New Group Represents Rural Health Clinics in California

A new acronym was coined last week in Sacramento — CARHC.

The first meeting of the California Association of Rural Health Clinics launched what organizers hope will be an effective advocate for “one of the most misunderstood and overlooked pieces in the health system.”

“We need to get on the radar screen in California,” said Gail Nickerson, who oversees the rural program for Adventist Health in Roseville and is a member of the new organization’s board of directors.

“Rural health is a technical term, not a generic term. One of our goals is to make sure the right people understand and appreciate the differences between rural clinics and all other kinds of clinics, like community clinics and primary care clinics,” Nickerson said.

The California fledgling is affiliated with the national acronym — NARHC, the National Association of Rural Health Clinics.

“The national organization covers changes at the federal level with CMS, but we haven’t had good advocacy here at the state level,” Nickerson said. “A lot of people are confused about what we are — and a lot of people just plain don’t know about us. We hope to change that,” Nickerson added.

Ron Nelson, associate executive director of the national association, welcomes the new acronym under the national umbrella.

“Often, issues are more easily handled at the state level rather than the national level,” Nelson said. “Each state has its own Medicaid issues and programs and because of the complexities of federal policies, we encourage states with a lot of rural clinics — like California — to organize and handle as many of those issues as possible.”

What Makes It Rural?

The Rural Health Clinics Act was passed by Congress and signed into law by President Carter in 1977. There were two main goals:

  • Encourage and support physicians’ assistants and nurse practitioners by providing reimbursement for services provided to Medicare and Medicaid beneficiaries; and
  • Increase health care accessibility in remote areas.

Federally designated rural clinics get “enhanced” reimbursement rates for treating Medicare and Medicaid beneficiaries. There are more than 3,000 federally certified rural health clinics providing care for more than seven million people in 47 states. California has 250 rural clinics.

Some hope that number goes up soon.

Pauline Campbell, vice president of off-site services for Sonora Regional Medical Center, welcomes the new organization and hopes it can bring about some changes.

Sonora Regional Medical Center — which provides care for people in Tuolumne, Calaveras and Mariposa counties — recently took over the only rural clinic in Sonora County, formerly operated by the county hospital. When the county hospital went out of business last summer, the clinic was threatened with closure as well.

“Our area in Sonora no longer qualifies for rural health,” Campbell said. “If that clinic had closed, there would be no way to re-establish it. And it’s a critical access point for our Medi-Cal patients to get services in general and to see specialists in particular.”

“We’re in an area that could definitely use more rural clinics, but because of new regulations, there are only two parts of our service area that qualify as rural,” Campbell said. “One of them is so remote, it doesn’t make sense and the other — nobody lives there,” Campbell added.

Campbell said she would welcome any help the new association can offer.

“Our clinic right now is maxed out. We’d like to have other options. When the requirements for rural status were changed a few years ago, we had no input in how that happened,” Campbell said.

“Maybe now we will. Certainly having a body to advocate for rural clinics in situations like this will be beneficial,” Campbell said.

State Licensing Official First Speaker

Kathleen Billingsley, deputy director of the California Department of Public Health’s Center for Healthcare Quality, delivered the keynote address to the new organization’s first meeting last week. The Center for Healthcare Quality oversees licensing and certification for health care facilities in the state.

“We look forward to developing a positive, collaborative relationship with CARHC and, to set the stage for future meetings, we will discuss the center’s state and federal survey responsibilities, surveyor training and the role of the California Association of Rural Health Clinics,” Billingsley told the new group.

Billingsley said meeting with associations like CARHC gives agency officials a chance to become aware of issues and situations that have “positive or adverse impact on facilities.” She added, “Through these meetings we can elicit feedback and input on significant activities such as the development of regulations, pending legislation, facility surveys, investigations and policies and procedures.”

“We welcome the establishment of regular meetings with the rural health clinic association to ensure ongoing communication and to gain the perspective of clinics operating under hospital licenses,” Billingsley said.

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