Patient Protection & Affordable Care Act, US Senate 2009: Frontier Provisions

1. Patient Protection & Affordable Care Act, US Senate 2009: Frontier Provisions Beth Landon beth.landon@uaa.alaska.edu Immediate Past-President, NRHA Director, Alaska Center for Rural Health – AHEC, UAA

2. Final Thought – 4 Pillars for RED Data Collection p. 1248 • Education • Public Infrastructure • Social Infrastructure • Entrepreneurialism Title XXXI – Data Collection, Analysis and Quality SEC. 3101. “(f) Data on Rural Underserved Populations. - The Secretary shall ensure that any data collected in accordance with this section regarding racial and ethnic minority groups are also collected regarding underserved rural and frontier populations.”

3. Frontier HPSA, p.1274 • Title V – Health Care Workforce • Subtitle A – Purpose and Definitions • (18) Frontier Health Professional Shortage Area. • The term ‘frontier health professional shortage area’ means an area • “(A) with a population density less than six persons per square mile within the service area; and • “(B) with respect to which the distance or time for the population to access care is excessive. • Inserted by WY Senator Enzi and AK Senator Murkowski during the HELP Committee hearings

4. National Health Care Workforce Commission SEC. 5101 National Health Care Workforce Commission. (a) Purpose. – It is the purpose of this section to establish a National Health Care Workforce Commission. . .. P. 1279 (ii) who will provide a combination of professional perspectives, broad geographic representation, and a balance between urban, suburban, rural and frontier representatives. - Inserted by NM Senator Bingaman, from his April 2009 workforce bill

5. Independent Medicare Advisory Board Under the bill, the proposed Medicare board must “give priority to recommendations that extend Medicare solvency” and include recommendations that: “protect and improve Medicare beneficiaries’ access to necessary and evidence-based items and services, including in rural and frontier areas.” - Introduced by WV Senator Rockefeller

6. 1.0 Floor on the Wage Index for Frontier States -Pages 208-212 – Wage Index Floor for Hospitals and Physicians in Select “Frontier” States (section 10324)- Would establish and apply a hospital wage index floor of 1.0 for inpatient hospital services and outpatient services in "frontier" states (defined as any state where more than half of its counties have a population density of less than 6 persons per square mile. A floor of 1.0 would also apply to the practice expense for physician services provided on or after January 1, 2011 in these frontier states. - This addition was introduced by NV Senator Reid as part of the Manager’s Amendments. It expands a provision for Alaska to also include Montana, Nevada, South Dakota, North Dakota and Wyoming.

7. Frontier Clinic Grant Program • Proposed Frontier Clinic Grant Program • Block funding, to support (24/7) staff, equipment, and facility upgrades • Would provide support to frontier clinics in Alaska, Montana, New Mexico, Montana, Wyoming, California, Oregon and other states • Would save Medicare dollars by reducing hospital admissions and medevacs • Eligibility • 1) The clinic must be located in a community where the closest short-term acute care hospital or critical access hospital is at least 60 miles/60 minutes from the community or is inaccessible by public road; and 2) designed to address the needs of – • seriously or critically ill or injured patients for stabilization prior to transport to definitive care; and • patients who need monitoring and observation for a limited period of time. • - This amendment was not successfully included in the bill