National Advisory Council
on Migrant Health (NACMH) Recommendations,
2006 (Second 2006 letter)
September
5, 2006
The
Honorable Secretary Michael O. Leavitt
Department of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201
Dear
Secretary Leavitt:
In
May of this year, the National Advisory
Council on Migrant Health[1]
met in San Antonio, Texas to continue
its work of developing recommendations
to you to improve the delivery of health
care to migrant farmworkers. The following
are the recommendations that arose out
of this meeting.
A.
Increase resource to both existing health
centers and to new access points to enable
these centers to provide ancillary services.
Such ancillary services would include
(a) outreach, (b) case management, (c)
transportation, (d) mobile services, and
(e) interpretation.
The
delivery of health care to migrant farmworkers
encounters obstacles that can only be
overcome by mechanisms that do not fall
within the traditional concept of health
care. Without integrating those mechanisms
into the day-to-day functioning of a health
center, providers and patients who are
migrant farmworkers are not connected.
To bridge this chasm, these ancillary
services need to be in place. However,
current Medicaid funding rules do not
pay for these ancillary services. As a
result, health centers must resort to
other sources such as their Federal grants
to pay for these services. Unfortunately,
these other sources are neither reliable
nor sufficient. As a result, when a health
center encounters financial stress, these
ancillary services are the first services
to be cut, which severs the link between
the provider and the patient who is a
migrant farmworker. We would not put a
doctor in a clinic without giving her/him
a stethoscope. These ancillary services
are as critical to a physician's
ability to deliver care to a migrant farmworker
as is a doctor's stethoscope. Therefore,
we would ask that you make targeted funds
available to Section 330(g) Health Centers
for these services.
B.
Reduce to 500 the number of migrant farmworkers/family
members required for Expanded Medical
Capacity.
Under
current requirements for Expanded Medical
Capacity grants, an applicant for such
a grant must demonstrate that funds will
be used to serve at least 1,000 migrant
farmworkers. The changing nature of the
agricultural industry has produced a demographic
change in migrant farmworkers such that
while the number of migrant farmworkers
has increased, the density of migrant
farmworkers in many areas has decreased.
Thus there are a substantial number of
areas in which there are a significant
number of migrant farmworkers, but fewer
than 1,000. Reducing to 500 the number
of migrant farmworkers required for Expanded
Medical Capacity grants will enable health
care centers to serve these smaller pockets
of migrant farmworkers. Such a change
would assist achieving the President's
initiative to make health care accessible
to the underserved.
C.
Identify successful systems of electronic
transfer of medical records
between health centers so that migrant
farmworkers are assured of continuity
of care.
A
migrant farmworker who receives health
care in one health center needs to have
available on an instantaneous basis the
record of that treatment in any other
center that he visits. Migrant farmworkers
may be in a local area for only a short
period of time. The transient nature of
a migrant farmworker's work, coupled
with the distance between a migrant farmworker's
work site and a health center, the work
schedule during harvest, and the other
dynamics associated with living away from
home, all mitigate against follow-up visits
to health centers by migrant farmworkers.
The treating provider in the health center
away from the migrant farmworker's home
needs access to that patient's health
care records to ensure that the treatment
provided is appropriate. In addition,
to ensure that the migrant farmworker's
regular physician is informed of care
received away from home by the farmworker,
a user-friendly method of transmitting
this information between health centers
needs to be developed. This continuity
of care is particularly important for
children of migrant farmworkers so as
to ensure that these children receive
the health care that is so critical during
their developing years. Therefore, we
would like to ask that you request HRSA
to conduct an analysis of programs utilizing
successfully methods of communication
and/or techniques for sharing patient's
medical information and to disseminate
this information for other Migrant Health
Programs to emulate.
On behalf of the National Advisory Council
on Migrant Health, we would like to again
thank you in advance for your consideration
of these recommendations.
Sincerely,
Wenceslao
Vasquez
Chair, National Advisory
Council on Migrant Health |
Robert
H. Scott, Jr.
Vice-Chair, National Advisory
Council on Migrant Health |
cc:
Dr. Elizabeth M. Duke
Mr. James Macrae
Dr. Marcia Gomez
.
_______________________________________
1) The
National Advisory Council for Migrant
Health was statutorily created by Congress
more than 30 years ago for the sole purpose
of advising the Secretary of Health and
Human Services on health matters affecting
migrant and seasonal farmworkers. Members
of this 15-person Council are appointed
by the Secretary for four-year terms.
Presently on the Council are patients
of migrant health clinics, board members
of migrant health clinics, and employees
of migrant health clinics.
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