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Witness Testimony of Marcia Brand, Ph.D., Health Resources and Services Administration, Associate Administrator, Rural Health Policy, U.S. Department of Health and Human Services

Mr. Chairman, Members of the Subcommittee, thank you for the opportunity to meet with you today on behalf of Dr. Elizabeth Duke, Administrator of the Health Resources and Services Administration (HRSA), to discuss rural access issues as they affect the nation and what is being done to meet the health care needs of the rural populations in this country.  We appreciate your interest and support of rural health care and access to care for rural veterans.

The Health Resources and Services Administration (HRSA) is the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable.  HRSA grantees provide health care to uninsured people, people living with HIV/AIDS, and pregnant women, mothers and children.  They train health professionals and improve systems of care in rural communities.  For HRSA, the Health Center program, the National Health Service Corps and rural health care needs are priorities.

The Health Center Program, a major component of America’s health care safety net for the Nation’s indigent populations for more than 40 years, is leading the Presidential Initiative to increase health care access in the Nation’s most needy communities.  Health Centers provide regular access to high quality, family oriented, comprehensive primary and preventative health care, regardless of ability to pay, and improve the health status of underserved populations living in inner cities and rural areas.

President Bush’s Initiative to expand the health centers, begun in FY 2002, will significantly affect over 1,200 communities through the support of new or expanded access points.  In FY 2001, HRSA funded 3,317 Health Center sites across the nation.  After distributing 514 New Access Point grants over the past few years, that count had grown to 3,831 sites by the end of 2006.  We expect the number of health center sites to grow to 4,053 by the end of FY 2008.   Just over half of all health center grantees serve rural populations. 

Besides the 514 new access points, HRSA has also distributed 385 grants to expand the medical capacity of existing service delivery sites; and another 340 grants to existing grantee organizations to add or expand oral health, mental health and substance abuse services.  Through these efforts the number of patients treated annually at Health Centers has grown from 10.3 million in 2001 to 14.1 million in 2005, a 37 percent increase.  Of those 14.1 million patients, 5.6 million were uninsured, 1.6 million more than were served in 2001 (a 40 percent increase).  We anticipate that health centers will serve an estimated 16.3 million patients by the end of 2008.

The National Health Service Corps (NHSC) is committed to improving the health of the Nation’s underserved by uniting communities in need with caring health professionals and supporting communities’ efforts to build better systems of care.  The NHSC provides comprehensive, team-based health care that bridges geographic, financial, cultural, and language barriers. 

Health Centers need committed staff and the National Health Service Corps plays an important role in the health center expansion.  Currently more than half of the NHSC’s doctors, dentists, nurses and mental and behavioral and other health care professionals serve in Health Centers around the nation.  Some 60 percent of all NHSC clinicians – about 2,700 health care professionals – currently work in rural areas.

HRSA’s Office of Rural Health Policy (ORHP) is charged with informing and advising the Department of Health and Human Services on matters affecting rural hospitals and health care, coordinating activities within the Department that relate to rural health care, and maintaining a national information clearinghouse.  HRSA, through ORHP, is the leading Federal proponent for better health care services for the 55 million people that live in rural America.

ORHP specifically promotes State and local empowerment to meet rural health needs in several ways: by supporting State Offices of Rural Health, by encouraging the formation of State Rural Health Associations, and by working with a variety of State agencies to improve rural health.  Through our Medicare Rural Flexibility (Flex) Grant Program, funding is provided to State governments to strengthen rural health.  The Small Rural Hospital Improvement Program (SHIP) provides funding to small rural hospitals through the States to help them pay for costs related to the implementation of the Prospective Payment System, comply with provisions of HIPAA and reduce medical errors and support quality improvement.  The State Office of Rural Health Grants are designed so the States can help their individual rural communities build health care delivery systems by collecting and disseminating information, providing technical assistance, helping to coordinate rural health interests state-wide and by supporting efforts to improve recruitment and retention of health professionals.

Additionally, the Rural Health Care Services Outreach Grant Program increases access to primary health care services for rural Americans.  The Rural Health Network Development Grant Program helps rural health providers develop community-based, integrated systems of care.  Grants support rural providers for up to three years who work together in formal networks, alliances, coalitions, or partnerships to integrate administrative, clinical, financial, and technological functions across their organizations.  The Network Development Planning Grant Program provides one year of funding to rural communities that seek to develop a formal integrated health care network and that do not have a significant history of collaboration.  We also support grants to the eight States in the Mississippi Delta for network and rural health infrastructure development and a cooperative agreement supporting targeted activities focusing on frontier extended stay clinics.  The Small Health Care Provider Quality Improvement Grant Program (SHCPQI) is designed to assist rural providers with the implementation of quality improvement strategies, while improving patient care and chronic disease outcomes.  The Rural Access to Emergency Devices (RAED) Grant Program provides funding to rural communities to purchase automated external defibrillators (AEDs) and provide training in their use and maintenance.  As you can see, HRSA administers a range of programs that serve rural communities.

HRSA also provides support staff to the Department’s cross-cutting rural efforts.  The HHS Rural Task Force is made up of representatives from each of the HHS agencies and staff offices and meets quarterly to discuss HHS programs and policies that affect the provision of health care and human services for rural Americans.  Another cross-cutting rural effort supported by HRSA is the National Advisory Committee on Rural Health and Human Services (NAC).  The NAC is a 21-member citizens’ panel of nationally recognized experts that provide recommendations on rural health and human services issues to the Secretary.

Effective, coordinated health care improves the health and well-being of Americans, regardless of where they live.  However, effective coordination is especially critical in rural communities, where services and providers are limited and resources are scarce.  The challenges of providing health care for rural communities are compounded by higher rates of poverty and lack of insurance.  Rural people are a little older and they have higher rates of chronic disease.  There are significant transportation barriers.  To provide for their needs, there are about 2,000 hospitals, nearly 1,500 of these with less than 50 beds.  There are 3,500 rural health clinics.  These facilities are located in rural areas and are authorized for special Medicare and Medicaid payments.  And there are nearly 2,000 Federally Qualified Health Centers which includes approximately 1,000 health center grantees.  Fifty-two percent of these some 1,000 centers are located in rural areas.

HRSA takes great pride in the work we do in providing better health care services for the rural population.  However, we are humbled by the significant challenges that remain for healthcare in rural areas and to the underserved.

We are pleased that the Department of Veterans Affairs is establishing an Office of Rural Health to assist the Under Secretary for Health in addressing issues affecting veterans living in rural areas.  We have contacted the individuals who are creating this Office and their charge sounds familiar.  With 20 years experience, we have some expertise regarding research and policy-making in this area.  We look forward to collaborating with the new Office and offer our assistance.

I would be happy to answer any questions at this time.