The Public Policy Forum was keynoted by Dr. Marcia Brand, Director of the Federal Office of Rural Health Policy (and the keynote speaker for Indiana’s Rural Health Public Policy Forum in January).  Alan Morgan and Greg Lynskey, of  NRHA’s Washington office provided information about this session of Congress, the implementation of the Rural provisions contained in the recently passed Medicare Reform Legislation and the 2005 Federal Budget.  (The President’s budget proposes cuts of 70% in HRSA’s rural specific programs—the largest cuts proposed for any health programs.

     Tuesday was spent calling on the members of Congress from Indiana.  The highpoint of the day was the last call of the day, when the delegation met with Congressman John Hostettler.  Other meetings included LeAnne Holdman, legislative assistant for Rep. Mike Pence; Erica Heikkila, legislative assistant to Rep. Mark Souder; Sohini Gupta, legislative assistant to Senator Evan Bayh, and Georgiana Cunningham, legislative Assistant to Senator Richard Lugar.  Several members of the group met with staff of Representative Steve Buyer Wednesday morning.

     Major issues the Indiana group raised during the hill visits included:

        Urging Congress to continue to fully fund existing rural health programs.

        Urging Congress to avoid trying to impose urban programs on rural communities, but to look to rural areas first for new models of health care delivery.

        Asking Congress and the Centers for Medicare and Medicaid Services to work together to promptly implement the rural provider provisions contained in the Medicare reform bill.

     Fully funding Title VII programs, including the Area Health Education Center (AHEC) program and other health manpower programs to assure an adequate supply of health professionals in rural America.

     Commenting on the Congressional visits, Frank Shelton reported that the congressional aides seemed much more aware of rural health issues this year than in previous years.  He noted that even some offices that did not vote for the Medicare Reform Legislation voiced their support for the Medicare provisions.  Several of the staff asked for information regarding rural health programs specific to their districts.

    On Wednesday, Dr. Elizabeth Dukes, the chief operating officer of HRSA, addressed the major issues HRSA is focusing on.  Following the adjournment of the Public Policy Forum, Shawna Girgis and Frank Shelton attended a meeting of NRHA’s State Association Council.

 Congress Receptive to Rural Health Concerns  

     Members of Congress and their health advisors continue to want input from their constituents on rural health issues.  In all of my years of meeting with Congressmen and their staff on health issues, I found much more awareness and concern for rural health issues on this visit than I have ever seen in the past.  Congressional staff were asking about how issues impacted their district, as well as requesting more information about the rural health infrastructure—the rural health clinics, rural hospitals, county health departments and other providers in their districts.

     At each visit, we took the opportunity to offer to host a round-table discussion with rural health advocates at a time and place of the Congressman’s choosing.  We also invited the Senators and Congressmen to send staff to the Annual Conference in June.  We need to continue to inform our representatives of the opportunities to improve the health of rural Indiana.  We need to make them aware of what our membership is accomplishing in their own communities.

     We had an excellent opportunity to thank those members who voted for the Medicare Reform legislation and the rural health component of that legislation.  I was impressed that even those who voted against the legislation voiced support for the rural health amendments.  As one staffer put it, “if we could have voted for the rural health amendments by themselves, we would have.”

     We are going to have the opportunity to see if those members follow through during this session of Congress.  There will be issues surrounding the regulations to implement the rural health amendments that we may need members of Congress to weigh in on.  In the face of the federal budget deficit, there will be a temptation to reduce funding for rural health—witness the 2005 Budget proposals.  Title 7, with the vitally important programs for health manpower, including the AHEC program, is in jeopardy.

     Rural health advocates in Indiana need to seize every opportunity to advocate for their issues.  Have you talked to your Congressman lately?  Invite your congressman to visit your site.  Write (actually fax or email)  about your concerns for rural health in your community—which is their district!

     If you are willing to get more involved in rural health advocacy, email or call our incoming President, Brian Shockney, or me.  Our goal over this next year is to recruit a contact person in each Congressional District who will be the prime contact for IRHA with their member of Congress.  Don’t leave it up to someone else to do it.  Call us today.

Rural Cooperative Home-Based Health Care Demonstration Program

Pre-Development Grant

Program Web Site

Purpose: Pre-planning grant funds will be used to retain a demonstration project organizer to accomplish the following:

  1.. Provide outreach to home-based health care providers, and assess worker needs,

  2.. Work with local level human service providers,

  3.. Build community support among those who have contact with the elderly (social workers,

       physicians, pharmacists, clergy, hospitals, hospice, meals on wheels, etc.),

  4.. Select and train membership for the steering committee,

  5.. Conduct a survey of potential members,

  6.. Analyze market for home-based health care services,

  7.. Prepare a business plan,

  8.. Assist in the incorporation of the cooperative,

  9.. Assist the cooperative in the preparation and adoption of bylaws and the election of a board of directors, and

  10. Hire a local cooperative service administrator and set up office.

Eligibility: Must be located in an eligible rural area; must be a nonprofit community development organization, or qualified public bodies. (See Notice of Funding Announcement for complete eligibility criteria.)

     The required forms and certifications can be downloaded from the RCDI Web site at http://www.rurdev.usda.gov/rhs/rcdi/index.htm.

Small Rural Hospital Improvement Grant Program (SHIP)

 Program Web site

Purpose: Grants to small rural hospitals to help them do any or all of the following:

  1) Pay for costs related to the implementation of prospective payment systems (PPS),

  2) Comply with provisions of the Health Insurance Portability and Accountability Act (HIPAA) of  1996, and

  3) Reduce medical errors and support quality improvement.

Eligibility: Hospitals that meet the following restrictions are eligible to apply:

  1) Small is defined as 49 available beds or less, as reported on the hospital's most recently filed Medicare Cost Report,

  2) Rural is defined as located outside a Metropolitan Statistical Area (MSA) or located in a rural census tract of a MSA as determined under the Goldsmith Modification, and

  3) Hospital is defined as a non-Federal, short-term, general acute care facility.

     Eligible hospitals are asked to submit a brief application to their State Office of Rural Health (SORH) that describes their need, and intended use and expenditure of grant funds. In turn, the SORH will prepare and submit a single grant application to HRSA on behalf of all hospital applicants. Applications are available on the program web page or by contacting your State Office of Rural Health. Note that the due date listed here is for the state application and that individual hospital applications are due to the SORH before that date. Contact your SORH for further details.

Policy-Oriented Rural Health Services Research Grant

 Program Web site

     Purpose: The Office of Rural Health Policy (ORHP) announces that approximately $900,000 in Fiscal Year (FY) 2003 funds are available for competitive grants for policy-oriented rural health services research. Individual research projects that address rural health services will be funded under this announcement.

     Eligibility: Public, private, and non-profit - including faith-based and community-based - organizations.

     Applicants are requested to notify the ORHP in writing of their intent to apply. Notification is requested no later than June 11, 2003. Completed applications must be sent to HRSA Grants Application Center (GAC), 901 Russell Avenue, Suite 450, Gaithersburg, MD 20879.

Rural Health Network Development Planning Grant Program

 Program Web Site

     Purpose: This Rural Health Network Development (RHND) Planning Grant Program supports one year of planning to develop integrated health care networks in rural areas. The program is designed to support organizations that wish to develop formal collaborative relationships among health care providers to integrate systems of care administratively, clinically, financially, and technologically. The goal of the RHND Program is to achieve efficiencies; expand access to, coordinate, and improve the quality of essential health care services; and strengthen the rural health care system as a whole. The RHND Planning Grant Program supports this overall program goal by providing support to entities in the formative stages of planning and organizing a rural health network.

     Eligibility: To be eligible to receive a grant under this program, an applicant must be a rural public or rural non-profit private entity.

     To receive a complete application kit, applicants may telephone the HRSA Grants Application Center at (877) 477-2123 and present the announcement number HRSA-04-003. All applications should be mailed or delivered to: Grants Management Officer, HRSA Grants Application Center, 901 Russell Avenue, Suite 450, Gaithersburg, MD 20879, telephone: (877) 477-2123, e-mail: hrsagac@hrsa.gov.

Impact of Smoking Ban on Restaurants and Bar Revenues Report

    The Friday, February 27, 2004, issue of CDC's Morbidity and Mortality Weekly Report will contain an article titled, "Impact of a Smoking Ban on Restaurant and Bar Revenues? El Paso, Texas, 2002." 

    The analysis found that no statistically significant changes in restaurant and bar revenues occurred after the smoking ban took effect. These findings are consistent with and add to the existing body of evidence that local and state laws making enclosed workplaces and public places smokefree do not negatively impact restaurant and bar sales or other related economic

indicators. 

Questions -please contact the OSH at 770-488-5493.

NRHA Expresses Concern Over the President's Budget

     Earlier this month, the President released his budget proposal for Fiscal Year 2005. Included in this budget are disturbing cuts to several rural programs in the budget of the Health Resources and Services Administration. For example, the budget eliminates funding for Rural Health Flexibility Grants and the Small Hospital Improvement Program and proposes dramatic cuts to the Community Access Program and Rural Health Outreach Grants. The NRHA has had conversations with the Administration and Congressional leaders in hopes of having these cuts reversed in the spending bills drafted by Congress and ultimately signed by the President later this year. We will continue to work with members to convey this important message. 

      To view the NRHA press release on the President's FY 05 budget proposal, please click on the following link: http://www.nrharural.org/pagefile/news/BudgetCuts.html

 Kaiser Family Foundation Releases New Report on

Role of Media in Childhood Obesity

     Washington Panel Discussion to Explore Role of Media/Policy Options Washington, DC - The Kaiser Family Foundation released a report today reviewing more than 40 studies on the role of media in the nation's dramatically increasing rates of childhood obesity. The report concludes that the majority of scientific research indicates that children who spend the most time with media are more likely to be overweight. Contrary to common assumptions, however, most research reviewed for this report does not find that children's media use displaces more vigorous physical activities. Therefore, the research indicates that there may be other factors related to children's media use that are contributing to weight gain. In particular, children's exposure to billions of dollars worth of food advertising and marketing in the media may be a key mechanism through which media contributes to childhood obesity.

      The report cites studies that show that the typical child sees about 40,000 ads a year on TV, and that the majority of ads targeted to kids are for candy, cereal, soda and fast food. Furthermore, many of the advertising and marketing campaigns enlist children's favorite TV and movie characters: from SpongeBob Cheez-Its to Scooby-Doo cereals and Teletubbies Happy Meals. The report also cites research indicating that exposure to food advertising affects children's food choices and requests for products in the supermarket.

      The report, The Role of Media in Childhood Obesity, brings together research from a variety of disciplines for the first time in a document that looks exclusively at the role of media in contributing to and potentially helping to reduce rates of childhood obesity.  It was presented to and discussed by a panel of experts representing entertainment media, child health advocacy, academia, and the food industry.

Key Findings:

     The majority of research finds a link between the amount of time children spend watching TV and their body weight.  While there have been several studies that do not find such a relationship, those have primarily been regional studies conducted among smaller demographic subgroups. 

     Interventions that reduce children's media time result in weight loss.  Experimental interventions indicate that there is an opportunity to reduce children's body weight by curbing the time they spend with media. 

     Most research indicates that time spent with media does not displace time spent in physical activities.  While logic suggests that kids who spend a lot of time with media spend less time in more active behaviors, a review of the research indicates that the evidence for this relationship is surprisingly weak. Children who watch less TV may be replacing TV time with other relatively sedentary activities such as reading books, talking on the phone, or playing board games instead.

The report is available online at: http://www.kff.org/entmedia/entmedia022404pkg.cfm  

NRHA RECOGNIZES RURAL HEALTH CHAMPIONS

From NRHA:

(Washington, D.C.) The National Rural Health Association (NRHA) is pleased to announce the recipients of the NRHA 2004 Legislative Awards, which were presented this morning in conjunction with the 15th Annual Rural Health Policy Institute, being held in Washington, D.C. The 2004 awards were given to Senator Charles Grassley (R-Iowa), Senator Ben Nelson (D-Nebraska), Representative Earl Pomeroy (D-North Dakota), and Representative Doug Bereuter (R-Nebraska). In addition, congressional staff awards were presented to Kim Keymer from the office of Representative Jerry Moran (R-Kansas) and Bruce Lesley from the office of Senator Jeff Bingaman (D-New Mexico). These individuals were selected for their efforts during the past year in promoting health care access, quality and equity in our country's rural communities.

      "Significant progress was made last year towards strengthening the rural health care system," NRHA President Dave Sniff said. "Each of these individuals played an integral role in improving the health of millions of rural Americans. We want to publicly recognize their efforts and thank them for a job well done. We look forward to continuing to work with them to promote rural health issues."

       The NRHA applauds Senator Grassley for his longstanding commitment to bringing fairness to the rural health care delivery system. As chairman of the Senate Finance Committee, Grassley kept rural Americans in the forefront while using his leadership skills to successfully craft a complicated Medicare prescription drug bill which was enacted into law late last year.

       We also commend Senator Nelson for his dedication to rural hospitals struggling under Medicare's prospective payment system. During last year's Medicare debate, Senator Nelson maintained steadfast support for these hospitals. His personal commitment led to the creation of a demonstration project studying the feasibility of a new Rural Community Hospital designation, a longtime priority of the NRHA.

       Representative Pomeroy, as co-chair of the House Rural Health Care Coalition and member of the House Ways & Means Committee, admirably worked in a bipartisan fashion to pass a Medicare bill containing a strong package of rural health provisions. Specifically, Pomeroy co-authored an amendment, enacted into law, that provided an additional incentive for physicians practicing in rural areas with the greatest scarcity of health care providers.

       Representative Bereuter served as interim co-chair of the House Rural Health Care Coalition during consideration of the Medicare bill. The progress made last year is due in large part to the dedication and commitment of the Health Care Coalition. In addition, Bereuter authored legislation, enacted into law in the Medicare bill, which ensures Medicare will not penalize physicians for choosing to practice in a rural area.

       The NRHA would also like to recognize congressional staff members who worked to improve rural health care. Kim Keymer serves as legislative director to Representative Jerry Moran. Besides, overseeing Congressman Moran's efforts as co-chair of the House Rural Health Care Coalition and Vice-Chairman of the House Veterans Affairs Subcommittee on Health, Keymer led efforts in the House to build momentum for the Rural Community Hospital Assistance Act.

       Bruce Lesley, Senior Health Advisor to Senator Jeff Bingaman, is directly involved in a wide variety of health issues in conjunction with Senator Bingaman's seats on both the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions Committee. Of particular note, Lesley led successful efforts in the Senate to improve Medicare incentive payments to rural physicians by making the program an automatic benefit. In addition, he worked to create legislation developing a federal advisory committee to study and recommend policy changes to address the growing workforce shortages.

       "Rural America is well served by each of the individuals we are honoring today," said Sniff. "I cannot thank them enough for what they have accomplished on behalf of the rural health care system."

   SAVE THE DATE
2004 Indiana Rural Health Conference

“Visions for Healthier Generations”

     Exchange ideas with statewide colleagues and learn about programs and resources that are creating the foundation for healthier generations in Indiana

       Hotel reservations for Annual Conference at French Lick:  A block of rooms for IRHA is being held at a special rate of $79 per night until May 21, 2004.  When making reservations, please call 1-800-457-4042, press 1, and tell the reservation clerk you are with the IRHA Conference. 

    The 7^th Annual Indiana Rural Health Association Conference is scheduled for June 9 to 11, 2004, at the French Lick Springs Resort, French Lick, Indiana. The speakers this year are outstanding, with many breakout sessions for everyone to enjoy.

    Nursing is featured with a Pre-Conference Workshop with 4.0 contact hours available for that session. The topic for the nursing workshop is “Psychiatric Emergencies – Crisis Assessment and Intervention.” There are two other Pre-Conference sessions as well if they interest you, the Critical Access Hospital Forum and Chronic Disease Management Workshop.

    The Conference will have a great start on Wednesday, June 9, with Miss Indiana, Bryn Chapman, singing the National Anthem and discussing her platform – S.H.I.N.E. (Strong Health Is Nutrition and Exercise). The keynote speaker is Dr. Larry Gamm, the Chief Investigator for Rural Healthy People 2010. Dr. Gamm, Dr. Greg Wilson, and Elise Papke, M.P.H., will be the participants in the Reactor Panel with Carole Kacius serving as moderator that afternoon. Wednesday night will be the annual Hog Roast, with music being provided by “Country Thunder.”

    Thursday, June 10, will start with a “Talk the Talk and Walk the Walk: Modeling for the Future of Indiana Children” walk. The first plenary session will be Connie Curran, Ed. D., R.N., F.A.A.N., discussing “Successful Recruitment and Retention In Rural Healthcare Organizations.”  Dr. Connie Curran’s career is remarkable.  She recently founded Your Virtual Executive and was founder and CEO of CurranCare, which offers a variety of executive positions in academic and multi-system health care operations.  She has published over 200 publications and several research programs, was editor of Nursing Economic$, and has held many faculty and administrative positions. She is one of the nurses we do not want to miss. Wendell Fowler will be the luncheon keynote speaker.  He will be talking about his book Eat Right, Now!  The afternoon will be free for you to explore the French Lick area or relax in the spa. That night will be the annual dinner and awards.

     Friday, June 11, starts out with, “Optional Aging: The Ultimate Initiative” by David Gobble, Ph. D., CHES. The luncheon will begin with Larry Bird discussing life in rural French Lick and the medical care that was available to him when he was growing up.  Harry Moody will then tell us about “The 122-Year-Old Man.”  The day will end at 1:00 p.m. so we can get back to our families for the weekend.

     Nurses will be offered 18.2 contact hours for the Conference.

 Join us at the 7^th Annual Indiana Rural Health Clinic in French Lick June 9 through 11, 2004.  All the information about this Conference is on our web site at www.indianaruralhealth.org.  Please check it out.

ISDH Announces Student Loan Repayment Program

     The Indiana State Department of Health announced the commencement of the Student Loan Repayment Program, which offers health care professionals partial reimbursement for their student loans after they have committed to work in a health professional shortage area (HPSA) in Indiana.  For further information, please contact Janet Chorpenning, R.N., at 1-800-809-8460 or email her at jchorpenni@isdh.state.in.us.

 Hepatitis C Treatment 

A Conference for Community Health Centers and

Local Health Departments

     The American Liver Foundation, Indiana Chapter, along with the Indiana State Department of Health and Schering Pharmaceuticals, is sponsoring a conference on Hepatitis C Treatment on March 17, 2004, from 8:30 a.m. to 3:30 p.m. at the Comfort Inn, 530 S. Capitol Avenue, Indianapolis.  For more information, contact DeLynn Cravens Brady 317/594-5074.

    That’s the message the Department of Public Health at the IU School of Medicine and the Indiana Rural Health Association are delivering to undergraduate, graduate and professional students in Indiana pursuing health-related degrees

“We want to entice people studying in health fields to consider life in rural Indiana,” said Carole Kacius, director of the Master of Public Health Program in the Department of Public Health at IUPUI. “Rural Indiana has a lot to offer and rural Indiana needs health professionals.”

    The Department of Public Health and the Indiana Rural Health Associated have joined forces to spread the word about rural health issues, policy, research and advocacy through a series of monthly events called “Frontiers in Health: Career Opportunities in Rural Health.”

    Undergraduate, graduate and professional students in the fields of dentistry, health administration, health economics, health informatics, environmental health, medicine, mental health, nursing, optometry, pharmacy, public health, statistics, veterinary medicine, wellness management, and other health related fields are invited to the second monthly event, a complimentary dinner March 2 from 5:30 to 7 p.m. The dinner will be held at the Department of Public Health. Participants are asked to rsvp to Kacius at Kacius@iupui.edu, or for more information call her 317-274-3847.

    Shawna Girgis, president of the Indiana Rural Health Association, and Dr. James Springer, director of the Indiana Area Health Education Centers, are featured speakers at the dinner.

    According to Kacius, the purpose of the monthly meetings is to provide a network for all students interested in relevant rural health issues; raise awareness of the disciplines involved with rural health provision, policy and research; provide a forum for students to express their ideas, concerns and experiences in dealing with rural health issues; and illustrate and promote grass roots rural health advocacy in Indiana.

    Efforts such as promoting rural health opportunities fit in with the Department of Public Health’s mission to improve the health of the residents of Indiana through teaching, research and community practice programs.

Indiana University–Purdue University Indianapolis
355 North Lansing Street, Indianapolis, IN 46202-2896
Phone (317) 274-7711

Frank Shelton

 Executive Director

Indiana Rural Health Association

P.O. Box 10366

Terre Haute, IN 47801

Shelton7500@msn.com

 Phone 812/238-4937 or 238-4936

 Fax 812/238-7460

www.indianaruralhealth.org