Rural Health Advisory Committee
Tuesday, November 27, 2012
10:00 a.m. - 2 p.m.
RHAC Members Present: John Baerg, Tom Boe, Tom Crowley, Ellen Delatorre, Daron Gersch, Margaret Kalina, Jackie Osterhaus, Millicent Simenson, Tom Vanderwal
ORHPC Staff: Judy Bergh, Darcy Dungan-Seaver, Nitika Moibi, Anne Schloegel, Mark Schoenbaum, Kristen Tharaldson
Guests: Sunny Ainley (Normandale Community College), Virginia Barzan (Minnesota Academy of Family Physicians), Pam Biladeau (EMS Review Board), Matt Burdick (National Alliance on Mental Illness-Minnesota), Marnie Falk (Minnesota Rural Health Association), Rachel Gunsalus (RHAC intern), Mary Krinkie (Minnesota Hospital Association), Jeff Lindoo (Minnesota Pharmacists Association), Shaista Malik (Mayo Preventative Health Fellow), Britta Orr (Local Public Health Association), Rick Panning (Fairview Health System), Rebecca Radcliffe (Essentia Health), Diane Rydryk (MDH), Bethany Snyder (Senator Franken’s office), Kari Thurlow (Aging Services of Minnesota), Jonathan Watson (Minnesota Association of Community Health Centers), Karen Welle (MDH)
Welcome and Introductions
John Baerg, RHAC chair, welcomed members and guests to the meeting. All present in the room and on the phone gave introductions.
Overview of RHAC priorities
RHAC staff gave an overview of RHAC and a newly revised list of work plan priorities. Recent work plan activities include:
- Rural health systems: Staff will report on a Critical Access Hospital survey of growth and consolidation issues at the next meeting.
- Rural obstetrics: RHAC workgroup studied provider training and education issues, current obstetrics workforce analysis, hospital issues, and patient/community issues.
- Rural health workforce shortages: Governor’s Task Force recommendations have been released. RHAC will review and see where they can help move the recommendations ahead.
Legislative Issues panel
The legislative panel provides a chance for health association representatives to present their top issues and concerns for the upcoming legislative session. Overarching concerns for budgetary or programmatic cuts are shared, as well as strategies for engaging legislators on key rural health-related issues. John Baerg introduced the panelists with a brief bio on each presenter.
- Kari Thurlow, Aging Services of MN.
This association is the state's largest senior services. Their largest and growing part of membership is home care providers. Many nursing homes are also members.
Aging Services will focus on one central issue: addressing the immediate provider shortages in the long-term care field. It is being felt throughout the state and it is immediate. Nursing facility rates have been frozen for four years, meaning nursing homes cannot change their rates to account for inflation. Reimbursements have been cut 40%. Most members haven’t given wage increases for long periods. Those that have are doing it only for retention of employees, yet that requires cuts in other areas. Both recruitment and retention come up again and again in meetings with association members. Even with high unemployment overall, people are not applying for long-term care positions.
A key shortage is with nursing assistants, and the impact is already being felt in rural areas. A state survey found 25% of west central members had suspended admissions because of staff shortages. Others are increasing temporary staff, which are more expensive and affect quality ratings. Others have staff working extra hours or are short-staffed. A registered nurse can make up to 30% more in a hospital setting. Long-term care staff are very dedicated, but their positions haven’t been elevated. Many of these folks are the working poor. They cannot work extra shifts because they will no longer qualify for MinnesotaCare.
Long-term care workforce shortages are not just a long-term care issue. A sufficient health care workforce is key to an integrated care approach. To get to integration, we need to address the workforce crisis. It must be addressed this year or next. Aging Services is glad to see RHAC has workforce and aging issues among their priorities. See “The Long-Term Care Imperative: 2013 Legislative Agenda” handout.
- Rick Panning, HealthForce Clinical Laboratory Group.
The HealthForce clinical laboratory group will focus on two legislative issues: credentialing for laboratory professionals and the laboratory workforce pipeline. Since 2006, their group has been going to the legislature about credentialing for lab professionals. Concerns from several groups have been addressed (pathologists, veteran’s groups, Mayo Health System). The bill for credentialing laboratory professionals did not get a hearing or vote in the House last year. Primary opposition is a group from Missouri, based on three issues: veteran’s issues; bill did not recognize outstate certification; did not want 4-year requirement for recertification. Some Minnesota hospitals also oppose it. The bill will be reintroduced in January at the start of session.
The second legislative issue concerns the laboratory workforce pipeline. Minnesota is unique in many ways. It prevented closure of the University of Minnesota’s clinical lab science program, which has now expanded to two campuses. This program has grown from 38 to over 70 students. It also expanded two-year programs, and introduced laboratory career ladders for those individuals. There are many applicants to these programs. With the success of adding programs comes the limitation of clinical sites for students. Many are turned away, and some educational programs are cutting back slots because of a lack of clinical sites. Part of the reason for a lack of sites is systems consolidating their labs. The Clinical Laboratory Group obtained grant funding to address the lack of sites. They provided simulation experiences, which allowed more students to advance. They are now seeking grant funding to set up a permanent simulation site.
- Jonathan Watson, Minnesota Association of Community Health Centers (MCACHC)
This association represents the state's federal qualified health centers (FQHCs), which also serve as MNACHC's board of directors.
In many rural areas, community health centers (CHCs) are the access point for all residents, not just the uninsured, and are often a rural economic engine. Rural Minnesota has five community health centers (some of which operate multiple sites) serving 35,000 patients. Currently 38% of rural patients of CHCs are uninsured, 18% are private pay, and 44% are on public programs. Rural patients are very poor – disproportionate compared to other areas. Rural CHC’s have seen the number of low-income patients growing in the past few years. See MNACHC Legislative Agenda 2012 slides handout.
MNACHC’s legislative agenda has 5 items:
(1) Medicaid reimbursement. They seek to change Medicaid reimbursement policy to allow CHCs payment for a mental health and medical visit that occurs on same day. Currently there is just one payment for all services in a single day. Some other states allow CHCs to have reimbursement for mental health and medical visits on the same day. An encounter at a CHC is much less expensive than a hospital/ED encounter. Rural health clinics (80 in Minnesota) would also benefit from this change.
(2) CHC appropriation. Fund the state CHC appropriation at $5 million per year – a $2.7 million increase per year. The increase would be used for a wide range of purposes, including health care home certification, staff recruitment and retention, expanding the range of services, and partial coverage of the costs of uncompensated care. The appropriation has not been adjusted since 2007 and in fact has decreased.
(3) ACA implementation. In Massachusetts, CHCs did not see much of a decrease in uninsured patients. Legislation sought includes: (a) expanding Medicaid to all below 138% federal poverty guidelines (FPG), in part to increase access to specialty care; (b) establishing a basic health plan for those 138-205% FPG to avoid the “bronze trap” of low premiums and high cost-sharing, and to provide mental health and oral health benefits; (c) ensure CHC staff can continue to serve as navigators for health insurance enrollment; and (d) require that all qualified health plans must be in the health insurance exchange with state-defined Essential Community Providers (similar to existing HMO law).
(4) Quality measurement. Establish a robust risk adjustment methodology to recognize social determinants of health. The state currently uses uninsurance as a proxy, but this in insufficient for things like poverty, geography, language, and other socio-economic factors.
(5) Restore/maintain/expand financial support to safety net providers overall. Strategic investments in Minnesota’s safety net include rural workforce (ORHPC loan forgiveness and grants/loans); Critical Access Dental Provider payments; restore MERC/DSH payments to targeted safety net hospitals; Portico and other alternative coverage programs; and HIT investments to enable rural participation in “reform” (e.g., Accountable Care Organizations).
- Mary Krinkie, Minnesota Hospital Association (MHA).
This association represents Minnesota's 145 hospitals and 17 health systems, which employ more than 113,000 people.
Today was the 20th anniversary celebration of MinnesotaCare. Minnesota should be proud of its work insuring people and addressing issues of access and quality long before the ACA. Other things came out of that the MinnesotaCare legislation, including the Office of Rural Health & Primary Care and MERC. See “Preview of Minnesota hospital priorities for the 2013 legislative session” and a Minnesota insurance statistics handout.
MHA’s legislative agenda has 5 items:
(1) ACA implementation. Expand Medicaid to 133% FPG. MHA has supported coverage of low-income individuals for a long time. Roughly 40,000 individuals now on MinnesotaCare will be eligible for Medicaid. MHA wonders if MinnesotaCare will be phased out. If MinnesotaCare is phased out, that may free up funds in the Health Care Access Fund.
(2) Implement a MN-based health insurance exchange (HIX). MHA is concerned about how it will be implemented. Top concerns are governance structure (MHA prefers a public-private partnership with consumer involvement) and flexibility (inclusion of county-based purchasing and how new ACOs will be paid). MHA is concerned about whether the HIX is being overbuilt. MHA wants it to be easy to use and they are concerned that providers will be taxed to pay for it. The Health Care Access Fund could also be tapped to pay for a portion of the Basic Health Plan, which MHA prefers over taxing providers. Out of Minnesota’s 201 legislators, 65 are new – over a quarter are new and another quarter has only two years of experience. A lot of work must be done to educate legislators. MHA encourages RHAC to reach out and help educate the legislature, especially in the midst of this major health reform component HIX.
(3) Restore MERC funding. MHA supports full restoration. Not all hospitals have cut residency positions, but some (including Children’s Hospital) have, which will eventually affect access. Physicians trained in Minnesota are more likely to stay in state.
(4) Oppose efforts by the Minnesota Nursing Association (MNA) to set mandated staffing ratios. If hospitals are required to have the ratios, they will take RNs from other parts of the health system, including long-term care and community health centers. The American Nursing Association also opposes staffing ratios (and National Nurses United does not). Clearly there are divisions even within the nursing community on this controversial issue.
(5) Support new payment models. These include the health care delivery demonstration projects. Total cost of care contracts for Medicaid population – paying for value vs. volume. Driven by having Medicaid population having a primary care home. Members realize they need to do things differently. She also shared a handout on changes in the percentage of patients having private vs. public insurance, and changes in deductibles that often result in uncompensated care.
- Jeff Lindoo, Minnesota Pharmacists Association (MPhA).
MPhA’s legislative agenda is fairly positive. Many issues of concern will come under a bill to address quality issues. One key area is pharmacists providing immunizations, which has improved immunization rates in Minnesota. Numerous proposals have emerged in response to fungal meningitis. This bill would address compounding, which is very broadly defined, to ensure quality without impeding access in places like a rural pharmacy. MPhA is looking at changes to Minnesota’s controlled substance reporting system by removing exemptions for hospice and some long-term care providers. MPhA wants to allow access to the controlled substance system for more provider types, such as medical examiners. MPhA wants to allow Minnesota to participate in interstate data exchanges, which are especially helpful to health providers in border areas. Other groups will introduce language for an electronic tracking system for purchases of pseudoephedrine (“Sudafed”) and MPhA supports this. The costs for this electronic tracking system would be borne by drug manufacturers and not by rural pharmacies. This system is currently used in bordering states.
MPhA is looking at changes to the Pharmacy Practice Act. A group reviewed it and wants it updated to reflect changes like health care homes, pharmacies involvement in clinical care, and upcoming health reform changes. They are looking for any impediments to these new roles of the pharmacist. The broader pharmacy community will be invited to review changes and MPhA will develop legislative action based on this review.
MERC funding cut is also a concern for MPhA. It has been felt by the University of Minnesota College of Pharmacy. Pharmacy programs have expanded to Duluth, including residency seats, in part to encourage students to practice in rural areas. Finding rural clinical sites continues to be an issue and the MERC cuts exacerbate this.
Another widespread concern in the pharmacy community is the abuse of prescription drugs. Federal agencies want to address the issue, but are not always coordinated. They have established a Prescription Drug Advisory Group to analyze the issue.
- Marnie Falk, Minnesota Rural Health Association (MRHA).
The Minnesota Rural Health Association (MRHA) was created in 1994 with the help of the Minnesota Department of Health's Office of Rural Health, Minnesota Rural Partners and the Minnesota Center for Rural Health.
MRHA is still finalizing its legislative agenda. It will be looking at the recommendations from the Governor’s Health Care Task Force. MRHA has concerns about the proposed HIX, including rural patient access, enrollment limitations, and network adequacy in rural areas. MRHA has concerns about the Accountable Care Organization (ACO) model. It believes the impact on rural providers will be different and participation in ACOs may not be financially feasible for many rural providers. MRHPA would like to see alternative models for rural practices. Another issue is the digital divide, including adequacy and reliability, and the lack of information technology expertise in rural areas.
- Matt Burdick, National Alliance on Mental Illness (NAMI-Minnesota).
NAMI-Minnesota’s top legislative item is educating legislators on the current mental health infrastructure. There was substantial investment in mental health programs in 2007, but much of this funding was scaled back. NAMI-Minnesota has good evidence on what these investments have accomplished. NAMI-Minnesota’s legislative agenda includes several items:
- School-based mental health. These programs have been very successful in increasing access to children’s mental health services and keeping kids in school. School-based mental health services also help eliminate transportation issues. NAMI is looking to double the investment in this type of care, as it is currently only available in 17% of Minnesota schools.
- Crisis services. These mental health services have a huge impact in rural Minnesota. All counties are supposed to have such services, but 37 counties currently go without. NAMI is proposing grants to help those counties get crisis services in place. Crisis services work well and cost effective.
- Respite care and supportive housing. On the employment side, individual placement and support (IPS) services have been very effective in helping people get employed. NAMI-Minnesota is looking to expand the employment network so more employers participate. ARM services are also a big issue. The current payment model is unsustainable, so some providers have dropped it. NAMI would like to restructure it so more are able to participate.
- Future goals. NAMI-Minnesota would like to move mental health into an early intervention model, with more wrap around services at the very first episode. HIX is also a big issue – the benefit set, parity, basic health plan, protecting the mental health benefit set in it. Peer specialists are also a big issue in rural areas. The use of telemedicine is another – it has helped expand reach, and NAMI-Minnesota is looking for ways to support its expansion.
- Britta Orr, Local Public Health Association (LPHA).
This association represents city, county and tribal public health leaders at the local level.
LPHA’s legislative priorities are still in development, but will likely include these priorities:
(1) Protecting health and safety. Investment through local public health grants are needed for the local public health infrastructure. A recent study by NACCHO showed that local public health departments continue to suffer cuts in essential services which affects things like responding to infectious disease outbreaks, pertussis increase, measles, and emergency preparedness. Recent cuts in staffing and programs mean Minnesota is doing worse than the national average. LPHA will be educating legislators on this issue.
(2) Local Public Health Act. This also addresses the level of funding for local public health. LPHA anticipates legislative action on this in 2014. It will also be talking to federal legislators about sequestration and impacts on local public health infrastructure. These are more defensive items.
(3) Restoring support for the Statewide Health Improvement Program (SHIP). The program now covers 51 counties and the number of grants has been reduced to 18. SHIP initiatives in rural areas have been successful with its focus on “making the healthy choice the easy choice.” A five county group in Southwestern Minnesota has been working together in multiple ways, including food producers, business and community members. SHIP funding supports a farm-to-school program, safe routes to school program, active classroom activities, area farmers markets, a local Food Policy council, tobacco cessation efforts with youth, and healthy childcare initiatives. In the health care setting, SHIP expanded screening protocols for chronic disease prevention and management. It has spawned incredible cross-sector collaborations. LPHA will gather and share these stories to support continued SHIP funding.
- RHAC members speak on behalf of organizations not represented
John Baerg added that county commissioners were initially hesitant about the SHIP initiative component that gives county employees an extra hour of PTO if they become regular walkers on their breaks. Now they love it for the health benefits as well as change in organizational culture towards wellness.
Tom Vanderwal mentioned that the Minnesota Ambulance Association (MAA) is meeting today about their legislative agenda. He believes one issue MAA will promote is community paramedic legislation, among other ambulance issues.
The Minnesota Medical Association was not able to send a representative to participate on the panel. Daron Gersch was willing to speak as president-elect of Minnesota Academy of Family Physicians (MAFP). There are many similar issues for MAFP that were already mentioned. Most notable are concerns about MERC funding, how ACOs will work in rural facilities, and how to make it easier for more clinics to implement the health care home model. Just a fraction of rural clinics are using the HCH model and that speaks to the difficulty. HIX and other issues brought up by others prompt similar concerns for rural health settings and providers.
Legislative Issues Q & A
Panelists were asked for ideas for where RHAC can best address health care reform and the formation of Accountable Care Organizations (ACOs). Funding for health information exchange is a foundational issue. Long-term care providers have not been eligible for these state grants. It is important to develop models to determine whether ACOs will work in rural areas. Rural communities know their providers and are often times more integrated than urban health settings. In some cases, they are already doing ACO-like integration. They are not called ACOs and they do not involve risk sharing, but they are similar models that can lay a good groundwork.
Moving forward, privacy laws may need updated to see real health information exchange and sharing. Sometimes hospitals do not have access to pharmacy records, which does affect readmissions. Most pharmacies are now using electronic prescribing, but communications between pharmacies and hospitals or long-term care providers is “still in the dark ages.” There is faxing paper back and forth and the risk of errors goes up. There are many anecdotes of barriers to health providers placing refills, along with extensive paperwork.
Another issue to address is reimbursement for telemedicine services. It is difficult to assess how much mental health care is being done via telemedicine. In northern Minnesota, the geography alone makes it so helpful. A mental health group in central Minnesota found that patient satisfaction with tele-mental health is high. Others have used tele-psychiatry in nursing homes and it decreased the number of medications being used as well as transfers to other settings since patients were more stable. Telemedicine options in small and isolated rural settings should be explored further in dermatology and other specialty areas, and for nursing homes settings.
How can RHAC move ahead with these ideas? First, we can forward information from today’s panel to others within the Health Policy Division at the Minnesota Department of Health. Second, RHAC members as rural leaders can talk to their legislators. Third, RHAC is in a good position right now to have impact. RHAC member Tony Lourey will lead a senate health policy committee during the next session. Rural health leader Tom Huntley will lead a health policy committee on the House side. RHAC staff will continue to make efforts outside of meetings to connect with RHAC member legislators, even if they do not attend meetings.
Bethany Snyder from Senator Franken’s office gave RHAC members and guests a federal update. Congress is currently debating the fiscal cliff and sequestration. Sen. Franken wants to be in the best position he can to advocate for Minnesota. They are looking for opportunities to engage Minnesotans in talking more about these issues.
In terms of the next Congress, Sen. Franken has a list of health issues he continues to work on. Priorities include diabetes prevention (he was able to help get pre-diabetic programs this into the ACA); addressing meningitis; Medicare; ACA implementation; and Medicaid impact. He introduced the Ride Act in September 2012 to support volunteer drivers who provide low-income seniors with rides to medical appointments. Because this is an issue that largely affects rural seniors, Sen. Franken is trying to get some Republicans from states with rural areas to join. RHAC provided a letter of support to Sen. Franken’s office regarding the Ride Act. Is this helpful and are there other ways RHAC can support this effort? Yes, letters of support are helpful to let Sen. Franken and congress see there is local support.
Franken got the legislator of the year award from the National Organization for State Offices of Rural Health (NOSORH). This was largely due to his work supporting rural veterans. News of a new Office of Rural Health within the Veteran’s Administration has not gotten out to communities. Sen. Franken’s introduced legislation to address it.
Physicians in rural areas want to know what Sen. Franken is doing about reductions in Medicare costs. They are being paid about 23 cents on each dollar. Sen. Franken hopes the upcoming budget talks will provide an opportunity to repeal the Sustainable Growth Rate (SGR).
Sen. Franken supports reauthorization of two important pieces of legislation – the Older Americans Act and the Ryan White Act. He is also interested in health workforce issues. In 2013, look for an invitation to give input on this, as interest is growing on a federal level. Please contact Bethany with any questions or concerns: Bethany_Snyder@franken.senate.gov.
RHAC Work Plan Updates
RHAC staff walked through the draft RHAC Work Plan Priorities and teams for 2012-2013. RHAC members were asked for overall feedback, whether additional RHAC members wanted to join a given group, and whether additional issues/topics should be added.
- RHAC Priority Area: Health Care Reform
Margaret suggested RHAC should continue to look at funding for rural workforce issues. Tom V. mentioned that another issue is to help multiple health disciplines train people. It is not just about MERC. It also seems to be about reform. How we have the workforce needed to implement the new system and imperatives that reform calls for? Daron asked how Accountable Care Organizations (ACOs) and Health Care Homes (HCHs) will work in rural Minnesota? Until ACOs are more solidified, it is hard to identify actions to take. The HCH realm may be more useful for rural providers than focusing on ACOs, as they may be more an issue for larger systems. For rural, RHAC should make sure HCHs do not go away with the primary focus on ACOs. Jeff Lindoo asked if health plans will be part of ACOs. Somehow there has to be a common entity to accommodate smaller practices. Daron asked if telemedicine should go here or in another area? Reimbursement for telemedicine is a big issue. Staff mentioned the RHAC Telemental Health report and the possibility of updating it or redistributing it to elevate this issue.
- RHAC Priority Area: Health Promotion and Wellness
This group has not met as a team, so no specific work areas have been identified. Jackie mentioned that funding for the SHIP program seems key here. John suggested talking with rural SHIP grantees to document their successes. ORHPC’s Flex coordinator, Judy Bergh, mentioned that one of ORHPC’s goals is to integrate its programs. The Flex program is currently supporting rural providers in community needs assessments through Flex grants, and these overlap with SHIP and similar health promotion efforts. Judy encouraged RHAC members to stay informed about Flex grants in this topic area. Virginia Barzan noted that the Governor’s Task Force is looking at “Accountable Health Communities,” which is something RHAC may want to follow. There may be future opportunities for funds through ACOs to invest in community prevention and promotion.
- RHAC Priority Area: Long-Term Care and Aging
This area has a plethora of issues. Are there issues that seem especially timely? It has been a priority area in the past, but it has always been difficult to identify the best rural angles or approaches to make an impact. Jackie stated that workforce issues are huge for long-term care, and shortages affect quality as well as access. As the panel explained, there are data privacy issues to address. Also, the rate structure is important. There has not been an increase in years and this has an impact on recruitment and retention.
- RHAC Priority Area: EMS Leadership
A lot of work was done in the last year to assemble an EMS Toolkit, and this work will continue. Tom Vanderwal stated that RHAC should continue to support roll-out of Community Paramedics, including how the role can be promoted and refined. A federal grant submitted by MDH includes a Community Paramedics component, and should be followed. Workforce issues arise here, too. In northwest Minnesota, 60 percent of the EMS services are volunteer-based. How do we make this work into the future?
- RHAC Priority Area: Rural Obstetrics
RHAC member Millicent Simenson and RHAC staff Kristen Tharaldson have begun work to address three recommendations from the Rural Obstetrics report: (1) educating rural providers and hospital staff about ways to better serve American Indian women; (2) educating rural providers and staff about the role of doulas; and (3) encouraging collaboration between rural obstetric providers and public health nurses to maximize the use of local resources available to pregnant women and new parents. Millicent and Kristen recently completed work group meetings with the American Indian Infant Mortality Review committee. The committee will issue recommendations that overlap with the RHAC Rural Obstetrics report, and they will seek to coordinate follow-up on both sets of recommendations. Kristen also reported on a meeting with Sanford during one of the “Pitch the Commissioner” events. Sanford recently received a $4 million NIH grant to study social determinants of health in American Indian communities in South Dakota and North Dakota, and that research will move into Minnesota next year, with sub-grants available.
RHAC staff member Paul Jansen is a new dad. Nancy Stratman is a new grandmother. Rachel Gunsalus, who worked as an intern supporting RHAC last summer, will return to ORHPC on a part-time basis in January to work on RHAC projects.
RHAC member Ray Christensen is president-elect of the National Rural Health Association.
With the newly elected Legislature, the Governor must appoint new legislative members to RHAC. Often this is just a matter of re-appointing legislative members. ORHPC is currently awaiting word from the Governor’s office.
The state submitted a grant to the CMS that includes a workforce emphasis on Community Health Workers, Community Paramedics and Dental Therapists. Much of this came out of the workforce recommendations submitted to the Governor’s Health Reform Task Force.
ORHPC workforce analysis staff Nitika Moibi gave an update and background on the Health Reform Task Force. Its draft recommendations, a 30-page document, are just out today with public comment invited. The Task Force hopes to get its finalized recommendations to the Governor by the end of December. The recommendations encompass eight areas, including telemedicine, total cost of care, and loan forgiveness.
ORHPC communications staff Darcy Dungan-Seaver gave an update on National Rural Health Day, which occurred November 15 this year. Governor Dayton issued a Proclamation for the day and ORHPC provided templates and materials on its website. Examples of activities included an open house at Madelia Community Hospital, a website tribute to patients and the community by Paynesville Area Health Services, and a poster contest, staff appreciation lunch and more at Ortonville Area Health Services. Darcy invited suggestions for statewide activities ORHPC could coordinate next year.
Tom reported on a statewide grant application that will be submitted this week to the Helmsley Foundation. If funded, the project has great potential for rural Minnesota. It requests equipment local hospitals can use for basic life support services, and upgrades to transmission capabilities for Advanced Life Support (ALS) services.
The meeting was adjourned at 2 p.m. The next RHAC meeting will be on January 29 from 9-11:30 a.m. via videoconference.