U.S. Department of Health and Human Services

Health Resources and Services Administration

Office of Rural Health Policy

2006 Annual Report
Table of Contents

ORHP Overview .............................................................................................................. 3

FY 2006 Overview........................................................................................................ 4

Budget................................................................................................................................ 6

Policy Activities................................................................................................................ 8

Regulations and Key Policy Activities:..................................................................... 8

Special Projects and Partnerships:........................................................................... 11

Provider‐Focused Technical Assistance ............................................................. 13

Health Information Technology .......................................................................... 14

Health Care Workforce ......................................................................................... 15

Program of All‐Inclusive Care for the Elderly (PACE) .................................... 16

Women’s Health Issues......................................................................................... 17

Frontier Health ....................................................................................................... 17

Collaboration with the National Rural Health Association (NRHA) ............ 17

Border Health ......................................................................................................... 19

Research and Policy Grant Programs ......................................................................... 21

Rural Health Research Centers ............................................................................ 21

One Year Rural Health Research Grant Program ............................................. 24

Frontier Extended Stay Clinic Program.............................................................. 26

Hospital‐State Based Grant Programs ........................................................................ 28

Medicare Rural Hospital Flexibility Grant Program (Flex) ............................. 30

Small Rural Hospital Improvement Grant Program (SHIP)............................ 32

State Offices of Rural Health Grant Program .................................................... 34

Community‐Based Grant Programs............................................................................ 36

Rural Health Care Services Outreach Grant Program...................................... 38

Delta States Rural Development Network Grant Program ............................. 40

Network Development Grant Program.............................................................. 42

Network Development Planning Grant Program............................................. 44

Rural Access to Emergency Devices ................................................................... 46

Public Access to Defibrillation Demonstration Projects................................... 48

Black Lung Clinics Grant Program...................................................................... 49

Small Health Care Provider Quality Improvement Grant Program .............. 51

Radiation Exposure Screening and Education Program.................................. 53

ORHP Staff...................................................................................................................... 54

Appendix – Authorizing Legislation .......................................................................... 58

2
ORHP Overview

The Office of Rural Health Policy (ORHP) coordinates rural health policy issues

within the U.S. Department of Health and Human Services.  In FY 2006, ORHP

administered 15 grant programs with a focus on capacity building at the

community and State levels. While located within the Health Resources and

Services Administration (HRSA), the Office has a department‐wide responsibility

to analyze the impact of departmental policy on rural communities.

ORHP is both a policy and programmatic resource for rural communities. The

Office’s policy role is created by Section 711 of the Social Security Act, which

charges the Office with advising the Secretary on rural health issues.  In that role,

the Office examines issues such as the effects of Medicare and Medicaid on rural

citizens’ access to health care, specifically on the viability of rural hospitals and

the availability of rural physicians.   

The Office’s programs also provide funding at both the community and State

levels to support improved rural health care delivery. Through its community‐

based programs, the Office supports projects that improve access to health care

services, encourage network development among rural health care providers,

enhance delivery of emergency medical services and place and train people in

the use of automatic external defibrillators.  In FY 2006, the Office also assumed

duties for two additional grant programs, overseeing the Black Lung Clinics

grant program and the Radiation Exposure Screening and Education grant

program.  While these programs are not solely focused on rural health issues,

many of the populations affected reside in rural areas.  The Office’s hospital‐State

programs provide grants to the States to support State‐wide activities via the 50

State Offices of Rural Health and to work with rural hospitals across the Nation.   

In addition, the Office is also charged with two agency‐wide coordinating

functions.  The Office manages HRSAʹs border health activities. Much of the

2,100‐mile U.S.‐Mexico border is rural and the urban regions face health care

delivery challenges similar to rural areas, such as limited health workforce

capacity and a fragile infrastructure.  In FY 2006, the Office also assumed a new

function for HRSA by serving as the primary coordinator of intergovernmental

affairs for all Agency activities.

3
ORHP Vision, Mission

and Strategic Goals

ORHP Vision

ORHPʹs vision is to improve

the health of Americans by

providing national

leadership in increasing

access to quality health care

in rural America.

Mission

The mission of the ORHP is

to sustain and improve

access to quality health care

services for rural

communities. In addition,

the Office coordinates access

to quality health care

activities along the U.S.‐

Mexico border.

Goals

In order to measure its

accomplishments, the office

has established the following

three long‐term goals:

Goal 1:  Improve the health

and wellness of people

living in rural communities

and in the U.S.‐Mexico

border region.

Goal 2:  Improve the

financial viability of small

rural hospitals, rural health

clinics, and other rural

providers.

Goal 3:  Sustain and

improve access to

outpatient, inpatient,

pharmaceutical, and

emergency room care for

rural communities and along

the U.S.‐Mexico border.

For information about the legislative authorization for ORHP ́s

programs, please see the appendix.

FY 2006 Overview

The Office had a typically busy year in FY 2006, with a variety

of noteworthy programmatic and policy accomplishments.  At

the beginning of the year, the Office identified health

information technology (HIT) as a key priority.  Toward that

end, the Office held its first‐ever national meeting on HIT for

rural health care providers.  The conference, which looked at

the critical link between HIT and quality improvement,  drew

more than 500 participants from across the Nation for a two‐day

meeting that addressed HIT challenges and opportunities for

rural health care providers.  The meeting showed that there is a

high interest among rural providers in learning more about

how HIT can be used in rural communities to improve quality

of care in rural communities.  The success of the conference

highlighted the need to ensure that rural providers are part of

the larger national discussion on HIT adoption.  

The Office also continued to focus on improving health quality

in rural communities in the past year.  The Office implemented

the Small Health Care Provider Quality Improvement grant

program by awarding funds to 15 grantees to focus on targeted

improvement in diabetes and cardiovascular health.

The Rural Hospital Flexibility Grant program continued its

success on a number of levels.  The number of rural hospitals

converting to “Critical Access Hospital” (CAH) status topped

the 1,200 threshold.  In addition, operating margins for CAHs

continued to improve.  The percent of CAHs with positive

operating margins improved from 27 percent in FY 2005 to 31.1

percent by FY 2006.  The median operating margin for CAHs

improved from ‐5.2 percent to in FY 2005 to ‐4.2 percent in FY

2006.  The Office also continued to work with CAHs on facility

replacement.  Many of the CAHs across the Nation are in

outdated structures but often struggle to replace or modernize

their existing facilities.  In FY 2006, the Office released a set of

4
publicly available “model blueprints” for a CAH replacement facility.  These

“model blueprints” can be obtained at no cost and modified to meet individual

community needs.  This helps CAHs avoid some of the initial costs of planning

by providing a common template from which to work.  They are available at:  

http://www.hud.gov/offices/hsg/hosp/prototype.pdf

http://www.hud.gov/offices/hsg/hosp/hsghospi.cfm

The Office also identified performance measurement as a key priority in FY 2006.  

The Office has identified draft performance measures for all of its programs over

the past year and began work with the HRSA Office of Information Technology

on the development of an electronic data collection tool that is compatible with

the Electronic Handbook used by grantees to submit their non‐competing

continuation guidance.  This system is expected to be operational by FY 2009.  

5
6

Budget

Chart 1 – Budget Summary

Labor‐Health and Human Services‐Education and Related Agencies

(Amounts in thousands)

FY 2005 Final

Appropriation

FY 2005

Amount to

Program

FY 2006 Final

Appropriation

FY 2006 Amount

to Program

Rural Health Programs

Rural Health Outreach 39,278 38,005 38,885 37,625

Rural Health Research 8,825 8,751 8,736 8,663

Medicare Rural

Hospital Flexibility 39,180 39,180 63,538 63,538*

Rural and Community

Access

to Emergency Devices 8,927 8,852 1,485 1,285

Rural EMS Training

and Assistance

Equipment Program 496 480 0 0

State Offices of Rural

Health 8,321 8,044 8,141 7,877

Denali Commission 39,680 39,680 39,283 39,283

Radiation, Screening,

Exposure and Education

Program 1,958 1,623

Black Lung 5,951 5,901

Total, Rural Health

Programs $ 144,707 $ 142,992 $ 167,977 $ 165,795

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 2006 includes $25 million above the base to fund the Delta Health Initiative.
Chart 2 ‐ Total number of ORHP grants and amounts by State, in FY 2006

State # Grants Awarded FY 2006 Funding State # Grants Awarded FY 2006 Funding

AK 6 $ MT 1,278,278 14 $ 2,791,843

AL 9 $ NC 2,106,843 6 $ 1,631,060

AR 6 $ ND 2,223,840 7 $ 1,597,929

AZ 7 $ NE 1,401,321 12 $ 3,013,053

CA 7 $ NH 1,638,352 7 $ 1,383,302

CO 8 $ NJ 2,487,952 1 $ 146,400

CT 2 $ NM 229,659 13 $ 2,470,822

DE 2 $ NV 249,400 6 $ 1,176,594

FL 8 $ NY 1,776,624 11 $ 1,841,548

GA 12 $ OH 2,669,244 8 $ 2,123,101

HI 3 $ OK 706,806 5 $ 1,629,947

IA 10 $ OR 2,551,573 8 $ 1,707,626

ID 5 $ PA 1,214,095 8 $ 1,478,505

IL 8 $ RI 2,905,358 1 $ 141,600

IN 7 $ SC 1,469,561 7 $ 1,554,780

KS 4 $ SD 1,770,130 7 $ 1,852,658

KY 11 $ TN 3,113,860 7 $ 1,702,972

LA 11 $ TX 2,672,574 13 $ 3,092,321

MA 6 $ UT 776,643 5 $ 1,119,056

MD 5 $ VA 1,022,657 7 $ 1,562,392

ME 8 $ VT 1,697,125 4 $ 690,437

MI 15 $ WA 2,968,040 7 $ 2,110,493

MN 9 $ WI 2,794,651 7 $ 1,952,746

MO 8 $ WV 2,338,720 5 $ 2,158,840

MS 8 $ WY 2,497,892 5 $ 1,042,704

Total Number of Grants: 366 Total Funding: $ 88,533,927

7
Policy Activities

Policy Coordinator: Carrie Cochran  

Grants Project Officer: Erica Molliver

Regulations and Key Policy Activities:

In its policy role, the Office focuses on issues related to access to care for

residents of rural areas.  Because many of the policy levers at the Federal level

are related to the Medicare program, Medicare policy review and analysis

comprise much of the Office’s policy work.  However, significant time and

attention are also devoted to other policy areas including Medicaid, the State

Children’s Health Insurance Program, workforce, quality, and health

information technology (HIT).

The specific Medicare regulations that come through ORHP for review vary

somewhat from year to year, however the major Medicare payment system

regulations generally come through for review during both the proposed rule‐

making and final rule‐making cycles.  Recently, regulations relating to the

Medicare Advantage, Medicare Drug Benefit, and various quality reporting

programs also have been reviewed for comment.

Medicaid and SCHIP are State‐based programs and much of the discretion for

these programs is left to the States. However, ORHP does participate in the

departmental review of Medicaid and SCHIP waiver proposals to assure that the

interests of rural Medicaid beneficiaries are considered.  Our role in workforce

policy encompasses a wide variety of issues including Medicare Graduate

Medical Education, J1‐Visa Waivers, the National Health Service Corps, and Title

VII programs that provide support to rural providers. Rural Health quality

issues are relatively new to the Office, as they are to Federal programs in general,

but review and input into quality measurement and reporting programs has

become a regular and important activity.

8
Key Policy Accomplishments:   

During Fiscal Year 2006, the policy staff in ORHP reviewed approximately 50

draft Federal regulations and policies to determine how they might affect rural

providers and the individuals they serve.  Of these regulations, ten included

provisions ORHP staff felt had the potential to adversely affect rural providers or

for which staff felt additional language should be added to provide adequate

protections for rural providers.  

ORHP often identifies issues of particular concern to rural providers during its

review of the Medicare payment system regulations.  The FY 2007 Inpatient

Prospective Payment System (IPPS) regulations included changes to the

weighting of IPPS diagnosis‐related groups (DRGs) and changes to the

occupational mix adjustments for the wage index.  ORHP analyzed the effects of

these changes on rural providers and will continue to monitor their effects as

they are implemented in the coming year.  Additionally, ORHP worked closely

with Center for Medicare and Medicaid Services (CMS) in revising the FY 2006

IPPS regulations regarding Critical Access Hospital (CAH) facility relocation and

supported its final policy.  During FY 2006, the Office continued to work with

CMS on the CAH relocation Interpretive Guidelines to encourage CMS to

establish reasonable flexibility for CAHs as these facilities proceed through the

relocation process.   

The CY 2007, Outpatient Prospective Payment System (OPPS) regulations

offered us the opportunity to provide assistance to CMS in developing a

payment add‐on for certain rural hospitals.  ORHP worked with CMS to review

data and payment policies that ultimately resulted in a payment add‐on for a

subset of rural hospitals that were determined to have the most need.  

Additionally, Office staff worked with CMS to ensure that Essential Access

Community Hospitals (EACHs) are treated as Sole Community Hospitals (SCHs)

for OPPS payment purposes.   

During FY 2006, regulations process, ORHP worked closely with CMS to revise

several definitions of rural used for both CAHs and other rural providers.  These

revised definitions will assure that hospitals in areas considered rural under

several different definitions will continue to be considered rural for purposes of

Medicare payment.   

In FY 2006, the ORHP worked internally with HRSA to recommend increasing

flexibility in eligibility criteria for the J1 Visa Waiver program.  In FY 2006, the

Office of Global Health Affairs lowered the required HPSA score for placement

9
of a J1‐Visa waiver physician in a Federally Qualified Health Center (FQHC) or

Rural Health Clinic (RHC) from 14 to 7.   This allowed more FQHCs and RHCs to

potentially qualify for placement of a J1‐Visa waiver physician.  

In FY 2006, for the first time the Quality Improvement Organizations (QIOs)

were required to engage Critical Access Hospitals (CAHs) and small rural

hospitals and encourage participation in reporting quality measures to the

Hospital Compare website operated by CMS.  If CAHs chose to participate, they

were asked to provide baseline and re‐measurement figures for the measures

and demonstrate improvement on at least one or more of the measures. The

measures address the same medical conditions that are required to be addressed

by other hospitals; however, there are fewer measures for these smaller facilities.  

By the end of FY 2006, approximately 60 percent of CAHs have voluntarily

chosen to participate.  This is significant.  Hospitals paid under the Medicare

Inpatient Prospective Payment System (IPPS) get a full payment update if they

submit quality data.  CAHs, which are not paid under the IPPS, get no payment

boost for reporting quality data. Studies show the CAHs voluntarily report their

data because they believe it is the right thing to do for the consumer.     

ORHP continues to act as primary staff for the HHS Secretary’s Rural Task Force

and the National Advisory Committee on Rural Health and Human Services

(NAC).  In FY 2006, the NAC issued its annual report to the Secretary, which

focused on access to pharmacy services, health information technology, and

family care giver support for the elderly in rural areas.  In 2006, the NAC will

complete its 2007 report, which topics include Medicare Advantage, Substance

Abuse, and Head Start in rural areas.   

In FY 2006, ORHP funded the Rural Policy Analysis Cooperative Agreement to

support research and analysis on key policy issues affecting rural communities.  

The 2006 funding supported several activities including work with rural

community colleges on health workforce issues, the Rural Policy Research

Institute Rural Health Panel, and the Rural Hospital Issues Group.  The RUPRI

Rural Health Panel provides science‐based, objective policy analysis to Federal

policymakers.  Panel members come from a variety of academic disciplines and

create documents that reflect the consensus judgment of all panelists.  The Rural

Hospitals Issues Group, a panel of small rural hospital administrators and rural

hospital finance experts from across the country, discuss issues such as the

MMA, Medicare Advantage, and other policy issues affecting small rural

hospitals.

10
Special Projects and Partnerships:

One of the unique aspects of the Office of Rural Health Policy is its

entrepreneurial nature.  Since its inception, the Office has put an emphasis on

working with key partners and organizations to develop projects to address

long‐standing rural health problems.  The Office uses a portion of its funding in

the Policy/Research line to support these activities.  The emphasis of these special

projects is either to highlight an issue or work with key rural partners to develop

services or resources that fill an identified need.    

Some of these “special projects” are focused on the needs of all rural

communities, such as the need for general information on rural health.  Others

may focus only on a specific issue such as the recruitment and retention of health

workforce or the role of economic development in health care.  Still other

activities focus on a particular type of health care providers.  In each case,

however, the projects and initiatives supported by the Office meet an identified

rural health care need.    

The Rural Assistance Center (RAC) is one of the best examples of this investment.  

In its authorizing statute, the Office was charged by Congress with establishing

and maintaining “a clearinghouse for collecting and disseminating information

on rural health care issues, including rural mental health, rural infant mortality

prevention, rural occupational safety and preventive health promotion, research

findings relating to rural health care and innovative approaches to the delivery

of health care in rural areas.”  The need for such a resource was further

heightened by the findings of “One Department Serving Rural America,” a

report by the Rural Task Force of the U.S. Department of Health and Human

Services to the Secretary.   This report identified the need for a single coordinated

point of contact on rural issues for all the HHS programs that affect rural

communities.  The RAC was established in December 2002 as a rural health and

human services ʺinformation portal.ʺ  RAC helps rural communities and other

rural stakeholders access the full range of available programs, funding, and

research that can enable them to provide quality health and human services to

rural residents.  Services provided include RACʹs Web site (www.raconline.org),

electronic mailing lists, and customized assistance.  The site has had over

6,000,000 visits since inception and averages more than 25,000 visits per month.  

RAC has an average turnaround time of less than 24 hours for individual

requests.  In FY 2006, the RAC continued to expand the level and breadth of

information and services for rural residents.  In addition, the project also added

11
new sites and information resources related to border health issues and health

disparities in the Delta region of the country.    

Another long‐standing effort of the Office examines the important link between

economic development and health care in rural communities.  The health sector

is often one of the top employers in a rural economy, a role and relationship that

often is not fully understood.   The Center for Rural Health Works (RHWks) is an

ongoing program that works to strengthen local systems of health.  As the

national focal point, it provides technical assistance, tools and training to help

States measure the economic impact of the health‐care sector on local, regional

and State economies.  It also develops feasibility studies for new health care

services.  During FY 2005 RHWks activities included conducting two regional

workshops, responding to more than 300 requests for technical assistance,

developing models for measuring the economic impact of a CAH and a FQHC

on local communities and sharing the results of their studies/activities at 16

regional and national conferences.

The National Association of Counties (NACo) has established a partnership with

Center for Rural Health Works to help county elected officials take the lead in

conducting a comprehensive community engagement process for health and

economic development.  The purpose of this project is to help communities

recognize that improving their health care system has a direct and positive

impact on local economic growth.  This was a new initiative for FY 2005 and

continues in FY 2006.   During this first year of the program, the NACo Project

produced three county‐level reports on economic impact, community need,

health services directory, and data/information.  The reports were provided to

each county and placed on the NACo Web site. NACo also disseminated

information about this project through workshops at its Western Regional and

Annual Conferences and through articles in NACo’s publication “County

News.”  

ORHP’s support for the National Conference of State Legislatures (NCSL) augments

an existing cooperative agreement through the Bureau of Primary Health Care

which provides funding support to the NCSL for an annual meeting focusing on

a key rural health issue of interest to rural State legislators.  With 2006 funds,

NCSL convened a day‐long conference to look at State‐based resources that focus

on rural health issues, including grants such as the State Offices of Rural Health

program and the Rural Hospital Flexibility program.  The meeting also examined

issues related to health information technology.

12
Provider‐Focused Technical Assistance

ORHP works to develop and provide technical assistance (TA) and information

sharing for rural health care providers to strengthen and expand their ability to

provide quality health care. ORHP’s provider‐focused TA and information

sharing efforts in 2006 involved Rural Health Clinic TA Conference Calls, 340B

TA for Rural Hospitals, the Delta Rural Hospital Performance Improvement

Project, and the Alaska Rural Hospital Performance Improvement Project.

ORHP funds supported a contract to conduct the Rural Health Clinic (RHC) TA

Conference Call Series, which provided Rural Health Clinics (RHCs) nationwide

with eight conference calls in FY06 on RHC policy and operational issues.  The

topics were determined approximately one month before each call by an

advisory group of RHC experts.  FY 2006 funds supported the cost of phone

lines, speakers and administration of the eight one hour‐long calls.  The topics

covered included billing and coding, Medicare Advantage, Pandemic Influenza,

benchmarking, shortage designation application, and RHC basics, among others.  

The calls attracted an average of 200 participants each.  These technical assistance

calls provide substantial benefits to RHCs, which typically cannot send staff to

technical assistance conferences or seminars.  Not only are RHCs unable to

function without key billing or clinical staff in the Office, but most RHCs simply

cannot afford the cost of travel, registration, etc. associated with attending such

an event.  A recent estimate shows that these calls save RHCs an average of $900

per call.  In the aggregate, this results in savings of $180,000 per call for the

participating RHCs.

As a result of a change in the law in 2003, approximately 350 rural hospitals

qualified to participate in the 340b Drug Pricing Program.  To assist these

facilities in signing up for the program, the ORHP provided supplemental

funding to the HRSA Pharmacy Services Support Center (PSSC) in FY 2006 to

assist rural hospitals in understanding and applying for participation in the 340b

discount drug purchasing program.  The PSSC is a resource established in 2002

to assist HRSA grantees and eligible health care sites to optimize the value of the

340B Program and provide clinically and cost effective pharmacy services that

improve medication use and advance patient care.  The PSSC operates under a

contract between the American Pharmacists Association (APhA) and the Office

of Pharmacy Affairs (OPA), in the HRSA Healthcare Systems Bureau.  To date,

over 180 rural hospitals are participating in the 340b program as a result of this

assistance.

13
The ORHP has also partnered with the Appalachian Regional Commission

(ARC) for a two‐year pilot program to increase access to affordable medications

by improving the management of patient assistance program (PAPs) at clinics

located within the ARC and Delta Regional Authority (DRA).  As a result of joint

ARC/DRA PAP workshop meetings, enhancements to PAP programs have been

identified and are being implemented at clinics in KY, OH, MS, and MO.

The Delta Rural Hospital Performance Improvement Project (RHPI) is designed

to increase access to quality health care services in the Mississippi Delta by

improving the financial, operational, and clinical performance of its small rural

hospitals.  On‐site technical assistance is available to 122 hospitals in eight States.  

This project is also developing and implementing a performance improvement

strategy based on the Balanced Scorecard (BSC) technology.  In 2006, the Delta

RHPI Project carried out a range of activities.  It delivered TA to 17 unique

hospitals, including 11 Performance Improvement Assessments (PIAs), 10

Targeted Consultations and Balance Scorecard (BSC) consultations in three

hospitals.  Additionally the project made tools available through the project Web

site, conducted sustainability meetings in four States, surveyed all assisted

hospitals regarding project success, and made numerous presentations about this

project.  The project has conducted both process and outcomes evaluations.

The Alaska Rural Hospital Performance Improvement Project, new in FY 2005,

provided on‐site technical assistance to hospitals in Alaska that request

assistance.  The TA was targeted at helping these hospitals improve their

financial, clinical, and operational performance.  FY 2006 funds supported three

on‐site TA visits to Alaska hospitals, as well as follow‐up services to provide

assistance during the implementation of recommendations made during the site

visits.  

Health Information Technology

There is an established link between the benefits of health information

technology (HIT) adoption and quality improvement.  There also is an emerging

need for support for rural providers to make informed decisions about how to

implement or enhance the use of HIT in their facilities.  As noted earlier, the

Office made HIT a priority in FY 2006.  In an effort to work toward rural equity

of HIT adoption, ORHP hosted the first national meeting focused solely on rural

HIT issues and challenges.  The meeting, “Health Information Technology: A

Provider’s Roadmap to Quality” took place September 21‐23, 2006 in Kansas

City, MO.  The meeting provided an opportunity for rural providers to learn

about the basic components of HIT, focus on the initial steps of strategic planning

14
for HIT investments and share best practices and lessons learned about HIT

implementation.  The event was successful in bringing together 500 rural

providers, vendors, and other interested parties to discuss strategic planning for

HIT investments.  

In other efforts to further the adoption and implementation of HIT by rural

providers, ORHP provided funding to the Technical Assistance and Services Center

to develop key expertise, partnerships and tools for critical access hospitals

(CAHs) to consider as they look to invest in HIT.  With FY 2006 funding, the

Technical Assistance and Services Center for the Rural Hospital Flexibility

program (TASC) will deliver tools and a customized portal.  The tools will

identify key areas of expertise needed to assist CAHs in their clinical, financial,

leadership, and staffing domains, most likely in the form of a primer on HIT.  

The portal will be a customized space for knowledge sharing, access, and

workspace on the AHRQ HIT portal site for the CAHs and other rural health

care providers.    

Health Care Workforce

    

The Office of Rural Health Policy also sponsors two projects meant to support

improved access to quality health care services by supporting the Nation’s health

care workforce.

The National Rural Recruitment and Retention Network (3RNet) works to increase

the number of providers practicing in rural America. The project consists of 43

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

Offices, Primary Care Associations, Area Health Education Centers, and other

not‐for‐profit entities.   

During FY 2006, 3RNet helped States improve their retention and recruitment

activities especially for primary care physicians, RNs, dentists, pharmacists, and

mental health professionals.  Members placed 725 medical professionals.  3RNet

also maintained a toll‐free phone line to assist providers interested in serving

rural America.  This included 207 family practice physicians, 57 internal

medicine physicians, 45 pediatricians, 90 dentists, 74 nurse practitioners, and 77

physician assistants.  

The 3RNet coordinated workshops, training, and presentations for those

interested in recruiting and keeping providers in rural communities.  In addition,

15
3RNet is working with HRSA programs to promote effective recruitment and

retention into areas served by these programs.

The 3RNet provides substantial savings to rural communities.  Research from the

3RNet shows that physician recruitment costs often cost up to $20,000 and non‐

physician recruitment costs often run more than $2,000. In FY 2006, it is

estimated that there will be 725 placements through 3RNet which will result in

up to $8.97 million in saved recruiting costs for rural communities.

  

Program of All‐Inclusive Care for the Elderly (PACE)

Rural America has a higher percentage of older residents per capita than urban

areas.  Access to long term care services continues to be a concern in many rural

communities.  In FY 2006, ORHP concluded a contract that examined the utility

of adapting a unique approach to caring for the frail elderly that to date had only

been offered in urban areas.  The Program of All‐inclusive Care for the Elderly

(PACE) allows frail seniors to avoid being placed in a nursing home by taking

part in a comprehensive care program that coordinates preventive, primary,

acute, and long‐term care services.  It is a unique capitated managed care benefit

for the frail elderly provided by a not‐for‐profit or public entity that features a

comprehensive medical and social service delivery system. There is little or no

penetration of this model into rural areas and the PACE contract has helped to

determine the level of interest among rural communities.    

For the past four years, the Office provided funds to the National PACE

Association to educate rural providers about the PACE model and provide

consultation on how to set up a program in a rural market. This project garnered

a great deal of interest from a variety of rural health organizations across the

Nation.  That interest culminated in the creation of a new grant program to help

rural organizations in a bill that passed Congress in FY 2006.   

The Deficit Reduction Act (DRA) of 2005, Section 5302 (c) (7) includes the Rural

PACE Grant Program.  This program is managed by the Centers of Medicare and

Medicaid (CMS) and allowed for $7.5 million in grants to be awarded so that

organizations are provided with start‐up funds.  These start‐up funds will help

organizations proceed with the development and implementation of a rural

PACE site in their community.  ORHP worked with staff from CMS on the

reviews and 15 grantees were chosen in September to receive funding.

16
Women’s Health Issues

In FY 2006, the ORHP provided funding to support the 2006 National Rural

Women’s Health Conference, titled “Expanding the Agenda for Rural Mental

Health Services Research:  Focus on the Rural Woman.”  Objectives of this rural

women’s health conference are to reveal how the unique characteristics of rural

communities and the diverse needs of rural women and families may impact

their mental health status and to identify and explore best practices and models

with an emphasis on capacity‐building, infrastructure, and leadership

development to facilitate collaborative, community‐based mental health services

research.  The rural adaptation of the healthy eating and physical activity tools of

the Bright Futures Initiative, which ORHP continues to guide, will aid rural

women and adolescent girls by providing information on recommended

preventive health services so that they seek care based on their individual needs

and share in the decision‐making about their health services.  The tools also

encourage rural practitioners to make all health care visits an opportunity to

offer preventive care.  The Bright Futures rural adaptation project was accepted

as a poster presentation at the 2006 Steps to a HealthierUS National Prevention

Summit. Final versions of these materials are expected at the end of CY 2006 for

distribution.

Frontier Health

Funding for a frontier health project supports the Frontier Education Center,

which provides technical assistance to individuals seeking information on

frontier health care issues and produces 3‐4 issue papers on frontier health‐

specific topics.  Funding supported papers focusing on topics including the use

of health information technology for public health activities in the U.S.‐Mexico

Border region, the applicability of the Frontier Extended Stay Clinic model to

sites in the “lower 48,” and developing baseline information to analyze the

impact of the Medicare drug benefit on frontier communities with a sole

pharmacy.

Collaboration with the National Rural Health Association (NRHA)

The Office of Rural Health Policy collaborates with the National Rural Health

Association (NRHA) to identify, analyze, and address rural health needs.

The purpose of one of the collaborative efforts, the Rural Medical Educators’

Conference and Technical Assistance, is to share innovative ways to get more

17
medical professionals into rural areas as well as discuss new issues in rural

health education.  This ongoing program supports the planning and execution of

the Rural Medical Educators Annual Conference, to be held in May 2007.  The

conference will bring together about 50 physicians, students, residents, and

professors who strive to bring medical professionals (including doctors and

nurses) into rural environments.

In response to issues brought to the forefront by the Institute of Medicine’s 2005

rural health quality report “Quality through Collaboration,” the NRHA launched

a Quality Initiative which continues to improve quality of health care in rural

communities.  In FY 2006, funds supported in‐depth technical assistance through

eleven site visits to rural facilities requesting targeted technical assistance.  These

visits are designed to promote health care quality in rural areas.  In addition, a

manual on quality improvement models will be produced and distributed to

rural communities.  Finally, the rural quality focus group continues to meet to

identify needs and develop solutions to address them.

In FY 2006, the NRHA focus on Quality supported several activities including

planning a quality conference and bringing in four speakers, two meeting breaks

and audio visual equipment rental at the Quality Conference in the Summer of

2007.   

Public health and emergency preparedness is a long‐standing need among rural

communities.  Funds in FY 2006 have been directed to support the development

of one chapter in a rural public health textbook in collaboration with the

Association of Schools of Public Health, the Council for Education in Public

Health, and other partners.  Public health will also be a focus at the 2007 Annual

NRHA Conference via a pre‐conference workshop, with an expected 40

participants.

The Office of Rural Health Policy also collaborates with the NRHA to hold

several policy forums throughout the year for key stakeholders to discuss

various issues, such as Medicare, Medicaid, acute care, etc. The forums educate

participants about rural community‐based health models and begin developing

reports on best practices.   

Further, an ongoing Annual Meeting Support project supports various parts of

the National Rural Health Association’s annual meeting.  The annual meeting

brings together the broad rural health community for continuing education and

networking.  FY 2006 funding was provided to support eight sessions on topics

such as rural Health Information Technology; an overview of findings from the  

18
National Advisory Committee’s report on family caregiver support for rural

elderly; Federal, State, and local measurement activity in quality small rural

hospitals; FLEX performance measurement;  an update from HRSA’s Office of

Rural Health Policy (ORHP) and Bureau of Primary Healthcare (BPHC);  and a

Medicare update coordinated with the Centers for Medicaid and Medicare

Services (CMS).

Another collaborative effort between ORHP and NRHA supports State Rural

Health Association Grants to support the rural health community at the State

level through a variety of different activities.  It is a continuing project.  With FY

2006 funding, 42 grants of $9,500 were administered to support activities such as

rural health newsletters, conferences, educational activities, skill building, etc.  

Other collaborative efforts with the NRHA resulted in the Ag Health program

that provides technical assistance in order to raise awareness of health and safety

issues associated with agriculture, decrease the number of related accidents and

illnesses and improve treatment.  In FY 2006, NRHA distributed a recently

developed peer‐reviewed brochure on respiratory hazards to over 5,000 farm

workers and health care providers working in farm safety.  Also in FY 2006, the

NRHA produced and disseminated guidelines for Critical Access Hospitals to

contract with hospice services, part of its effort to promote options for rural

palliative care.

Finally, no health care effort can be successful without competent and informed

health care professionals.  In FY 2006, NRHA held the first Rural Clinicians’

Conference which trained over 200 rural healthcare professionals and

emphasized agriculture‐related disease and injury.  ORHP supported travel and

honoraria for six conference speakers along with other supportive services for

the conference.

Border Health

ORHP also facilitates intra‐agency border health activities that cut across the

Bureaus and Offices of HRSA.  In FY 2006, funds supported the Border Health

Clearinghouse in the Rural Assistance Center, which developed a border Web site

within the RAC (www.raconline.org ww.raconline.org) for health and human services information.  

This bilingual site serves as a clearinghouse for information on border health

issues.  The border health Web site was launched on schedule in January 2006.  

In FY 2006, ORHP also supported the U.S.‐Mexico Border Health Association

Meeting and Immunizations in the Americas Weeks. The purpose of the former was

19
to further educate clinicians and community workers about HRSA programs and

the progress toward achieving U.S.‐Mexico Border 2010 Health Objectives.  

ORHP supported the annual U.S.‐Mexico Border Health Association Meeting in

Laredo, Texas, through the provision of logistical support for educational

seminars for providers.

The purpose of the Pan‐American Health Organization Immunizations program is to

further educate clinicians and community workers in the appropriate use of

vaccines and to facilitate the vaccination of children and adults in local clinics

and community health centers along the US‐Mexico border.  FY 2006 funding

provided logistical support for Immunization in the Americas Week.     

In FY 2006 HRSA and ORHP organized a Border Health Summit in Tucson, AZ

on August 22‐24, 2006.  Approximately 100 attendees participated, representing

HRSA border grantees; key border, bi‐national, and Federal partners. Plenary

sessions included updates on border initiatives from the Pan American Health

Organization, U.S.‐Mexico Border Health Association, U.S.‐Mexico Border

Health Commission, and State‐specific initiatives.  Sessions covered the

pandemic flu, HIV/AIDS sponsored programs, and border workforce analysis.  

Primary care and oral health research and education programs were described,

including diabetes, the Border Infectious Disease Surveillance (BIDS) project,

health literacy, and an analysis of diabetes/tuberculosis findings.  A presentation

on environmental issues and their impact was followed by a comprehensive

overview of demographic projections and their subsequent impact along the

U.S.‐Mexico border.  

The presentation of success stories from each State’s prior years’ bi‐national

border health week celebrations set the stage for the State break‐out sessions.  

State teams met to network and discuss current health care challenges and

prioritize identifiable needs and recommendations.   

20
Research and Policy Grant Programs

Rural Health Research Centers

Program Coordinator: Joan Van Nostrand

The Rural Health Research Centers (RHRCs) Program is designed to help policy

makers understand the problems that rural communities face in assuring good

health and access to health care for their

members.  The RHRCs study issues facing

rural communities in their quest to secure

adequate, affordable, quality health services

for their residents.  This is the only Federal

program that is entirely dedicated to

producing policy‐relevant research on

health care and population health in rural

areas.  The work done by the Centers is also

critical to helping the Office play its policy

role within the Department.  The research

done by the RHRCs help provide important data and findings to the office’s

policy staff which they bring to bear in their annual review of key Departmental

regulations.  

At A Glance

Amount Awarded:

2004:   $ 4 million

2005: $ 4.4 million

2006: $ 4 million

Grants Awarded:

2004: 8 new awards

2005: 8 continuing awards

2006: 8 continuing awards

In FY 2006, 8 noncompetitive awards were made to the research centers, in eight

States, totaling $4,000,000.  

Changes to the Program:

The eight RHRCs conducted 25 research projects and wrote 30 policy briefs and

technical reports about their results.  All RHRCs have Web sites which highlight

their rural research results.   

Key Program accomplishments:

21
Research Centers study a wide variety of issues about the rural health care

infrastructure and health status of members of rural communities.  Some

examples from the 30 briefs and reports include:

• Medicare Part D:  First snapshot of enrollment in Medicare Part D in rural

as compared to urban areas showed higher enrollment in stand‐alone

prescription drug plans (PDP) balanced by low enrollment in Medicare

Advantage PDP.

• Critical Access Hospitals:  Administrators of Critical Access Hospitals

described their experiences with contracts offered by Medicare Advantage

Plans and provided advice to others dealing with this issue.

• Medicaid:  Insights into the potential rural impact of Medicaid policy

changes showed that some could adversely affect the rural health

infrastructure or the ability of rural residents to access services.

• Quality:  An assessment of the capacity of a sample of rural hospitals to

implement medication safety practices showed that the majority are using

pharmacy computers.  However, a significant proportion either do not

have a pharmacy computer or are not using it for clinical purposes.

• Substance Abuse:  Rates of methamphetamine use were higher for rural

young adults.   Those in smaller rural counties, in particular, were twice as

likely to use methamphetamine than urban young adults.

• Disability:  Rural as compared to urban adults aged 65‐69 lived a greater

percent of their lives with a disability.  Women lived longer, more

disabled lives than men.  African Americans lived shorter, more disabled

lives than Whites.  Persons with more than twelve years of education lived

substantially longer, less disabled lives that those with less education.

• Health Insurance:  Examination of annual out‐of‐pocket health care

expenditures of those under age 65 who were continuously insured by a

private plan looked at the issue of underinsurance.  Despite private

insurance, those in rural, as compared to urban, areas paid for a

substantial portion of their own health care costs.  

• Health Professions:  Rural Community Health Centers (CHCs) had a

higher proportion of vacancies for major clinical disciplines and reported

greater difficulty filling positions compared to urban CHCs.  Physician

22
recruitment in rural CHCs is heavily dependent on National Health

Service Corps scholarships, loan repayment programs, and international

medical graduates with J‐1 visa waivers.  

• Bioterrorism:  Roles of the State Offices of Rural Health in preparing for

bioterrorism and other health system emergencies varied considerably

across States.  In some, the Office had significant involvement as a source

of information for rural constituents.  In others, the role was as a source of

information on behalf of rural constituents.  Most offices were involved in

activities related to development of an emergency preparedness (EP)

response plan for the State or regions within the State.  A major role was

in the assessment of training needs of emergency personnel and of EP of

rural hospitals.    

In conclusion, others have recognized the outstanding work of the Research

Centers.  Twenty articles were published in peer‐reviewed scientific journals,

such as Health Affairs, Journal of the American Medical Association, and Journal

of Rural Health.  The National Rural Health Association gives an award to an

outstanding rural researcher at its annual meeting.  Since the year 2000, five of

the directors and staff of Rural Health Research Centers have received the award

as a special recognition of the contributions their research has made to rural

America.  

23
One Year Rural Health Research Grant Program

Program Coordinator: Erica Molliver

The One Year Rural Health Research Grant program provides one year of

funding for policy‐oriented rural health care services research projects.  Grantee

research findings help to inform the Office as well

as National, State, and local decision‐makers

about current rural health care services issues.  

Research findings have been instrumental in

bridging gaps between policy and program

needs, and have complemented the larger scale

projects conducted by the eight Rural Health

Research Centers. This grant program is unique

in its dual mission of both enhancing

policymakers’ knowledge of rural health, and

expanding the pool of experienced rural health

care services researchers.  

At A Glance

Amount Awarded:

2004:     $ 1,018,642

2005:     $ 590,574

2006:     $ 449,923

Grants Awarded:

2004: 7 new awards

2005: 4 new awards

2006: 3 new awards

States:

These grants provide up to $150,000 per grantee.  

Four awards were made on September 1, 2005

with FY05 funds, and three awards were made on September 1, 2006 with FY06

funds.  All four grantees awarded in FY05 are currently on a one‐year no‐cost

extension and are completing their final projects.   

ORHP awarded 3 grants to

3 States in 2006: MA, MT,

MO

Changes in the Program:

Key Program accomplishments:

FY05 grantees generated research findings in the following areas:  

• “Diabetes Burden and Lack of Preventive Care in the Rural United

States”  

• “Rural and Frontier Hospital Patients with Ambulatory Care Sensitive

Conditions: Predictors of Health Care Quality and Improved Outcomes

Utilizing HCUP Data”  

• “Evaluation of  an Outpatient Modified Rx Form”

• “Rural‐Urban Differences in Nursing Home Admissions, Service Usage,

and Discharge”

24
FY06 Grantees began research projects in the following areas:

• “Preventive Care: Supports and Barriers to Best Practices for a National

Sample of Rural Medicare Beneficiaries”

• “Diabetes and Obesity: Is There a Rural‐Urban Difference in the Burden?ʺ 

• ʺDescriptive Analysis of the Health Status of a National Asbestos‐Related

Cohortʺ 

25
Frontier Extended Stay Clinic Program

Project Officer: Carrie Cochran

The purpose of the Frontier Extended Stay Clinic (FESC) Cooperative Agreement

Program is to examine the effectiveness and appropriateness of a new type of

provider, the FESC, in providing health care services in certain remote locations.  

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.

Provision of these services requires the

staffing, equipment, and quality assurance

programs of an acute care hospital. However,

extended stay services are not currently

reimbursed by Medicare, Medicaid, or other

third‐party payers. For several years, officials in the State of Alaska and several

State Offices of Rural Health, Primary Care Offices and Primary Care

Associations have explored the development of a new provider type, or other

mechanism, that would enable reimbursement of these services through the

FESC model.  

At A Glance

Amount Awarded:

2004:   $ 1.5 million

2005: $ 1.5 million

2006: $ 1.5 million

Grants Awarded:

2004: 1 new award

2005: 1 continuing award

2006: 1 continuing award

States:

ORHP awarded 1 grant to 1

State in FY 2005

The Medicare Prescription Drug Improvement and Modernization Act of 2003

(MMA) authorized the Centers for Medicare and Medicaid Services (CMS) to

conduct a demonstration program in which FESCs would be treated as Medicare

providers. Under MMA, FESCs are defined as clinics that are: 1) located in

communities which are at least 75 miles away from the closest hospital or are

inaccessible by public road and 2) 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.

In a separate recognition of the extended care services provided by some frontier

clinics, an additional demonstration program to be administered by the Health

Resources and Services Administration (HRSA) was established by the

Consolidated Appropriations Act of 2004.  

26
Changes to the Program:

The ORHP Frontier Extended Stay Clinics Cooperative Agreement was the

catalyst for a significant increase in the availability of quality health care in four

frontier communities in Alaska and Washington.  The Cooperative Agreement

provided funding to the Alaska FESC Consortium for additional provider staff,

equipment, and facility upgrades.  Each site meticulously recorded every

extended stay via a detailed, web‐based encounter log.  In addition, the Alaska

FESC Consortium worked closely with State and Federal partners to craft

standards, policies and procedures, regulations, and conditions of participation.  

They qualified the conditions under which patients can safely be monitored and

observed, and when they must be transferred to a higher level of care.  

In August of 2006, CMS released a notice of application for the CMS Frontier

Extended Stay Clinic (FESC) demonstration.  The CMS FESC demonstration

program will test the feasibility of providing extended stay services to remote

frontier areas under Medicare payment and regulations.  The funding will be

provided for three years in order for FESC sites to provided services for seriously

or critically ill or injure patients who, due to adverse weather conditions or other

reasons, cannot be transferred to acute care hospitals, or patients who do not

need a hospital level of care but need monitoring and observation for limited

periods of time.  Based on our experience with the FESC Cooperative Agreement,

ORHP worked closely with CMS to develop the conditions of participation for

clinics participating in the CMS demo.   

Key Program Accomplishments:

Preliminary results of the first year of data collection indicate that the four clinics

recorded 693 extended stays (two hours or greater duration).  Only 6 percent of

the stays were over 24 hours; 44 percent of the extended stays resulted in being

discharged home, without further referral; 42 percent resulted in emergency

transfer to a higher level of care; 12 percent were referred on a non‐emergent

basis.   

27
Hospital‐State Based Grant Programs

The primary mission of the Hospital‐State Team (HST) is to promote the

improvement of:  1) rural healthcare quality; 2) access to healthcare; and 3)

financial viability of rural hospitals. To accomplish this mission, HST members

manage a multi‐state portfolio of three State‐based grants. These include: 1) the

State Office of Rural Health (SORH); 2) Rural Hospital Flexibility (Flex); and 3)

Small Rural Hospital Performance Improvement (SHIP) grant programs.  In

addition, the HST identifies and maintains relationships with key partners and

stays abreast of State and regional specific rural health issues. Collectively, the

HST serves as a base of knowledge and expertise on State and regional rural

health issues.  

The team consists of eight members. Two serve primarily as the Program

Coordinator (PC) for the three State‐based grants while seven (including one PC)

serve as both a Project Officer (PO) for multiple State‐based grants and Regional

Liaison (RL) to one of five multi‐State regions.  In addition, several HST members

serve as PO for technical assistance contracts and one is the PO for a cooperative

agreement with the National Association of State Offices of Rural Health.  

During FY 2005, the HST reviewed and managed 141 grants with a total

investment of almost $44.0 million.  

In order to provide quality customer service and help grantees improve their

performance, the HST:

• Met every two weeks to share information and solve problems

• Developed and refined written roles for RLs and PCs

• Oriented new Team members on the history, intent and requirements for

each of the three grant programs, including training at the Technical

Assistance Support Center (TASC)

• Developed an orientation program for all new SORH Directors

• Provided feedback to grantees about their applications that included a

formal presentation by the PC on SORH at each of the Regional Meetings.  

• Invited the Department of Housing and Urban Development, and HRSA’s

Office of  Performance Review, and Grants Management Office to meet

with the Team and discuss their activities/responsibilities

28
• Held regular conference calls with all States in their Region to share

information and address issues

• Worked with States to organize regional meetings to inform and address

needs within their State.

• Designed and implemented a new Web template that allows States to “tell

their story”

• Developed performance measures for the three grant programs

• Kept informed about issues facing hospitals and/or States including

Health Information Technology, Pay for Performance, capital funding,

universal services fund, etc.

• Worked to build relationships with TASC, NOSORH, AHA, AHQA, etc.

29
Medicare Rural Hospital Flexibility Grant Program (Flex)  

Program Coordinator: Steve Hirsch

The Rural Hospital Flexibility Program is a Federal initiative that provides

funding to State governments to stabilize rural hospital economics, integrate

emergency medical services (EMS) into the health care system and improve

quality of care.  Flex funds support the

conversion of small rural hospitals to CAH

status, which allows them to receive cost‐

based reimbursement from Medicare for

inpatient and outpatient services.  Flex

funding to the States also encourages the

development of collaborative systems of care

in rural areas, including the CAHs, EMS

providers, clinics, and other providers of high‐

quality, necessary health care services.

At A Glance

The FLEX program requires States to develop

rural health plans, and funds the States to

support and implement community‐level

outreach and technical assistance.  Although focused on very small, rural

hospitals, this complex intervention operates on the National, State, community,

and facility levels and covers a broad range of health service issues.

Amount Awarded:

2004:   $ 22.4 million

2005: $ 22.2 million

2006: $ 22.2 million  

Grants Awarded:

2004: 45 continuing awards

2005: 45 continuing awards

2006: 45 continuing awards  

States:

ORHP awarded 45 grants to 45  

States in FY 2006

Changes to the Program:

The FLEX program is developing performance measures to show the impact the

Flex funding has on CAHs and the communities they serve.  In FY 2006, the

program’s ongoing focus on quality improvement showed that 400 CAHs

reported to the CMS Hospital Compare Web Site with quality data even though

they are not required to do so.  Early analysis shows that CAHs actually perform

better than many urban hospitals on treating pneumonia patients.   

Key Program Accomplishments:

Since the inception of the Flex Program, more than 1,200 hospitals have

converted to CAH status.  Most of these hospitals have seen an improvement in

their financial status.  Most hospitals have offered new, needed services to their

30
communities.  More than 80 percent of CAHs report engaging in activities to

improve the quality of care provided to patients.   

In FY 2006 the FLEX grantees assisted  over 900 Critical Access Hospitals, Rural

Health Networks and EMS providers with over $11 million in direct technical

assistance, services, and grants to rural communities and more than 900 CAH

and small rural hospitals.

31
Small Rural Hospital Improvement Grant Program (SHIP)  

Program Coordinator: Keith J. Midberry

The purpose of the SHIP grant program is to help small rural hospitals do any or

all of the following: 1) pay for costs related to implementation of prospective

payment systems (PPS); 2) comply with provisions of the Health Insurance

Portability and Accountability Act (HIPAA) of

1996; and 3) reduce medical errors and support

quality improvement (QI) efforts.     

At A Glance

Amount Awarded:

2004:   $ 14.7 million

2005: $ 14.8 million

2006: $ 14.5 million

Grants Awarded:

2004: 49 continuing awards

2005: 47 new awards

2006: 47 continuing awards  

State Offices of Rural Health coordinate rural

hospitals’ participation in the program.  In FY

2006, $14.5 million was awarded to 1,591

eligible hospitals in 46 States and Puerto Rico,

each hospital received approximately $9,000.  

Changes to the Program:

Since FY 2002, the first year of the program, the number of participating hospitals

has increased by 141 hospitals or approximately 10% percent.   

The use of SHIP funds for reduction of medical error and quality improvement

activities increased from 53 percent in FY 2004 to 60 percent in FY 2005. The use

of SHIP funds for HIPAA activities decreased from 39.5 percent in FY 2004 to 34

percent in FY 2005.  The use of grant funds for PPS activities remains relatively

constant at 6 percent.

Key Program Accomplishments:

During FY 2006, 60 percent of the funds ($8.8 million) were expended for projects

and initiatives related to quality improvement.  HIPAA activities received 34

percent of the funds ($5 million) and PPS activities received 6 percent ($ 900,000)

of the funds.  Of the 1,591 participating SHIP hospitals, 941 or 59 percent used

some or all of their grant funds to invest in health information technology (HIT).   

Ninety percent (847) of the hospitals used SHIP funds to secure new or upgrade

existing hardware and software infrastructure that serve as the foundation for

business office, security and quality improvement functions.  Ten percent (94) of

the hospitals expended funds on hardware or software related to business office

32
functions such as coding, billing or accounting software. Fifty‐four percent (508)

identified their HIT expenditures as specific to compliance with the HIPAA

security rule and 46 percent (432) invested in HIT for quality improvement

activities  

33
State Offices of Rural Health Grant Program

Program Coordinator: Keith J. Midberry

The purpose of the State Offices of Rural Health (SORH) Grant Program is to

assist States in strengthening rural health care delivery systems by creating a

focal point for rural health within each State.  

The program provides an institutional

framework that links small rural

communities with State and Federal

resources to help develop long term

solutions to rural health problems.   

At A Glance

There are three core functions of the SORH:

(1) to serve as a rural health clearinghouse

of information and innovative approaches to

the delivery of services; (2) to coordinate

State activities related to rural health in

order to avoid duplication of efforts and resources; and (3) to identify Federal,

State, and nongovernmental programs regarding rural health and provide

technical assistance to public and nonprofit private entities regarding

participation in such programs.   

Amount Awarded:

2005:   $ 7.4 million

2006: $ 7.2 million

2007: $ 7.2 million (anticipated)

Grants Awarded:

2005: 50 continuing awards

2006: 50 continuing awards

2007: 50 continuing awards

Additionally, the program encourages State Offices to promote rural recruitment

and retention efforts of health professionals within their State.  Hence, the

SORHs are the primary dues‐paying members to the 3RNet.  In 2006 recruited

750 health professionals of which approximately 50 percent were primary care

physicians.   Approximately 90 percent went to underserved areas.  

   

In FY 2006, 50 non‐competing continuation grants were awarded for a total of

$7,264,000.  The maximum level of funding awarded was $146,400, which 47 of

the 50 States requested and received.  The program requires a State funding

match to  the Federal funding at a minimum 3:1 ratio; a unique leveraging

component for the program.   

Changes to the Program:

The program was enhanced by a new five year cooperative agreement with the

National Association of State Offices of Rural Health (NOSORH) which was

designed to build and sustain rural health infrastructure in each State.   Under

34
the agreement, NOSORH coordinates the planning and logistics for five regional

grantee meetings, the State Office new directors’ orientation, and the annual

grantee meeting.  Peer‐to‐peer mentoring has also been strengthened and

improved under the cooperative agreement.   

Key Program Accomplishments:

State Offices continue to leverage significant partnerships with the goal of

improving rural health.  In 2006, an example of the impact of these partnerships

is seen through the Rural Hospital Performance Improvement project (RHPI).  

SORHs in Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi,

Missouri, and Tennessee continue to work collaboratively with their State

Hospital Associations (SHAs) to provide input and expertise for this project.  In

particular, the SORHs worked with the contractor to ensure that the on‐site

technical assistance was well‐managed and appropriate to the needs of each

hospital.  The SORHs and SHAs also continue to follow up with the hospital

after technical assistance is rendered.   

The SORHs are continuously working with Federal, State, and local partners to

improve the collaboration among safety net providers in rural areas of their

States.  In particular, 14 SORHs applied with their State partners to an ORHP

initiative to “Improve Collaboration between Critical Access Hospitals (CAHs)

and Federally Qualified Health Centers (FQHCs).”  The following States applied

for technical assistance under this initiative: Alaska, George, Hawaii, Idaho,

Montana, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Vermont,

Washington, and Wisconsin. In each of these States the SORH is taking the lead

in bringing together the State‐level partners (Primary Care Offices, Primary Care

Associations, SHA) as well as safety‐net providers.  The technical assistance is

being provided through consultants to the State teams to assist them in better

understanding the roles and relationships between CAHs and FQHCs.  As a

result of the leadership from the SORHs, each of the States will be developing

plans and strategies for improved collaboration between the CAHs and FQHCs

in their States.

35
Community‐Based Grant Programs

In FY 2006, ORHP administered 8 community‐based grant programs with 213

grants and a combined program budget of $48,178,350.   Each community‐based

grant program and grant administered by the Community‐Based Team (CBT)

have differences, but each is predicated upon on a defined underserved

population, a commitment to change and a set of linked objectives designed to

build on local assets while addressing  the common issues of a collapsing safety

net and unique local issues.

The administration of the grants are grouped by subject or issue area, which

include: access to health care, chronic diseases, community health models, health

literacy and promotion, mental health and substance abuse, primary care,

transitional care, and vulnerable populations.  The CBT chose the subject areas

based on the awards to communities.  For example, almost half of the 2006 newly

funded Network Development grants focused on health information technology.  

The team increased its focus on HIT by having two members specializing in this

subject area as a resource to the grantees.

As discussed earlier most of the CBT grant programs are authorized and funded

by the same budgetary funding line, the Rural Health Outreach line, which

expired during the fiscal year.   The 2006 report for each program will be in the

context of the funding line.   

As ORHP reorganized into teams, HRSA reorganized by moving the Black Lung

Clinics Program and the Radiation Exposure Screening and Education Program

to ORHP because both programs principally serve rural communities.  The team

was expanded to include the two new programs, each with their own funding

line.  Both programs were reviewed by OMB under the PART process during FY

2006 for changes in the program in FY 2008.

Twenty‐five subject or issue areas of interest to community‐based team are listed

below (alphabetically) and represent the areas of need and interest of our

community grants:

36
• Access to care

• Cardiovascular health

• Case management

• Chronic disease (Alzheimer’s)

• Diabetes

• Domestic violence

• Elder care

• Emergency management

services and trauma care

• Health professions education

• Health information technology

• Maternal and child health

• Mental health and substance

abuse

• Nutrition

• Obesity

• Oral health

• Pharmacy

• Public health

• Quality

• Recruitment and retention

• “Safety net” collaboration

• School‐based health centers  

• Telehealth

• Transportation

• Uninsured

• Women’s health

37
Rural Health Care Services Outreach Grant Program

Program Coordinators: Nisha Patel and Jennifer Chang

The Rural Health Care Services Outreach Grant Program (Outreach) encourages

the development of new and innovative health care delivery systems in rural

communities that lack essential health care services.  The projects implemented

demonstrate creative models of outreach and health services delivery. The

emphasis of this grant program is on service

delivery through collaboration, requiring the

grantee to form a consortium with at least

two additional partners.   

At A Glance

   

The Outreach projects are based on

demonstrated community needs, calling for

involvement of the community in the

development and implementation of the

project.  Outreach projects are community‐

defined and the ORHP does not limit the

type of health services provided, except in‐

patient care.  This has resulted in a broad

variety of health services provided, including

primary health care, dental care, mental health services, home health care,

emergency care, health promotion and education programs, outpatient day care,

and many others.  Outreach grantees also serve a wide range of population

groups, including low‐income populations, the elderly, pregnant women,

infants, adolescents, minority populations, and rural populations with special

health care needs.     

Amount Awarded:

2004:   $ 19.9 million

2005: $ 18.8 million

2006: $ 17.9 million

Grants Awarded:

2004: 96 continuing awards, 13

new awards

2005: 71 continuing awards, 30

new awards

2006: 43 continuing awards, 65

new awards  

In FY 2006, 65 new and 43 continuing grants were awarded in 41 States for a total

of $17,880,245.  

Changes to the Program:

For FY 2006, a change in the maximum amount of funding that applicants could

request for the three‐year budget period was implemented.  Outreach applicants

can request up to $150,000 in the first budget period, $125,000 in the second

budget period and $100,000 in the third budget period, for a total award of

$375,000.  The Outreach program has also redesigned the way that grantees are

assigned project officers.  Twenty‐three common focus areas were identified for

the community‐based teams, with project officers managing each. Grantees are

38
assigned to project officers by the issue their grant seeks to address such as

chronic diseases management, oral health, mental health, and others.  This

structure creates an environment where ORHP can provide specialized technical

assistance, more grantee‐to‐grantee interaction regarding best practices, and

support.  In FY 2006, the Outreach program strengthened its performance

improvement initiative at the programmatic and grantee level.  Performance

measures are being developed to meet the unique needs of the grantees.  The

measures will enhance the Outreach program and the quality of the services

being provided by the grantees.   

Key Program Accomplishments:

The Outreach grant program has had tremendous success in providing needed

health services to rural communities.  The program has helped to bring rural

communities together to work towards a common goal, which is to improve the

health and well‐being of rural populations.  Although the Outreach program is a

three‐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.   

39
Delta States Rural Development Network Grant Program  

Program Coordinator: Lakisha M. Smith

The purpose of the Delta States Rural Development (Delta) Grant Program is to

support community organizations in the development and implementation of

projects to address local health care needs in the rural Delta Region. A single

grant is awarded to one organization within

each of the eight Delta States (Alabama,

Arkansas, Illinois, Kentucky, Louisiana,

Mississippi, Missouri, and Tennessee)

collectively known as the Delta Regional

Authority (DRA). The eight States are

comprised of 207 eligible counties.

At A Glance

ORHP provides support for the counties

within the DRA through activities designed to

strengthen the safety net and small rural

hospital performance, to implement demonstration projects for improving

collaboration across counties among existing grant programs and to provide

technical assistance and outreach funds to small rural Delta communities.

Amount Awarded:

2004:   $ 5.1 million

2005: $ 5.1 million

2006: $ 5.1 million

Grants Awarded:

2004: 8 new awards

2005: 8 continuing awards

2006: 8 continuing awards

In FY 2006, eight grants were awarded totaling $5,090,751.

Changes to the Program:

To achieve greater financial impact and partner collaboration across the Delta

counties/parishes, the Delta program encouraged grantees to form multi‐county

consortia instead of single‐county networks.   Additionally, an evaluation of the

program was commissioned to determine the overall effect upon the Delta

region.  New performance measures are being developed to enhance the quality

of project activities associated with the Delta grant program.

Key Program Accomplishments:

The Delta program has fostered improvements in health status, financial

viability, and access to care through regional network oriented structures that are

guided by local providers, capacities, and community needs.  The program

evaluation has demonstrated that over 94 percent of the Delta communities and

40
parishes have established functional local single county or multi‐county or parish

network structures through which communication and coordination was

enhanced within the community.  It is estimated that over 450 different agencies

which included public health departments, hospitals, clinics, mental health

providers, community health centers, faith based organizations, local school

districts, universities, and governmental agencies were involved in local Delta

network activities.  Most significantly, approximately 3 percent of the Delta

population or an estimated 136,000 people have received services or have been

reached by a Delta related project.

  

41
Network Development Grant Program

Program Coordinator: Sherilyn Pruitt  

  

The purpose of the grant 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 together in formal networks,

alliances, coalitions or partnerships to

integrate administrative, clinical,

technological, and financial functions across

their organizations. The funds provided

through this program are not used for the

direct delivery of services. The ultimate goal

of the RHND Grant Program is to strengthen

existing health care networks in order to

achieve business (network partner return)

and social (community return) competencies

that increase access and quality of rural

health care and, ultimately, the health status

of rural residents.

At A Glance

Amount Awarded:

2004: $ 6.6 million

2005: $ 7 million

2006: $ 6.7 million  

Grants Awarded:

2004: 29 continuing awards, 5

new awards

2005: 27 continuing awards, 10

new awards

2006: 15 continuing awards, 23

new awards  

States:

ORHP awarded 38 grants to 25  

States in FY 2006

  

Twenty three new grants and 15 continuing grants were funded in FY 2006 (38

total grants) totaling $6,668,686.  

  

Changes to the Program:

The Office of Rural Health Policy (ORHP) hired additional project officers and

reorganized the manner in which grants were allocated to project officers.  The

new allocation assigns grantees to project officers by issue area instead of

program.  This has resulted in fewer grants per project officer and allows project

officers to develop areas of expertise that may be shared across programs.  The

program also held a two‐day grantee meeting in conjunction with the Rural

Health Network Planning Grant Program.  This provided opportunities for

training, networking, and face‐to‐face interaction with the ORHP project officers.

  

Key Program Accomplishments:  

42
The 38 Network Development grantees encompass over 400 individual

organizations and represent a wide variety of public and private entities that

support the health of rural communities.  The network member organizations

include many diverse partners such as critical access hospitals, universities,

health departments, community health centers, and social service providers.  All

of the Network Development grantees have made progress streamlining

processes and systems between network members.  A large majority of the

grantees this year have focused on improving the quality of health care delivery

and staff development activities, including staff training, and recruitment and

retention.  Implementing or improving health care technology, including

streamlining payer information, educating staff, reducing medical errors,

enforcing HIPAA regulations, providing resources for clients, and implementing

telemedicine, was also the focus of Network grantee activity.  As required by the

grant, all grantees focused on sustainability, and grantee plans for sustaining

their program once Federal funding ceases, included obtaining additional grants,

partnering with State and local government agencies, procuring private

investors, soliciting membership dues/fees from partners and offering cost‐based

products and services.

43
Network Development Planning Grant Program

Program Coordinator:  Eileen M. Holloran

The purpose of the Rural Health Network Development Planning Grant Program

is similar to the Network Development Grant

Program in that it seeks to “achieve

efficiencies; expand access to, coordinate and

improve the quality of essential health care

services; and strengthen the rural health care

system as a whole.”  These grants support

rural communities needing assistance in

planning, organizing and developing a

health care network.  Funds cannot be used

for direct delivery of health care services.  

The grant supports one year of planning to

develop a network and help them become

operational.   

At A Glance

Amount Awarded:

2004:   $ 1 million

2005: $ 1.6 million

2006: $ 1.2 million  

Grants Awarded:

2004: 12 new awards

2005: 19 new awards

2006: 15 new awards  

States:

ORHP awarded 15 grants to 15  

States in FY 2006  

Fifteen new grants were awarded in fiscal year 2006 totaling $1,222,256.   

Changes to the Program:

No changes to the program in 2006.  

Key Program Accomplishments:

In FY 2006 the Rural Health Network Development Planning Grant Program

awarded $1,222,356 to 15 grantees for one‐year projects.

The focus of the awards varied widely from developing Statewide Electronic

Medical Record systems in Wyoming to providing Mental Health Services to the

Hispanic/Latino population in Connecticut.

Ohio University, a new awardee, has begun work on a project focused on

activities to develop partnerships for strengthening the communityʹs ability to

identify, refer, and coordinate comprehensive care to children with

developmental and behavioral disabilities in 19 rural Appalachian Counties.  

This project received national recognition when the project was chosen for a

presentation at the National Rural Health Association Meeting in May 2007.

44
In 2007 several former Planning grantees were contacted by telephone to learn if

they were continuing the Planning network activities that were begun with grant

funds.  Most of those contacted said they not only were still working together but

that they had collaborated on other activities and expanded the network

partnerships since the Planning grant ended.

Additionally, for FY 2007, two of the five new Rural Health Network

Development Grant awardees were FY 2006 Planning grantees.

45
Rural Access to Emergency Devices

Program Coordinator: Sheila Warren

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

nationally recognized training courses.  The

legislation that created this program states that

awards will be made to community

partnerships.  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.  

At A Glance

Amount Awarded:

2004:   $ 9.2 million

2005: $ 7.4 million

2006: $ 309,408

Grants Awarded:

2004: 49 continuing awards

2005: 48 continuing awards

2006: 4 new awards

States:

ORHP awarded 4 grants to 3  

States in FY 2006

Four new grants were awarded in FY 2006 totaling $309,408.  

Changes to the Program:

No changes to the program in 2006.  

Key Program Accomplishments:  

In 2006, approximately 275 AEDs were placed and approximately 650 lay

persons and first responders were trained in their utilization.  There were no

AED uses reported.  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.  The RAED Program has resulted in an increased

public awareness, increased number of AEDs available and an increase in

46
persons, first responders, and lay persons trained in their utilization in the event

of sudden cardiac arrest.  

47
Public Access to Defibrillation Demonstration Projects

Program Coordinator: Sheila Warren

The purpose of the Public Access to Defibrillation Demonstration Project

(PADDP) is to award grants to political

subdivisions of States, Indian tribes and tribal

organizations to develop and implement

innovative, community‐based programs that

provide cardiopulmonary resuscitation (CPR) and

automated external defibrillation (AED) to cardiac

arrest victims, provide training to community

members in CPR and AED usage, and to

maximize community access to AEDs.

At A Glance

Amount Awarded:

2004:   $ 930,663

2005: $ 930,663

2006: $ 930,663

Grants Awarded:

2004: 4 new awards

2005: 4 continuing awards

In FY 2006 four non‐competing continuation 2006: 4 continuing awards

grants were awarded totaling $930,663.  

Changes to the Program:

The program is still making the transition from a national formula‐based

program to a community‐focused grant program with fewer grantees.  

Key Program Accomplishments:

In FY 2006, approximately 475 AEDs were placed and approximately 559 lay

persons and first responders were trained to use them.  AEDs have been placed

in colleges, universities, community centers, Indian reservations, local

businesses, law enforcement and ambulance vehicles, fire trucks, 911 dispatch

centers, sporting events, major tourist attractions, and offices.  The grant has

created methodologies 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.

The PADDP program has resulted in increased public awareness, increased

number of AEDs available and an increase in persons, first responders, and lay

persons, trained in the utilization of AEDs in the event of sudden cardiac arrest.

48
Black Lung Clinics Grant Program

Program Coordinator: Kristin Martinsen

The purposes of the Black Lung Clinics Grant Program (BLCP) are to: (1) seek

out and provide services to miners (active and inactive) with the intention of

minimizing the effects of respiratory

impairment or improving the health status of

miners or coal miners exposed to coal dust as

a result of employment; and (2) increase

coordination with other services and benefits

programs to meet the health‐related needs of

this population.  Grantees provide specific

diagnostic and treatment procedures

required in the management of problems

associated with black lung disease, which

improve the quality of life of the miner and

reduce economic costs associated with

morbidity and mortality arising from

pulmonary diseases.  

At A Glance

Amount Awarded:

2004:   $ 5.8 million

2005: $ 5.8 million

2006: $ 5.7 million

Grants Awarded:

2004: 13 continuing awards, 2

new awards

2005: 12 continuing awards, 3

new awards

2006: 15 continuing awards

  

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 Community Health Centers (Federally

Qualified Health Centers), hospitals, State health departments, mobile vans, and

stand alone clinics.   

In FY 2006, 15 continuation grants were awarded in 13 States, totaling $5,749,106.  

Changes to the Program:

In July 2006, the program moved from HRSA’s Bureau of Primary Health Care to

the ORHP to better serve the needs of its grantees and constituents, most of

whom are located in rural areas.    

Key Program Accomplishments:   

Program grantees were awarded additional outreach funding to enhance their

outreach programs in FY 2005.  The number of active and inactive miners seen at

49
the clinic increased from 9055 in FY 2005 to 10790 in FY 2006.  Enhanced outreach

activities included media advertisements, the development of Web sites,

increased hours of outreach staff, and time dedicated to coordination of activities

with community organizations.

During FY 2006, as part of the FY 2008 budget process, the program was

evaluated by the Office of Management and Budget’s Program Assessment

Rating Tool (PART) and will be implementing new annual and long term

performance measures.   

50
Small Health Care Provider Quality Improvement Grant Program

Program Coordinator: Heather Dimeris

The purpose of the Small Health Care Provider Quality Improvement Grant

Program (SHCPQI) is to assist rural providers with the implementation of

quality improvement strategies, while

improving patient care and chronic disease

outcomes.  Improving the quality of chronic

disease management in ambulatory care

settings can improve health indicators and

decrease emergency room visits and

admissions to hospitals.  The Small Health

Care Provider Quality Improvement Grant focuses on quality improvement for

chronic diseases, i.e., diabetes mellitus and cardiovascular disease.   

At A Glance

Grant Amount Awarded:

2006: $ 737,757

Grants Awarded:

2006: 15 new awards  

The ultimate goal of this program is to improve health outcomes through

enhanced chronic disease management in rural health care provider settings by

utilizing a patient registry system; tracking and reporting specific health

indicators using nationally accepted performance measures; assessing the need

for quality improvement and developing additional performance measures;  and

participating in technical assistance through peer learning workshops with

fellow Small Health Care Provider Quality Improvement Program grantees,

facilitated by a quality improvement specialist.

FY 2006 was the first year of funding under the program and 15 SCHPQI grants

were awarded to 13 States, totaling $737,757 and 38 eligible applications were

reviewed by an objective review committee.

Changes to the Program:

No changes to the program in 2006.  

Key Program Accomplishments:

To assist the SHCPQI grantees, HRSA’s ORHP awarded a technical assistance

contract to Management Solutions Consulting Group to support SHCPQI

51
grantees with implementing quality improvement strategies and an electronic

patient registry system.  

52
Radiation Exposure Screening and Education Program

Program Coordinator:  Vanessa Hooker

The purpose of the Radiation Exposure Screening and Education Program

(RESEP) is to assist individuals involved in mining, transporting, and processing

uranium; as well as, testing nuclear weapons

by identifying and preventing illnesses that

may have resulted from these activities.   This

is accomplished by providing grants to States,

local governments, and other eligible entities to

establish and  support programs to:   1) screen

individuals for cancer and other radiogenic

diseases; 2) provide referrals for medical

treatment of individuals screened; 3) develop

and disseminate public information and

education programs for the detection,

prevention, and treatment of radiogenic

cancers and diseases; and 4) facilitate

documentation of claims for the Radiation Exposure Compensation Act (RECA)

program.  

At A Glance

Amount Awarded:

2004: $1.974 million

2005: $1.958 million

2006: $1.917 million

Grants Awarded:

2002: 6 new awards

2003: 6 continuing  awards,  1

new

2004:  6 continuing awards

2005: 7 new awards  

In FY 2006, HRSA awarded continuation grants to seven organizations in five

southwestern States (Arizona, Colorado, Nevada, New Mexico and Utah)

totaling $1,917,000.  

Changes to the Program:

In July 2006, the program moved from HRSA’s Bureau of Primary Health Care to

the Office of Rural Health Policy (ORHP) to better serve the needs of its grantees

and constituents, most of whom are located in rural areas.    

Key Program Accomplishments:

During FY 2006, as part of the FY 2008 budget process, the program was

evaluated by the Office of Management and Budget’s Program Assessment

Rating Tool (PART) and will be implementing new annual and long term

performance measures.   

53
ORHP Staff

Marcia Brand, Ph.D – Associate Administrator

Budget, personnel, Government relations, operations oversight, legislation,

policy and administration issues, Secretaryʹs Rural Initiative, tribal health, oral

health

Tom Morris, MPA – Deputy Associate Administrator

Budget, personnel, National Advisory Committee on Rural Health and Human

Services, policy and research coordination, administrative issues

Jennifer Riggle, JD – Associate Director

Grants Program Director (program oversight), guidance preparation, re‐

Authorization, Division of Independent Review liaison, liaison to Grants

Management and Division of Grants Policy and Grants Tracking,  State‐based

activities

George Brown, MPH, CHES – Grants Project Officer

Delta Health Initiative Grant Program, Delta Small Rural Hospital Performance

Improvement Initiative, SOUTHEAST REGION LIAISON (Project Officer for

Southeast States in FLEX, SHIP, and State Office of Rural Health)

Jennifer Chang, MPH – Grants Project Officer

Rural Health Care Services Outreach Grant Program Coordinator. Issue Areas:

women’s health, maternal and child health, domestic violence, school‐based

programs

Carrie Cochran, MPA – Policy Coordinator

Rapid Response for Requests of Rural Data Analysis Cooperative Agreement.

Rural health policy issues, including: Medicare and Medicaid payment policy,

critical access hospitals, rural hospitals, workforce, health information

technology.  National Advisory Committee on Rural Health and Human Services

and HHS Rural Task Force.  Rural Medicare demonstrations including the

Frontier Extended Stay Clinic model.

54
Jerry Coopey, MPH – Grants Project Officer

Issue Areas: Rural Recruitment and Retention Network liaison, Access to Capital,

MIDWEST REGION LIAISON

Lt. Heather Dimeris, MS, RD – Grants Project Officer

Small Health Care Provider Quality Improvement Grant Program Coordinator.

Issue Areas: health information technology, case management services, public

health, dietary/ metabolic syndrome issues

Nancy Egbert, RN, MPH – Senior Clinical Advisor

Issue Areas: clinical advisor/evaluation, quality (especially hospital and primary

care), nursing issues, influenza pandemic, State Hospital Team Leader,

NORTHWEST REGIONAL LIAISON

Steve Hirsch, MSLS – Grants Project Officer

Rural Hospital Flexibility Grant Program coordinator, Rural Assistance Center

Cooperative Agreement. Issue Areas:  definitions of Rural (including Rural

Urban Commuting Areas), NORTHEAST REGIONAL LIAISON

Eileen Holloran – Grants Project Officer

Grant Program Coordinator.  Issue Areas: transportation (mobile clinics), chronic

disease, and Alzheimer’s

Vanessa Hooker – Grants Project Officer

Radiation Exposure Screening and Education Program, Coordinator, Rural

Health Outreach and Network Development Grant Programs

Issue Areas: Diabetes, recruitment, and retention

Kristin Martinsen – Grants Project Officer

Black Lung Clinics Program, Coordinator, Rural Health Outreach Grants  

Issue Areas: mental health and substance abuse

Keith J. Midberry, MHSA – Grants Project Officer

State Offices of Rural Health Grant Program Coordinator, Small Hospital

Improvement Program Coordinator, and Human Resources Coordinator

Erica Molliver, MHS – Grants Project Officer

Single‐Year Rural Research Grant Program. Rural health policy issues including:

Medicare payment policy, Medicaid payment policy, rural health clinics, Health

Professional Shortage Areas, National Advisory Committee on Rural Health and

Human Services.

55
Nisha Patel – Grants Project Officer

Rural Health Care Services Outreach Grant Program Coordinator. Issue Areas:

cardiovascular health, diabetes, nutrition, obesity, and elder care

Michele Pray‐Gibson, MHS – Grants Project Officer

Executive Officer Liaison to the Office of the Administrator, Budget Coordinator,

National Advisory Committee on Rural Health and Human Services logistics,

SOUTHWEST REGION LIAISON

Sherilyn Z. Pruitt, MPH – Grants Project Officer

Network Development Grant Program coordinator. Issue Area: HIT.  Project

officer for Georgia Health Policy Center technical assistance contract.

Elizabeth Rezai‐zadeh, MPH – Grants Project Officer

Border Health Initiative, U.S.‐ Mexico Border Health Commission liaison,  

SOUTHWEST REGION LIAISON

Jacob L. Rueda, MPH – Grants Project Officer

Project Officer for Network, Outreach, Black Lung, and RESEP Grants. Issue

Areas: Rural EMS, Pharmacy, and Medicaid

Lilly Smetana – Grants Project Officer

Grants Program Assistant, Electronic Handbook liaison, File Master. Issue Areas:

earmarks grants, health professions education, health literacy, and oral health

Lakisha Smith, MPH – Grants Project Officer

Delta Network Development Grant Program Coordinator, Issue Areas:

HIV/AIDS, minority health, Indian/Tribal liaison, agricultural health and safety,

safety net collaboration, school‐based programs, and health

education/promotion, and disease prevention (general)

Vacant – Grants Project Officer

Acting Intergovernmental Affairs Coordinator (State Organizations: NGA,

NACO, ASTHO, NCSL, NRHA, NACCHO, Commissions, Technical Assistance

Coordination) and NHRA Liaison.

Sonja Carter Taylor – Grants Project Officer

Community‐based team grants project officer, Inter/Intra Agency Agreements

Coordinator, contracts backup. Issue Areas: primary care access (general)

56
Amal Thomas – Staff Assistant

Administrative Team Coordinator, Special Assistant to the Director

Shelia Tibbs – Grants Project Officer

Project Officer, Hospital‐State based team working on Flex, SHIP and State Office

grant programs. Co‐Regional Liaison for the Southwest

Joan Van Nostrand, DPA – Research Coordinator  

Rural Health Research Centers Grant Program Coordinator.  Issue Areas: aging,

disability, long‐term care, and palliative care

Sheila Warren – Grants Project Officer

Rural Access to Emergency Devices/Public Access to Defibrillation

Demonstration Grant Program Coordinator and Contracts Coordinator.  Issue

Areas:  health education/promotion and disease prevention (general)

Kathryn Umali – Grants Project Officer

Intergovernmental Affairs coordination; Delta Health Initiative

Mary Collier – Support Staff

Controlled correspondence coordination; travel, timekeeping

April Ward – Support Staff  

Travel Coordinator, National Advisory Committee on Rural Health and Human

Services; Timekeeping; Special Assistant to the Deputy Director

57
Appendix – Authorizing Legislation

Black Lung

Authorization:  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

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

Delta States Rural Development Network Grant Program

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

Frontier Extended Stay Clinics Demonstration

Authorization: Section 301 and 330A of the Public Health Service Act 42 U.S.C.

241 and 254c.

Medicare Rural Hospital Flexibility Grant Program

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

Network Development Grant Program

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

Network Development Planning Grant Program

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

Policy Oriented Rural Health Services Research Program  

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

Public Access to Defibrillation Demonstration Projects

Authorization: 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.

58
Radiation Exposure, Screening and Education Program

Authorization:  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

Authorization: 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

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

Rural Health Research Centers Program

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

Small Health Care Provider Quality Improvement Grant Program

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

Policy‐Oriented Rural Health Services Research Program  

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

  

Small Rural Hospital Improvement Grant Program

Authorization: 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

Authorization: Section 338J of the Public Health Service Act 42 U.S.C. 254r as

amended by section 301, P.L. 105‐392.  

59