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Arizona Rural Health Conference July 30-August 1, 2007

RURAL HEALTH RESOLUTION

Resolution Title: Preservation of Medicare Payments to Rural Hospitals
(Submitted by Jim Dickson)

WHEREAS rural hospitals provide essential health care services to nearly 54 million people, including 9 million Medicare beneficiaries. Because of their small size, modest assets and financial reserves, and higher percentage of Medicare patients, these hospitals face great pressures as government payments decline. Given that rural populations are typically older, rural hospitals are even more dependent on Medicare. Yet Medicare margins are the lowest for rural hospitals, with the smallest hospitals having the lowest margins, and

WHEREAS recent and proposed federal cutbacks would further jeopardize the rural hospitals in Arizona,

THEREFORE BE IT RESOLVED that the Arizona Rural Health Association endorses and advocates for the following Federal legislation to preserve our rural hospitals:

The Rural Community Hospital Assistance Act (S. 933/H.R. 2350) which would expand cost-based reimbursement to hospitals with between 25 and 51 beds eligible for Medicare inpatient and outpatient services, and provide cost-based reimbursement for CAH skilled nursing facilities, home health services and ambulance services.

The Sole Community Hospital Preservation Act (H.R. 2961) which would make permanent the hold harmless provision for outpatient payments to sole community hospitals and improve inpatient payments to sole community hospitals.

The Medicare Rural Home Health Payment Fairness Act (S.300/H.R.11) which would provide for a two-year extension of the temporary 5 percent Medicare payment increase for home health services furnished in rural areas.

Pulmonary and Cardiac Rehabilitation Act (S.1440/ H.R. 4824) which would establish a statutory benefit category under Medicare for pulmonary and cardiac rehabilitation services.

The Medicare Rural Health Provider Payment Extension Act (H.R. 5118) which would amend the MMA of 2003 to extend certain Medicare payment methodologies provided for rural health care providers including:

Extension of the outpatient hold harmless for rural hospitals under 100 beds and Sole Community Hospitals
Reasonable cost payment for outpatient lab services performed by rural hospitals and,
A 5% rural add-on for home health services.

The Rural Health Equity Act (H.R. 880) which would ensure that Medicare Advantage plans pay Critical Access Hospitals (CAH) at least 101 percent of costs for inpatient and outpatient services, regardless of whether the CAH has a contract with the patient's Medicare Advantage plan.

The Critical Access to Clinical Lab Services Act (S.236/H.R. 1016) which would reinstate cost-based reimbursement to CAHs for lab services provided to patients who are not physically present in the hospital.

The Safety Net Inpatient Drug Affordability Act (S.1840/H.R.3547) which would expand the 340b drug discount program to include inpatient services and allow CAHs to participate. The 340b drug discount program provides safety net hospitals with the ability to purchase pharmaceuticals at significantly reduced rates. Currently, CAHs are unable to participate because they do not receive Medicare disproportionate share payments

Resolution passed

RURAL HEALTH RESOLUTION

Resolution Title: Preserving Medicaid Programs in Rural Communities
(Submitted by Jack Beveridge)

WHEREAS rural communities have higher Medicaid eligibility and enrollment rates and rely on the Medicaid funded healthcare systems more than in urban areas, and

WHEREAS Medicaid eligibility and enrollment is threatened by new federal and state requirements for documentation of citizenship, placing an extreme hardship on special populations like minorities and seniors, especially in rural communities, and

WHEREAS accessibility to Medicaid services is further threatened in rural communities due to higher co-payment requirements, greater coverage limitations and transportation issues due to collapsing provider networks,

THEREFORE BE IT RESOLVED that the Arizona Rural Health Association strongly advocates against such restrictive requirements in the Medicaid program and will work to help people overcome such barriers to needed healthcare in rural communities of the state, and

BE IT FURTHER RESOLVED, that the Arizona Rural Health Association will contact decision makers such as legislators, AHCCCS and ADHS officials, rural Medicaid healthcare providers, Area Health Education Centers and other advocacy groups to develop strategies and inform consumers on how to overcome the restrictions and barriers to Medicaid programs.

Resolution passed

RURAL HEALTH RESOLUTION

Resolution Title: Immigration Policy, Public Health and Human Rights
(Submitted by Jill de Zapien, Carmen Downing, Jean McClelland, Joel Meister, and Cecilia Rosales)

WHEREAS we recognize that migration will continue to grow and become the public health challenge of the 21st Century if current immigration and border control policies are not re-examined; and

WHEREAS immigration and border control policies contribute to loss of life of immigrants crossing the Arizona-Mexico border;

THEREFORE BE IT RESOLVED that legislative and administrative reforms uphold the basic dignity and human rights of all immigrants, and assure prevention of further loss of life;

AND BE IT FURTHER RESOLVED that the Arizona Rural Health Association requests the Arizona state legislature, the Arizona Governor, U.S. Congress, Mexico and the United Nations seek a speedy, just and fair solution to this problem; and

BE IT FURTHER RESOLVED that the 2006 33rd Annual Rural Health Conference participants call upon local, state and federal policy makers and other parties in positions of influence to recognize the contributions that immigrants make to our state and country;

AND BE IT FURTHER RESOLVED that actions to follow should include forwarding the resolution to the Border Health Commission, the Arizona-Mexico Commission and others as appropriate.

Resolution passed

RURAL HEALTH RESOLUTION

Resolution Title: Supporting the Implementation of Electronic Health Records
(Submitted by Alison Hughes)

WHEREAS there is a national and state of Arizona priority for implementing an interoperable, private, secure electronic health record system throughout the country, and

WHEREAS rural health providers (private and public hospital and clinic-based, as well as private practice providers) cannot accrue the financial burden required to implement such records without subsidy, and

WHEREAS many rural health information organizations (RHIOs) that are in the process of being implemented throughout the country and in Arizona have not actively engaged private and public hospital and clinic-based, as well as private practice providers in rural communities in the design of such RHIO's because such rural providers do not have the financing capacity to contribute to RHIO organization structures,

THEREFORE BE IT RESOLVED that the Arizona Rural Health Association supports efforts by the U.S. Congress, the Arizona State Legislature, and the Arizona Governor to appropriate funding specifically to assist rural providers in implementing electronic health record systems, as well as in participating in RHIO organizational and implementation structures that are designing health information exchange systems that affect the transfer of data in electronic health record systems, and expanding high-speed access to rural areas.

Resolution passed

RURAL HEALTH RESOLUTION

Resolution Title: Malpractice / Tort Reform
(Submitted by Jim Dickson)

WHEREAS rural healthcare providers including hospitals, physicians, long-term care, and behavioral health are facing crushing increases in medical liability insurance. This is a precipitous situation as the reinsurance industry is subject to vagaries such as 9-11 or hurricanes. One more large terrorist attack or hurricane could cause more insurers to leave the Arizona market, and

WHEREAS the majority of the state of Arizona's rural areas are designated as Medically Underserved and Health Care Professional Shortage Areas. The recruitment and retention of healthcare providers becomes a critical necessity to maintain a modicum of service. This effort to recruit and retain providers is seriously hampered by inordinate malpractice insurance costs making worse an already unacceptable shortage,

THERFORE BE IT RESOLVED that the Arizona Rural Health Association supports efforts in the state of Arizona to achieve a balanced malpractice/reform in the state. These include Caps, mandatory mediation, structured settlements as well as other successful reforms used by other states. These reforms should be tempered by an individual's rights to redress damages wrongfully incurred when receiving care.

Resolution passed

RURAL HEALTH RESOLUTION

Resolution Title: FY2007 Appropriations for Rural Health/Indian Health
(Submitted by the Arizona Rural Health Association, Tribal Caucus)

WHEREAS rural communities overall receive significantly, one-third to one-half, less funding than metro areas;

WHEREAS rural communities have higher rates of unemployment, and there are greater numbers of uninsured, or underinsured;

WHEREAS tribal communities are rural communities, also, and have mutual concerns about health status and economic development;

WHEREAS $133 million reduced funding is proposed for FY 2007 rural health care and rural health programs;

WHEREAS expenditures for American Indian beneficiaries receiving services from the Indian Health Service (I.H.S.) are approximately one-half of the per capita expenditures for Medicaid beneficiaries and the Federal government spends nearly twice as much for a Federal prisoner's health care than it does for an American Indian or Alaska Native;

WHEREAS the proposed I.H.S. budget increase (4% over FY 2005) does not adequately address base disparity, unmet need, medical inflation and population growth, and the FY 2006 rescission and previous rescissions have eroded the I.H.S. budget base such that there are no real program increases and basic Current Services are jeopardized;

THEREFORE BE IT RESOLVED, that The Arizona Rural Health Association requests the Congress of the United States to restore funding for the rural health programs that were eliminated, including: Rural and Community Access to Emergency Devices (9 million), Rural EMS ($500,000), Health Education Training Centers ($4 million), Quentin Burdick Rural Training ($6 million), Geriatric Education Centers ($31.5 million) and the Healthy Community Access Program ($83 million);

AND BE IT FURTHER RESOLVED, THAT I.H.S. budget increases ($400+million) be provided for Current Services with additional program increases for Contract Health Services ($35 million), Indian Health Care Improvement Fund ($35 million), Hospitals and Clinics ($35 million), and the Health Care Facilities Construction fund ($120.3 million) be restored for inpatient & outpatient facilities, dental, small ambulatory construction programs and equipment.

Resolution passed

RURAL HEALTH RESOLUTION

Resolution Title: Support for Rural Healthcare Residency Programs
(Submitted by: Jack Beveridge)

WHEREAS healthcare providers frequently remain to practice in the communities where they complete their residency programs, and

WHEREAS rural communities have significant need for more healthcare practitioners and recognize the virtues of "growing their own", and

WHEREAS Arizona's medical, nursing and other health sciences schools are growing and providing more opportunities for residency programs in rural communities,

THEREFORE BE IT RESOLVED that The Arizona Rural Health Association strongly supports the development of more residency programs and placements in rural communities of the state, and

AND BE IT FURTHER RESOLVED, that the Arizona Rural Health Association will contact decision makers such as presidents and deans of the schools, directors of rural hospitals and community health centers, workforce development and investment program managers, Area Health Education Center directors and others to encourage and assist in the development and utilization of residency programs for healthcare practitioners in rural communities.

Resolution passed

RURAL HEALTH RESOLUTION

Resolution Title: Universal Health Care
(Submitted by: Rick Swanson)

WHEREAS healthcare costs are escalating; and

WHEREAS the number of uninsured is growing; and

WHEREAS Arizona residents are entitled to access to healthcare;

THEREFORE BE IT RESOLVED that the Arizona Rural Health Association supports a healthcare system that provides universal, comprehensive, affordable and equitable healthcare; and

FURTHER BE IT RESOLVED that the Arizona Rural Health Association will work with other organizations, agencies and coalitions to realize this goal.

Resolution passed