VRHA Weekly Update
In this Issue June 9, 2014

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


Check out & share the new
"Expand Medicaid!" video! 





VRHA in the News 

By Fairfax News

A coalition of Virginia public health groups has endorsed the U.S. Environmental Protection Agency’s proposal that would set carbon pollution standards for existing power plants.

“Carbon pollution is a clear threat to public health. We can’t protect ourselves or our most vulnerable neighbors without cutting carbon pollution from existing power plants,” the groups said in a prepared statement. “In the American Lung Association’s ‘State of the Air 2014’ report, half of the cities and counties in Virginia with complete monitoring data received failing grades for their levels of ozone, including Alexandria, Arlington, Charles City, Chesterfield, Fairfax, Hampton, Hanover, Henrico, Loudoun, Stafford, and Suffolk. The Washington-Baltimore-Northern Virginia metropolitan area is the 8th most polluted in the country for ozone.”

The Virginia organizations endorsing the plan are the Allergy Partners of Eastern Virginia, the Alliance of Nurses for Healthy Environments, the American Lung Association in Virginia, the Central Virginia Asthma Coalition, Community Health Charities of Virginia, the Healthy Individuals through Prevention and Education (HiPE) Coalition, the Healthcare Council of the National Capital Area, the Pulmonary Pals of Greater Fredericksburg, the Virginia Rural Health Association, and the Virginia Society for Respiratory Care.

Read the full article.

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Members in the News

By Katie Demeria - NV Daily

[VRHA member] Shenandoah County Free Clinic and Shenandoah Dental Clinic have operated under the same leadership and within the same facility, but now they will finally be officially combined as the Shenandoah Community Health Clinic. Executive Director Pam Murphy said the decision to combine the clinics under one name was made both as a response to community needs as well as the changing national health care climate.

Since the mission of helping underinsured, low-income families is the same for both, Murphy said it made sense to group them together. Another benefit of the new name, she added, is hopefully avoiding the stigma usually associated with free clinics. Some patients are distraught over having to take what they refer to as charity. 

Read the full article.

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HPV Cancer Prevention

VRHA is teaming up with the Virginia Community Healthcare Association to bring you:

You Are the Key to HPV Cancer Prevention - Webinar, July 2nd, noon
Stagnant HPV vaccination rates are leaving another cohort of boys and girls vulnerable to devastating HPV cancers. Vaccination could prevent most of these cancers. Provided in this presentation is up-to-date information on HPV infection, HPV-related disease, and HPV cancers. HPV vaccine information and recommendations, as well as HPV vaccine safety and impact, are reviewed. The presentation also provides evidence-based suggestions for successful HPV vaccine communication with patients and their parents, as well as the current HPV vaccine communication resources available from CDC.
1) Define the importance of HPV vaccination for cancer prevention and the rationale for vaccinating at ages 11 or 12.     
2) List the indications for HPV vaccine for girls and for boys.   
3) Provide useful and compelling information about HPV vaccine to parents to aid in making the decision to vaccinate.     
4) Locate resources relevant to current immunization practice.
To join the meeting, click on the link below. We recommend joining the webinar a few minutes early to make sure everything is working correctly.
Attendee URL: https://www.livemeeting.com/cc/cdc/join?id=D5287M&role=attend&pw=mXs%24c3%5Dxt
Meeting ID: D5287M
Attendee Entry Code: mXs$c3]xt
Audio: 866-785-3412
Participant code:  6724731#

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Virginia News

Puckett Resigns

By Jim Nolan - Richmond Times-Dispatch

State Sen. Phillip Puckett- D-Russell County has resigned his seat, leaving Democrats one vote shy of the majority they need to control the chamber.  Puckett's stunning resignation throws Democratic budget strategy into chaos and opening the way for Republicans to seize control of the chamber and reorganize its committees with GOP majorities.

“I am deeply disappointed by this news and the uncertainty it creates at a time when 400,000 Virginians are waiting for access to quality health care, especially those in Southwest Virginia,” Gov. Terry McAuliffe said in a statement.

Read the full article and related articles in the Washington Post and Daily Progress.

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Pushing for Reform

By Newsplex

Since the death of his son last November, State Senator Creigh Deeds has made it his mission to improve mental health care services across Virginia. Deeds and members of the Community Mental Health and Wellness Coalition spoke at the Jefferson School City Center Thursday afternoon about the progress legislators have made in pushing for reform to the mental health care system and the challenges ahead.

"When a crisis occurs you're flushed with money," Deeds said. "You make sure it's a priority. When the crisis goes away, the money goes away. That's not acceptable but that's the way it works."

Read the full article and related articles in the Richmomd Times-DispatchNewsLeaderDaily Progress.

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RAM for Lee

By Wes Bunch - Times News

Remote Area Medical is coming to Lee County.  RAM founder and President Stan Brock, along with local health and county government officials, confirmed Tuesday that the Knoxville- based nonprofit is planning to host a free two-day health care clinic beginning Sept. 13 at the Lee County Airport in Jonesville.

Brock said the need for routine medical, dental and vision treatment was enough in Lee County and surrounding areas to warrant a third RAM event in Southwest Virginia.  The Lee County clinic is part of a larger effort by RAM to increase its focus on Appalachia, Brock said.

Read the full article.

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National News

On the Critical List

By Ruth Ravve - Fox News

The U.S. Department of Agriculture estimates more than 46 million Americans live in rural areas, working on farms or in small factories that provide resources for the rest of the country. Often in these less populated areas, there is only one medical facility for the entire community.

Much of the funding for rural hospitals, about 60 percent, comes from Medicare. The rest comes from Medicaid or from general health insurance. Budgets are so tight for these smaller hospitals, where patients are often older and sicker than the general population, that any changes to these programs -- even slight changes -- can have drastic effects on their budgets.

The combination of Medicare cuts and the added expense of transferring to electronic records is part of the reason there has been an epidemic of rural hospital closures. Eighteen have shut their doors since the beginning of 2013, more than closed in the entire decade before then.

The National Rural Health Association warned the fate of rural hospitals is a bellwether for the nation's healthcare system.  NRHA's Brock Slabach stated;

"I think your rural hospitals are going to be the canaries in the coal mine that lead to disaster for hospitals all over if we continue some of our current trends" Slabach said.

He called it a domino effect: when rural communities suffer, the whole country suffers. "The sustenance of our country's health and well being is produced in the rural areas of our country," he said. "The second we begin to dismiss that is the second that we're going to be very regretful of having lost those resources."

Read the full article.

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Rural Health Transportation

By David Pendered - Saporta Report

Rural Georgia may become an increasingly difficult place to live for current residents who hope to age in place, and for those who move from a city to a small town or the countryside. The government likely will have to determine whether to pay for a steep rise in the cost of helping rural Georgians travel to see a doctor or get treatment such as dialysis. 

Two years ago, consolidation of service providers seemed to be the solution for containing costs. The idea was that costs could be lowered through better management of services provided by three state entities – the departments of transportation, human services and community health. Further research suggests that better coordination may not yield significant savings – because there’s already a good bit of coordination.

Read the full article.

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Telemedicine Opposition

By Emily Kubis - Nashville Post

The Tennessee Board of Medical Examiners heard from a number of health care providers in response to proposed regulation surrounding the practice of telemedicine in the state.  Facing notable opposition from rural providers as well as representatives from Cigna and WellPoint, the proposed amendment would require that the initial and fourth health care encounter take place face-to-face between patient and physician.

Rural providers criticized the rules as restrictive, and suggested they were in direct contradiction to the state's need for more accessible care.

Read the full article.

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Not "Medically Necessary?"

By Bill Finerfrock - National Association of Rural Health Clinics

Since 2011, Medicare has been covering certain preventive services.  In most instances the co-pay and deductible are waived as long as the patients and providers adhere to the frequency scheduled established for that particular preventive service.  This expansion occurred as a result of changes mandated by enactment of the Affordable Care Act.
Services such as Cervical or Vaginal Cancer screening; pelvic and breast examinations; and, screening pap smears have been covered as “stand-alone” services and billable as RHC visits in accordance with CMS published policy (see links below).  

Recently, CMS announced that these services are no longer considered “medically necessary” face-to-face visits when performed in an RHC or FQHC and therefore not billable as stand-alone services. Here is the specific language published by one of the Medicare contractors:
“…HCPCS G0101, Cervical or vaginal cancer screening; pelvic and clinical breast examination and Q0091, screening papanicolaou smear, are not considered to be a medically necessary face-to-face visits and will not be billed or paid at the all-inclusive rate when performed alone.”
The RHC/FQHC policy announcement goes on to state,
“Claims billed with a preventive service code(s) that does not generate a separate payment without another covered service will be rejected”
What makes this determination particularly offensive is that CMS will continue to pay for these preventive services as stand-alone services when provided in other settings.  Here is how CMS describes coverage for screening pelvic exams in the non-RHC setting:

The screening pelvic examination benefit covered by Medicare is a stand-alone billable service. It is separate from the Initial Preventive Physical Examination (IPPE) or the Annual Wellness Visit (AWV).  Medicare beneficiaries may obtain a screening pelvic examination at any time following Medicare Part B enrollment, including during their IPPE or AWV encounter.
In other words, if an otherwise healthy woman on Medicare living in a rural underserved area wants a screening pelvic exam as a stand-alone service and goes to a physician’s office in an urban area, Medicare will deem that service medically necessary and reimburse the physician 100% of the Medicare allowable charge for that service as a stand-alone service.  But if that same woman were to go to the RHC in her rural underserved community and have that screening pelvic exam performed as a stand-alone service, Medicare would deem the screening pelvic exam NOT medically necessary and deny the claim.
The idea that a service is NOT medically nececesary if provided in an RHC or FQHC setting but IS medically necessary if provided in a non-RHC setting is absurd and offensive.  This represents a huge barrier for rural women and discourages them from obtaining care in RHCs and FQHCs.  

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Mark Your Calendar

For more information about these and other events, visit the VRHA Calendar

June 11: SW VA Managed Care Provider Meeting - Abingdon
June 12: The  State Street Project: Health Across Borders - Bristol
June 16: Health on the Homefront: Addressing the Health Needs of Members of the U.S. Armed Forces, Veterans and Their Families - Hampton Roads
June 20-21: Dental Care Approaches for Adults with Disabilities - Lynchburg
June 26: Addressing Disaster Preparedness in Rural Communities - Richmond & videoconference
July 16-18: Rural Quality & Clinical Confernce - Atlanta, GA
September 30-October 1: Rural Health Clinic Conference - Kansas City, MO
October 1-3: Critical Access Hospital Conference - Kansas City, MO

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New Models for Rural Post-Acute Care  
White paper on the Transitional Care Model, as developed and experienced at Mayo Clinic, is an opportunity for Critical Access Hospitals to thrive in a challenging environment.  By adopting a care coordinating approach and leveraging their strengths, Critical Access Hospitals can thrive and provide significant benefits to acute hospitals, patients and families, and the communities they serve.  

National Healthcare Quality Report  National Healthcare Disparities Report
These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. The reports present, in chart form, the latest available findings on quality of and access to health care. Chapter 11 of the NHDR focuses on quality and disparities in care for populations at elevated risk for receiving poor health care, including the rural population.

State Profiles of Medicaid and SCHIP in Rural and Urban Areas
Provides national and state-level data comparing Medicaid enrollment and expenditures in rural and urban counties.

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Funding Opportunities

Teen Volunteer Initiative 
Y Street is the Virginia Foundation for Healthy Youth’s award-winning teen volunteer initiative for high school students. The Y Street Grant program was launched in 2008 to recruit youth throughout Virginia to be trained as youth activists. Grant recipients receive up to $2,000 while simultaneously tackling important issues related to tobacco and childhood obesity. School-based and community-based organizations located in Virginia that work with high school teens are encouraged to apply to become part of this statewide movement. 
Deadline: June 30

Centers for Disease Control and Prevention: Occupational Safety and Health Training Project Grants
This program supports projects focused on occupational safety and health training and on research training.

National Alliance for Grieving Children: Grief Reach Grant Program
The goal of the Grief Reach Grant Program, administered by the National Alliance for Grieving Children with funding from the New York Life Foundation, is to provide support for children's bereavement programs in order to expand their reach to include underserved youth populations. The program offers Community Expansion Grants, ranging from $15,000 to $100,000, to fund program expansion to include bereaved children and teens not currently served by existing services. A total of 50% of the children served by funded programs must be from low-income families, or 50% of the children must be from minority communities. Capacity Building Grants of $10,000 allow nonprofit organizations to secure the professional assistance necessary to enhance organizational capacity and address important issues of organizational development and effectiveness. The application deadline for both grant opportunities is July 7, 2014.

PeopleForBikes Community Grant Program
The PeopleForBikes Community Grant Program offers funding for important and influential projects that leverage federal funding and build momentum for bicycling in communities across the United States. Grants of up to $10,000 are provided for bicycle infrastructure projects and targeted advocacy initiatives that make it easier and safer for people of all ages and abilities to ride. Eligible applicants include nonprofit organizations with a focus on bicycling, active transportation, or community development; city or county agencies or departments; and state or federal agencies working locally. The upcoming deadline for online letters of interest is August 1, 2014.

American Legion Child Welfare Foundation
The mission of the American Legion Child Welfare Foundation is to provide nonprofit organizations with a means to educate the public about the needs of children across the United States. The Foundation supports organizations that contribute to the physical, mental, emotional, and spiritual welfare of children through the dissemination of information about new and innovative programs designed to benefit youth, or through the dissemination of information already possessed by well-established organizations. Grant requests should have the potential of helping American children in a broad geographic area (more than one state). Application forms must be postmarked no later than July 15, 2014. 

Monroe E. Trout Premier Cares Award
The Monroe E. Trout Premier Cares Award was established to recognize exemplary programs nationwide that have made health services more accessible to a specific medically underserved population. The award honors innovative programs that support people excluded from or underserved by the mainstream health delivery system, including farm workers, homeless children, pregnant teens, low-income mothers and infants, and individuals who don't have the strength or means to reach a clinic or hospital. The winning program must be able to show measurable benefits/outcomes covering a full two-year span and must be capable of being replicated. (Please note: The Premier Cares Award is not a grant for future work, rather it is a recognition award for work already accomplished in the past.) The award winner receives $100,000 and the other five finalists receive $24,000 each. The entry deadline is July 31, 2014.

FY14 Partnerships to Increase Coverage in Communities Initiative
Department of Health and Human Services
Office of the Assistant Secretary for Health
Due: June 16 / Award ceiling: $250,000
“The purpose of the Partnerships to Increase Coverage in Communities Initiative is to identify and assist minority populations, to educate them about the Health Insurance Marketplace (Marketplace) and to assist them with enrollment, completion of the application to determine their eligibility and purchase of health insurance offered through the Marketplace. Activities will include: utilizing coalitions and partnerships to maximize outreach and education of the underserved population(s); developing and providing comprehensive information and education sessions to consumers relative to the Health Insurance Marketplace; disseminating CMS or state developed information that will increase awareness of the Marketplace and, where necessary, appropriately updating materials to more effectively provide culturally competent services specific to the underserved population, including translation services; assisting individuals from underserved and hard to reach minority populations and help them apply for health insurance coverage offered through the Health Insurance Marketplace; and monitoring and adapting strategies to reach enrollment targets.” 

Rural Community Facility Financing Available through USDA Rural Development
Deadline: Applications accepted on an ongoing basis
The Community Facilities Direct and Guaranteed Loans Program provides support to develop essential community facilities for public use in rural areas. Loan funds may be used to construct, enlarge, or improve community facilities. 

Evidence-Based Tele-Emergency Network Grant Program (EB TNGP)
Application deadline: Jun 19, 2014
Supports implementation and evaluation of broad telehealth networks to deliver emergency department consultation services via telehealth to rural and community providers without emergency care specialists.
Sponsor: Office of Rural Health Policy 

Community Economic Development (CED) Projects
Application deadline: Jun 21, 2014
Offers funds to Community Development Corporations (CDCs) for projects designed to address the economic needs of low-income individuals and families through the creation of employment and business opportunities, including expansion or construction of clinics and health centers. Bonus points will be given to projects that create jobs in rural communities.
Sponsor: Administration for Children and Families 

Foundation for Rural Service Grant Program
Application deadline: Oct 1, 2014
Provides grants for rural communities in the areas of business development, community development, education, and telecommunications.
Sponsor: Foundation for Rural Service 

Weingart Foundation Grants
Deadline: Ongoing
Funding to support organizations that operate in the areas of health, human services, or education. The Foundation gives highest priority to activities that provide greater access to people who are economically disadvantaged and underserved.  
Farmers' Market and Local Food Promotion Program
Deadline: Ongoing
Funding to support domestic consumption of and access to locally and regionally produced agricultural products, and to develop new market opportunities for farm and ranch operations serving local markets, by providing training, and assistance to domestic farmers. 

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