Office of Rural Health Policy

2008 Annual Report

U.S. Department of Health and Human Services

Health Resources and Services Administration

August 2009
1

Table of Contents

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

FY 2008 OVERVIEW...................................................................................................................................................................... 3

ORHP BUDGET .............................................................................................................................................................................. 4

POLICY ACTIVITIES..................................................................................................................................................................... 5

KEY REGULATORY REVIEW AND POLICY ACTIVITIES .............................................................................................5

Rural Medicare Payment...................................................................................................................... 5

Rural Health Care Quality .................................................................................................................... 5

Health and Human Services (HHS) Rural Task Force......................................................................... 5

National Advisory Committee on Rural Health and Human Services (NACRHHS)............................. 6

POLICY RELATED PROJECTS AND PARTNERSHIPS ...................................................................................................7

340B Technical Assistance .................................................................................................................. 7

CAH Replacement Manual................................................................................................................... 7

National Technical Assistance to Rural Communities.......................................................................... 7

Rapid Response to Requests for Rural Data Analysis......................................................................... 7

Rural Assistance Center....................................................................................................................... 8

Rural Health and Economic Development ........................................................................................... 8

Rural Health Clinic Technical Assistance Series ................................................................................. 8

Rural Health Research Center Gateway, Research Alerts, and Impacts on Policy............................. 9

Rural Hospital Performance Improvement Project............................................................................... 9

Rural Policy Analysis Cooperative Agreement..................................................................................... 9

State Partnerships................................................................................................................................ 9

Technical Assistance and Services Center.......................................................................................... 9

Workforce ............................................................................................................................................10

GRANT PROGRAMS.................................................................................................................................................................... 11

RESEARCH AND POLICY GRANT PROGRAMS......................................................................................................... 11

Frontier Extended Stay Clinic Program (FESC)..................................................................................12

Rural Health Research Centers Program (Research Centers)...........................................................13

Targeted Rural Health Research Grant (TRHR) .................................................................................14

Critical Access Hospitals Transitioning to Skilled Nursing Facilities and Assisted Living Facilities....15

HOSPITAL STATETEAM GRANT PROGRAMS ......................................................................................................... 16

Critical Access Hospital Health Information Technology Network Grant Program (CAHHIT) ............17

Delta Health Initiative (DHI).................................................................................................................18

Medicare Rural Hospital Flexibility Grant Program (Flex)...................................................................19

Small Rural Hospital Improvement Grant Program (SHIP).................................................................20

State Offices of Rural Health Grant Program (SORH)........................................................................21

COMMUNITY BASED GRANT PROGRAMS.............................................................................................................. 22

Black Lung Clinics Program (BLCP) ...................................................................................................23

Delta States Rural Development Network Grant Program (Delta)......................................................24

Radiation Exposure Screening and Education Program (RESEP).....................................................25

Rural Health Care Services Outreach Grant Program (Outreach)......................................................25

Rural Health Network Development Grant Program...........................................................................27

Rural Health Network Development Planning Grant Program (Network Planning) ............................28

Rural Access to Emergency Devices (RAED).....................................................................................29

Small Health Care Provider Quality Improvement Grant Program (Rural Quality) .............................30

OTHER HRSA INITIATIVES ADMINISTERED BY ORHP ...................................................................................................... 31

BORDER HEALTH.................................................................................................................................................... 32

DENALI COMMISSION............................................................................................................................................. 33

INTERGOVERNMENTAL AFFAIRS (IGA)................................................................................................................. 34

APPENDIX A: CONTRACTS ....................................................................................................................................................... 35

APPENDIX B: ORHP STAFF ....................................................................................................................................................... 38
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ORHP Overview

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

Department of Health and Human Services. Part of the Health Resources and Services Administration

(HRSA), ORHP has department-wide responsibility for analyzing the possible effects of policy on 62

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

the Secretary on health issues within these

communities, including the effects of Medicare

and Medicaid on rural citizens access to care,

the viability of rural hospitals, and the

availability of physicians and other health

professionals.

In FY 2008, ORHP also administered 17 grant

programs designed to build health care capacity

at both the local and State levels.

These grants provide funds to 50 State Offices

of Rural Health (SORH) to support on-going

improvements in care, and to rural hospitals

through the Medicare Rural Hospital Flexibility

Grant (Flex).

Through its community-based programs, ORHP

encourages network development among rural

health care providers; upgrades in emergency

medical services; and places and trains people

in the use of automatic external defibrillators.

ORHP also oversees the Black Lung Clinics

grant program and the Radiation Exposure

Screening and Education grant program. While

these efforts are not solely focused on rural

health issues, many of the populations affected

reside in rural areas.

Finally, ORHP coordinates two Agency-wide

enterprises: HRSAs border health initiative

concentrates on improving care in the largely

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

the U.S. and Mexico. The program includes

urban centers in this zone, as they face

challenges similar to rural areas, such as fragile

infrastructure and difficulty attracting and

retaining an adequate health workforce. ORHP

also coordinates HRSAs intergovernmental

affairs endeavors.

Authorizing Legislation

Office of Rural Health Policy

Section 711 of the Social Security Act

Black Lung

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

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

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

Reform Act of 1977.

Critical Access Hospitals Transitioning to Skilled Nursing Facilities and

Assisted Living Facilities

Section 1820(g)(7) of the Social Security Act as amended, (42 U.S.C. 1395i4(g)(7))

Delta Health Initiative Grant Program

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

Delta States Rural Development Network Grant Program

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

Frontier Extended Stay Clinics Demonstration

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

Medicare Rural Hospital Flexibility Grant Program

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

Network Development Grant Program

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

Network Development Planning Grant Program

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

Policy Oriented Rural Health Services Research Program

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

Public Access to Defibrillation Demonstration Projects

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

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

Response Act of 2002.

Radiation Exposure, Screening and Education Program

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

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

Rural Access to Emergency Devices Grant Program

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

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

Rural Health Outreach Grant Program

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

Rural Health Research Centers Program

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

Small Health Care Provider Quality Improvement Grant Program

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

Small Rural Hospital Improvement Grant Program

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

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

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

State Offices of Rural Health Grant Program

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

301, P.L. 105-392.
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FY 2008 Overview

ORHP advanced several key priority areas in FY 2008: health care workforce development; health

information technology (HIT); and performance measurement and quality improvement for rural health

care providers:

• Workforce Development – One out of five Americans lives in a rural area that historically have had

trouble recruiting, supporting and retaining healthcare workers  a problem now heightened by a

projected overall national shortage of clinicians and nurses. ORHP is at the forefront of efforts to monitor

and address a scarcity of some 27,000 Primary Care providers already affecting 20 largely rural States.

In addition to supporting the National Rural Recruitment and Retention Network (3RNet), ORHP also

worked with the National Conference of State Legislatures (NCSL) on a State-based workforce meeting

last year that attracted legislators from more than 25 States. ORHP also supports the Rural Medical

Educators (RME) Annual Conference in advancing the training of physicians for rural practice through

network development and education. This years meeting drew 75 attendees, the largest number to date.

 HIT  To further encourage rural hospitals to adopt health information technology (HIT), ORHP funded

an evaluation of the Flex Critical Access Hospital (CAH) HIT Network grant program, which provided

about $25 million to State Offices of Rural Health in FY 2007. At completion of the 18-month grant

period, 12 of 16 grantees had a fully operational HIT network. The four remaining grantees were given 6-

month extensions to overcome difficulties in securing a vendor. The ongoing evaluation effort will

examine whether the program has been successful at implementing health information exchange in rural

communities. The ultimate aim of the evaluation project is to serve as a reference guide for rural

communities interested in developing HIT networks. The final report will be available by December 2009

on the ORHP Web site.

• Quality Improvement -- ORHP made several significant investments in quality improvement and

performance measurement for rural health care providers in FY 2008.

Among other efforts, ORHP awarded more than $4 million to 55 community-based organizations in the

Rural Quality grant program. First piloted in FY 2006 with just 15 grantees, participation has increased by

73 percent. The funds assist primary care providers in improving health outcomes for patients with

diabetes and cardiovascular disease (which disproportionately affect rural areas).

In an effort to reduce the adverse health consequences of pharmacy errors, ORHP and State Offices of

Rural Health actively recruited rural providers to join the HRSA Patient Safety Pharmacy Services

Collaborative. Of the 80 teams involved in this effort to improve patient safety and the cost-effectiveness

of clinical pharmacy services, one third are located in rural communities.

In the past year, ORHP also developed performance measures for all 17 of its grants programs, and is

now working with a contractor to develop a performance improvement and measurement system (PIMS)

to demonstrate the success of these programs. This information has never been easily accessible before.

But once PIMS is operational in February 2009, and the initial reporting cycle is completed, the aggregate

data for each grant program will be available on the ORHP Web site.
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ORHP Budget

Chart 1  Budget Summary for Programs, FY 2007 and FY 2008 (amounts in thousands)

Rural Health Programs

FY 2007 Final

Appropriation

FY 2008 Final

Appropriation

Rural Health Outreach 38,885 48,031

Rural Health Research 8,737 8,584

Medicare Rural Hospital Flexibility 63,538 37,865

Rural and Community Access to Emergency

Devices

1,487 1,461

Delta Health Initiative 0 24,563

State Offices of Rural Health 8,141 7,999

Denali Commission 39,283 38,597

Radiation, Screening, Exposure and

Education Program

1, 919 1, 884

Black Lung 5,891 5,788

Federal Hospital Insurance Trust Funds 0 942,123

Total $ 167,881 $ 175,713

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 Offices policy activities. Also, the Flex Line for FY 2007 includes $25 million above the base to fund the Critical Access Hospital

Health Information Technology Network Grant Program.

Chart 2 – Total number of ORHP Grants and Amounts by State, FY 2008

Total number of Grants awarded: 457

Total amount Funding provided: $115,869,683

State # Grants

Awarded

FY 2006

Funding State # GrantsAwarded

FY 2006

Funding State # GrantsAwarded

FY 2006

Funding

AK 10 1,695,871 LA 12 2,540,419 OH 11 2,246,166

AL 14 2,376,182 MA 4 603,612 OK 7 1,762,525

AR 13 2,572313 MD 5 528,855 OR 9 1,664,618

AZ 9 1,537,250 ME 10 2,002,708 PA 9 1,548,216

CA 16 2,278,155 MI 16 2,340,254 RI 1 147,700

CO 5 1,583,297 MN 8 2,540,207 SC 9 1,982,098

CT 2 272,700 MO 10 2,297,739 SD 8 1,621,793

DE 3 332,213 MS 8 26,184,098 TN 8 1,951,282

FL 11 1,795,511 MT 17 2,836,343 TX 13 3,506,917

GA 10 1,957,945 NC 10 2,340,463 UT 6 1,191,052

HI 4 433,023 ND 11 3,767,476 VA 9 1,747,609

IA 10 2,138,794 NE 12 2,503,828 VT 7 1,077,136

ID 5 1,165,596 NH 9 1,325,365 WA 12 2,721,437

IL 14 3,385,578 NJ 2 244,092 WI 8 1,533,832

IN 10 1,872,180 NM 10 1,789,315 WV 9 3,152,823

KS 8 2,116,407 NV 8 1,303,809 WY 5 1,135,696

KY 16 3,201,377 NY 12 1,862,128
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Policy Activities

Key Regulatory Review and Policy Activities

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

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

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

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

other policy areas, including Medicaid, the State Childrens Health Insurance Program (SCHIP),

workforce, quality, and health information technology (HIT).

Rural Medicare Payment

During Fiscal Year 2008, the policy staff in ORHP reviewed approximately 150 drafts of Federal

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

Of these regulations, 16 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.

ORHP often identifies issues of particular concern to rural communities during its review of the Medicare

payment system regulations. In 2008, ORHP worked with CMS on the development of a proposed rule to

update certification and participation regulations, and payment provisions, for Rural Health Clinics (RHCs)

and Federally Qualified Health Centers (FQHCs). Key terms of the proposed rule include location and

shortage area requirements, contracting with non-physician practitioners, and establishment of a Quality

Assurance/Performance Improvement program. Also in 2008, ORHP identified independent pharmacies

in rural areas as a key policy area to monitor. Recent policy changes affecting these providers include

the implementation of Medicare Part D, as well as Medicaid program payment changes. ORHP has

concern about the long-term viability of these pharmacies and what their closure could mean for access

to pharmaceutical services in remote areas.

Rural Health Care Quality

In 2008, the Quality Improvement Organizations (QIOs) continued their work with Critical Access

Hospitals (CAHs) and small rural hospitals under the CMS 8th Scope of work. CAHs continued to

increase their participation in reporting quality measures to the Hospital Compare Web site operated by

CMS. For 2006 discharges, 63 percent submitted data for at least one patient on one measure. This total

does not include 289 CAHs that did not consent to have their 2006 discharge data publicly reported.

Submission rates vary by State and by CAH organizational characteristics. By State, the percentage of

participating CAHs ranged from 7.7 to 100 percent. Seven States had all of their CAHs participating.

CAHs were more likely to report data on pneumonia and heart failure measures than on AMI and surgical

infection prevention measures. Participation in the program is significant since CAHs submit data on a

voluntary basis, unlike hospitals paid under the Medicare Inpatient Prospective Payment System (IPPS),

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

Throughout 2008, ORHP continued to work with CMS and others on rural issues related to a prospective

Value-Based Purchasing (VBP) plan. CMSs VBP plan, described in a 2007 Report to Congress,

proposed to link payments more directly to the quality of care (i.e., pay-for-performance) under the

Medicare program for hospitals. Congress discussed a VBP plan in 2008, but did not pass legislation.

ORHP contributed funds to the HRSA Patient Safety and Pharmacy Serves Collaborative (PSPC) began

in August, 2008 with a mission to eliminate adverse drug events and improve patient outcomes. There

are 79 teams representing 230 organizations in 40 States and Puerto Rico. Approximately 40 percent of

the teams serve rural populations and include CAHs, FQHCs, and RHCs.

Health and Human Services (HHS) Rural Task Force

ORHP continues to coordinate the HHS Secretarys Rural Task Force. Established in 2001, it is

comprised of representatives from each Agency and Office of the Secretary Staff Divisions. The Task

Force continues to conduct department-wide quarterly meetings to encourage collaboration and

partnership among HHS agencies on topics that affect rural communities. In 2008, a range of issues

were presented, including the implementation of Health Information Technology in rural America.
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National Advisory Committee on Rural Health and Human Services (NACRHHS)

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

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

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

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

The year 2008 marked the 20th anniversary of ORHP. Accordingly, the 2008 Report provided a

retrospective of rural health and human services, key changes that have affected the health of rural

people, and analysis of emerging issues and trends. The 2009 Report topics include:

o The Medical Home Model: Viability for Rural Communities

o Treating At Risk Children in Rural Areas

o Workforce and Community Development
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Policy Related Projects and Partnerships

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

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

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

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

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

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

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

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

initiatives meet an identified need in rural health care.

 340B Technical Assistance -- As a result of a 2003 change in the law, approximately 350 rural

hospitals qualified for the 340B Drug Pricing Program. ORHP provided supplemental funding to the HRSA

Pharmacy Services Support Center (PSSC) in FY 2008 to assist grantees and other eligible providers in

securing 340B discount drug purchasing. Established in 2002, the aim of PSSC is to expand pharmacy

services in needy populations. The Center operates under a contract between HRSA and the American

Pharmacists Association (APhA). To date, it has helped almost 200 hospitals enter the 340B program.

• CAH Replacement Manual – ORHP is developing a Roadmap and Manual for CAH Replacement,

containing step-by-step guidance, simple tools and successful strategies for obtaining capital and building

new facilities. Some CAHs are considering replacing their facilities, many of which were built in the

1950s. These projects have proven to increase admissions and outpatient visits; as well as improving

staff recruitment and clinical performance, and boosting local economies. But hospital CEOs and Boards

in rural communities typically encounter serious technical hurdles. Few local lenders (public or private),

architects or builders have the requisite experience with hospital projects.

• National Technical Assistance to Rural Communities -- In 2008, ORHP joined with the National

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

rural providers; advance health quality initiatives; and increase leadership and skills development training.

Through teleconference and Webinar series, this initiative extends continuing education to providers in

remote communities, while affording ongoing technical assistance to entities like the State Offices of

Rural Health (SORHs) and State Rural Health Associations (SRHAs). Example technical assistance

includes new treatment protocols for agriculture-related diseases and injury via AgriSafe Network

Resources.

Through these innovative networks, technical assistance was provided to nine SRHAs (NY, SC, AZ, FL,

WA, ID, TN, IN, and TX) in such areas as board leadership development, organizational development,

strategic planning and membership growth and retention. Other accomplishments due to the technical

assistance provided to the networks include North Dakota becoming an official SRHA in March, the Rural

Medical Educators Annual Conference had its largest turnout in history, and 20 small rural hospitals

agreed to participate in a rigorous efficiency and patient safety assessment project undertaken by the

University of Nebraska Medical Center under a contract with the NRHA.

This national effort also provided training grants to 40 State-based organizations, and underwrote a 40-

credit hour Agricultural Health Training for rural health professionals offered by the University of Iowa's

Center for Agricultural Safety and Health. Finally, NRHA hosted two policy meetings on access to rural

trauma services and value-based purchasing and rural hospitals.

• Rapid Response to Requests for Rural Data Analysis -- In 2008, ORHP funded the Rapid Response

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

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

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

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

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

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

information. Topics analyzed for policy makers in 2008 include the experience of rural independent
8

pharmacies with Medicare Part D, Medicare Advantage and CAHs, Rural Health Clinic geographic

locations and shortage designation status, and Value Based Purchasing in rural hospitals.

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

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

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

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

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

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

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

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

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

2008, RAC responded to over 900 individual requests for assistance.

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

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

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

America. The RAC site averages over 70,000 visits per month, while its e-mail listservs have over 14,000

combined subscribers.

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

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

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

States and communities substantiate the broader economic impact of the health care sector as a spur to

further investment. RHW also develops profitability studies to help policymakers illustrate the economic

benefits of new or expanded services in existing facilities.

During FY 2008, RHW conducted regional workshops in Pennsylvania and Colorado; responded to more

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

research in this area. A new economic impact application is under development to calculate the value of

rural residency programs to local economies. A new feasibility study nearing publication will quantify the

costs and revenues for a rural physician practice. RHW sends representatives to conferences nationwide

to actively promote the tools and applications it has developed over the past 9 years.

RHW also has joined The National Association of Counties (NACo) in an outreach campaign to elected

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

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

initiative in FY 2005, it continued through FY 2008 with on-site technical assistance to nine rural

counties. Three more counties will be funded in FY 2009. For each, the project has produced a countylevel report covering such topics as economic impact, community need, and a health services

directory. All are posted on the NACo Web site and were featured in workshops at the Western Regional

and Annual Conferences, as well as in articles for NACos publication County News.

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

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

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

administrative challenges that often require real-time technical assistance. ORHP provides this support

through conference calls, as well as frequent updates through a listserv, free of charge. The RHC Web

site posts written transcripts, speaker presentations, and audio transcripts of each call as a readyreference for clinicians and administrators.

In FY 2008, the RHC Conference Call series provided seven sessions, with topics determined by an

advisory group of national experts versed in the most pressing concerns of rural providers. Discussions

included: cost reporting guidance; electronic health record implementation; rural health information

resources; proposed rule changes affecting rural communities; and health professions shortage area

designations. An average of 286 providers nationwide dialed in for each session, saving rural clinics

about $900 per conference compared to the cost of sending staff to off-site training. In the aggregate, this

savings amounted to over $250,000 per session, substantially extending local patient care budgets.
9

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

Web site was developed to speed the dissemination of information and publications of the Rural Health

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

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

Fact Sheets, and other products of the Research Centers. In 2008, the Gateway added a Research Alert

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

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

as resources permit.

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

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

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

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

had the resources to afford these needed services.

In 2008, RHPI provided 48 consultations at 41 of the 171 eligible hospitals in DRA. Thirty-eight hospitals

received on-site consultations, and 10 received feedback assessments. Of the on-site visits, 10 were

general Performance Improvement Assessments, and 27 were consultations for specified issues, with

one Balanced Scorecard review. Of the feedback assessments, three each were conducted for

community and trustees, and four were employee assessments. There were 7 Webex calls with 39

hospitals participating. Sixteen Sessions in Sustainability conferences and workshops were held. In

2008, ORHP launched an initiative to have the projects various efforts formally evaluated. RHPI has

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

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

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

Agreement to support research and analysis on key policy issues affecting rural communities. In 2008,

this funding supported activities with rural community colleges health workforce development; the Rural

Policy Research Institute (RUPRI) Rural Health Panel; the Rural Hospital Issues Group; and the creation

of a RUPRI Rural Human Services Panel. The RUPRI Rural Health Panel provides science-based,

objective analysis to Federal policymakers. Panel members come from a variety of academic disciplines

and author documents that reflect the consensus judgment of all panelists. The Rural Hospitals Issues

Group, a panel of hospital administrators and finance experts from across the country, discuss issues

such as the Medicare reimbursement, Medicare Advantage, and other policy issues affecting small rural

hospitals. The Rural Human Services Panel met for the first time in August and November 2008. This

Panel also will work to provide background, advice and presentations to the National Advisory

Commission on Rural Health and Human Services.

• State Partnerships -- The State Office of Rural Health (SORH) network funded by ORHP entered into a

cooperative agreement with the National Organization of State Offices of Rural Health (NOSORH) to

assist in the development of State-level leadership and create further partnerships between national and

State-level interest groups. The Technical Assistance to States cooperative agreement coordinated five

regional grantee meetings in 2008, a new SORH director orientation meeting and an annual grantee

meeting. In addition, the partners developed a curriculum for rural health grant writing and a Promising

Practices Evaluation of SORHs. The creation of a Leadership Institute also is being explored.

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

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

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

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

TASC supported 45 participating State Flex Programs in 2008 through the following activities: converting

rural prospective payment hospitals to Critical Access Hospital (CAH) status; integrating emergency

medical services into rural medical delivery systems with more than 12 EMS educational sessions and 3

manuals for hospital leaders; building rural hospital networks to exchange information, provide economies

of scale, obtain collective volume, and increase cost efficiency. TASC provides advice to hundreds of

these networks in rural America, in addition to educational sessions, and has coordinated three national

quality forums. Staff also has presented papers at over 50 State performance improvement events.
10

• Workforce – In conjunction with the National Conference of State Legislatures (NCSL), ORHP holds an

annual meeting for an average of 30-50 elected State officials from rural communities. In 2008, the

conference focused on the continuing health care workforce recruitment challenges faced by their

constituents, The Rural Physician Pipeline: Increasing the Number of Physicians Practicing in Rural

Areas. This meeting provided an overview of the family physician shortage in the United States and how

State lawmakers might contribute to ameliorating chronic clinician scarcities in rural communities.

Rural Recruitment and Retention:

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

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

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

professional associations; Area Health Education Centers; the Cherokee Nation; CNMI, and other not-forprofit entities.

During FY 2007, 3RNet placed 750 medical professionals, including 220 family practice physicians, 65

internal medicine physicians, 50 pediatricians, 100 dentists, 80 nurse practitioners, and 80 physician

assistants. The 3RNet also maintained a toll-free phone line to assist providers interested in serving rural

America, saving rural communities substantial recruitment costs. Analysis shows that physician

placement fees average about $28,000, while non-physician recruitment costs are generally 30 percent of

the first years salary. Thus, total recruitment costs for the workforce above would have been over $18

million. Of the 564 communities in which professionals were placed by 3RNet members, 524 (or 93

percent) are federally designated health professional shortage areas.
11

Grant Programs

Research and Policy Grant Programs

In FY 2008, ORHP administered four grant programs within the Policy Research Team. The grant

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

Centers; 3) the Targeted Rural Health Research grant program; and 4) Critical Access Hospitals

Transitioning to Skilled Nursing Facilities and Assisted Living Facilities program. There were 10 grants

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

Policy Research team members manage numerous cooperative agreements and contracts that support

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

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

Policy Research Team Members:

Carrie Cochran, Team Lead

Heather Dimeris Tom Morris

Nancy Egbert Erica Molliver

Michelle Goodman Joan Van Nostrand

Truman Fellows: Jenna Kennedy, Meghana Desale
12

Frontier Extended Stay Clinic Program (FESC)

PROGRAM COORDINATOR: Carrie Cochran, MPA At a Glance Email: ccochran@hrsa.gov

Grants Awarded:

2006: 1 continuing award

2007: 1 continuing award

2008: 1 continuing award

Amount Awarded: Up to $1.5 million

per year, per grantee

2006: $1.5 million

2007: $1.5 million

2008: $1.5 million

Project Period: 4 years

Next Competitive Grant

Application:

Year: 2011

Anticipated # Grants: 1

Anticipated Grant Amount: Up

to $1.5 million per year

Phone: (301) 443-4701

AUTHORIZING LEGISLATION: Title III, Section 330A of the

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

PROGRAM OVERVIEW:

The purpose of the Frontier Extended Stay Clinic cooperative

agreement demonstration program is to examine the

effectiveness of a new type of provider in providing health

care services in certain remote clinic sites. The FESC is

designed to address the needs of patients who are unable to

be transferred to an acute care facility because of adverse

weather conditions, or who need monitoring and observation

for a limited period of time.

FY 2008 program activities include, but are not limited to:

Implementation and testing of FESC protocols;

Evaluation of program and financial activities;

Provision of technical assistance to CMS FESC

Demonstration Project and participating organizations;

Developing or continuing Health Information Technology (HIT) and quality initiatives; and

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

Hospitals.

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

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

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

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

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

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

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

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

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

KEY PROGRAM ACCOMPLISHMENTS:

In 2008, ORHP continued the work started in 2004 by providing funding to the Alaska FESC Consortium

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

year of data collection indicate that the 5 clinics recorded 1,449 Monitoring and Observation stays of 2

hours or greater duration, and 1,397 Transfer stays (no minimum stay length). The mean length of these

encounters was 6.76 hours for Monitoring and Observation and 3.97 for Transfers. Only 9 percent of the

stays were over 12 hours. While 37 percent of the extended stays resulted in patients being discharged

without further referral, 53 percent resulted in emergency transfer to a higher level of care.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
13

Rural Health Research Centers Program

PROGRAM COORDINATOR: Joan F. Van Nostrand, DPA At a Glance

Grants Awarded:

2006: 8 continuing awards

2007: 8 continuing awards

2008: 6 new awards

Amount Awarded: Prior to 2008, up to

$550,000 per year, per grantee

2006: $4 million

2007: $4 million

For 2008, up to $660,000 per year, per

grantee

2008: $3.96 million

Project Period: 4 years

Next Competitive Grant Application:

Year: 2012

Anticipated Grants: Up to 6

Anticipated Grant Amount: Up

to $660,000 per year, per grantee

(up to $3,960,000 combined)

Email: jvan_nostrand@hrsa.gov

Phone: (301) 443-0613

AUTHORIZING LEGISLATION: Section 711 of the Social

Security Act

PROGRAM OVERVIEW:

The ORHP funded Rural Health Research Centers conduct

and disseminate policy-relevant research on the problems

that rural communities face in assuring access to health

care and strengthening health of their residents. These

studies help to inform ORHP policy staff in their annual

review of key Departmental regulations, and assists

policymakers seeking to improve access to care in remote

communities.

Initiated in 1987, the Research Centers Program is the only

Federal effort dedicated entirely to producing policy-relevant

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

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

inter-disciplinary team of experts in health services research,

epidemiology, public health, geography, medicine, and

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

portfolio of three projects annually in consultation with

ORHP and its advisors. Projects are designed to address HHS, HRSA and ORHP goals.

KEY PROGRAM ACCOMPLISHMENTS:

In 2008, the 8 Research Centers conducted 24 projects and wrote 30 policy briefs and reports. They also

authored 27 peer-reviewed journal articles in 2008, and another 15 that have been accepted for

publication and are in pre-press. To widen dissemination of these results, the Rural Health Research

Gateway was updated in 2008. The Gateway is a Web site that allows one-stop shopping for all projects

produced by the respective research teams, as well as summaries of projects in progress. In 2008, the

Gateway began to issue Research Alerts each time a new report is issued. Additionally, the Centers

each have Web sites that highlight and summarize their projects. There were over 163,000 visits to these

sites in 2008. Staff also presented their findings to 176 policy, provider, payer, and academic audiences;

and responded to over 300 requests for information from various national and State policymakers. In

September 2008, competitive awards were made to six new Research Centers for the 2008-2012 cycle.

See the Research Gateway (www.ruralhealthresearch.org) for a list of the new Research Centers.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
14

Targeted Rural Health Research Grant (TRHR)

PROGRAM COORDINATOR: Erica Molliver, MHS At a Glance

Grants Awarded:

Email: Emolliver@hrsa.gov

Phone: (301) 443-1520

2006: 3 new awards

2007: 2 new awards

2008: 2 new awards

Amount Awarded: Up to $150,000

per grantee

2006: $449,923

2007: $300,000

2008: $299,512

Project Period: 18 months

Next Competitive Grant

Application:

Year: 2009

Anticipated # Grants: Up to 3

Anticipated Grant Amount: Up

to $150,000 per grantee (up to

$450,000 combined)

AUTHORIZING LEGISLATION: Section 711 of the Social

Security Act

PROGRAM OVERVIEW:

The Targeted Rural Health Research Grant Program

(TRHR) funds policy-oriented projects which address critical

issues facing rural communities in their quest to secure

affordable, high quality health services. The program is

unique in its dual purpose of enhancing policymakers

knowledge of rural health, and expanding the pool of

experienced researchers in this complex field. Grantees

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

local decision makers. Grantees must address one of a

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

be national in scope. Studies in 2008 included the following

issues of national significance: Rural Health Clinics,

Frontier Health Services Delivery, EMS, Rural Health

Leadership, Allied Health Workforce, and Public Health.

Originally entitled Policy-Oriented Rural Health Services Research Grant Program, TRHR was launched

in 2003 on a single-year grant cycle. In 2007, however, it became apparent that the 12-month timeframe

was unrealistic, considering the complexity of the research involved. Under expanded authority, ORHP

notified grantees that they could extend their projects without formally requesting approval of a no-cost

extension. Reflective of this shift, the name of the program eventually was changed, and the FY 2008

competitive funding cycle and budget periods were formally extended to 18 months.

KEY PROGRAM ACCOMPLISHMENTS:

Grantees research findings have been instrumental in helping policymakers bridge conceptual gaps

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

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

generated research findings in the following areas:

Organizational Impact of the Deployment of Ambulance Quality Feedback Systems (QFS) on

Rural Volunteer EMS Agencies

Rural Health Clinics: Measuring Efficiency & Effectiveness

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
15

Critical Access Hospitals Transitioning to Skilled Nursing

Facilities and Assisted Living Facilities (CAH SNF)

PROGRAM COORDINATOR: Heather Dimeris, MS, RD At a Glance

Grants Awarded:

2006: N/A

Email: hdimeris@hrsa.gov

Phone: (301) 443-4657

2007: N/A

2008: 1 new award

Amount Awarded: Up to $1,000,000

per year, per grantee

2006: N/A

2007: N/A

2008: $942,123

Project Period: 1 year

Next Competitive Grant Application:

Year: TBD

Anticipated Grants: TBD

Anticipated Grant Amount: TBD

AUTHORIZING LEGISLATION: Section 1820(g)(7) of the

Social Security Act as amended, (42 U.S.C. 1395i4(g)(7))

PROGRAM OVERVIEW:

Section 121 of the Medicare Improvement for Patients and

Providers Act of 2008 (MIPPA) included a provision for the

Health Resources and Services Administration to support

eligible critical access hospitals (CAH) in making the

transition to Skilled Nursing Facilities (SNF) and/or

Assisted Living Facilities (ALF).

There are more than 1,290 CAHs across the country.

These facilities can have up to a maximum of 25 beds

available for any combination of acute and/or swing-bed

nursing care. As population demographics and service

areas change, some CAHs face higher demand for swingbed nursing, rather than acute care services. These

facilities may find the costs of maintaining acute care and emergency room status difficult. Particularly as

their local populations age, they may better serve community needs by shifting their mission to that of

either a nursing home or an assisted living facility. This especially is true if there is another acute care

facility nearby. These grants are designed to help defray the cost of shifting a CAH to an SNF or ALF.

To be eligible for this program, a CAH must have an average daily acute census of less than 0.5 and an

average daily swing-bed census of greater than 10.0. An eligible hospital also must provide assurance

that it will surrender its Critical Access Hospital status within 180 days of receiving the grant.

KEY PROGRAM ACCOMPLISHMENTS:

Key program accomplishments are yet to be demonstrated for the CAH SNF grantee, as the grant was

awarded in September of the 2008 fiscal year.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
16

Hospital State Team Grant Programs

In FY 2008, ORHP administered four grant programs within the Hospital State Team (HST). The grant

programs are: 1) the Critical Access Hospital Health Information Technology (CAHHIT) Network; 2) Rural

Hospital Medicare Flexibility (Flex); 3) Small Rural Hospital Improvement Program (SHIP); and 4) the

State Office of Rural Health (SORH).

There were 157 grants awarded in these four programs with a budget of almost $69 million. In addition to

the above grants, HST members manage a wide range of cooperative agreements and contracts that

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

funds to build replacement facilities and other activities.

Hospital State Team Members:

Nancy Egbert, Team Lead

Region A

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

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

Vermont

Region B

Anthony Achampong: Arkansas, Kentucky, North Carolina, Tennessee, Virginia, West Virginia

Steve Hirsch: Louisiana, Mississippi, South Carolina

Keith Midberry: Alabama, Georgia, Florida

Region C

Jerry Coopey: Illinois, Indiana, Iowa, Minnesota, Nebraska

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

Region D

Michelle Goodman: Arizona, California, New Mexico, Texas

Kathryn Umali: Hawaii, Nevada, Oklahoma

Region E

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

Bridget Ware: Alaska, Colorado, Oregon, South Dakota, Utah
17

Critical Access Hospital Health Information Technology

Network Grant Program (CAH-HIT)

PROGRAM COORDINATOR: Michael McNeely, MBA, MPH At a Glance Email: mmcneely@hrsa.gov

# Grants Awarded:

2006: N/A

2007: 16 new awards

2008: N/A

Amount Awarded: Up to $1.6M per

grantee

2006: N/A

2007: $25 M

2008: N/A

Project Period: 18 months

Next Competitive Grant Application:

Year: TBD

Anticipated # Grants: TBD

Anticipated Grant Amount: TBD

Phone: (301) 443-5812

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

Security Act

PROGRAM OVERVIEW:

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

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

program is to support development of Health Information

Technology (HIT) systems in rural communities through the 16

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

develop networks and implement HIT across the continuum of

care to improved case coordination and health outcomes for rural

residents. HRSAs experience has shown that it is cost effective to

utilize networks of providers to develop HIT. Therefore, grantees

may focus their projects on any of the following systems:

Practice management

Disease registry

Care management

Clinical messaging

E-prescription

Telemedicine/Telepharmacy applications

Personal health record

Electronic health record

Health information exchanges

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

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

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

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

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

test bed pilot program on HIT network implementation in rural areas. A thorough evaluation is underway

to provide lessons learned for similar projects in future.

KEY PROGRAM ACCOMPLISHMENTS:

At completion of the 18-month grant period, 12 of the 16 grantees had a fully operational HIT network.

The four remaining grantees experienced early delays in securing vendors, so ORHP approved a 6-

month extension for them to complete the Flex CAH-HIT Network activities. By the end of the grant cycle,

it was anticipated that the grantees would have developed comprehensive management systems for

medical information, and its secure exchange between and among consumers and providers. ORHP also

funded an evaluation contract to document whether the program succeeds in improving quality of care,

reduction in medical errors, administrative efficiencies, and overall access.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
18

Delta Health Initiative (DHI)

PROGRAM COORDINATOR: Kathryn Umali, MPH At a Glance

Grants Awarded:

2006: 1 new award

2007: no award

2008: 1 continuing award

Amount Awarded:

2006: $24.75 million

2007: $0

2008: $23 million

Project Period: 5 years

Next Competitive Grant

Application:

Year: 2011

Anticipated Grants: Up to 1

Anticipated Grant Amount: Up

to $24,750,000 per year, per

grantee

Email: kumali@hrsa.gov

Phone: (301) 443-7444

AUTHORIZING LEGISLATION: Public Law 109-149,

Departments of Labor, Health and Human Services, and

Education, and Related Agencies Appropriations Act, 2006

PROGRAM OVERVIEW:

The purpose of the DHI Cooperative Agreement Program is

to fund an alliance of providers to address longstanding

unmet rural health needs (access to health care, health

education, research, job training and capital improvements)

in the Delta. The goal of the DHI is to improve the health of

people living in this historically distressed region.

HRSAs Office of Rural Health Policy funded a 5-year

cooperative agreement in the amount of $24.75 million in

FY 2006, and $23 million in FY 2008. The grantee is

working with 10 partners on projects aimed at improving:

Chronic disease management

Health education

Intervention

Wellness promotion

Access to health care services

Health Information Technology

Workforce training

Care coordination

Construction of health facilities.

The consortium proposed 24 projects, and devised communication and coordination systems among

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

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

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

KEY PROGRAM ACCOMPLISHMENTS:

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

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

also has fostered better collaboration between the partners through the grantees continuing efforts to

improve its organizational structures. The DHI has conducted 156 community-based wellness events and

classes, and 146 professional education seminars. It has trained 1,812 health professionals, and 20,978

Delta residents. The consortium has conducted 2,321 screenings/patient interviews; accounted for 7,062

patient-encounters for medical services; and held 117 community-based career recruitment events.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
19

Medicare Rural Hospital Flexibility Grant Program (Flex)

PROGRAM COORDINATOR: Steven Hirsch, MSLS At a Glance

Grants Awarded:

2006: 45 continuing awards

2007: 45 continuing awards

2008: 45 new awards

Amount Awarded: Up to $650,000 per

year, per grantee, with an average

grant of $490,000

2006: $22.2 million

2007: $22.2 million

2008: $22 million

Project Period: 3 years

Next Competitive Grant Application:

Year: 2010

Anticipated Grants: 45

Anticipated Grant Amount: Up

to $650,000 per year, per grantee,

with an average grant of $490,000

Email: shirsch@hrsa.gov

Phone: (301) 443-7322

AUTHORIZING LEGISLATION: Section 1820(j) of the Social

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

Medicare Improvements for Patients and Providers Act of

2008

PROGRAM OVERVIEW:

The Rural Hospital Flexibility Program (Flex) provides

funding to state governments to spur quality and

performance improvement activities; stabilize rural hospital

finance; and integrate emergency medical services (EMS)

into their health care systems. Only States with Critical

Access Hospitals (CAH) or potential CAHs are eligible for

the Flex program.

Flex funding encourages the development of cooperative

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

EMS providers, clinics, and health practitioners to increase

efficiencies and quality of care. The Flex program requires

States to develop rural health plans, and funds their efforts

to implement community-level outreach and technical assistance to advance the following goals:

Improve quality of care and performance management

Improve and integrate EMS

Develop and implement rural health networks

Support existing CAHs and eligible hospitals

Designate CAHs in the State

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

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

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

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

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

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

KEY PROGRAM ACCOMPLISHMENTS:

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

Services Hospital Compare Web site, even though they received no financial incentives to do so. This

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

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

But more than 80 percent of CAHs have undertaken programs to improve their service standards. After

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

of patients receiving care under recommended protocols.

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

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

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
20

Small Rural Hospital Improvement Grant Program (SHIP)

PROGRAM COORDINATOR: Jeanene Meyers, MPH At a Glance Email: jmeyers@hrsa.gov

Grants Awarded:

2006: 47 continuing awards

2007: 46 continuing awards

2008: 46 new awards

Amount Awarded: Up to $1,200,000

per year, per State grantee

2006: $ 14.5 million

2007: $ 14.5 million

2008: $ 14.2 million

Project Period: 5 years, starting with FY

2008 grants (previously, project period

was 3 years)

Next Competitive Grant Application:

Year: 2013

Anticipated Grants: Up to 47

Anticipated Grant Amount:

Average of $309,500 per year, per

State grantee, up to $14.5 million,

combined

Phone: (301) 443-2482

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

Social Security Act, 42 U.S.C. 1395i-4

PROGRAM OVERVIEW:

SHIP is available to assist small rural hospitals that are

essential access points for Medicare and Medicaid

beneficiaries. Each State Office of Rural Health (SORH)

coordinates participation of the small rural hospitals

within its State. For example, $14.2 million was awarded

across 46 States in FY 2008, which the SORHs then

disbursed across 1,633 eligible hospitals.

The SHIP program is authorized by section 1820(g)(3) of

the Social Security Act to help small rural hospitals pay

costs related to the implementation of prospective

payment systems; the purchase of computer software

and hardware that would protect patient privacy;

educating and training hospital staff on computer

information systems to protect patient privacy; purchase

of computer software and hardware to help reduce

medical errors and support quality improvement; and/or educating and training hospital staff on computer

information systems to help reduce medical errors and support quality improvement.

The SHIP program allows funds to purchase equipment and software for regulatory compliance and

improvements that can be cost-prohibitive for small hospitals. The goal of the program is to allow small

rural hospitals to purchase equipment and materials, information technology, training and education,

technical assistance, and consultants or assessments within the areas of PPS implementation, protection

of patient privacy and quality improvement support. Examples of allowable activities include: 1) purchase

of billing and coding software and charge-master review for PPS implementation, 2) purchase of security

application software to increase security and privacy for patients, and 3) purchase of electronic health

record systems and providing staff training and educational materials on information systems.

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

safety, cost, and value of health care services.

KEY PROGRAM ACCOMPLISHMENTS:

To maximize purchasing power through economies of scale, eligible hospital grantees are encouraged to

form consortiums in order to pool grant funds for the purchase of services. For the most recent reporting

year, a reported $2.4 million was invested in consortiums; this comprises 16 percent of FY 2007 funds. In

the most recent award cycle (FY 2008), 11 more hospitals were funded than in the previous year.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
21

State Offices of Rural Health Grant Program (SORH)

PROGRAM COORDINATOR: Keith J. Midberry, MHSA At a Glance

Grants Awarded:

2006: 50 continuing awards

2007: 50 continuing awards

2008: 50 continuing awards

Amount Awarded: Up to $150,000

per year per grantee

2006: $7.4 million

2007: $7.2 million

2008: $7.2 million

Project Period: 5 years

Next Non- competitive Continuation

Grant Application:

Year: 2009

Anticipated Grants: 50

Anticipated Grant Amount: Up

to $150,000 per year, per

grantee

Email: kmidberry@hrsa.gov

Phone: (301) 443-2669

AUTHORIZING LEGISLATION: Public Health Service Act,

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

PROGRAM OVERVIEW:

The State Offices of Rural Health Grant (SORH) Program

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

The program provides an institutional framework that links

communities with State and Federal resources to help

develop long-term solutions to rural health problems.

The three core functions of the SORH program are to:

Serve as a clearinghouse of information and innovative

approaches to rural health services delivery

Coordinate State activities related to rural health in order to

avoid duplication of efforts and resources

Identify Federal, State, and nongovernmental programs

that can afford technical assistance to public and private,

nonprofit entities serving rural populations.

Additionally, the SORH program strengthens Federal, State,

and partnerships in rural health; and promotes recruitment and retention of a competent health care

workforce. Funds cannot be used for direct delivery of health care services, purchase of real property or

equipment (vehicles, medical, communications), or to conduct any activity regarding a Certificate of Need.

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

from each State, and requires a State match of $3 for each $1 in Federal funding. Over the past 16

years, this program has leveraged in excess of $200 million in State matching funds. Currently, 36 Offices

are located in State health departments, 11 in academic settings, and three in non-profit organizations.

KEY PROGRAM ACCOMPLISHMENTS:

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

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

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

The following information will be posted on the ORHP Performance Information Management System

within 30 days of the end of grant period:

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

SORH.

2. The total number of clients within the State that received TA directly from SORH.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
22

Community Based Grant Programs

In FY 2008, ORHP administered 9 community-based grant programs through its Community-Based Team

(CBT), made up of 14 project officers. The programs are: the Black Lung Clinics Program; Delta Health

Initiative; Delta States Rural Development Network Grant Program; Network Development Grant

Program; Network Development Planning Grant Program; Radiation Exposure Screening and Education

Program; Rural Access to Emergency Devices (RAED) Grant Program; Rural Health Outreach Grant

Program; and the Small Health Care Provider Quality Improvement (SHCPQI) Grant Program. This year,

305 grants (for a combined program budget of over $43 million) were awarded.

In FY 2008, ORHP implemented a new strategy for managing the community-based grant programs

which staggers the competitive cycle between programs. By doing this, ORHP will bring consistency to

its grant funding cycle and each program (Quality, Network Development and Outreach) will be able to

fund grantees in the same cycle, allowing for more peer-to-peer learning and better coordinated technical

assistance. This approach is the same used by ORHP in funding the State and Research grant

opportunities, and allows ORHP to achieve efficiencies that permit additional grant awards.

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

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

understand the CBT programs and develop an area of expertise for the team and ORHP. Below are the

primary issue areas addressed through the Community Based programs:

Access to care

Cardiovascular health

Case management

Chronic disease

Diabetes

Emergency management services and

trauma care

Health information technology

Maternal and child health

Mental health and substance abuse

Nutrition

Obesity

Oral health

Pharmacy

Quality

Recruitment and retention

Safety net collaboration

School-based health centers

Transportation

Uninsured

Womens health

Community-Based Team Members:

Sherilyn Pruitt, Team Lead

Karen Beckham Vanessa Hooker Lakisha Smith

George Brown Kristi Martinsen Sonja Carter Taylor

Julia Bryan Nisha Patel Shelia Tibbs

Eileen Holloran Elizabeth Rezai-zadeh Shelia Warren

Lilly Smetana
23

Black Lung Clinics Program (BLCP)

PROGRAM COORDINATOR: Kristin Martinsen, MPM At a Glance

Grants Awarded:

2006: 15 continuing awards

2007: 15 new awards

2008: 15 continuing awards

Amount Awarded:

2006: $5.7 million

2007: $5.65 million

2008: $ 5.62 million

Email: kmartinsen@hrsa.gov

Phone: (301) 594-4438

AUTHORIZING LEGISLATION: Black Lung Benefits Reform

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

PROGRAM OVERVIEW:

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

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

to minimize the effects of job-related respiratory impairment,

improve the health status of miners exposed to coal dust,

and to increase coordination with other benefit programs to

meet the special health needs of this population.

Project Period: 3 years (with

possibility of competitive continuation)

Next Competitive Grant

Application:

Year: 2010

Anticipated Grants: Up to 15

Anticipated Grant Amount:

Varies by grantee

Grantees have varied models of service delivery. BLCP

services may be provided either directly or through formal

arrangements with appropriate health care providers. Current

clinics include Federally Qualified Health Centers, hospitals,

state health departments, mobile vans, and clinics.

Programs meet the health care needs of the population

through services that include:

Outreach

Primary care (including screening, diagnosis and treatment)

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

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

indicated)

Pulmonary rehabilitation

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

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

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

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

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

administered by HRSAs Bureau of Primary Health Care, the program was moved to the Office of Rural

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

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

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

care and improving health outcomes.

KEY PROGRAM ACCOMPLISHMENTS:

In 2008, ORHP sponsored a contract to locate potentially affected miners, improve outreach, and

increase participation in the BLCP by targeting information at likely populations. Grantees provided a total

of 22,488 medical encounters -- an increase of 17 percent from 2006  and served 11,110 miners.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
24

Delta States Rural Development Network Grant Program

(Delta)

PROGRAM COORDINATOR: Heather Dimeris, MS, RD At a Glance

Grants Awarded: Email: hdimeris@hrsa.gov

Phone: (301) 443-4657 2006: 8 continuing awards

2007: 12 new awards

2008: 12 continuing awards

Amount Awarded: Award range

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

2006: $5.1 million

2007: $5.1 million

2008: $5.1 million

Project Period: 3 years

Next Competitive Grant Application:

Year: 2010

Anticipated Grants: Up to 12

Anticipated Grant Amount:

between $300,000 - $430,000 per

grantee.

AUTHORIZING LEGISLATION: Public Health Service Act,

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

PROGRAM OVERVIEW:

The purpose of the Delta States Rural Development Network

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

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

Louisiana, Mississippi, Missouri, and Tennessee) which

address unmet local health care needs and prevalent health

disparities through the development of new and innovative

projects.

The Delta grant program fosters collaborative efforts among

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

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

grantees are expected to propose multi-county projects that

address the following key areas:

Delivery of preventative or clinical health services surrounding chronic disease

Increase access to prescription drugs for the medically indigent

Practice management technical assistance services.

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

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

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

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

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

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

previous grant cycles.

KEY PROGRAM ACCOMPLISHMENTS:

The Delta grant program had success in providing needed health services to rural communities in this

hard hit region. There have been marked achievements particularly in oral health care, chronic disease

management and school-based health services. Most notably, approximately 3 percent of the Delta

population (an estimated 181,000 people) have been served or reached by this program over the past

year by a variety of community-based institutions. Since the grants inception in 2001, several

organizations continue to implement successful projects and partnerships as a result of initial funding

from the Delta Grant program. During the 2008 Delta Grantees Meeting, participants obtained tools and

key resources on developing a sustainability plan, which continued into a broader sustainability series as

highlighted in their technical assistance site visits and quarterly conference calls.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
25

Radiation Exposure Screening and Education Program

(RESEP)

PROGRAM COORDINATOR: Vanessa Hooker At a Glance Email: vhooker@hrsa.gov

Grants Awarded:

2006: 7 continuing awards

2007: 7 continuing awards

2008: 1 new/ 6 continuing awards

Amount Awarded:

2006: $1.917 million

2007: $1.586 million

2008: $1.517 million

Project Period: 3 years

Next Competitive Grant Application:

Year: 2011

Anticipated # Grants: 7-10

Anticipated Grant Amount: Up to

$300,000 per year, per grantee

Phone: (301) 594-5105

AUTHORIZING LEGISLATION: Public Health Service Act

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

PROGRAM OVERVIEW:

The purpose of the Radiation Exposure Screening and

Education Program (RESEP) is to help individuals adversely

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

testing of nuclear weapons, to receive medical care and

compensation for illnesses that may have resulted from these

activities. This is accomplished by providing competitive grant

opportunities to States, local governments, and other health

care organizations establish cancer screening programs.

The major objectives of the programs are to:

Screen individuals for cancer and other radiogenic

diseases

Provide referrals for diagnostic testing medical

treatment of individuals screened

Develop and disseminate public information and

education programs for the detection, prevention, and treatment of radiogenic cancers and

diseases; and

Facilitate medical documentation of claims for the Radiation Exposure Compensation Act

(RECA) program

There are seven health care organizations in five southwestern States (Arizona, Colorado, Nevada, New

Mexico and Utah) participating in the RESEP Program. These organizations include hospitals,

universities, Indian Health Service facilities, medical centers and community health centers. In FY 2008,

competitive grants totaling $1,517,931 were awarded to these organizations for a total of $1,917,000.

KEY PROGRAM ACCOMPLISHMENTS:

The following accomplishments support the programs long-term and annual performance measures:

Launched a National Outreach effort to identify potentially eligible individuals no longer residing in

the area served by program grantees

HRSA Outreach Seeks to Raise Cancer Awareness Among People Who Lived Near Nuclear

Sites and Mined Uranium- Inside HRSA article on the University of Nevada RESEP Center

activities, located on the Web site at: http://newsroom.hrsa.gov/insidehrsa/may2008/default.htm

Implemented depression screening in accordance with the US Preventative Services Task Force

(USPSTF) at every RESEP clinic

Screened 1,464 individuals for radiogenic disease; made 2,001 referrals for additional diagnostic

testing; provided assistance to 7,183 individuals; and informed more than 41,347 residents about

the program through brochures, presentations, and letters during the previous program year

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
26

Rural Health Care Services Outreach Grant Program

PROGRAM COORDINATOR: Nisha Patel, MA, CHES At a Glance Email: npatel@hrsa.gov

Grants Awarded:

2006: 65 new / 43 continuing

2007: 27 new / 95 continuing

2008: 0 new/ 122 continuing

Amount Awarded: Up to $150,000 in

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

$100,000 in Year 3, per grantee

2006: $17.9 million

2007: $17.6 million

2008: $17.7 million

Project Period: 3 years

Next Competitive Grant Application:

Year: FY 2009

Anticipated Grants: Up to 90

Anticipated Grant Amount: Up to

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

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

per grantee

Phone: (301) 443-6894

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

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

PROGRAM OVERVIEW:

The purpose of the Outreach program is to promote rural

health care services outreach by expanding the delivery of

health care services to include new and enhanced services in

rural areas. The Outreach program supports projects that

demonstrate creative or effective models of outreach and

service delivery in rural communities. Applicants may propose

projects to address the needs of a wide range of population

groups including, but not limited to, low-income populations, the

elderly, pregnant women, infants, adolescents, rural minority

populations, and rural populations with special health care

needs. All projects should be responsive to any unique cultural,

social, religious, and linguistic needs of the target population.

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

status and outcome in rural areas by providing diverse health

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

services may include: health education and promotion; health

screenings; health fairs; and training and education to providers, among other activities. Grantees may

focus on health topics that include primary health care, dental care, mental health services, home health

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

not requiring in-patient care.

KEY PROGRAM ACCOMPLISHMENTS:

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

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

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

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

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

to be expanded and enhanced. Since the programs inception in FY 1991, to-date funding has been

provided to 683 grantees in 48 States and 3 Territories.

In FY 2008, ORHP awarded a Sustainability Technical Assistance Contract to Georgia State University.

The purpose of the contract is to provide extensive technical assistance around sustainability so that the

grantees are able to sustain their program once Federal funds have ended. The contract will conduct

workshops, peer-to-peer learning seminars and webinars to help grantees develop and implement a

sustainability plan. In addition, ORHP has awarded an Economic Impact Analysis contract. This

contractor will work with grantees to conduct an analysis on grantees to help determine the impact of the

program in their community.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
27

Rural Health Network Development Grant Program

PROGRAM COORDINATOR: Sherilyn Z. Pruitt, MPH At a Glance

Grants Awarded:

Email: spruitt@hrsa.gov

Phone: (301) 594-0819

2006: 23 new / 15 continuing

2007: 5 new / 33 continuing

2008: 51 new/ 28 continuing

Amount Awarded: Up to $180,000 per

year per grantee (3 year award)

2006: $6.7 million

2007: $6.5 million

2008: $13.7 million

Project Period: 3 years

Next Competitive Grant Application:

Year: 2011

Anticipated Grants: Up to 30

Anticipated Grant Amount: Up

to $180,000 per year, per grantee

(up to $540,000, combined)

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

Health Service Act, as amended

PROGRAM OVERVIEW:

The purpose of the Rural Health Network Development Grant

Program is to expand access to, coordinate and improve the

quality of essential health care services, and enhance the

delivery of health care in rural areas. These grants support

rural providers who work in formal networks, alliances,

coalitions or partnerships to integrate administrative, clinical,

technological, and financial functions. Funds provided

through this program are not used for direct delivery of

services. The ultimate goal is to strengthen the rural health

care delivery system by 1) improving the viability of the

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

delivery of care to people served by the network. Networks

must consist of at least three separately owned entities, and

each must sign a memorandum of agreement or similar

document. Upon completion of the grant program, a network

should have completed a thorough strategic planning process, business planning process, be able to

clearly articulate the benefits of the network to its network partners/members and to the community it

serves, and have a sound strategy in place for sustaining its operations.

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

Achieving economies of scale and cost efficiencies of certain administrative functions

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

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

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

technologies

Ensuring continuous quality improvement of the care provided by network members

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

changes in the health care environment

The Network Development Grant Program was started in 1997 with 34 grantees and $6.1 million. Todate, the program has awarded almost $89 million to support 210 Network Development grants.

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

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

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

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

KEY PROGRAM ACCOMPLISHMENTS:

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

that were anticipated to be awarded. One-hundred eighty grantees attended a Network Development

Grantee Conference held in Washington, DC in August 2008. Grantees learned techniques to become an

effective Network Director, and learned strategies to sustain their Networks after Federal funding ceases.

ORHP collaborated with the Georgia Health Policy Center and the National Cooperative of Health

Networks to provide joint technical assistance to grantees at this meeting.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
28

Rural Health Network Development Planning Grant Program

(Network Planning)

PROGRAM COORDINATOR: Eileen Holloran

At a Glance Email: eholloran@hrsa.gov

Phone: (301) 443-7529 Grants Awarded:

2006: 15 new awards

2007: 10 new awards

2008: 33 new awards

Amount Awarded: Up to $85,000 per year,

per grantee

2006: $1.2 million

2007: $841,391

2008: $2.7 million

Project Period: 1 year

Next Competitive Grant Application:

Year: FY 2009

Anticipated Grants: Up to 10

Anticipated Grant Amount: Up to

$100,000 per year. per grantee

AUTHORIZING LEGISLATION: Public Law 107-251m 116

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

42 U.S.C. 254c.

PROGRAM OVERVIEW: The legislative purpose of the Rural

Health Network Development Planning Grant Program

(Network Planning) program is to expand access to,

coordinate and improve the quality of essential health care

services and enhance the delivery of health care, in rural

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

to plan and develop a formal health care network. Grant

funds typically are used to acquire staff, contract with

technical experts, and purchase resources to build the

network (funds cannot be used for direct delivery of health

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

year Network Development implementation grant to continue

the work they started under the Network Planning grant.

Network Planning grantees use the planning grant to lay the foundation of a rural health network by:

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

2. Convening potential collaborating network partners;

3. Conducting planning activities; and

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

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

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

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

providers in underserved areas.

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

FY 2005, the maximum award was lowered to $85,000. The average award for FY 2008 was $82,400.

KEY PROGRAM ACCOMPLISHMENTS:

Two Grantee Meetings were held in FY 2008. The first meeting was held in conjunction with the National

Cooperative of Health Networks (NCHN) annual meeting in April 2008. Several of the NCHN members

served as Peer Counselors to the new Network Planning Grantees to assist the new grantees in

understanding what a formal health network is and some of the issues surrounding working with other

organizations for a common good. The grantees also received information on how to develop boards and

the legal consequences of incorporating. The second meeting was held separately in June 2008 and was

identical to the first in substance. Evaluation analysis showed that the grantees were very satisfied with

both meetings.

Five, of thirteen, FY 2007 Network Planning Grantees received FY 2008 Network Development Grants;

and 4, of 16, FY 2006 Network Planning Grantees received FY 2008 Network Development Grants. This

indicates that the grantees successfully completed their Planning projects and were able to continue to

develop their fledgling networks.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
29

Rural Access to Emergency Devices (RAED)

PROGRAM COORDINATOR: Eileen Holloran At a Glance

Grants Awarded:

Email: eholloran@hrsa.gov

Phone: (301) 443-7529

2006: 4 new awards

2007: 4 continuing/ 9 new awards

2008: 13 continuing awards

Amount Awarded:

2006: $309,408

2007: $1.2 million

2008: $1.2 million

Project Period: 2 - 3 years

Next Competitive Grant Application:

Year: 2009

Anticipated Grants: 10

Anticipated Grant Amount: Up to

$99,900 per year, per grantee for up

to 2 years

AUTHORIZING LEGISLATION: Public Health Improvement Act

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

PROGRAM OVERVIEW:

The purpose of the Rural Access to Emergency Devices

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

partnerships to purchase automated external defibrillators

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

the Food and Drug Administration; and provide defibrillator and

basic life support training in AED usage through the American

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

A community partnership is composed of local emergency

response entities such as community training facilities, local

emergency responders, fire and rescue departments, police,

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

entities.

In the past, AEDs have been placed in colleges, universities, community centers, local businesses, law

enforcement and ambulance vehicles, fire trucks, 911 dispatch centers, and offices. The grant creates

opportunities to educate the public on AEDs via advertisements, news media, schools, churches,

shopping malls, restaurants, home owner associations, businesses, local government bodies, security

firms, etc.

The 13 current RAED grantees are located in 12 States across the Nation (Alaska, Arizona, Delaware,

Florida, Iowa, Illinois, Louisiana, New Jersey, Nevada, Pennsylvania, Texas and Utah).

KEY PROGRAM ACCOMPLISHMENTS:

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

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

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

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

In FY 2008 we anticipate approximately 700 new AEDs to be purchased with an additional 2,100 persons

trained; this is an increase from FY 2007 levels: 675 AEDs were purchased and an estimated 2,000

persons were trained in their use.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
30

Small Health Care Provider Quality Improvement Grant

Program

PROGRAM COORDINATOR: Elizabeth Rezai-zadeh, MPH At a Glance

Grants Awarded:

Email: erezai@hrsa.gov

Phone: (301) 443-4107

2006: 15 new awards

2007: 15 continuing awards

2008: 55 new awards

Amount Awarded: Up to $75,000 per

year, per grantee

2006: $ 737,757

2007: $ 680,202

2008: $ 4,026,691

Project Period: 2 years

Next Competitive Grant Application:

Year: 2010

Anticipated Grants: Up to 60

Anticipated Grant Amount: Up to

$75,000 per year, per grantee (up to

$4.5 million, combined)

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

Public Health Service Act

PROGRAM OVERVIEW:

The purpose of the program is to help rural primary care

providers implement quality improvement strategies in the

practice of chronic disease management by the following

means:

Adoption of electronic patient registry systems

Tracking specific health indicators using nationallyaccepted measures

Performing routine needs assessments as part of a

continuous quality improvement program

Participating in monthly conference calls and peerlearning workshops with fellow program grantees, facilitated by a quality improvement specialist.

The Rural Quality program was sponsored by ORHP for the first time in FY 2006 under a 2-year grant

cycle. The grantees focus was on diabetes in the first learning year and cardiovascular disease (CVD) in

the second.

The Institute of Medicines (IOM) reports, To Err is Human and Crossing the Quality Chasm, highlight

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

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

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

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

While many initiatives focus on in-patient hospital care, improvement also is needed in the primary care

setting to decrease morbidity and mortality, and foster cost-effective care. Timely disease prevention and

management in the primary care setting decreases expensive emergency room visits and hospital

admissions, which often result from deferred primary care. The Rural Quality program addresses this

need for continuous improvement in primary care in distant communities.

KEY PROGRAM ACCOMPLISHMENTS:

Since the inception of the Rural Quality program in FY 2006, over 2,400 patients have been served by the

15 grantee organizations. Among patients with measured HbA1c lab values, the annual average was 7.1

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

the year to the patient registry. Other goals for clinical measures that were met or nearly achieved

include:

40 percent of patients with BP <130/80

75 percent of patients with LDL < 100

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
31

Other HRSA Initiatives Administered by ORHP

The Office of Rural Health Policy manages two agency-wide HRSA activities: border health and

intergovernmental affairs (IGA).

Border Health

ORHP is charged with managing border health activities for the Agency, as much of the 2,100-mile U.S.-

Mexico border is rural. The regions along the border face similar health care delivery challenges as rural

areas, such as limited health workforce capacity and a fragile infrastructure. ORHP coordinates these

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

Office of Intergovernmental Affairs (IGA)

ORHP serves as the primary coordinator of all IGA activities for HRSA. This includes serving as HRSAs

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

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

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

as cooperative agreements and activities related to HRSAs offices and bureaus.

Denali Commission

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

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

help develop and expand the rural health care infrastructure.

Denali Commission Team Members:

Carrie Cochran

Heather Dimeris

Tom Morris

Sonja Carter-Taylor

Border Team Members:

Frank Cantu Lilia Salazar

Margarita Figueroa-Gonzalez Christina Villalobos

Michelle Goodman Erma Woodard

Michelle Mellen

IGA Team Members:

Karen Beckham

Tom Morris

Kathryn Umali

Administrative Team

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

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

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

Administrative Team Members:

Heather Dimeris, Team Lead

Julia Bryan Michele Pray-Gibson Amal Thomas

Mary Collier Lilly Smetana April Williams

Keith Midberry Sonja Carter-Taylor Sheila Warren
32

Border Health

PROGRAM COORDINATOR: Frank Cantu

FCantu@hrsa.gov

Phone:(214) 767-8068

PROGRAM OVERVIEW:

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

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

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

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

KEY PROGRAM ACCOMPLISHMENTS:

The inter-agency agreement with the Environmental Protection Agency represents an innovative part of

Border Health activities. One Border Environmental Health Coordination Program Cooperative

Agreement award was made to Texas A & M University to test the effectiveness of environmental health

education and training by promatoras (lay community health workers) in reducing pesticide exposure and

illness in residents of border colonias.

Over the past 4 years, FY 2005 to FY 2008, ORHP has supported two annual events; the U.S.-Mexico

Border Health Association Meeting, and the Pan-American Health Organizations Immunizations in the

Americas Weeks. The purpose of the former was to further educate clinicians and community workers

about HRSA programs and the progress toward achieving U.S.-Mexico Border 2010 Health Objectives.

The purpose of the Pan-American Health Organizations event is to further educate clinicians and

community workers in the appropriate use of vaccines, and to facilitate the inoculation of children and

adults in local clinics and community health centers along the U.S.-Mexico border.

In FYs 2006 and 2007, ORHP organized an expert meeting, Improving Knowledge Transfer among

Health Researchers and Decision Makers at the Border in Dallas, TX on June 26, 2007. The purpose of

this meeting was to identify ways to improve the translation and dissemination of border health research

produced in the United States so as to maximize its use by decision makers in health policy and practice.

This invitational meeting brought together representatives from government agencies and foundations

that fund research, leading researchers and university officials, health policymakers, program

administrators, and health care providers to discuss their experiences and ways to improve the flow of

knowledge among stakeholders at the border. A report of this meeting is posted on the ORHP Web site

at: http://ruralhealth.hrsa.gov/border/dallasmeeting.htm.

A follow-up meeting, Options for Improving Access to Clinical Information for Border Health Grantees,

was held on December 8-9, 2008 at HRSAs Headquarters in Rockville, MD. The purpose of this meeting

was to examine options to transfer new and emerging clinical information into the hands of clinicians

working on HRSA funded projects along the U.S.Mexico border.
33

Denali Commission

PROGRAM COORDINATOR: Tom Morris, MPA At a Glance

Grants Awarded:

2006: 1 new award

2007: 1 new award

2008: 1 new award

Amount Awarded:

2006: $39,283,000

2007: $39,283,000

2008: $38,597,000

Project Period: 1 year

Email: tmorris@hrsa.gov

Phone: (301) 443-4269

AUTHORIZING LEGISLATION: Section 309 of Public Law 105-

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

PROGRAM OVERVIEW:

Through an agreement with the Denali Commission, an agency

of the Department of Commerce, HRSA provides funds to help

develop and expand the rural health care infrastructure in

Alaska. In 1999, the Commission was granted authority by

Congress to address rural Alaskan health care issues. The

funds in this program, which are transferred to the Denali

Commission via an inter-agency agreement with HRSA, support

planning, construction and equipping of health, nutrition, and child care projects across the State.

Potential venues include hospitals, health care clinics, and mental health facilities, including drug and

alcohol treatment centers.

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

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

$38,597,000 appropriated to HRSA for the Commission in FY 2008 was combined with other resources

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

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

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

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

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

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

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

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

KEY PROGRAM ACCOMPLISHMENTS:

The Denali Commission made 28 sub-awards to Alaskan communities in 2008. The Commission

recognized the Primary Care Clinic program as a priority funding area within health. New clinic

construction grants were dedicated to the communities of Kasigluk, Hughes, Selawik, Skagway, Craig,

Levelock, and Nanwalek.

Other priority areas included construction funding for a new domestic violence shelter in Bethel,

construction funding for a youth psychiatric facility in South Central Alaska, design funding for a new

Indian Health Service hospital in Nome, and funding for a grant program providing construction funding to

elder housing projects, as well as a grant program providing renovation and/or equipment upgrades for

primary care in hospitals.

For additional information on program background, eligibility, and other requirements, please contact the

Program Coordinator listed above, or refer to http://ruralhealth.hrsa.gov/funding/GrantPrograms.htm
34

Intergovernmental Affairs (IGA)

PROGRAM COORDINATORS: Kathryn Umali, MPH, CHES

Email: kumali@hrsa.gov

Phone: (301) 443-7444

Karen Beckham, MA

Email: kbeckham@hrsa.gov

Phone: (301) 443-0502

PROGRAM OVERVIEW:

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

Administrations (HRSA) Office of Intergovernmental Affairs (IGA) is to facilitate and coordinate HRSAs

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

The purpose of HRSAs Intergovernmental Affairs is to:

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

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

Coordinate Agency cross-Bureau cooperative agreements and activities with organizations

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

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

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

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

Boards of Health (NALBOH).

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

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

Commission.

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

Intergovernmental Affairs.

KEY PROGRAM ACCOMPLISHMENTS:

Some of the primary functions of HRSA IGA are to respond and coordinate information and meeting

requests. In 2008, 19 information requests and 4 meeting requests were processed. ORHP has

developed a systematic process in managing the coordination of these requests, which entails

responding to a variety of problems, questions, or situations relevant to health services and intragovernmental affairs. This may involve program planning and implementation for which there may not be

established criteria. The work facilitates national dissemination of information about HRSA's programs,

functions, and activities to partnering organizations and agencies.
35

Appendix A: Contracts

Title of Procurement Description of Product or Service

Rural Health Clinic Technical Assistance

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

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

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

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

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

improvement.

Contract for Services of Technical

Assistance for the Office of Rural Health

Policy

The purpose of this contract is to provide TA to the State Rural Health Associations and to

support analysis of emerging rural health issues.

Logistical Support Services for Functions

of the National Advisory Committee on

Rural Health and Human Services and

Rural Health Policy Activities

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

the functions of the National Advisory Committee on Rural Health and Human Services and

to support the rural health policy functions of ORHP.

Rural Counties and Economic

Development (RHWs)

The purpose of this contract is to raise awareness to county officials about the Rural Health

Works (RHWks) projects by conducting a RHWks demo in three rural counties, educating

county officials on the benefits of the program, and providing opportunities for peer-to-peer

learning about RHW through the National Association of Counties (NACo) conferences and

publications.

WWAMI Work Related Inquiries

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

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

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

Frontier Extended Stay Clinics (FESC)

National Partners' Meeting

The contractor provides logistical support related to meetings focusing on the Frontier

Extended Stay demonstration project.

Black Lung Evaluation

The purpose of this contract is to provide evaluative services around the Black Lung Clinics

Program. The evaluation activities involve answering questions around two specific issues.

The activities also involve gathering data from government resources, stakeholder

organizations and from the 15 existing grantee programs.

Rural Hospital Performance Improvement

Project

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

hospitals in the Delta region.

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

Improvement program.

Rural Hospital Issues Group Logistics

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

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

days in order to discuss emerging issues facing rural hospitals.

Chronic Disease Self Management

The purpose of this contract is to analyze existing data about a model of care by a health

promotion nurse for self-management of chronic conditions by the rural elderly. The goal of

the refined model is to reduce limitations while not increasing health care costs for rural

elderly with chronic conditions.

Delta States Rural Development Network

Grant Program Evaluation

The evaluation of the Delta States Grant Program is needed to gauge the program's

effectiveness upon the Delta Region. The main purpose is to examine TA previously

provided to the grantees and to identify ways to improve the performance and outcomes of

the project.

Analysis of Elderly in Rural Hospitals for

Respiratory Conditions

The purpose of this contract is to support the contractor in a 2-year effort to do further

analysis on an existing data set dealing with the care of elderly in rural hospitals due to

respiratory conditions.

EHB - Web Based Data Management

System

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

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

Access to Oral Health Care and the Oral

Health Workforce

The purpose of this contract is to form a consensus committee to evaluate the current oral

health care workforce and consider how that workforce contributes to problems of access to

oral health care services. This contract is being implemented in partnership with BHPr.
36

U.S. Mexico Border Health Conference

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

States Mexico Border Association (USMBHA) sponsored conference in Laredo, Texas in

June 2008. At these workshops local providers from both sides of the border received

current information regarding the progress made and future plans to achieve U.S.-Mexico

Border 2010 Health Objectives.

Immunization Week in the Americas

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

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

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

the educational workshops that are conducted in the border area.

Center for Rural Health Works (RHWKs)

The purpose of this contract is to support ongoing analysis of the link between health care

services and rural economic development. The Center for Rural Health Works collaborates

with State Offices of Rural Health and rural communities on planning and economic

development/health care issues. Additionally, the contract demonstrates the effectiveness

of using County Executives to provide leadership in the Rural Health Works process.

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

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

Rural Outreach Grantee Technical

Assistance Contract

The purpose of this contract is to provide TA for up to 91 Rural Health Care Services

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

The contract will also support sustainability for the 30 grantees that close-out in FY 2008.

Rural Quality Improvement Technical

Assistance Contract

The purpose of this contract is to provide TA for up to 60 Small Health Care Provider Quality

Improvement Grantees to help them implement quality improvement strategies.

Rural Hospital Performance Improvement

Evaluation

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

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

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

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

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

National Rural and Underserved

Workforce Summit

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

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

and underserved communities with an emphasis on "Safety Net" Providers.

Federally Qualified Health Centers

(FQHC)-Critical Access Hospitals (CAH)

Collaboration

The purpose of this contract is to examine and disseminate information about how critical

access hospitals and Federally Qualified Health Centers in rural underserved areas can

work together to jointly meet health care needs.

Rural Health Outreach Manual on HIV

Care in Rural Communities

The purpose of this contract is to develop a manual examining effective programs in rural

and frontier HIV care and disseminate findings among current and future grantees. It

provides assistance to potential rural grant applicants focusing on HIV care in rural

communities.

Rural Health Outreach Manual on Mental

Health Best Practices

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

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

Best Practices and Economic Impact

Analysis

The purpose of this contract is to collect best practices from current ORHP grantees and

disseminate those findings. An analysis of the economic and service impact of the grantees

and a formula for quantifying the impact of the programmatic investment on rural

communities is in production.

Rural Recruitment and Retention

The purpose of this contract is to support collaboration with the State Offices of Rural

Health, the State Primary Care Associations, and others involved in rural recruitment and

retention of health care professionals. This also includes working with professional

organizations and health professional training programs to focus on rural recruitment and

retention issues.

Logistical Support Services for

Appalachian Region Prescription Drug

Abuse and Best Practices Dissemination

The purpose of the contract is to support logistical, technical, and administrative support to

facilitate holding meetings of grantees and applicants for funding to address prescription

drug abuse and methamphetamine abuse in the Appalachian Region and for the producing

and disseminating best practice materials on how to address issues relating to prescription

drug abuse and methamphetamine abuse.
37

Logistical Support Services for the

development of a frontier definition

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

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

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

service need for isolated islands.

Analysis of a Frontier Definition

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

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

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

A State Perspective on Frontier Issues The purpose of this contract is to fund expert consultations at the State level regarding

access to care issues in frontier areas and to develop white papers on their findings.
38

Appendix B: ORHP Staff

Office of Rural Health Policy and Intergovernmental Affairs

Staff List as of October 2008

1. The Team Structure: All staff are assigned to specific teams within ORHP. These teams are: the Community-Based Team (which

includes all staff who work on the community based grant programs under the jurisdiction of the ORHP); the Hospital-State Team

(which includes all staff who serve as regional liaisons and project officers for the ORHPs State-based programs), the PolicyResearch Team (which includes staff who oversee either regulatory issues or research issues), the Intergovernmental Affairs (IGA)

Team (which includes all staff who coordinate HRSA's intergovernmental affairs activities), the Administrative Team (which includes

all staff who are charged with overseeing specific administrative duties) and the Management Team (which includes all staff who are

charged with overseeing management duties). There are also five staff, based in Dallas, assigned to the Division of Border Health.

Two staff are also assigned to working with the Director to coordinate HRSA's Intergovernmental Affairs Activities (IGA).

2. How Issues Are Assigned: All staff are also assigned issue areas. For members of the Community-Based Team, this relates to

the focus areas of the grants on which they serve as project officers. For members of the Policy-Research team, this relates to

policy areas they oversee. For members of the Management, IGA and Administrative Teams, this relates to those issues for which

they bear responsibility.

Name and Title Team Program or Policy

Assignments Issue Areas Phone Email

Tom Morris,

Associate

Administrator

Mgt;

PRT;

IGA;

Border

Oversees all aspects of ORHP,

including rural health policy and

programs; border health, international

health and intergovernmental affairs;

primary staff to HHS Rural Task

Force; National Advisory Committee

on Rural Health and Human Services

Ex Officio Staff.

Budget, Personnel, Operations

oversight; Legislation; Policy

(301)

443-

0835

tmorris@hrsa.gov

Staff

Anthony

Achampong HST

Region B Co-Regional Liaison (project

officer for that region's Flex, SORH

and SHIP grants); Data and

Performance Measurement

Coordinator; Liaison to OIT for the

ORHP PIMS Contract, Representative

on the HRSA IT Internal Review Board

Data and Performance

Measurement Coordinator

(301)

594-

4429

aachampong@hrsa.gov

George Brown CBT

Project Officer for Network Planning

and Small Health Care Provider

Quality Improvement grants

Delta Rural Hospital

Performance Improvement

Project; HIT; Access to Care

(301)

443-

7321

gbrown@hrsa.gov

Karen Beckham CBT;

IGA

Project Officer for Rural Health

Outreach and Rural Health Network

Development grants; Rural Best

Practices Cooperative Agreement

Intergovernmental Affairs

coordination for HRSA;

Women's Health; EMS

(301)

443-

0502

kbeckham@hrsa.gov

Julia Bryan Mgt

Liaison to Grants Management,

Division of Independent Review, Office

of Financial Assistance Management,

Division of Grants Policy, OPR

Grants Coordinator; Grants

technical assistance

(301)

443-

6707

jbryan@hrsa.gov

Jennifer Chang HST

Executive Secretary, National

Advisory Committee on Rural Health

and Human Services; Region A CoRegional Liaison (project officer for

that region's Flex grants, SORH grants

and SHIP grants)

National Advisory Committee

on Rural Health and Human

Services

(301)

443-

0736

jchang@hrsa.gov

Carrie Cochran Mgt;

PRT

Quick Data Turnaround Cooperative

Agreement; Frontier Extended Stay

Clinic Cooperative Agreement;

National Advisory Committee on Rural

Health and Human Services staff

Budget; Personnel; Operations

oversight; Medicare

reimbursement including

inpatient hospital

reimbursement; Supervisor for

interns

(301)

443-

4701

ccochran@hrsa.gov

Mary Collier Admin

Phones; meeting scheduling; travel;

timekeeping; correspondence

(SWIFT); FOIA requests; conference

room reservations and IT equipment;

mail pick up and distribution; meet and

greet visitors.

Administrative; provide services

and support to ORHP staff and

external customers.

(301)

443-

0836

mcollier@hrsa.gov

Jerry Coopey HST

Region C Co-Regional Liaison (project

officer for that region's Flex, SORH

and SHIP grants)

Rural Recruitment and

Retention Network (3RNet)

liaison; Access to Capital; Rural

Health and Economic

Development; safety-net

collaboration; hospital

performance improvement

(301)

443-

7306

jcoopey@hrsa.gov
39

Staff

Heather

Dimeris

Mgt;

PRT;

CBT;

Admin

Oversees the Administrative Team; CAHs

Transitioning to Skilled Nursing Facilities

Grant Program Coordinator; quality-related

policy activities; grants processes; Delta

Network Development Program

Coordinator; Delta Liaison to HST

Budget; Personnel; Operations

oversight; Regulation review;

Quality improvement

(301)

443-

4657

hdimeris@hrsa.gov

Nancy

Egbert HST

Region E Co-Regional Liaison (project

officer for that region's Flex, SORH and

SHIP grants); Flex Monitoring Cooperative

Agreement

Clinical Advisor; health quality;

nursing; pandemic influenza

(301)

443-

0614

negbert@hrsa.gov

Michelle

Goodman

HST;

PRT

Region D Co-Regional Liaison (project

officer for that region's Flex grants, SORH

grants and SHIP grants); Rural Policy

Analysis Cooperative Agreement; National

Advisory Committee on Rural Health and

Human Services staff; and U.S.-Mexico

Border Health staff

Health Workforce;

Communications Coordinator;

Border Health

(301)

443-

7440

mgoodman@hrsa.gov

Steve

Hirsch HST

Rural Hospital Flexibility (Flex) Program

Coordinator; Region B Co-Regional

Liaison (project officer for that Flex grants,

SORH grants and SHIP grant); Rural

Assistance Center Cooperative Agreement

Definitions of Rural

(301)

443-

7322

shirsch@hrsa.gov

Eileen

Holloran CBT

Network Planning Grants Coordinator;

Rural AED Coordinator; Project Officer for

the Outreach programs

Transportation; EMS; chronic

disease management; Alzheimer's

(301)

443-

7529

eholloran@hrsa.gov

Vanessa

Hooker CBT

Radiation Exposure Screening and

Education Program (RESEP) Coordinator;

Project Officer for Outreach and Network

Development grant programs

Diabetes, Recruitment and

Retention

(301)

594-

5105

vhooker@hrsa.gov

Kristi

Martinsen CBT

Black Lung Program Coordinator; Project

Officer for Outreach and Network

Development grant programs; National

Advisory Committee on Rural Health and

Human Services staff

Mental health; Substance Abuse

(301)

594-

4438

kmartinsen@hrsa.gov

Michael

McNeely HST

Flex Critical Access Hospital-Health

Information Technology Network

(CAHHITN) Coordinator; Region C CoRegional Liaison (project officer for that

region's Flex, SORH and SHIP grants)

HIT; OIT Liaison including web

material coordinator

(301)

443-

5812

mmcneely@hrsa.gov

Jeanene

Meyers HST

Small Rural Hospital Improvement Grant

Program (SHIP) Coordinator; Region A

Co-Regional Liaison (project officer for that

region's Flex grants, SORH grants and

SHIP grants)

Pharmacy & 340B

(301)

443-

2482

jmeyers@hrsa.gov

Keith J.

Midberry

HST;

Mgt

State Offices of Rural Health Program

Coordinator; (project officer for that Flex

grants, SORH grants and SHIP grants);

NOSORH Cooperative Agreement

Human Resources Coordinator

(301)

443-

2669

kmidberry@hrsa.gov

Erica

Molliver PRT

Targeted Rural Health Research grants;

National Advisory Committee on Rural

Health and Human Services staff, Rural

Health Clinic Technical Assistance, Rural

Hospital Issues Group.

Physician fee schedule;

ambulance fee schedule;

outpatient hospital reimbursement;

Medicare Part D; Medicaid

waivers; health professional

shortage areas; frontier health

(301)

443-

1520

emolliver@hrsa.gov

Nisha Patel CBT

Rural Health Care Services Outreach

Grant Program Coordinator; Project Officer

for Network Development and Network

Planning grant programs

Cardiovascular health; obesity;

nutrition; elder care

(301)

443-

6894

npatel@hrsa.gov

Michele

PrayGibson

Mgt;

Admin

Budget Coordinator; National Advisory

Committee on Rural Health and Human

Services Administrative Coordinator

Executive Officer; Budget

Coordinator; backup on contracts

coordination

(301)

443-

7320

mpray@hrsa.gov

Sherilyn

Pruitt CBT

Grants Files coordinator; Electronic

Handbook Liaison; Grants Program

Administrator; Outreach programs

Health information technology;

telehealth

(301)

594-

0819

sadams@hrsa.gov

Elizabeth

Rezaizadeh

CBT

Small Health Care Provider Quality

Improvement Program Coordinator; Project

Officer for Quality and Outreach grant

programs

Quality Improvement

(301)

443-

4107

erezai@hrsa.gov

Lilly

Smetana CBT

Grants Files coordinator; Electronic

Handbook Liaison; Grants Program

Administrator; Outreach programs

Earmarks; health literacy; health

professions education; oral health

(301)

443-

6884

lsmetana@hrsa.gov

Sonja

Carter

Taylor

CBT;

Mgt

Project Officer for Rural Health Outreach,

Small Health Care Provider Quality

Improvement, and Rural Health Network

Development grant programs

General rural health; school-based

health; Inter-Agency agreement

coordinator

(301)

443-

1902

staylor@hrsa.gov

Shelia

Tibbs CBT

Project Officer for Network Development,

Small Health Care Provider Quality

Improvement, and Black Lung grant

programs

Public health; capital construction

monitoring for Delta Health

Initiative

(301)

443-

4304

stibbs@hrsa.gov
40

Staff

Amal

Thomas Admin

Phones; meeting scheduling; travel; Com.

Corps timekeeping; Sec. Forecast; training

coordinator; HR assistant; supplies;

correspondence backup; conference room

reservations & IT equipment; mail pick

up and distribution; meet and greet visitors;

Administrative coordinator; provide

services and support to ORHP

staff and external customers

(301)

443-

0139

athomas@hrsa.gov

Kathryn

Umali

HST;

IGA

Delta Health Initiative Program

Coordinator; Region D Co-Regional

Liaison (project officer for that region's Flex

grants, SORH grants and SHIP grants)

Intergovernmental Affairs

coordination for HRSA

(301)

443-

7444

kumali@hrsa.gov

Christina

Villalobos Mgt

Special Assistant for Management Team;

Annual Report; U.S.-Mexico Border Health

staff

Border Health

(301)

443-

3590

cvillalobos@hrsa.gov

Joan Van

Nostrand PRT

Rural Health Research Coordinator; Rural

Health Research Center Cooperative

Agreement

Disability; long-term care; research

data; Healthy People 2010-access

chapter

(301)

443-

0613

jvan_nostrand@hrsa.gov

Bridget

Ware HST

Region E Co-Regional Liaison (project

officer for that region's Flex grants, SORH

grants and SHIP grants)

Access to Capital; HIV/AIDS;

minority health and cultural

competence

(301)

594-

4241

bware@hrsa.gov

April

Williams Admin

Phones; meeting scheduling; travel; NAC

administrative duties; timekeeping;

correspondence backup; conference room

reservations and IT equipment; mail pick

up and distribution; meet and greet visitors.

Administrative; provide services

and support to ORHP staff and

external customers.

(301)

443-

3999

award@hrsa.gov

Sheila

Warren

CBT;

Mgt

Project Officer for Outreach, Small Health

Care Provider Quality Improvement, and

Network Development grant programs

Contracts Coordinator; Health

promotion and disease prevention;

Health education

(301)

443-

0246

swarren@hrsa.gov

Division of Border Health

Frank

Cantu Border Coordinates HRSA's border health

activities Budget, personnel, administration

(214)

767-

3881

fcantu@hrsa.gov

Margarita

FigueroaGonzalez

Border

Pan-American Health Organization

contract project officer; NM border health

liaison

HIV/AIDS

(214)

767-

8068

mfigueroa@hrsa.gov

Michelle

Mellen Border AZ border health liaison Maternal and Child Health

(214)

767-

3070

mmellen@hrsa.gov

Lilia

Salazar Border CA border health liaison Travel, administrative

(214)

767-

3073

lsalazar@hrsa.gov

Erma

Woodard Border Administrative support Phones, scheduling, meetings

(214)

767-

3171

ewoodard@hrsa.gov