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NCHN eNews
November 1, 2011 16 days until National Rural Health Day
Dear NCHN Members and Friends,

Welcome to the latest issue of the NCHN Weekly Digest. The biggest news this week revolves around large impending cuts to rural hospitals. Over the last week, we have shared emails from Tim Size and NRHA including a letter you can send to your representative. Please encourage them to support rural health by co-signing the letter. The deadline for signatures is tomorrow - Wednesday, November 2nd @ noon. Time is running out to make our voices heard.

In NCHN news, we still need members for the 2012 Conference Planning Committee and the 2012 Leadership Summit Committee. To participate in either of those, contact Rebecca.

Let us know what's going on with your network
If you have information you would like to share, or have any feedback, please email us.







NRHD November 17, 2011

Upcoming NCHN Calls & Events

2012 Annual Conference Planning Committee
Monday, November 7 @ 2:00 PM ET
Monday, November 21 @ 2:00 PM ET

Board of Directors Call
Monday, November 14 @ 2:00 PM ET

Program Development Committee Call
Tuesday, November 15 @ 1:00 PM ET

Coffee/Tea Chats with Dr. Mary Kay Chess
Wednesday, November 16 @ 11:00 AM

National Rural Health Day
Thursday, November 17, 2011

NCHN Transformer Leadership Learning Community Session
Friday, November 18 @ 11:00 AM ET

NCHN Offices Closed for Thanksgiving
Thursday and Friday, November 24 & 25

NCHN Quarterly Membership Call
Business Plans for Networks
Monday, December 12 @ 2:00 PM ET



From the Forum

There are no new posts this week.


The kids on Abracadabra Street counted all of their Halloween candy. They had 18 pieces of candy in all.

Abby had fewer than 4 pieces of candy.


Billy had twice as much as Abby.


Charlie had twice as much as Billy.


David had 2 pieces more than Abby.

How many pieces of candy did each kid have?



Members Needed for 2012 Leadership Summit Committee

The 2012 NCHN Leadership Summit Committee is seeking members!  If you are interested in serving on the 2012 Leadership Summit Planning Committee, please let Rebecca know by email at

The purpose of the Leadership Summit Committee is to manage the annual Leadership Summit. This includes selection of dates and location for the 2013 Leadership Summit, development of the topic focus, identification of speaker(s) to support the topic, and overall management of the 2012 Leadership Summit. This Committee will determine their meeting schedule and will meet as needed. Any NCHN member is eligible to serve on the Leadership Summit Committee.

2012 Annual Conference Planning Committee

The 2012 Annual Conference Planning Committee is forming to plan the upcoming 2012 Annual Educational Conference scheduled for April 15 – 18, 2012 in Denver, CO.  The first meeting will be on Monday, November 7 at 2:00 PM ET.  If you are interested in serving on the 2012 Conference Planning Committee and have not signed up, please let Rebecca know by email at   

The purpose of the 2012 Conference Planning Committee is to organize and plan the Annual NCHN Conference. This includes selection of dates and location for the 2013 annual conference, development of the theme and workshops to support the theme, and overall management of the 2012 conference. The committee will meet bi-monthly on the first and third Monday of the month at 2:00 PM ET.  Heather Fuller, NCHN Vice-President will chair the committee.  Any NCHN member is eligible to serve on the 2012 Annual Conference Planning Committee.



ED Opening at North Country Health Consortium

Application deadline: November 23, 2011

The Northern NH Area Health Education Center/North Country Health Consortium is seeking a highly experienced leader to become its Executive Director. The ideal candidate will have an appropriate Masters Degree in public health, health systems administration, or similar.

AHEC/NCHC is a workforce education development center and vertical network of not for profit organizations. The Executive Director will lead innovative collaboration to improve health access to a regional population in the rural White Mountains of Northern New Hampshire.

Highly qualified candidates should submit letters of interest and curriculum vitae to the Chair of the Search Committee, Edward D Shanshala II, by email at Ed.Shanshala@ACHS-Inc.Org or by mail to 25 Mount Eustis Road, Littleton, New Hampshire 03561.



PARTNER BLURBS Upcoming Events for NRHD is including events planned for National Rural Health Day. Don't forget to submit yours and share what you will be doing to Celebrate the Power of Rural.




HHS Conference Call: Affordable Care Act 101

November 1, 2011 @ 12:30 PM EST

Did you know...?

  • young adults can stay on their parent’s health insurance until the age of 26, even if they don’t live at home or are married?
  • there is now a plan for people with pre-existing conditions to access health insurance called the Pre-Existing Condition Insurance Plan?
  • 8 million children who are currently uninsured are eligible to receive care through the Children’s Health Insurance Program known as CHIP?

There are millions of people who lack access to health care, essential for healthy children, families and communities, throughout the United States.  Many families don’t know what their options are to access better care.

NOW YOU CAN LEARN MORE about many provisions that are currently in place that could help you and those in your congregation or community.

The Affordable Care Act expands access to care, ends abuses of insurers, and makes health care more affordable.  The law helps those with pre-existing health conditions, people who are under age 26 and without health insurance, the most vulnerable in our society and those who are currently insured.  To learn more about the health care law and how to access health care benefits in your community, RSVP to attend the HHS Affordable Care Act 101 Conference Call.


SNHPA Webinar: Addressing Declining Third Party Reimbursement for 340B Drugs

November 3, 2011
1:00 - 2:30 PM EST

Who Should Attend: Pharmacy directors, CFOs, supply chain staff, contracting staff, government relations staff, and in-house counsel.

Registration Deadline: Nov. 1, 2011

A number of 340B hospitals and health centers are reporting to Safety Net Hospitals for Pharmaceutical Access (SNHPA) that several third party payors and their pharmacy benefit managers (PBMs) are offering 340B-specific reimbursement rates at levels that are well below those which they offer non-340B pharmacies. At least one PBM contract requires providers to pass along their entire 340B savings, which would essentially rob 340B providers of the entire 340B discount to which they are entitled under federal law. The purpose of giving safety net providers access to 340B discounts is to enable them to stretch their scarce resources to provide much-needed care to indigent and low income patients. Without adequate reimbursement – which SNHPA views as a direct attack on the 340B program itself and its statutory purpose – 340B hospitals face millions of dollars in lost revenue and an eroded capacity to provide this care.

SNHPA continues to monitor these troubling developments and is taking action on a variety of fronts to address the problem.


Emergency Alert System (EAS) Nationwide Test - November 9

On November 9, 2011, at 2:00 p.m. Eastern Time the Federal Communications Commission and FEMA will conduct the first-ever nationwide test of the Emergency Alert System (EAS). An announcement will come on every TV and radio channel indicating that there is an emergency. This will only be a test and you do not need to take any action. The purpose of this test is to find out how well the EAS can alert the public about dangers to life and property in the event of an actual emergency.


HRSA Health IT & Quality Webinar

“Tips For Overcoming the Gray Areas of Meaningful Use Stage 1 for Safety Net Providers”

November 18, 2011 @ 2:00 PM EST




Rural Hospitals are in Jeopardy
If the Super-Committee fails to meet the Thanksgiving deadline, projected cuts to rural facilities over the next 10 years will be $6 billion

(From NRHA > Government Affairs > Congressional Action Kit)
As part of the debt ceiling bill, a 12-person "Super Committee" was established and tasked with finding an additional $1.5 trillion in cuts to the deficit by Thanksgiving.  If Congress deadlocks and fails to pass the plan or enacts less than $1.2 trillion in cuts by Dec. 23, across-the-board spending cuts would be triggered to make up the difference between the committee number and the $1.2 trillion savings goal, largely affecting Medicare. Under the Budget Control Act of 2011, if Congress fails to meet the $1.2T budget reduction goal by November 23, 2011 an automatic sequestration process will reduce government spending programs, including up to a 2% reduction to Medicare. Decreasing Medicare payments to Critical Access Hospitals (CAHs) will push many of these rural hospitals to the brink of closing their doors. (READ MORE from NRHA in Rural Hospitals Hurt in Sequestrian)

What You Can Do
Forward this letter (doc) to your representatives and ask them to sign it and send it to the Joint Select Committee on Deficit Reduction in support of rural communities.

» Click here to access NRHA’s congressional action kit, which includes more sample letters, suggestions, and tips.

Rural hospitals in crosshairs of federal budget-cutters (, October 17, 2011)
Senator Jerry Moran urges Super Committee to protect rural safety nets (Rural Health Voices, October 28, 2011)
Senators Conrad, Hoeven support Frontier States amendment (Rural Health Voices, October 27, 2011)
Super Committee meets, discusses discretionary spending (Rural Health Voices, October 26, 2011)

Just Released: Healthy People 2020 Leading Health Indicators

Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans. Healthy People 2020 contains 42 topic areas with nearly 600 objectives (with others still evolving), which encompass 1,200 measures. A smaller set of Healthy People 2020 objectives, called Leading Health Indicators, has been selected to communicate high-priority health issues and actions that can be taken to address them.


Bracing for Medicaid expansion
by Doug Trapp, amednews staff

October 3, 2011 ( - States with low physician supply could struggle to meet the demand posed by the health reform law's Medicaid expansion starting in 2014.

More than two years remain before millions of low-income Americans gain Medicaid eligibility through an expansion authorized by the health system reform law, but it's already clear the overhaul will affect some states much more than others.

Certain states in the Northeast and Midwest already cover most or all of their poorest residents. So the health reform law's Medicaid expansion to 133% of the federal poverty level should pose relatively little strain to their safety nets.


Medicaid math—fun and confusion with numbers (, October 28, 2011)

EMRs: Your transition from paper
by Pamela Lewis Dolan, amednews staff

October 24, 2011 ( - Going to electronic records is more than flipping a switch. Practices must determine what do with old charts -- and how long to hang onto them.

During the change to an electronic medical record system, the focus for many practices is on how data will be collected, stored and analyzed going forward. But in most cases, there are many years' worth of historical data in paper files that physicians will need post-EMR.

Many practices are left wondering what data should be transferred to the EMR and how. And what happens to the data that remain on paper?


Two New CMS FAQs: Counting Thresholds in Multiple Certified EHR Environments
by Louis Winzlow

October 29, 2011 ( - Two New CMS FAQs: Counting Thresholds in Multiple Certified EHR Environments

CMS has issued two new FAQs that address the issue of how providers should count meaningful use objective thresholds when utilizing different certified EHR technologies in different settings. This could be an issue for those that are, for example, utilizing a certified ED EHR that’s different than the hospital’s certified inpatient EHR and not interfacing every objective’s numerator data captured in the ED back to the inpatient (HIS) side (which would be common in this dual-system circumstance).  

According to the FAQs:
For the clinical quality measures objective, “eligible hospitals and CAHs that have multiple systems should generate a report from each of those certified EHR systems and then add the numerators, denominators, and exclusions from each generated report in order to arrive at a number that reflects the total data output for patient encounters in the relevant departments of the eligible hospital or CAH.”


CMS: Rural Health Clinic Claims on Hold

October 28, 2011 ( - CMS has identified a claim processing problem impacting Rural Health Clinic (RHC) claims where claims submitted with more than one preventative service results in double reimbursement. We are holding RHC claims, type of bill 71X, submitted with more than one of the preventative services noted in change request (CR) 7208 found on the CMS Web site (PDF, 210 KB). As soon as a system fix is in place and successfully tested, these claims will be released for processing.


Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery Facilities for Approval of Deeming Authority for Rural Health Clinics
Comment Request

Oct 28, 2011 ( - Comments are being requested by Centers for Medicare & Medicaid Services on this proposed notice with comment period that acknowledges the receipt of a deeming application from the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for recognition as a national accrediting organization for rural health clinics (RHCs) that wish to participate in the Medicare or Medicaid programs.


CMS redesigns Medicare ACOs to be more appealing to physicians
by Charles Fiegl, amednews staff

October 31, 2011 ( - Organized medicine continues to review the final rule but welcomes what it says are needed changes to the shared savings program.

The Obama administration's final rule on Medicare accountable care organizations removes several proposed conditions on participants in an effort to make the new shared savings payment model more enticing to physicians and other key players.

As many as 270 ACO networks are expected to participate in the Medicare pay model that encourages physicians and hospitals to coordinate patient care in a way that improves quality and saves the program money. From 2012 through 2015, Medicare could save an estimated $1.8 billion and let groups share in $1.3 billion in bonuses for hitting savings targets, thus saving Medicare a net of about $500 million.

After criticism about its March 31 proposed rule, the Centers for Medicare & Medicaid Services released an Oct. 20 final rule that gives physicians the option to join an ACO without being exposed to financial penalties if saving targets are not achieved. CMS also softened program requirements by reducing the number of quality measures physicians must report and removing a condition that at least 50% of participants must satisfy meaningful use standards for electronic medical records.




ORHP Funding Announcement: Rural Health Care Services Outreach Program

The Office of Rural Health Policy (ORHP) is pleased to announce the release of the FY 2012 Rural Health Care Services Outreach Grant Program (announcement number: HRSA-12-083). ORHP’s Outreach Program supports projects that demonstrate effective models of outreach and service delivery through collaboration, adoption of an evidence-based or promising practice model, demonstration of health outcomes, replicability and sustainability. Proposed projects will have an outcomes-oriented approach that will enhance and sustain the delivery of effective health care in rural communities by tracking specific health indicators that will demonstrate the impact of their project at the end of their grant period. They will be based on evidence-based or promising practice models in order to avoid “reinventing the wheel” and demonstrate health status improvement in rural communities. Proposed Outreach projects can take the framework of an evidence-based or promising practice model and tailor it to their community’s need and organization.

Applicants may propose funding for up to three (3) years from May 1, 2012 to April 30, 2015. The maximum award is up to $150,000 per year. We expect to fund approximately 80 grantees.

Closing Date: November 22, 2011

TA Call
A technical assistance call was held on September 29, 2011 (Thursday). The call was recorded and available for playback. To access the playback, please call: 1-800-229-6331. It will be available until November 22, 2011.

For further questions on this funding opportunity, please contact the program coordinator, Kathryn Umali, 301-443-7444,

Need help writing your Outreach Program application?
Contact your State Of-fice of Rural Health (SORH) for grant-writing resources. Please visit: to find your SORH contact information. A webinar about evidence-based/promising practice mod-els and evaluation will be posted on starting October 7, 2011.


Public Education Efforts To Increase Solid Organ Donation Program

Deadline: November 16, 2011

Description: The purpose of this program is to support the implementation of public education and outreach programs that show promise of increasing organ donation.  Specifically, this program supports the replication of strategies that have been identified through the research grant program of the Division of Transplantation as effective in increasing donation or strategies identified in the public health literature as being effective in modifying health behavior.  The program also supports the implementation of public education and outreach efforts that are based on an established framework for successful public health outreach programs.  This grant program is supportive of the Division's mission to educate the public about deceased donation and to encourage individuals to document their decision to be a donor in their statewide donor registry or by some other mechanism where a registry is unavailable. Projects may also increase knowledge of opportunities to donate specific organs or organ sections while living and the process, risks, and benefits of living donation. 

Eligibility: This funding opportunity is open to nonprofit providers, including faith-based and community organizations.

Funding: Up to four awards, with funding from $250,000 to $1,000,000.


Social and Behavioral Interventions To Increase Solid Organ Donation

Deadline: November 30, 2011

Description: This grant program is to increase solid organ donation and to improve understanding of how to increase solid organ donation.  The goal of the grant program is to assist eligible entities in the evaluation of, or the implementation and evaluation of, highly promising strategies and approaches that can serve as model interventions for increasing solid organ donation. Projects may focus on community education and outreach initiatives or hospital based efforts focused on family consent for donation when a death has occurred. Projects may also increase knowledge of opportunities to donate specific organs or organ sections while living and the process, risks, and benefits of living donation.

Eligibility: This funding opportunity is open to nonprofit providers, including faith-based and community organizations.

Funding: Up to four awards, with funding from $300,000 to $1,250,000.




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