Rural Health Safety Net and Infrastructure

Presented to the California State Legislature’s Rural Caucus

February 16, 2010

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Rural Safety NetHealth Care CoverageState and Federal Agencies Involved in Rural Health CarePotential Impact of American Reinvestment and Recovery

Act (ARRA) on Rural Health Federal Health Care ReformA Rural Patient StoryRural Health ClinicsPoints to Remember

Overview

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California’s rural health care safety net for low income and uninsured patients includes hospitals, several types of clinics, some public health departments, and also some private providers.

It also includes a variety of auxiliary health care support services, such as labs, pharmacies, radiology services, home health, and medical equipment and supply providers.

Rural Safety Net

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Hospitals in rural areas include:– Critical access hospitals (low census, basic

services)– Rural hospitals (often under 50 beds)– General acute care hospitals

Rural Safety Net

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Clinics in rural areas include:– Rural Health Clinics (RHC)– Indian Health Services (IHS)– Federally Qualified Health Centers (FQHC)– Federally Qualified Health Center Look-Alikes

(FQHC-LA)– Community Clinics

Rural Safety Net

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Public health services in rural areas can include:– Immunization clinics– Women’s health services– AIDS/HIV and tuberculosis testing

Rural Safety Net

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Private providers in rural areas include:– Individual physicians– Individual nurse practitioners– Physician groups– Physician assistants are also providers in rural

areas, but per California law, cannot own a medical practice on their own.

Rural Safety Net

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Statistically, rural areas have more Medicare patients and more patients on public insurance such as Medi-Cal, CHDP and Healthy Families.

There are also fewer insurance choices – HMOs have avoided most of the rural areas of California, or have come and gone.

Health Care Coverage

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There are many state agencies that are involved with rural health:– State Office of Rural Health (CalSORH)– California Dept of Public Health (CDPH)– Dept of Health Care Services (DHCS)– Managed Risk Medical Insurance Board (MRMIB)– First 5 County Commissions– Rural Health Policy Council (RHPC)

State and Federal Agencies

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There are also many federal agencies that are involved with rural health:– Centers for Medicare and Medicaid Services

(CMS)– Health Resources and Services Administration

(HRSA)– Federal Office of Rural Health Policy – U.S. Dept of Agriculture/Food Stamp Program

State and Federal Agencies

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There is money in the HITECH portion of the American Reinvestment and Recovery Act (ARRA) for hospitals and physicians who become “meaningful users” of electronic health records.

This funding will be available through Medicare Part B and also through Medicaid (administered by the state).

Potential Impact of ARRA

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The ARRA legislation also included funding for FQHCs’ program expansion, infrastructure and technology.

Potential Impact of ARRA

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As we know, federal health care reform has hit a snag and may not recover. The two bills that were passed in the House and Senate did include some provisions that would be helpful to rural health care providers, but not enough.

Federal Health Care Reform

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A Rural Patient Story

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Rural Health Clinics– Any legal medical provider in the state who

qualifies for RHC status can be certified. In California, this includes:HospitalsCommunity-based organizationsCountiesPhysiciansNurse practitioners

Rural Health Clinics

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Rural Health Clinics (continued)– Because of the various types of ownership, RHCs

may be licensed as departments of hospitals, as primary care clinics, or may operate under the license of the physician or nurse practitioner. Clinics that are owned by counties are exempt from licensure.

– Regardless of licensure, every RHC must be certified by Medicare.

Rural Health Clinics

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Rural Health Clinics (continued)– In order to be eligible for certification, RHCs must be:

Located in a non-urbanized area according to the Census Bureau,

in an area designated as a Health Professional Shortage Area (HPSA) or Medical Underserved Area (MUA) by HRSA, and

have a nurse practitioner, physician assistant or certified nurse midwife available to see patients at least half of the time that the clinic is open.

Rural Health Clinics

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Rural Health Clinics (continued)– California RHCs are mostly owned by hospitals or

private providers.– There are over 260 RHCs in our state – only

Missouri and Texas have more.– 40 out of 58 counties in California have at least

one RHC.

Rural Health Clinics

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The safety net in rural areas has many strands, many types of providers – hospitals, community-based organizations, public health departments, and individuals.

Strategies that work in urban environments do not always translate to rural.

Every health service in a rural area is important – collaboration rather than competition is what helps to preserve the rural safety net.

Points to Remember