required data storage capacity, personnel, and computer resources to provide the

information. Topics analyzed for policy makers in 2009 include the experience of rural independent

pharmacies with Medicare Part D, Medicare Advantage & Part D Rural Medicare beneficiary enrollment,

and rural implications of health care reform.

• Rural Assistance Center – Based at the University of North Dakota School of Medicine and Health

Sciences, the ORHP-funded Rural Assistance Center (RAC) helps rural residents navigate a wide range

of health policy and social services information online. RAC assists individual communities and providers

in identifying potential funding streams that best meet their needs. Staff researchers also provide no-cost,

customized assistance, performing database searches; referring users to qualified experts and

organizations; furnishing publications; and posting a wide variety of timely information on the Internet

(regulatory updates, conference announcements, bibliographies, directories, and full-text documents).

The Center also acts as a repository and retrieval portal for information and research from a myriad of

Federal, State, and private sources, and makes that information actionable for rural stakeholders. In

2009, RAC responded to over 910 individual requests for assistance.

The RAC Web site is the most comprehensive source of reliable information on rural health and human

services on the Internet. To ensure timely and widespread distribution to often-remote communities, the

Center maintains an electronic mailing list that reaches a broad audience across the breadth of rural

America. The RAC site averages over 77,000 visits per month, while its electronic updates have over

13,000 combined subscribers.

• Rural Health and Economic Development -- The health sector usually is one of the top employers in a

rural economy, a role and relationship that often is not fully understood. The National Center for Rural

Health Works is an ongoing program that provides technical assistance, tools and training to help States

and communities substantiate the broader economic impact of the health care sector as a spur for further

investment. Rural Health Works also develops profitability studies to help policymakers illustrate the

economic benefits of new or expanded services in existing facilities.
7

During FY 2009, Rural Health Works conducted regional workshops in Wyoming and Maine; responded

to more than 250 requests for technical assistance; and updated their Web site to keep current with the

latest research in this area. A feasibility study was published that quantifies the costs and revenues for a

rural physician practice. A new economic impact study nearing completion will quantify the costs and

revenues for general surgery in rural Critical Access Hospitals. Rural Health Works completed an

economic impact of Hawaiian Critical Access Hospitals on a Community, County, and State level.

Rural Health Works sends representatives to conferences nationwide to actively promote the tools and

applications it has developed over the past 10 years. Rural Health Works is planning two regional training

sessions in 2010 where they will hold workshops on how to conduct economic impact studies as well as

how to undertake community health engagement process and health feasibility studies.

Rural Health Works joined with the National Association of Counties (NACo) in an outreach campaign to

elected county officials interested in launching community engagement projects to help rural communities

recognize that improving their health care systems boosts local economic growth generally. A new

initiative in FY 2005, it continued through FY 2009 with on-site technical assistance to three rural

counties. The partnership between the Center and NACo will evolve to include two webcasts for NACo

members and continued technical assistance. For each, the project has produced a county-level report

covering such topics as economic impact, community need, and a health services directory. All are

posted on the NACo Web site and were featured in NACo workshops at the Western Regional and

Annual Conferences, as well as in articles for NACo’s publication “County News.”

• Rural Health Clinic Technical Assistance -- More than 3,000 Rural Health Clinics (RHCs) nationwide

receive technical assistance funded by ORHP. As safety-net providers, these clinics are critical in

maintaining access to care for underserved rural populations. RHCs face unique operational and

administrative challenges however, which often require real-time technical assistance. ORHP provides

this support through conference calls, as well as frequent updates through a listserv, free of charge. The

RHC Web site posts written transcripts, speaker presentations, and audio transcripts of each call as a

ready-reference for clinicians and administrators.

In FY 2009, the RHC technical assistance conference call series provided five calls, with topics

determined by an advisory group of national experts versed in the most pressing concerns of rural

providers. Discussions included: RHC billing issues; RHC clinician recruitment strategies; Medicare

Administrative Contractors’ (MAC) transitions; Electronic Health Record incentives; and depression &

mental health screening for adolescents (“Teen Screen”). An average of 300 providers nationwide dialed

in for each session, saving RHCs about $900 per conference call compared to the cost of sending staff to

similar training/conferences off-site. In the aggregate, this savings amounted to over $270,000 per

session, thereby substantially extending local patient care budgets. Average call participation in FY2009

increased by approximately 5% in comparison to FY2008.

• Rural Health Research Center Gateway -- The Rural Health Research Gateway (Research Gateway)

Web site was developed to speed the dissemination of information and publications of the ORHP-funded

Rural Health Research Centers, including contact information for subject-area experts; summaries of

research projects, both those underway and completed; full text versions of Policy Briefs, Analytic

Reports, Fact Sheets, and other products of the Research Centers. In 2009, the Gateway continued a

Research Alert feature to notify listserv members about the availability of recently released reports. The

Gateway includes all projects and their related publications dating from 2006. Earlier publications are

being added as resources permit.

• Rural Hospital Performance Improvement Project (RHPI) – ORHP provides ongoing technical

assistance to historically distressed rural hospitals in the Mississippi Delta Region, as defined by the

Delta Regional Authority (DRA). The program focuses on improving financial, operational, and clinical

performance through remote and on-site consultative services for hospitals that otherwise would not have

had the resources to afford these needed services.

In 2009, RHPI provided 41 consultations at 39 of the 171 eligible hospitals in DRA. Thirty-eight hospitals

received on-site consultations, and nine received feedback assessments. Of the on-site visits, 7 were

general Performance Improvement Assessments (PIA), and 25 were consultations for specified issues,

with 6 leadership development trainings and two “Balanced Scorecard” review. Of the feedback
8

assessments, seven each were conducted for community feedback, and two were employee feedback

assessments. There was 400% increase in the number of participants in the web trainings. The schedule

was preset for 2009 and time changed to avoid conflict with shift changes. The results for the first year of

an evaluation indicate hospitals have overall demonstrated improved post PIA financial performance.

RHPI has developed performance improvement strategies at the State, regional and local (hospital) levels

in conjunction with State offices of rural health (SORH) and State hospital associations.

• Rural Policy Analysis Cooperative Agreement -- ORHP funds the Rural Policy Analysis Cooperative

Agreement to support research and analysis on key policy issues affecting rural communities. In 2009,

this funding supported activities with the Rural Policy Research Institute (RUPRI) Rural Health Panel; the

Rural Hospital Issues Group; and the RUPRI Rural Human Services Panel. The Rural Health Panel

provides science-based, objective analysis to Federal policymakers. Panel members come from a variety

of academic disciplines and author documents that reflect the consensus judgment of all panelists. The

Rural Hospitals Issues Group, a panel of hospital administrators and finance experts from across the

country, discuss issues such as the Medicare reimbursement, Medicare Advantage, and other policy

issues affecting small rural hospitals. The Rural Human Services Panel provides background, advice and

presentations on rural human services issues and the intersection between health and human services to

the National Advisory Commission on Rural Health and Human Services. As with the Rural Health Panel,

the Rural Human Services Panel members come from a variety of human services disciplines and author

documents that reflect the consensus judgment of all panelists.

• State Partnerships -- For the fourth consecutive year, ORHP continued a cooperative agreement with

the National Organization of State Offices of Rural Health (NOSORH). The purpose of the State Rural

Health Coordination and Development Cooperative Agreement (SRHCD-CA) is to enhance the rural

health infrastructure in each State by providing guidance and technical assistance to State Offices of

Rural Health (SORHs) as well as their partners and to identify and promote best practices. The goals of

the SRHCD-CA are 1) to assist in the coordination of health care delivery through the development of

State level rural health leadership; and 2) to facilitate partnerships and collaboration at the national and

State levels to improve the exchange of information and engage in collaborative activities for supporting

rural health.

NOSORH and the National Association of Rural Health Clinics are working together on a pilot project to

build the capacity of SORH to provide technical assistance to rural health clinics (RHCs). The project will

identify and document best practices by SORHs when rendering technical assistance to RHCs in their

states and develop resources for SORH to support the work of rural health clinics. SORHs will work with

NOSORH to make recommendations, identify and document best practices, barriers to rendering

technical assistance, estimated staffing and start-up costs; and identify other key elements necessary for

SORHs to start offering technical assistance to RHC’s including developing learning modules for SORHs.

• Technical Assistance Services Center -- The Technical Assistance Services Center (TASC) provides

expert guidance to Rural Hospital Flexibility Program (Flex Program) grantees in such areas as Medicare

reimbursement policies, Federal regulations, and hospital operations. The staff of ORHP works closely

with TASC to prioritize key issues and develop information resources to share with Flex grantees.

TASC supported the 45 participating State Flex Programs in 2009 as they: converted prospective

payment hospitals to Critical Access Hospital (CAH) status; integrated emergency medical services into

rural medical delivery systems; build rural hospital networks to exchange information, provide economies

of scale, obtain collective volume, and increase cost efficiency; and helped to improve quality and overall

organizational performance. TASC provided technical assistance to these 45 State Flex Programs, their

1,302 CAHs, and related partners and networks. TASC facilitated the collection and dissemination of

rural-relevant information; gathered and evaluated materials; maintained relationships with national rural

health organizations and experts; and conducted conferences and educational sessions. In FY2009,

TASC’s areas of concentration included performance improvement and health information technology,

including the support for the National Rural Health Information Technology Coalition. TASC conducted

eleven state site visits in FY2009, provided four conference presentations, facilitated numerous

conference calls and face-to-face meetings for states and their partners, and produced two technical

assistance manuals.

• Targeted Rural Health Care Outreach Services for Vermiculite Asbestos-Related Diseases

Program —The Environmental Protection Agency (EPA) has identified Lincoln County, Montana, as a
9

“public health emergency” based on the residents in this rural community that have been adversely

affected by the asbestos released from the vermiculite mines. Asbestos-related diseases in which Lincoln

County residents have been diagnosed include asbestosis, lung cancer, colorectal cancer, and others.

As a result, HRSA issued a single source award to Lincoln County Health Department on August 1,

2009 in response to the urgent public health problem in Lincoln County. The total award amount for this

organization is $6M with a two year project period- $4M from HRSA to support the provision of health

related services and $2M from CDC to support screening related costs. Screening and other health

related services for this program began in November 2009.

• Workforce – In conjunction with the Bureau of Health Professions, the Bureau of Clinician Recruitment

and Services, and the Bureau of Primary Health Care, the Office of Rural Health Policy held a national

meeting on August 10-12, 2009 in Washington, DC focusing on the challenges rural and urban

underserved communities face in attracting and retaining an adequate number of primary care providers.

This meeting brought together about 500 researchers, clinicians, policy makers, national associations,

and community leaders to addresses primary care workforce challenges. At the meeting participants

engaged in a broader discussion on how to move forward and assist rural and urban underserved

communities attract needed health care providers. Specific attention was given to the current primary

care workforce challenges and successful models of primary care training and practice as well as how to

identify promising future strategies. At the meeting participants were asked to provide feedback and

comments on what HRSA should be doing now and in the future to address primary care workforce

shortages. An email address was also set up for participants to use after the meeting and was checked

daily for submission until September 30, 2009. In total, HRSA received 250 comments from participants.

These recommendations are currently under review by the HRSA Administrator.

Rural Recruitment and Retention:

The National Rural Recruitment and Retention Network (3RNet) consists of 51 State-based, not-for-profit

organizations that encourage and assist physicians and other health professionals in locating practices in

underserved rural communities. Members include State Offices of Rural Health, Primary Care,

associations, Area Health Education Centers, and other not-for-profit entities.

During FY 2008, 3RNet members placed 1,023 medical professionals, including 218 family practice

physicians, 87 internal medicine physicians, 55 pediatricians, 105 dentists, 121 nurse practitioners, and

99 physician assistants. 3RNet also maintained a toll-free phone line to assist providers interested in

serving rural America, saving rural communities substantial recruitment costs. A conservative estimate of

physician placement fees is about $28,000 (many are in excess of $30,000), and members placed 515

physicians in FY2008. While taking into account that some 3RNet members have small posting or

placement fees to support their recruitment programs, communities saved an estimated $13,420,000 in

recruitment fees that can be used for patient care services in those communities. In 2008, 740 designated

underserved areas (HPSA or MUA communities) received placements, compared to 2007, (524), 2006

(627), 2005 (568) and 2004 (541)

The National Resource Center has performed an independent evaluation of 3RNet since 2004. While

placements are important, the best measure of 3RNet is the number applications. Health care facilities

themselves do not have control over placements since candidates make that decision.

2004: 3,520 postings, 10,602 applicants and 753 placements

2005: 4,299 postings, 11,914 applications and 715 placements

2006: 7,125 postings, 12,632 applications and 734 placements

2007: 5,700 postings, 15,382 applications and 681 placements

2008: 5,894 postings, 16,513 applications and 1,023 placements
10

Grant Programs

Research and Policy Grant Programs

In FY 2009, ORHP administered three grant programs within the Policy Research Team. The grant

programs are: 1) the Frontier Extended Stay Clinic Demonstration program; 2) the Rural Health Research

Centers; and 3) the Targeted Rural Health Research grant program. There were 11 grants awarded in

these 3 programs with a total budget of almost $7 million. In addition to the above grants, Policy

Research team members manage numerous cooperative agreements and contracts that support

research and analysis of key policy issues affecting rural communities. These activities work to educate

and inform rural decision makers and policy leaders at the local, State, and Federal level.

Policy Research Team Members:

Carrie Cochran, Team Lead

Heather Dimeris Tom Morris

Nancy Egbert Erica Molliver

Michelle Goodman Joan Van Nostrand

Truman Fellows: Laura Merritt, Kai Smith
11

At a Glance

Grants Awarded:

2007: 1 continuing award

2008: 1 continuing award

2009: 1 continuing award

Amount Awarded: Up to $1.5 million

per year, per grantee

2007: $1.5 million

2008: $1.5 million

2009: $1.5 million

Project Period: 4 years

Next Competitive Grant Application:

None

Frontier Extended Stay Clinic Program (FESC)

AUTHORIZING LEGISLATION: Title III, Section 330A of the

Public Health Services Act, 42 U.S.C. 254c.

PROGRAM OVERVIEW:

The purpose of the Frontier Extended Stay Clinic cooperative

agreement demonstration program is to examine the

effectiveness of a new type of provider in providing health

care services in certain remote clinic sites. The FESC is

designed to address the needs of patients who are unable to

be transferred to an acute care facility because of adverse

weather conditions, or who need monitoring and observation

for a limited period of time.

FY 2009 program activities include, but are not limited to:

Implementation and testing of FESC protocols;

Evaluation of program and financial activities;

Provision of technical assistance to CMS FESC

Demonstration Project and participating organizations;

Developing or continuing Health Information Technology

(HIT) and quality initiatives; and

Exploring the FESC model in the lower 48 states, including the relationship with Critical Access

Hospitals.

In remote, frontier areas of the country, weather and distance can prevent patients who experience

severe injury or illness from obtaining immediate transport to an acute care hospital. For residents in

some of those communities, providers offer observation services traditionally associated with acute care

inpatient hospitals until the patient can be transferred or is no longer in need of transport. However,

extended stay services are not currently reimbursed by Medicare, Medicaid, or other third-party payers.

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) authorized CMS to

conduct a demonstration program in which FESCs would be treated as Medicare providers. In a separate

recognition of the extended care services provided by some frontier clinics, an additional demonstration

program to be administered by ORHP was established by the Consolidated Appropriations Act of 2004.

KEY PROGRAM ACCOMPLISHMENTS:

In 2009, ORHP continued the work started in 2004 by providing funding to the Alaska FESC Consortium

for the participation of five clinic sites in frontier Alaska and Washington. Preliminary results of the 3rd

year of data collection indicate that the 5 clinics recorded 1,226 FESC encounters greater than or equal to

four hours and 1,634 encounters less than four hours. The mean length of these encounters was 8.8

hours. Monitoring and observation accounted for 64% of the project’s overall encounters. The most

frequent diagnoses for FESC encounters were cardiovascular, gastrointestinal, and injury. Over the three

data years, 25.7% of total FESC encounters (315 of 1,226) were eligible for Medicare reimbursement.
12

At a Glance

Grants Awarded:

2007: 8 continuing awards

2008: 6 new awards

2009: 6 continuing awards

Amount Awarded: Prior to 2008, up to

$550,000 per year, per grantee

2007: $4 million

For 2008 and later, up to $660,000 per

year, per grantee

2008: $3.96 million

2009: $3.96 million

Project Period: 4 years

Next Competitive Grant Application:

Year: 2012

Anticipated Grants: Up to 6

Anticipated Grant Amount: Up

to $660,000 per year, per grantee

(up to $3,960,000 combined)

Rural Health Research Centers Program

AUTHORIZING LEGISLATION: Section 711 of the Social

Security Act

PROGRAM OVERVIEW:

The ORHP funded Rural Health Research Centers conduct

and disseminate policy-relevant research on the problems

that rural communities face in assuring access to health care

and strengthening health of their residents. These studies

help to inform ORHP policy staff in their annual review of

key Departmental regulations, and assists policymakers

seeking to improve access to care in remote communities.

Initiated in 1987, the Research Centers Program is the only

Federal effort dedicated entirely to producing policy-relevant

research in this arena. Often housed at major U.S.

universities, each Center has its own identity, Web site, and

inter-disciplinary team of experts in health services research,

epidemiology, public health, geography, medicine, and

nursing. Over the 4-year award cycle, each team develops a

portfolio of three projects annually in consultation with

ORHP and its advisors. Projects are designed to address

HHS, HRSA, and ORHP goals.

KEY PROGRAM ACCOMPLISHMENTS:

In 2009, the 6 Research Centers conducted 18 projects and

wrote 30 policy briefs and reports. Over 20 of the Policy Briefs focused on health care reform issues in

rural places. The Research Centers also authored 23 peer-reviewed journal articles in 2009, and another

11 have been accepted for publication and are in pre-press. To widen dissemination of these results, the

Rural Health Research Gateway was updated in 2009. The Gateway is a Web site that allows “one-stop

shopping” for all completed projects and reports produced by the respective research teams, as well as

summaries of projects in progress. In 2009, the Gateway continued to issue Research Alerts each time a

new report was issued. Additionally, the Centers each have Web sites that highlight and summarize their

projects. There were over 104,000 visits to these sites in 2009. Staff also presented their findings to 111

policy, provider, payer, and academic audiences; and responded to over 200 requests for information

from various national and State policymakers. In 2009, the 6 Research Centers were in the 2nd year of

the 2008-2012 cycle. See the Research Gateway (http://www.ruralhealthresearch.org) for a list of the 6

Research Centers.
13

At a Glance

Grants Awarded:

2007 : 2 new awards

2008 : 2 new awards

2009 : 3 new awards

Amount Awarded: Up to $150,000 per

grantee

2007 : $300,000

2008 : $299,512

2009 : $449,653

Project Period: 18 months

Next Competitive Grant Application:

None

Targeted Rural Health Research Grant (TRHR)

AUTHORIZING LEGISLATION: Section 711 of the Social

Security Act

PROGRAM OVERVIEW:

The Targeted Rural Health Research Grant Program

(TRHR) funds policy-oriented projects which address critical

issues facing rural communities in their quest to secure

affordable, high quality health services. The program is

unique in its dual purpose of enhancing policymakers’

knowledge of rural health, and expanding the pool of

experienced researchers in this complex field. Grantees’

findings inform the ORHP, as well as National, State, and

local decision makers. Grantees must address one of a

selected group of topics, and all aspects of the project must

be national in scope. Studies funded in FY09 included the

following issues of national significance: Rural Health

Clinics, Rural Health Workforce, Frontier Health Services

Delivery, and Rural Hospital Leadership.

Originally entitled “Policy-Oriented Rural Health Services Research Grant Program,” the Targeted Rural

Health Research Grant Program was launched in 2003 on a single-year grant cycle. In 2007, however, it

became apparent that the 12-month timeframe was unrealistic, considering the complexity of the research

involved. Under expanded authority, ORHP notified grantees that they could extend their projects without

formally requesting approval of a no-cost extension. Reflective of this shift, the name of the program was

changed to “Targeted Rural Health Research Grant Program,” and the grant budget & project periods

were formally extended to 18 months, as of the FY2008 funding cycle. The Targeted Rural Health

Research Grant Program will not be re-competed in FY2010.

KEY PROGRAM ACCOMPLISHMENTS:

Grantees’ research findings have been instrumental in helping policy makers bridge conceptual gaps

between abstract policy aims and the real-time needs of rural communities, while complimenting the

larger scale projects conducted by the ORHP-funded Rural Health Research Centers. FY 2008 grantees

generated research findings in the following areas:

“Healthy Frontier and Rural Medical Services (Healthy FARMS): Securing access to health care

in rural and frontier America”

“How is the Economic Downturn Impacting Rural Health Clinics?”

“A National Study of Nurse Leadership in Rural Hospitals: The Impact on Patient Safety”

FY2009 Study Topics Include:

"Healthy Frontier and Rural Medical Services (Healthy FARMS): Securing access to health care

in rural and frontier America"

"How is the Economic Downturn Impacting Rural Health Clinics?"

"A National Study of Nurse Leadership in Rural Hospitals: The Impact on Patient Safety"
14

Hospital State Division Grant Programs

In FY 2009, ORHP administered three grant programs within the Hospital State Division (HSD). The grant

programs are: 1) Rural Hospital Medicare Flexibility (Flex); 2) Small Rural Hospital Improvement Program

(SHIP); and 3) the State Office of Rural Health (SORH). Additionally, the Critical Access Hospital Health

Information Technology (CAHHIT) Network grant program grantees completed their projects.

There were 141 grants awarded in these three programs with a budget of more than $45 million. In

addition to the above grants, HSD members manage a wide range of cooperative agreements and

contracts that support States with technical assistance, recruitment of health care providers, assistance in

attaining funds to build replacement facilities and other activities.

Hospital State Division Members:

Kristi Martinsen, Division Director

Region A

Jennifer Chang: Connecticut, Delaware, Maine, Maryland, Rhode Island

Jeanene Meyers: Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania,

Vermont

Region B

Samantha Williams: Arkansas, Kentucky, North Carolina, Tennessee, Virginia, West Virginia

Bridget Ware: Louisiana, Mississippi, South Carolina, Alabama, Georgia, Florida

Region C

Megan Alavi: Illinois, Indiana, Iowa, Minnesota, Nebraska

Michael McNeely: Kansas, Michigan, Missouri, Ohio, Wisconsin

Region D

Michelle Goodman: Arizona, California, New Mexico, Texas

Steve Hirsch: Hawaii, Nevada, Oklahoma

Region E

Nancy Egbert: Idaho, Montana, North Dakota, Washington, Wyoming

Keith Midberry: Alaska, Colorado, Oregon, South Dakota, Utah
15

At a Glance

# Grants Awarded:

2007: 16 new awards

2008: N/A

2009: N/A

Amount Awarded: Up to $1.6M per

grantee

2007: $25 M

2008: N/A

2009: N/A

Project Period: 18 months

Next Competitive Grant Application:

None

Critical Access Hospital Health Information Technology

Network Grant Program (CAH-HIT)

AUTHORIZING LEGISLATION: Section 1820 (g) 3 of the Social

Security Act

PROGRAM OVERVIEW:

This was a one-time only award that the Office of Rural Health

Policy offered in FY 2007. The purpose of this 18-month pilot

program is to support development of Health Information

Technology (HIT) systems in rural communities through the 16

States that received CAH-HIT Network grants. The aim is to

develop networks and implement HIT across the continuum of

care to improve ORHP’s case coordination and health outcomes

for rural residents. HRSA’s experience has shown that it is cost

effective to utilize networks of providers to develop HIT. Therefore,

grantees may focus their projects on any of the following systems:

Practice management

Disease registry

Care management

Clinical messaging

E-prescription

Telemedicine/Telepharmacy applications

Personal health record

Electronic health record

Health information exchanges

The grantees have included various organizations in their “share” networks, such as public health

departments, community-based clinics, faith-based organizations, and other HRSA grantees. These

networks will enable quality improvement programs, linked to HIT tracking of five outcome measures, two

of which will be diabetes control and health disease risk reduction.

Although the CAH-HIT Network program is a one-time funding opportunity, it is being administered as a

“test bed” pilot program on HIT network implementation in rural areas. A thorough evaluation has been

completed with the intent to provide the outcomes to all the participants as well as to the general

populace by February 2010. The evaluation report outlines the work of the 16 grantees and describes 16

separate successful templates of HIT implementation that can be duplicated.

KEY PROGRAM ACCOMPLISHMENTS:

At the close of 2009, all of the grantees had completed the implementation of their projects and were

utilizing a fully operational HIT network. By the end of the grant cycle, it was anticipated that the grantees

would have developed comprehensive management systems for medical information, and its secure

exchange between and among consumers and providers. ORHP has funded an evaluation contract to

document the process of the implementation of the program so that the projects’ outcomes can be

evaluated at a later date to determine if they succeed in improving quality of care, reduction in medical

errors, administrative efficiencies, and overall access. ORHP has also funded a primer to be utilized by

State Offices of Rural Health and rural health care providers to communicate the lessons learned from

CAH HIT in a post-ARRA world. The primer is set for delivery at the end of the second quarter FY 2010.
16

At a Glance

Grants Awarded:

2007: no award

2008: 1 continuing award

2009: 1 continuing award

Amount Awarded:

2007: $0

2008: $23 million

2009: $25 million

Project Period: 5 years

Next Competitive Grant

Application:

Year: 2011

Anticipated Grants: Up to 1

Anticipated Grant Amount: Up

to $24,750,000 per year, per

grantee

Delta Health Initiative (DHI)

AUTHORIZING LEGISLATION: Public Law 109-149,

Departments of Labor, Health and Human Services, and

Education, and Related Agencies Appropriations Act, 2006

PROGRAM OVERVIEW:

The purpose of the Delta Health Initiative Cooperative

Agreement Program is to fund an alliance of providers to

address longstanding unmet rural health needs (access to

health care, health education, research, job training and

capital improvements) in the Delta. The goal of the DHI is

to improve the health of people living in this historically

distressed region.

HRSA’s Office of Rural Health Policy funded a 5-year

cooperative agreement in the amount of $23 million in FY

2008, and $25 million in FY 2009. The grantee is working

with 10 partners on projects aimed at improving:

Chronic disease management

Health education

Intervention

Wellness promotion

Access to health care services

Health Information Technology

Workforce training

Care coordination

Construction of health facilities.

The consortium proposed 26 projects, and devised communication and coordination systems among

themselves. Three of these projects were major public works undertakings, entailing the construction of

public health facilities. Through these projects, DHI supports multiple HHS, HRSA and ORHP goals and

objectives, including improving the safety, quality and access to health care.

KEY PROGRAM ACCOMPLISHMENTS:

Since its initial funding in 2006, DHI has improved health outcome measures across a broad spectrum of

the Delta population. Many projects continue to date as a result of this initial “seed” funding. The program

also has fostered better collaboration between the partners through the grantee’s continuing efforts to

improve its organizational structures. The DHI has conducted 425 community-based wellness events and

classes, and 399 professional education seminars. It has trained 4,562 health professionals, and 34,837

Delta residents. The consortium has conducted 4,471 screenings/patient interviews; accounted for 15,028

patient-encounters for medical services; held 1,607 community-based career recruitment events, and

networked 669,803 patients into Electronic Health Records (EHR) systems.
17

At a Glance

Grants Awarded:

2007: 45 continuing awards

2008: 45 continuing awards

2009: 45 continuing awards

Amount Awarded: Up to $650,000 per

year, per grantee, with an average

grant of $490,000

2007: $22.2 million

2008: $22 million

2009: $22.3 million

Project Period: 3 years

Next Competitive Grant Application:

Year: 2010

Anticipated Grants: 45

Anticipated Grant Amount: Up

to $750,000 per year, per grantee,

with an average grant of $490,000

Medicare Rural Hospital Flexibility Grant Program (Flex)

AUTHORIZING LEGISLATION: Section 1820(j) of the Social

Security Act (42 U.S.C. 1395) as reauthorized in the

Medicare Improvements for Patients and Providers Act of

2008

PROGRAM OVERVIEW:

The Rural Hospital Flexibility Program (Flex) provides

funding to state governments to spur quality and

performance improvement activities; stabilize rural hospital

finance; and integrate emergency medical services (EMS)

into their health care systems. Only States with Critical

Access Hospitals (CAH) or potential CAHs are eligible for

the Flex program.

Flex funding encourages the development of cooperative

systems of care in rural areas -- joining together CAHs,

EMS providers, clinics, and health practitioners to increase

efficiencies and quality of care. The Flex program requires

States to develop rural health plans, and funds their efforts

to implement community-level outreach and technical

assistance to advance the following goals:

Improve quality of care and performance management

Improve and integrate EMS

Develop and implement rural health networks

Support existing CAHs and eligible hospitals

Designate CAHs in the State

Although focused on small, rural hospitals, the Flex program operates on the National, State, community,

and facility levels to cover a broad range of fundamental health service issues and “modernization” goals.

States use Flex resources for performance management activities, training programs, needs

assessments, and network building. Efforts have included the use of a balanced scorecard approach,

forming relationships with state Quality Improvement Organizations (QIOs), developing quality

improvement-related networks, and participating in national quality improvement and reporting efforts.

KEY PROGRAM ACCOMPLISHMENTS:

Over 60 percent of CAHs voluntarily reported quality data to the Centers for Medicare and Medicaid

Services’ Hospital Compare Web site, even though they received no financial incentives. This increase

may be due to the incorporation of new rural-relevant measures in Hospital Compare; the quality

improvement focus added to the Flex program; and/or technical assistance from the TASC and the QIOs.

More than 80 percent of CAHs have undertaken programs to improve their service standards. After two

years of reporting these measures to ORHP, CAHs have shown significant increases in the percent of

patients receiving care under recommended protocols.

Approximately 1,300 hospitals have converted to CAH status; and most have shown improvement in their

financial status, while simultaneously expanding the array of services needed in their communities.

In FY2009, State Flex Programs distributed over $16 million from their grants to directly benefit CAHs,

EMS providers and others organizations providing rural health care.
18

At a Glance

# Grants Awarded:

2007: 46 continuing awards

2008: 46 new awards

2009: 46 continuing awards

Amount Awarded:

2007: $ 14.5 million

2008: $ 14.2 million

2009: $ 14.8 million

Program Duration: 5 years, starting with

FY 2008 grants

Next Competitive Grant Application:

Year: 2013

Anticipated # Grants: Up to 46

Anticipated Grant Amount: Up to

approximately $9,000 per year per

participating hospital.

Small Rural Hospital Improvement Grant Program (SHIP)

AUTHORIZING LEGISLATION: Section 1820(g)(3) of the

Social Security Act, 42 U.S.C. 1395iPROGRAM OVERVIEW:

The Small Rural Hospital Improvement Grant Program

(SHIP) assists small rural hospitals in meeting the costs

of implementing data systems required to meet

requirements established under the Medicare program

pursuant to amendments made by the Balanced Budget

Act of 1997. Under this section, small rural hospitals

may use funds to: 1) Purchase computer software and

hardware (such as applications that focus on quality

improvement, performance improvement and patient

safety); 2) Educate and train hospital staff on computer

information systems (such as using technology to

improve patient outcomes); and 3) Offset costs related to

the implementation of prospective payment systems

(PPS) (such as updating chargemasters or providing

training in billing and coding).

PROGRAM BACKGROUND:

The SHIP Grant Program is authorized by section 1820(g)(3) of the SSA. Under this

section, small rural hospitals may: pay for costs related to the implementation of

prospective payment systems; purchase computer software and hardware that would

protect patient privacy; educate and train hospital staff on computer information systems

to protect patient privacy; and support quality improvement and computer assisted

activities. Funding for this program was first provided by the Labor/HHS Appropriations

Act for FY 2002 in which conference report language expanded the purpose of this grant program to also

help small rural hospitals (1) comply with provisions of HIPAA and (2) reduce medical errors and support

quality improvement.

Individual hospitals do not apply directly to ORHP for this grant. Instead, the SORH help rural hospitals to

participate in the program. Eligible hospitals submit an application to their SORH, and the SORH

prepares and submits a single grant application to HRSA on behalf of all hospital applicants in the State.

The SHIP program addresses HHS, HRSA, and ORHP goals related to HIPAA and improving the quality,

safety, cost, and value of health care services.

KEY PROGRAM ACCOMPLISHMENTS:

In 2009 1,635 hospitals in forty-six States were funded, an increase of 185 hospitals since the program’s

inception in 2002. Connecticut, Delaware, New Jersey and Rhode Island have no eligible rural hospitals.
19

At a Glance

Grants Awarded:

2007: 50 continuing awards

2008: 50 continuing awards

2009: 50 continuing awards

Amount for SORH Grants:

2007: $7.2 million

2008: $7.2 million

2009: $8.2 million

Project Period: New 5 year period

started FY 2008.

Next Competitive Continuation (2 of

4) SORH Grant Application:

Year: 2013

Grants: 50

Amount available - $8.9 million

Anticipated Amount per

Grantee: Up to $180,000

State Offices of Rural Health Grant Program (SORH)

AUTHORIZING LEGISLATION: Public Health Service Act,

Section 338J; (42 U.S.C. 254r).

PROGRAM OVERVIEW:

The State Offices of Rural Health Grant (SORH) Program

creates a focal point within each State for rural health issues.

The program provides an institutional framework that links

communities with State and Federal resources to help

develop long-term solutions to rural health problems.

The three core functions of the SORH program are to:

clearinghouse of information and

innovative approaches to rural health services

delivery

oordinate State activities related to rural health in

order to avoid duplication of efforts and resources

dentify Federal, State, and nongovernmental rural

health programs and provide technical assistance to

public and private, nonprofit entities serving rural

populations.

Additionally, the SORH program strengthens Federal, State, and partnerships in rural health; and

promotes recruitment and retention of a competent health care workforce. Funds cannot be used for

direct delivery of health care services, purchase of real property or equipment or to conduct any activity

regarding a Certificate of Need. Up to 10% of funds may be used for research.

The SORH program was developed in 1991 as a Federal-State partnership. It features a single grantee

from each State and requires a State match of $3 for each $1 in Federal funding. Over the past 18 years,

this program has leveraged in excess of $250 million in State matching funds. Currently, 37 Offices are

located in State health departments, 10 in academic settings and three in non-profit organizations.

KEY PROGRAM ACCOMPLISHMENTS:

During the FY 2008 budget period (7/1/08 - 6/30/09), SORHs started collecting new performance

measurement information on the provision of technical assistance to clients within their States. This

information will be used collectively to produce more detailed yearly reports about the SORH program.

The following information was posted on the ORHP Performance Information Management System within

30 days of the end of grant period:

1. The total number of technical assistance (TA) encounters provided directly to clients within State by

SORH. Total for all fifty SORHs - 61,934.

2. The total number of clients within State that received TA directly from SORH. Total for all fifty SORHs -

32,330.
20

Community-Based Grant Programs

The Community-Based Division programs provide funding to increase access to care in rural

communities. ORHP currently administers 8 grant programs and multiple contracts through its

Community-Based Division (CBD) which is made up of 15 project officers. The programs on the division

include: Rural Health Care Services Outreach Grant Program, Delta States Rural Development Network

Grant Program, Network Development Grant Program, Network Planning Grant Program, Small Health

Care Provider Quality Improvement (SHCPQI) Grant Program, Radiation Exposure Screening and

Education Program, Black Lung Clinics Program and the Rural Access to Emergency Devices (RAED)

Grant Program. In FY 2009, approximately 305 grants were awarded from the Community-Based Division

for a combined program budget of over $43 million. To find out further information on the CommunityBased Programs, please click on Find Grants.

In FY 2008, ORHP’s Community Based Division implemented a new strategy for the Outreach, Network

Development and Quality programs to help manage them in a more effective way.. The grant cycles for

these programs are now staggered instead of being competitive on an annual basis With this new

strategy, ORHP will pay particular attention to the issue of sustainability and evaluation and also focus

more on peer-peer learning and better coordinated technical assistance. Similar to the funding cycle of

state and research grant opportunities, the efficiencies in funding will allow ORHP to award several more

grants per year.

CBD Structure

Project officers on CBD manage grants based on the primary issue area addressed in the application,

instead of focusing solely on one program or one geographic area. This ensures that all project officers

understand the CBD programs and develop an area of expertise for the division and ORHP. Below are

some topic areas addressed through the Community Based programs:

Access to care

Cardiovascular health

Case management

Chronic disease

Diabetes

Emergency management services and

trauma care

Health information technology

Maternal and child health

Mental health and substance abuse

Nutrition

Obesity

Oral health

Pharmacy

Quality

Recruitment and retention

“Safety net” collaboration

School-based health centers

Transportation

Uninsured

Women’s health

Community-Based Team Members:

Nisha Patel, Division Director

Karen Beckham Eileen Holloran Lilly Smetana

Sonja Carter-Taylor Vanessa Hooker Sheila Tibbs

Valerie Darden Leticia Manning Kathryn Umali

Ann Ferrero Sherilyn Pruitt Christina Villalobos

Marcia Green Elizabeth Rezai-zadeh Sheila Warren
21

At a Glance

Grants Awarded:

2007: 15 new awards

2008: 15 continuing awards

2009: 15 new awards

Amount Awarded:

2007: $5.65 million

2008: $ 5.62 million

2009: $ 7.2 million

Project Period: 3 years (with

possibility of competitive continuation)

Next Competitive Grant

Application:

Year: 2010

Anticipated Grants: Up to 15

Anticipated Grant Amount:

Varies by grantee

Black Lung Clinics Program (BLCP)

AUTHORIZING LEGISLATION: Black Lung Benefits Reform

Act of 1977, Section 427(a), and 42 CFR Part 55a

PROGRAM OVERVIEW:

The purpose of the Black Lung Clinics Program (BLCP) is to

seek out and provide services to miners (active and inactive)

to minimize the effects of job-related respiratory impairment,

improve the health status of miners exposed to coal dust,

and to increase coordination with other benefit programs to

meet the special health needs of this population.

Grantees have varied models of service delivery. BLCP

services may be provided either directly or through formal

arrangements with appropriate health care providers. Current

clinics include Federally Qualified Health Centers, hospitals,

state health departments, mobile vans, and clinics.

Programs meet the health care needs of the population

through services that include:

Outreach

Primary care (including screening, diagnosis and

treatment)

Patient and family education and counseling (including anti-smoking education)

Patient care and coordination (including individual patient care plans for all patients and referrals

as indicated)

Pulmonary rehabilitation

In 1972, Congress amended the Federal Coal Mine Health and Safety Act of 1969 to establish a program

of grants and contracts to fund clinics to treat coal miners with respiratory diseases. The “Black Lung

Benefits Reform Act of 1977" (Public Law 95-239) was intended by Congress to ensure the continued

expansion of the program. The Federal Register (50 FR 7913) in 1985 clarified the authority of the HHS

Secretary to support clinics that evaluate and treat coal miners with respiratory impairments. Formerly

administered by HRSA’s Bureau of Primary Health Care, the program was moved to the Office of Rural

Health Policy in 2006, as most affected constituents reside in rural areas.

The program addresses the HHS strategic plan goal of increasing health care service availability and

accessibility, and improving health care quality, as well as the HRSA goals of improving access to health

care and improving health outcomes.

KEY PROGRAM ACCOMPLISHMENTS:

ORHP contract with John Snow Inc. to map out the location of miners to make sure that the location of

miners were being targeted that is most need. The outcome of the research was a success and the result

shows that the populations most need is being targeted.
22

At a Glance

Grants Awarded:

2007: 12 new awards

2008: 12 continuing awards

2009: 12 continuing awards

Amount Awarded: Award range

$400,000 - $1,000,000 per grantee

2007: $5.1 million

2008: $5.1 million

2009: $5.1 million

Project Period: 3 years

Next Competitive Grant Application:

Year: 2010

Anticipated Grants: Up to 12

Anticipated Grant Amount:

between $300,000 - $430,000 per

grantee.

Delta States Rural Development Network Grant Program

(Delta)

AUTHORIZING LEGISLATION: Public Health Service Act,

Section 330A (e) (42 U.S.C. 254c)

PROGRAM OVERVIEW:

The purpose of the Delta States Rural Development Network

Grant Program (Delta) is to fund organizations located in the

eight Delta States (Alabama, Arkansas, Illinois, Kentucky,

Louisiana, Mississippi, Missouri, and Tennessee) which

address unmet local health care needs and prevalent health

disparities through the development of new and innovative

projects.

The Delta grant program fosters collaborative efforts among

rural providers, as many of these disparities could not be solved

by single entities working alone. In the current grant cycle,

grantees are expected to propose multi-county projects that

address the following key areas:

surrounding chronic disease

Increase access to prescription drugs for the medically

indigent

Practice management technical assistance services.

Grantees may also focus grant activities around the following priorities: oral health improvement, schoolbased health services, mental health, and/or teenage pregnancy prevention efforts.

The Delta Grant Program was first competed in FY 2001 when the Senate Appropriations Committee

allocated $6.8 million towards addressing health care needs in the Mississippi Delta. The current

grantees have identified specific targeted focus areas for their project activities. This change has served

as a better fit for performance measurement activities within ORHP. More applicants were also funded in

the current cycle to bring about greater impact and service delivery capacity in the Delta region than in

previous grant cycles.

KEY PROGRAM ACCOMPLISHMENTS:

The Delta Grant Program had many successes in working toward eliminating health disparities in the

Delta Region. There have been marked achievements particularly in oral health care, chronic disease

management and school-based health services. The Program has reached over 6.1 residents and has

services in 224 counties and parishes. Most notably the Delta Grant Program has saved approximately

32,132 Delta residents an estimated $4,702,837.00 is savings on prescriptions.
23

At a Glance

Grants Awarded:

2007: 7 continuing awards

2008: 1 new/ 6 continuing awards

2009: 1 new/6 continuing awards

Amount Awarded:

2007: $1.586 million

2008: $1.517 million

2009: $1.642 million

Project Period: 3 years

Next Competitive Grant Application:

Year: 2011

Anticipated # Grants: 7-10

Anticipated Grant Amount: Up to

$300,000 per year, per grantee

Radiation Exposure Screening and Education Program

(RESEP)

AUTHORIZING LEGISLATION: Public Health Service Act

Section 417C; 42 USC 285(a)-9

PROGRAM OVERVIEW:

The purpose of the Radiation Exposure Screening and

Education Program (RESEP) is to help individuals adversely

affected by mining, transport, and processing of uranium, or the

testing of nuclear weapons, receive medical care and

compensation for illnesses that may have resulted from these

activities. This is accomplished by providing competitive grant

opportunities to States, local governments, and other health

care organizations for cancer screening programs.

The major objectives of the programs are to:

Screen individuals for cancer and other

radiogenic diseases;

Provide referrals for diagnostic testing or

medical treatment of individuals screened;

Develop and disseminate public information

and education programs for the detection,

prevention, and treatment of radiogenic

cancers and diseases; and

Facilitate medical documentation of claims for the Radiation Exposure Compensation Act

(RECA) program

There are seven organizations in five southwestern States (Arizona, Colorado, Nevada, New Mexico and

Utah) participating in the RESEP Program. These organizations include hospitals, universities, Indian

Health Service facilities, medical centers and community health centers. In FY 2009, one new

competitive award in the amount of $235,000 and six non-competitive awards in the amount of

$1,407,032 were issued, totaling $1,642,032.00.

KEY PROGRAM ACCOMPLISHMENTS:

National Jewish Health (NJH) in Denver, Colorado was successfully awarded as a new grantee of the

program in August 2009. NJH has more than two decades of experience in providing services to miners

in Colorado and the Intermountain West. The physicians are trained and certified in pulmonary and

occupational medicine; and allergic diseases. NJH will be an asset to the program in the provision of

services to individuals affected by radiogenic disease.

RESEP Program accomplishments include:

Screened 1,270 individuals for radiogenic disease and made 2,663 referrals for

diagnostic testing and/or treatment,

Provided Radiation Exposure Compensation Act (RECA) eligibility assistance to 5,178

individuals, and

Informed more than 36,000 individuals about the program through brochures,

presentations, and letters.
24

At a Glance

Grants Awarded:

2007: 27 new / 95 continuing

2008: 0 new/ 122 continuing

2009: 111 new/ 27 continuing

Amount Awarded: Up to $150,000 in

Year 1; $125,000 in Year 2; and

$100,000 in Year 3, per grantee

2007: $17.6 million

2008: $17.7 million

2009: $19.1 million

Project Period: 3 years

Next Competitive Grant Application:

Year: FY 2012

Anticipated Grants: Up to 100

Anticipated Grant Amount: Up to

$150,000 in Year 1; $125,000 in

Year 2; and $100,000 in Year 3,

per grantee

Rural Health Care Services Outreach Grant Program

AUTHORIZING LEGISLATION: Section 330A (e) of the Public

Health Service Act 42 U.S.C 254c (E).

PROGRAM OVERVIEW:

The purpose of the Outreach program is to promote rural health

care services outreach by expanding the delivery of health care

services to include new and enhanced services in rural areas.

The Outreach program supports projects that demonstrate

creative or effective models of outreach and service delivery in

rural communities. Applicants may propose projects to address

the needs of a wide range of population groups including, but

not limited to, low-income populations, the elderly, pregnant

women, infants, adolescents, rural minority populations, and

rural populations with special health care needs. All projects

should be responsive to any unique cultural, social, religious,

and linguistic needs of the target population.

The goal of the Outreach grant program is to improve the health

status and outcome in rural areas by providing diverse health

services on a variety of health topics to the community. The

services may include: health education and promotion; health

screenings; health fairs; and training and education to

providers, among other activities. Grantees may focus on

health topics that include primary health care, dental care,

mental health services, home health care, emergency care, health promotion and education programs,

outpatient day care, and other services not requiring in-patient care.

KEY PROGRAM ACCOMPLISHMENTS:

The Outreach grant program has success in providing needed health services to rural communities. The

program has helped to bring rural communities together to work toward a common goal, which is to

improve the health and well-being of rural populations. Although the Outreach program is a 3-year grant,

many of the programs have continued success beyond the project period and Federal funding. The

grantees are encouraged to develop creative sustainability and evaluation plans that allow their program

to be expanded and enhanced. Since the program’s inception in FY 1991, to date funding has been

provided to 794 grantees in 48 States and 3 Territories.

In FY 2009, the program launched its Performance Improvement Measurement System (PIMS). PIMS

was developed to quantify the impact of the program’s funding on access to health care, quality of

services, and improvement of health outcomes. ORHP hopes to use the PIMS data to assess the impact

that ORHP programs have on rural communities and to enhance ongoing quality improvement. ORHP

has incorporated these performance measures as a requirement for all ORHP grant programs in order to

achieve the stated objectives. Based on the PIMS data collected in 2009, the number of people (total) in

the target population for all Outreach Program projects in the last year is 1,425,601. The number of

people (total) in the target population with access to new/expanded programs/services in the last year

through the Outreach grant program is 844,570.
25

At a Glance

Grants Awarded:

2007: 5 new / 33 continuing

2008: 51 new/ 28 continuing

2009: 49 continuing

Amount Awarded: Up to $180,000 per

year per grantee (3 year award)

2007: $6.5 million

2008: $13.7 million

2009: $ 8.7 million

Project Period: 3 years

Next Competitive Grant Application:

Year: 2011

Anticipated Grants: Up to 30

Anticipated Grant Amount: Up

to $180,000 per year, per grantee

(up to $540,000, combined)

Rural Health Network Development Grant Program

AUTHORIZING LEGISLATION: Section 330A(f) of the Public

Health Service Act, as amended

PROGRAM OVERVIEW:

The purpose of the Rural Health Network Development Grant

Program is to expand access to, coordinate and improve the

quality of essential health care services, and enhance the

delivery of health care in rural areas. These grants support

rural providers who work in formal networks, alliances,

coalitions or partnerships to integrate administrative, clinical,

technological, and financial functions. Funds provided

through this program are not used for direct delivery of

services. The ultimate goal is to strengthen the rural health

care delivery system by 1) improving the viability of the

individual providers in the network, and/or 2) improving the

delivery of care to people served by the network. Networks

must consist of at least three separately owned entities, and

each must sign a memorandum of agreement or similar

document. Upon completion of the grant program, a network

should have completed a thorough strategic planning

process, business planning process, be able to clearly

articulate the benefits of the network to its network

partners/members and to the community it serves, and have

a sound strategy in place for sustaining its operations.

Some anticipated outcomes of supporting the development of rural health networks include:

Achieving economies of scale and cost efficiencies of certain administrative functions

Increasing the financial viability of the network; enhancing workforce recruitment and retention

Sharing staff and expertise across network members; enhancing the continuum of care

Providing services to the underinsured and uninsured; improving access to capital and

technologies

Ensuring continuous quality improvement of the care provided by network members

Enhancing the ability of network members to respond positively to rapid and fundamental

changes in the health care environment

The Network Development Grant Program was started in 1997 with 34 grantees and $6.1 million. Todate, the program has awarded almost $97 million to support 210 Network Development grants.

The Network Development program supports HRSA goals of improving access and quality of health care,

improving health outcomes, and improving public health and health care systems. The Program also

supports HHS goals to improve the safety, quality, affordability and accessibility of health care; and to

promote the economic and social well-being of individuals, families, and communities.

KEY PROGRAM ACCOMPLISHMENTS:

Due to an increase in funding, 51 new grants were funded in 2008 – an increase of 21 over the 30 grants

that were anticipated to be awarded. Representatives from the Network projects were among over 900

ORHP grantees that participated in a Grantee Partnership meeting held in Washington, D.C. in August

2009. Grantees learned techniques to become an effective Network Director, and learned strategies to

sustain their Networks after Federal funding ceases. ORHP collaborated with the Georgia Health Policy

Center and the National Cooperative of Health Networks to provide joint technical assistance to grantees

at this meeting.
26

At a Glance

Grants Awarded:

2007: 10 new awards

2008: 33 new awards

2009: 19 new awards

Amount Awarded: Up to $85,000 per

year, per grantee

2007: $841,391

2008: $2.7 million

2009: $1.6 million

Project Period: 1 year

Next Competitive Grant Application:

Year: FY 2010

Anticipated Grants: Up to 20

Anticipated Grant Amount: Up to

$85,000 per year, per grantee

Rural Health Network Development Planning Grant Program

(Network Planning)

AUTHORIZING LEGISLATION: Public Law 107-251m 116

Stat. 1621, Section 330A(f) of the Public Health Service Act,

42 U.S.C. 254c.

PROGRAM OVERVIEW: The legislative purpose of the Rural

Health Network Development Planning Grant Program

(Network Planning) program is to expand access to,

coordinate and improve the quality of essential health care

services and enhance the delivery of health care, in rural

areas. The program provides 1-year grants to rural entities

to plan and develop a formal health care network. Grant

funds typically are used to acquire staff, contract with

technical experts, and purchase resources to “build” the

network (funds cannot be used for direct delivery of health

care services). Successful grantees often apply for the 3-

year Network Development implementation grant to continue

the work they started under the Network Planning grant.

Network Planning grantees use the planning grant to lay the

foundation of a rural health network by:

1. Identifying potential collaborating network partners in the community/region;

2. Convening potential collaborating network partners;

3. Conducting planning activities, such as developing Strategic and Business Plans; and

4. Begin carrying out network activities, including activities to promote the network’s sustainability.

In addition to the activities mentioned above, for the 2010 application cycle, projects can also focus on

community needs assessments, HIT readiness and Economic Impact Analyses.

By helping rural providers develop formal integrated health care networks, the Network Planning program

supports multiple HHS, HRSA, and ORHP goals and objectives, including improving the health care

system, access to care, the continuity and quality of care, and the financial viability of health care

providers in underserved areas.

Network Planning Grants were first awarded in 2004. The maximum award in FY 2004 was $100,000. In

FY 2005, the maximum award was lowered to $85,000. The average award for FY 2009 was $82,800.

KEY PROGRAM ACCOMPLISHMENTS:

Key representatives of the Network Planning projects participated in a Grantee Partnership Meeting held

in Washington, D.C. in August 2009 that was attended by over 900 ORHP Grantees. The new Network

Planning Grantees were provided educational opportunities that would assist them with the development

and successful outcome of their grant projects. Among the topics offered was information on how to

develop boards, the legal consequences of incorporation, and Strategic and Business Plan development.

The Network Development Grantees continue to apply for and receive additional Office of Rural Health

Policy grant funds that assist in the sustainability and growth of their projects.
27

At a Glance

Grants Awarded:

2007: 4 continuing/ 9 new awards

2008: 13 continuing awards

2009: 5 new awards

Amount Awarded:

2007: $1.2 million

2008: $1.2 million

2009: $ .5 Million

Project Period: 2 - 3 years

Next Competitive Grant Application:

Year: 2011

Anticipated Grants: 10

Anticipated Grant Amount: Up to

$100,000 per year, per grantee for

up to 3 years

Rural Access to Emergency Devices (RAED)

AUTHORIZING LEGISLATION: Public Health Improvement Act

Title IV, Subtitle B, 42 U.S.C. 254c note, Public Law 106-505

PROGRAM OVERVIEW:

The purpose of the Rural Access to Emergency Devices

(RAED) Grant Program is to provide funding to rural community

partnerships to purchase automated external defibrillators

(AEDs) that have been approved, or cleared for marketing by

the Food and Drug Administration; and provide defibrillator and

basic life support training in AED usage through the American

Heart Association, the American Red Cross, or other nationallyrecognized training courses.

A community partnership is composed of local emergency

response entities such as community training facilities, local

emergency responders, fire and rescue departments, police,

community hospitals, and local non-profit entities and for-profit

entities.

In the past, AEDs have been placed in colleges, universities,

community centers, local businesses, law enforcement and

ambulance vehicles, fire trucks, 911 dispatch centers, and

offices. The grant creates opportunities to educate the public on AEDs via advertisements, news media,

schools, churches, shopping malls, restaurants, home owner associations, businesses, local government

bodies, security firms, etc.

KEY PROGRAM ACCOMPLISHMENTS:

The RAED Program has increased public awareness of the poor outcomes of persons suffering sudden

cardiac arrest in rural areas. The program increased the number of AEDs available and the number of

fire, rescue, police, first responders, and lay persons trained in using an AED to decrease mortality rates

in the event of sudden cardiac arrests in isolated rural areas. In 2008 we continued to fund 13 grantees.

In FY 2009 we anticipate approximately 100 new AEDs to be purchased with an additional 500 persons

trained. For the years FY2006 through 2008 over 1000 new AEDs were purchased and over 5,000

persons were trained in their use.
28

At a Glance

Program Duration: 2 years

# Grants Awarded:

2007: 15 continuing awards

2008: 55 new awards

2009: 55 continuing awards

Amount Awarded:

2007: $ 680,202

2008: $ 4,026.691

2009: $ 4,003,244

Next Competitive Grant Application:

Year: 2010

Anticipated # Grants: Up to 60

Anticipated Grant Amount: Up to

$75,000 per year per grantee

Small Health Care Provider Quality Improvement Grant

Program (Rural Quality)

AUTHORIZING LEGISLATION: Section 330A (g), Title II of

the Public Health Service Act, as amended

PROGRAM OVERVIEW:

The Rural Quality Grant Program (Rural Quality) is available

to support rural public, rural non-profit, or other providers of

healthcare services, such as critical access hospitals or rural

health clinics. The purpose of the program is to improve

patient care and chronic disease outcomes by assisting rural

primary care providers with the implementation of quality

improvement strategies, with a focus on quality improvement

for chronic disease management.

The goal of the Rural Quality program is to improve health

outcomes through enhanced chronic disease management in

rural primary care settings by:

1. Implementing and using an electronic patient registry

system;

2. Tracking and reporting specific health indicators by using

nationally-accepted performance measures;

3. Assessing the need for and implementing additional quality improvement activities; and

4. Participating in technical assistance through monthly conference calls and peer-learning workshops

with fellow Rural Quality grantees, facilitated by a quality improvement specialist.

The Rural Quality program was sponsored by ORHP for the first time in Federal fiscal year (FY) 2006 as

a two-year grant program. The grantees’ focus was on diabetes in the first learning year and

cardiovascular disease (CVD) in the second learning year.

The Institute of Medicine’s (IOM) reports, “To Err is Human” and “Crossing the Quality Chasm”, highlight

the urgency of improving the quality of health care in the United States. As identified by the IOM reports,

patient care should be safe, timely, effective, efficient, patient-centered, and equitable (STEEPE). The

IOM report, “Quality Through Collaboration: The Future of Rural Health,” released in November 2004,

identified that rural health care organizations can be leaders in quality improvement.

While many quality improvement initiatives focus on in-patient hospital care, quality improvement is also

needed in the primary care setting to decrease morbidity and mortality and foster cost-effective care.

Timely disease prevention and management in the primary care setting can improve patient health and

decrease costly emergency room visits and hospital admissions that often follow deferred primary care.

The Rural Quality program addresses this need for quality primary care in the rural setting.

KEY PROGRAM ACCOMPLISHMENTS:

Since the inception of the Rural Quality program in FY 2006, over 10,000 diabetic patients have been

served. Among patients from the 2006 pilot with measured HbA1c lab values, the annual average HbA1c

was 7.1 (slightly above the goal of <7.0). This average was maintained as new patients were added

throughout the year to the patient registry.
29

Other HRSA Initiatives Administered by ORHP

In 2009, The Office of Rural Health Policy managed two agency-wide HRSA activities: border health and

intergovernmental affairs (IGA).

Border Health

In 2009, ORHP is charged with managing border health activities for the Agency, as much of the 2,100-

mile U.S.-Mexico border is rural. The regions along the border face similar health care delivery

challenges as rural areas, such as limited health workforce capacity and a fragile infrastructure. ORHP

coordinates these activities through its Division of Border Health in Dallas, Texas.

Office of Intergovernmental Affairs (IGA)

ORHP served as the primary coordinator of all IGA activities for HRSA. This includes serving as HRSA’s

primary liaison to the U.S. Department of Health and Human Services’ Office of Intergovernmental Affairs.

In addition, ORHP is the single point of contact for HRSA on all external activities, such as State and local

governmental affairs, stakeholder association and interest group activities, and all internal activities, such

as cooperative agreements and activities related to HRSA’s offices and bureaus.

Denali Commission

ORHP also manages a cooperative agreement with the Denali Commission for just under $40 million.

The Denali Commission is an agency of the Department of Commerce which provides funds to Alaska to

help develop and expand the rural health care infrastructure.

Administrative Team

ORHP is staffed by an Administrative Team responsible for office functions such as phone reception,

travel processing, and day-to-day office operation. Staff on this team is also responsible for budget

development, contracts, grants, and inter-agency agreement processing, and human resources.

Administrative Team Members:

Heather Dimeris, Team Lead

Julia Bryan Debbie DeMasse-Snell

Mary Collier Michele Pray-Gibson

Amal Thomas

Border Team Members:

Frank Cantu Lilia Salazar

Margarita Figueroa-Gonzalez Christina Villalobos

Erma Woodard Michelle Mellen

IGA Team Members:

Karen Beckham

Tom Morris

Kathryn Umali
30

Border Health

PROGRAM OVERVIEW:

In September 2004, the Office of Rural Health Policy (ORHP) assumed responsibility for coordinating

border health activities for HRSA. Border Health initiatives are supported through cooperative and interagency agreements, and/or contracts. The purpose of the Division is to:

Ensure agency-wide coordination by creating a focal point for HRSA activities

Track health issues along the U.S.-Mexico border that affect HRSA grantees.

KEY PROGRAM ACCOMPLISHMENTS:

HRSA continued its annual support for several key border health meetings. This included the Binational

Border Health Week as well as the U.S.-Mexico Border Health Association Meeting and the PanAmerican Health Organization’s Immunizations in the Americas Weeks. Bi-National Border Health Week

continues to be a key joint annual health event between the United States and Mexico. This week-long

event highlights key policy issues and focuses on promoting access to high quality health services for the

populations that live along the border. HRSA also continues its longstanding support of the Pan-American

Health Organization and its work on immunizations. Through this event, HRSA works with other key

partners to further educate clinicians and community workers in the appropriate use of vaccines, and to

facilitate the inoculation of children and adults in local clinics and community health centers along the

U.S.-Mexico border.

HRSA’s Border Health Division staff continue to play a critical role in linking with their respective partners

in the four Border Health Offices for Texas, New Mexico, Arizona and California. In addition, HRSA

Border Health Staff also serve as the key link between the agency and the U.S.-Mexico Border Health

Commission in El Paso, Texas.
31

At a Glance

Grants Awarded:

2007: 1 new award

2008: 1 new award

2009: 1 new award

Amount Awarded:

2007: $39,283,000

2008: $38,597,00

2009: $19,642,000

Project Period: 1 year

Denali Commission

AUTHORIZING LEGISLATION: Section 309 of Public Law 105-

277, Denali Commission Act of 1998, 42 U.S.C. 3121 note,

PROGRAM OVERVIEW:

Through an agreement with the Denali Commission, an agency

of the Department of Commerce, HRSA provides funds to help

develop and expand the rural health care infrastructure in

Alaska. In 1999, the Commission was granted authority by

Congress to address rural Alaskan health care issues. The

funds in this program, which are transferred to the Denali

Commission via an inter-agency agreement with HRSA, support

planning, construction and equipping of health, nutrition, and

child care projects across the State. Potential venues include

hospitals, health care clinics, and mental health facilities,

including drug and alcohol treatment centers.

This program, which began in 2001, is modeled on the Appalachian Regional Commission and directed

by Federal and State (Alaska) co-chairs. Its core mission is economic development in rural Alaska. The

$19,642,000 appropriated to HRSA for the Commission in FY 2009 was combined with other resources

for planning, designing and constructing primary health care facilities in the State. Resources were also

used to assist other facilities, such as hospitals and facilities that provide mental health services. The

program makes a single annual award to the Commission to support up to 35 projects each year.

Project selection is made through an advisory panel, the Health Steering Committee, which is composed

of a panel of health experts in Alaska. Recommendations are forwarded to the full Commission and

leadership prior to incorporation into an Annual Work Plan, which is then forwarded to the Secretary of

Commerce for approval. Projects are first vetted by staff to ensure they demonstrate sustainability and

feasibility, and criteria are developed and updated through the advisory committee process.

KEY PROGRAM ACCOMPLISHMENTS:

The Denali Commission contributed to 20 health-related projects across Alaska in 2009. The

Commission recognized the Primary Care Clinic program as a priority funding area within health. The

communities of Mountain Village, Nunapitchuk, Ouzinkie, Hydaburg, Noorvik, and New Stuyahok all

received new facility construction awards. The Commission also supported the construction of elder

supportive housing projects in Ketchikan and Togiak. Grant awards also complemented rural hospital

purchases of diagnostic equipment in Juneau, Kodiak Island, Petersburg, Wrangell, Nome and Valdez.
32

Intergovernmental Affairs (IGA)

PROGRAM OVERVIEW:

Located in the Office of Rural Health Policy (ORHP), the mission of the Health Resources and Services

Administration’s (HRSA) Office of Intergovernmental Affairs (IGA) is to facilitate and coordinate HRSA’s

programmatic interaction with organizations that represent units of State and local government.

The purpose of HRSA’s Intergovernmental Affairs is to:

Provide the HRSA Administrator with a single point of contact on all activities related to important

State and local governmental, stakeholder association and interest group activities.

Coordinate Agency cross-Bureau cooperative agreements and activities with organizations

representing units of State and local governments, including such entities as the National

Governors Association (NGA), National Conference of State Legislatures (NCSL), Association of

State and Territorial Health Officials (ASTHO), National Association of Counties (NACo), National

Association of County and City Health Officials (NACCHO), and National Association of Local

Boards of Health (NALBOH).

Interact with health-focused Federal Commissions such as the Delta Regional Authority,

Appalachian Regional Commission, Denali Commission and United States-Mexico Border Health

Commission.

Serve as primary liaison to the U.S. Department of Health and Human Services’ Office of

Intergovernmental Affairs.

KEY PROGRAM ACCOMPLISHMENTS:

One of the primary functions of HRSA IGA is to respond and coordinate information and meeting

requests. In FY 2009, 36 IGA requests were processed. In addition, HRSA IGA has coordinated 117 IGA

activities since 2007. ORHP has developed a systematic process in managing the coordination of these

requests, which entails responding to a variety of problems, questions, or situations relevant to health

services and intra-governmental affairs. This may involve program planning and implementation for

which there may not be established criteria. The work facilitates national dissemination of information

about HRSA's programs, functions, and activities to partnering organizations and agencies.
33

Appendix A: Contracts

Title of Procurement Description of Product or Service

Development and Implementation of a

Rural Health Network, Network Planning,

and Outreach Technical Assistance

Program

The purpose of this contract is to provide TA for the Network, Network Planning, and the

Rural Health Care Services Outreach Grantees to help further develop and implement

program goals and objectives. This contract also supports sustainability for the grantees.

Rural Health Clinic Technical Assistance

This contract supports the development of a Rural Health Clinic Technical Assistance

Series. It also supports a quarterly series of conference calls to provide technical assistance

(TA) to rural health clinics. Many of these RHCs lack the resources to attend national

conferences for training and TA. This series provides the clinics with assistance on a range

of topics including finance, regulation, health information technology, and quality

improvement.

Contract for Services of Technical

Assistance for the Office of Rural Health

Policy

The purpose of this contract is to provide technical assistance to the State Rural Health

Associations and to support analysis of emerging rural health issues.

Tracking and Best Practices The purpose of this contract is to track progress of hospitals taking part in the Small Hospital

Improvement program.

Rural Hospital Issues Group Logistics

The purpose of this contract is to provide logistical and administrative support to facilitate

meetings of the Rural Hospital Issues Group. The work group meets twice a year for 1 to 2

days in order to discuss emerging issues facing rural hospitals.

Delta States Rural Development Network

Grant Program Evaluation

The purpose of this contract is for an evaluation of the Delta States Grant Program which is

needed to gauge the program's effectiveness upon the Delta Region. The main purpose is

to examine technical assistance previously provided to the grantees and to identify ways to

improve the performance and outcomes of the project.

EHB - Web Based Data Management

System

The purpose of this contract is to support the development of a Web-based data

management system for the ORHP's 12 grant programs in conjunction with OIT.

WWAMI Work Related Inquiries

The purpose of this contract is to provide general TA to researchers, policy makers and

grant program applicants (i.e. the general public) about the Rural Urban Commuting Areas

(RUCAs) methodology for identifying rural and urban areas in the United States.

ORHP Grant Program Support The purpose of this contract is Logistical support related to holding HRSA All Programs

Meetings, grantee and other meetings for the Office of Rural Health Policy's grant programs.

Rural Outreach Grantee Technical

Assistance Contract

The purpose of this contract is to provide TA for Rural Health Care Services Outreach

Grantees to help further develop and implement program goals and objectives. The

contract will also support sustainability for the grantees that close-out in FY 2008.

Rural Quality Improvement Technical

Assistance Contract

The purpose of this contract is to provide TA for Small Health Care Provider Quality

Improvement Grantees to help them implement quality improvement strategies.

Rural Hospital Performance Improvement

Evaluation

The purpose of this contract is to evaluate the effectiveness of the Delta Rural Hospital

Performance Improvement (RHPI) program. The RHPI works with eligible rural hospitals in

the eight Delta States to help these facilities improve their financial and clinical operations.

This evaluation examines the impact of the program to date and make recommendations on

ensuring that the program continues to meet the need in coming years.

Rural Hospital Performance Improvement

Project

The purpose of this contract is to support the provision of targeted TA to eligible rural

hospitals in the Delta region.

National Rural and Underserved

Workforce Summit

The purpose of this contract is to support a logistic contract that is used to help plan and

conduct a meeting looking at the emerging workforce needs for health care providers in rural

and underserved communities with an emphasis on primary care providers.

Logistical Support Services for the

Development of a Frontier Definition

The purpose of this contract is to support logistical and administrative support to facilitate

holding meetings with HRSA, USDA, and other Federal and private sector experts to identify

potential models for a census-tract based frontier definition and examine how to define

service need for isolated islands.
34

Title of Procurement Description of Product or Service

Analysis of a Frontier Definition

The purpose of this contract is to support the examination of various definitions of frontier

areas and assess new approaches for how to define frontier areas and for identifying how to

best define island communities in terms of access to health services.

Logistical Support Services for the

Development of a Frontier Definition

The purpose of this contract is to support logistical and administrative support to facilitate

holding meetings with HRSA, USDA, and other Federal and private sector experts to identify

potential models for a census-tract based frontier definition and examine how to define

service need for isolated islands.

Analysis of a Frontier Definition

The purpose of this contract is to support the examination of various definitions of frontier

areas and assess new approaches for how to define frontier areas and for identifying how to

best define island communities in terms of access to health services.

Analysis of Elderly in Rural Hospitals for

Respiratory Conditions

This contract modifies the CMS demonstration model of primary care physician health

promotion nurse team to develop the new rural intervention to prevent functional decline in a

frail elderly population and assess the intervention in a sample of frail rural elderly receiving

care at rural community health centers, a primary care setting generally available in many

rural areas.

Logistical Support for Rural Networks

The purpose of this contract is to support rural network planning capacity and development.

Primary activities that include funding a document highlighting successful rural networks and

community partners.

Rural Health Outreach Manual on Mental

Health Best Practices

The purpose of this contract is to examine effective programs in rural and frontier mental

health to disseminate among current grantees and future rural health applicants.

Immunization Week in the Americas

The purpose of this contract is to support educational workshops during the Pan American

Health Organization (PAHO) sponsored Immunization Week in the Americas at the U.S.-

Mexico Border. The contract provides PAHO with funds to coordinate the implementation of

the educational workshops that are conducted in the border area.

U.S. Mexico Border Health Conference

The purpose of this contract is to support two educational workshops during the United

States Mexico Border Association (USMBHA) sponsored conference in Laredo, Texas in

June 2008. At these workshops local providers from both sides of the border received

current information regarding the progress made and future plans to achieve U.S.-Mexico

Border 2010 Health Objectives.

Rural Counties and Economic

Development (RHWs)

The purpose of this contract is to raise awareness to county officials about the Rural Health

Works (RHWks) projects by conducting a RHWks demo in three rural counties, educating

county officials on the benefits of the program, and providing opportunities for peer-to-peer

learning about RHW through the National Association of Counties (NACo) conferences and

publications.

Rural Health Outreach Tracking and

Evaluation

This contract supports a contract to track, assess, and evaluate the impact of the Public

Health Service Section 330A grant programs.

Logistical Support for Frontier Technical

Assistance Workshops and the

Development of White papers on Frontier

Issues

This contract supports a contract to provide logistical support for a consortium of community

and research partners to develop frontier technical assistance workshops for grantees and

to produce white papers on key frontier issues.

Rural Health Analysis, Issues, and

Logistics

This contract provides logistical and administrative services for meetings with consortiums

comprised of community and research.

Rural Pharmacy Best Practices

The purpose of this contract is to provide logistical and administrative support to develop a

document highlighting rural pharmacy best practices that work across the continuum of care.

State- Based Agricultural Health and

Safety Technical Assistance

The purpose of this contract is to expand AgriSafe Network Services to rural providers in at

least six additional states.