The Office of the National Coordinator for Health Information Technology has withdrawn the proposed rule establishing a certification program for electronic health records software and replaced it with a corrected version.
ONC on March 2 placed the proposed rule on the Federal Register's public inspection desk, making it available for viewing before official publication. That version, FR Doc. 2010-04665, has been replaced with version FR Doc. 2010-4991, which will be officially published in the Federal Register on March 10. Publication will start the clock for public comment periods for the proposed temporary and permanent EHR testing and certification programs.
Press Release - 3/08/2010 Atlas of Heart Disease Hospitalizations Among Medicare Beneficiaries
CDC's Division for Heart Disease and Stroke Prevention this week released the 123 page report: "Atlas of Heart Disease Hospitalizations Among Medicare Beneficiaries." CDC states that the atlas "provides for the first time statistics about heart disease hospitalizations at the county level. Data came from the Medicare records of more than 28 million people each year between 2000 and 2006 in the 50 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands. The report documented an average of 2.1 million hospitalizations for heart disease each year."
CDC points out that "heart disease is the nation’s leading cause of death. In 2010, it is estimated to cost the United States $316.4 billion in health care services, medications and lost productivity." and that when you drill down into the demographics of heart disease, there are distinctive discrepancies. CDC noted that
"In states with the highest heart disease hospitalization rate, the burden is generally two times higher than states with the lowest rates. For instance, in Louisiana there were 95.2 hospitalizations for every 1,000 Medicare beneficiaries, compared with 44.8 in Hawaii over the same six–year period."
"The heart disease hospitalization rate is much higher among blacks (85.3 hospitalizations per 1,000 beneficiaries) than for whites (74.4 per 1,000) or Hispanics (73.6 per 1,000)."
"The atlas also points out geographical differences in access to hospitals with the capability to treat heart disease patients. In 2005, 21 percent of all counties in the United States had no hospital, and 31 percent lacked a hospital with an emergency room. Specialized cardiac services are even more limited, with 63 percent of U.S. counties lacking a cardiologist outside the Veterans Affairs system."
We focused on the State Tables provided with the report, which include state-by-state breakdowns of the following:
Heart Disease Hospitalization Rates, by State, Race/Ethnicity, and Heart Disease Subtype—Medicare Beneficiaries Ages 65 and Older, 2000–2006
Number and Percentage Distribution of Heart Disease Hospitalizations, by State and Heart Disease Subtype—Medicare Beneficiaries Ages 65 and Older, 2000–2006
Percentage of Heart Disease Hospitalizations, by State and Discharge Status—Medicare Beneficiaries Ages 65 and Older, 2000–2006
Number of Health Care Facilities and Cardiologists, by State, 2005
Here are the top ten states, with the lowest overall heart disease hospitalization rates, along with their rates by subtype:
Rank
State
All Heart Diseases
Coronary Heart Disease
Acute Myocardial Infarction
Cardiac Dysrhythmia
Heart Failure
Other Heart Disease
1
Hawaii
44.8
19.3
8.7
8.5
12.0
5.0
2
Utah
51.1
23.3
8.2
9.0
11.3
7.4
3
Washington
51.4
21.8
9.2
9.8
13.0
6.7
4
New Mexico
52.7
24.2
9.7
8.9
13.4
6.3
5
Idaho
54.1
25.1
9.0
10.2
11.7
7.1
6
Colorado
55.3
22.5
9.6
11.0
13.6
8.2
7
Montana
55.8
25.0
8.4
10.3
13.2
7.4
8
Alaska
58.0
22.9
8.6
13.3
14.5
7.2
9
South Dakota
58.6
27.0
10.7
11.4
14.4
5.7
10
Vermont
58.6
27.1
12.3
11.2
13.5
6.8
And here are the bottom ten states:
Rank
State
All Heart Diseases
Coronary Heart Disease
Acute Myocardial Infarction
Cardiac Dysrhythmia
Heart Failure
Other Heart Disease
50
West Virginia
104.5
47.2
17.6
17.1
31.1
9.2
49
Louisiana
95.2
37.9
11.3
16.0
31.5
9.8
48
Kentucky
92.8
39.9
14.8
16.0
28.7
8.2
47
Alabama
90.1
38.8
12.3
15.9
25.8
9.6
46
Mississippi
88.5
34.5
12.1
14.5
29.3
10.2
45
New Jersey
85.5
35.4
12.8
15.2
24.3
10.7
44
Ohio
85.4
35.4
13.0
15.3
25.7
9.1
43
Pennsylvania
84.9
33.3
13.3
15.6
26.4
9.6
42
Arkansas
83.3
35.8
12.7
15.0
25.1
7.4
41
Michigan
82.8
36.5
13.1
14.3
23.0
8.9
Notice some regional patterns here? Also, while it’s not a perfect match by any means, overlay the state by state obesity rates and smoking rates for Seniors, and you'll see a similar cast of characters.
Greer SA, Nwaise IA, Casper ML. Atlas of Heart Disease Hospitalizations Among Medicare Beneficiaries. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2010. http://www.cdc.gov/DHDSP/library/heart_atlas/index.htm
Press Release - 3/03/2010 Proposed Rule for the Establishment of Certification Programs for Health Information Technology
A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
March 2, 2010
Today the Secretary of the Department of Health and Human Services (HHS) released a notice of proposed rulemaking (NPRM) outlining the proposed approach for establishing a certification program to test and certify electronic health records (EHRs). The HITECH Act mandates the development of a certification program which will give purchasers and users of EHR technology assurances that the technology and products have the necessary functionality and security to help meet meaningful use criteria. While we are making significant strides toward modernizing our health care system, these efforts will only succeed if providers and patients are confident that their health information systems are safe and functional.
The proposed rule incorporates two phases of development for the certification program to ensure that eligible professionals and eligible hospitals are able to adopt and implement Certified EHR Technology in time to qualify for meaningful use incentive payments. The rulemaking process will take time, so this phased approach provides a bridge to detailed guidelines to support an ongoing program of testing and certification of health IT.
The first proposed program creates a temporary certification process under which the National Coordinator would authorize organizations to assume many of the responsibilities that will eventually be fulfilled under the permanent certification program. For the permanent certification program, the rule proposes transitioning much of the responsibility for testing and certification to organizations in the private sector.
Publication of the proposed rule on the Establishment of Certification Programs for Health Information Technology is an important first step in bringing structure and cohesion to the evaluation of EHRs, EHR modules, and potentially other types of health IT. The programs will help support end users of certified products, and ultimately serve the interests of each patient by ensuring that their information is securely managed and available where and when it is needed.
Your input is essential to bringing this important process to fruition. We encourage your participation in the open public comment period.
Additional information on both of these programs and how you can comment can be found through the HHS news release issued today and at the http://HealthIT.HHS.Gov website.
The vision of the HITECH Act is unfolding rapidly, and all of us at ONC look forward to continuing to work with you to achieve the meaningful use of EHRs.
Sincerely,
David Blumenthal, M.D., M.P.P. National Coordinator for Health Information Technology U.S. Department of Health & Human Services
Press Release - 2/26/2010 FTC continues crackdown on physician associations and targets an executive director
The Federal Trade Commission recently announced a Consent Order with Roaring Fork Valley Physicians I.P.A., Inc (RFV), an independent physician association representing approximately 85 physicians, or almost 80 percent of the doctors in Garfield County, Colorado, settling charges of price-fixing and other anticompetitive conduct by RFV.
The FTC alleged that, although purporting to use a messenger model, RFV negotiated price-related terms on behalf of its members, who otherwise were competing small and solo practices. RFV increased rates by pressuring payors to include automatic cost-of-living adjustments and other terms in their provider contracts, and refusing, on behalf of its members, to messenger contracts with Medicare-based rates because of the potential of those rates to decline over time. The FTC also charged that, to enhance its bargaining power, RFV actively discouraged members from entering into individual contracts with insurers, while at the same time agreeing to contracts only if at least 80 percent of RFV's primary care physicians and 50 percent of its specialty doctors accepted the proposed contract's rates and terms. The FTC further found no efficiency enhancing or quality of care improvements based upon the collective behavior.
The FTC settlement bars RFV from encouraging, aiding or organizing its members to engage in collective price negotiations and collectively refusing to deal with insurers. In addition, RFV must terminate existing provider contracts entered into as a result of the illegal activity; for three years notify the FTC before acting as agent or messenger for providers negotiating contracts with payors; and, for three years notify the FTC before participating in any collaborative arrangement with its members.
In an unrelated matter, by a majority of 3-1, the FTC issued for public comment a decision and order settling charges that the executive director of another Colorado independent physicians association attempted to circumvent the terms of an earlier settlement between the physicians association and the Commission. This matter is significant because it targets an individual and because of the very strong dissent of one commissioner.
In a 2008 settlement agreement, the FTC issued a decision and order against Boulder Valley Individual Practice Association (BVIPA) for price fixing. The FTC alleged that BVIPA, a 365-member IPA in Boulder County, Colorado, negotiated price and other contractual terms on behalf of its members, encouraged its physicians not to contract with payors independently, and threatened payors with a boycott of its members if they refused to negotiate (or renegotiate) higher reimbursement rates. The FTC's order prohibited BVIPA from facilitating certain physician negotiations; threatening to refuse to deal with payors based upon price terms; or otherwise facilitating improper collective activity among its members, except that BVIPA is not precluded from engaging in conduct that is reasonably necessary to form or participate in legitimate joint contracting arrangements among competing physicians, such as financially or clinically integrated joint arrangements. The order also contained various notification provisions if BVIPA again acted as an agent or representative of any of its members. The Commission alleged that M. Catherine Higgins, BVIPA's executive director, sought to circumvent the FTC order, by maintaining that because she was not named personally in the previous proceedings, she was free to personally negotiate contractual agreements on behalf of BVIPA's members. The settlement with Ms. Higgins contains broad limitations and notification requirements restricting her activities as an agent or representative for BVIPA's members.
Commissioner Rosch dissented, complaining that the order was unnecessarily punitive, punishing Ms. Higgins for publicly criticizing the FTC order concerning BVIPA; overly broad, in that it prohibited Ms. Higgins from negotiating non-price terms with payors; and, contrary to what he believed to be the FTC's earlier agreement not to pursue Ms. Higgins individually, a shift he suggests might have been influenced by Anthem Blue Cross. According to Commissioner Rosch: "Today's events represent a sad conclusion to an unnecessarily sordid tale."
In a statement issued with the decision and order, the other three commissioners responded to Mr. Rosch's criticism, stating that they "had reason to believe that, absent injunctive relief against her in her individual capacity, Ms. Higgins is likely to engage in conduct that is prohibited by the BVIPA order." Additionally, the majority pointed out that, while perhaps not common, the FTC has on numerous occasions named individuals, including non-physician contracting agents in IPA consent orders, and insisted that there was nothing in the BVIPA decision and order prohibiting future action against Ms. Higgins.
The Consent Orders with RFV and Ms. Higgins are the latest in a string of enforcement actions brought by the FTC against physician groups, especially those claiming to use a messenger model in facilitating contracting between doctors and third-party payors. This is a reminder of the need to properly structure messenger model arrangements. Of particular importance, among other things, is that any entity acting as a messenger may not:
negotiate price or other competitive contractual terms with payors;
take any action to influence provider members from negotiating separately with insurers; or
refuse to convey an offer of a payor to messenger's members when requested by the payor to do so.
Press Release - 2/25/2010 OIG Advisory Opinion 10-03 – Concerning the use of a "preferred hospital" network as part of a Medicare Supplemental Health Insurance ["Medigap"] policy.
Press Release - 2/24/2010 Information exchanges have positive effect: GAO
Electronic personal health information exchanges are helping providers better coordinate patient care and root out abuse, concludes a report by the Government Accountability Office.
The review of four health information exchanges indicates that they are having a positive effect on quality of care, the GAO said in the report issued this month.
Press Release - 2/23/2010 Advancing Health Information Exchange: A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology
Today we announce the first cooperative agreement awards authorized by the Health Information Technology for Economic and Clinical Health (HITECH) Act. It marks a major milestone in our journey towards nationwide adoption and meaningful use of health information technology (health IT). One set of awards provides $386 million to 40 States and qualified State-Designated Entities to rapidly build capacity for exchanging health information across the health care system both within and between states through the State Health Information Exchange Cooperative Agreement Program. The other awards provide $375 million to create 32 Regional Extension Centers (RECs) that will support the efforts of health professionals, starting with priority primary care providers, to become meaningful users of electronic health records (EHRs). Additional awards will be made in both programs over the coming weeks. Together, these programs will help modernize the use of health information, improving the quality and efficiency of care for all Americans.
As part of the State Health Information Exchange Cooperative Agreement Program, states will play a leadership role in achieving HIE to meet health reform goals. The funds awarded will be used to establish and implement plans for statewide HIE by creating the appropriate governance, policies, and technical services required to support HIE. Developing this state-level capability will help us break down the current barriers to HIE and help providers to qualify for Medicare and Medicaid incentives under the HITECH Act. The awards will also strongly encourage states to consider participating in the Nationwide Health Information Network as an approach to HIE. This would create a pathway toward seamless, nationwide health information exchange.
While the State HIE awards will strengthen capacity for health information exchange, the Health Information Technology Extension Program awards will establish RECs to deliver direct outreach, education, and technical assistance services to health care providers in their regions. Each REC will focus most intensively on the physicians, physician assistants, and nurse practitioners who work as part of individual and small group primary care practices, as well as those who dedicate themselves to providing health care to the underserved. Primary care providers in small practices provide the great majority of such services in the U.S. but have limited resources to implement, meaningfully use, and maintain EHR systems. On-site technical assistance for these priority primary care providers will be a key service offered by the RECs. RECs will assist providers who have not adopted EHRs, as well as those who have but need help progressing to meaningful use. Regional extension centers will also help providers keep health information private and secure.
The Health Information Technology Extension Program and the State Health Information Exchange Cooperative Agreement Program are critical components to the end of a nation-wide interoperable, private and secure electronic health information system. I look forward to working in collaboration with each state and REC as they establish their programs, begin work within their communities, and promote the transformation of our health care system. I applaud each awarded entity for its dedication to the mission of improving the quality of health care and for the leadership and guidance it will provide.
Sincerely, David Blumenthal, M.D., M.P.P. National Coordinator for Health Information Technology U.S. Department of Health & Human Services
The Office of the National Coordinator for Health Information Technology (ONC) encourages you to share this information as we work together to enhance the quality, safety and value of care and the health of all Americans through the use of electronic health records and health information technology.
Press Release - 2/17/2010 CDC notes rise in use of medical technology
The rate of MRI and CT/PET scans—either ordered or provided—tripled between 1996 and 2007, according to the federal government's 33rd annual report to the president and Congress on the nation's health.
Prepared by the Centers for Disease Control and Prevention's National Center for Health Statistics, the report includes a special feature on the use of medical technology, which the agency said rose sharply. For example, for all age groups in 1996, out of 100 visits to physician offices and outpatient departments, 3.9 visits resulted in MRI/CT/PET scans being ordered or provided compared with 12.6 per 100 visits in 2007.
The study said overall U.S. life expectancy was 77.9 years in 2007, while life expectancy at birth increased more for blacks than the white population between 1990 and 2007, narrowing the gap between these two racial groups. Smoking in the U.S. decreased slightly, as the study said 20% of U.S. adults were current cigarette smokers in 2007, compared with 21% in the three previous years. The report also said men were more likely to smoke than women: 22% vs. 17%.
Meanwhile, the study reported that 47% of the population reported taking at least one prescription drug during the previous month compared with 38% between 1988 and 1994.
Press Release - 2/17/2010 2010 Olympic Medals fabricated from recovered computer parts
When Olympic champions are crowned at this year's winter games in Vancouver, these elite athletes will be taking home more than just gold, silver or bronze medals—they will be playing a role in Canada's efforts to reduce electronic waste. That's because each medal was made with a tiny bit of the more than 140,000 tons of e-waste that otherwise would have been sent to Canadian landfills.
The more than 1,000 medals to be awarded at the Vancouver 2010 Olympic and Paralympic Winter Games, which kick off today, amount to 2.05 kilograms of gold, 1,950 kilograms of silver (Olympic gold medals are about 92.5 per cent silver, plated with six grams of gold) and 903 kilograms of copper. A little more than 1.5 percent of each gold medal was made with metals harvested from cathode ray tube glass, computer parts, circuit boards and other trashed tech. Each copper medal contains just over one percent e-waste, while the silver medals contain only small traces of recycled electronics.
This is the first time that recycled materials have been added to Olympic medals, which historically have been made from mined mineral deposits refined for commercial use. Each Olympic medal is 100 millimeters in diameter, about six millimeters thick and weighs between 500 and 576 grams, depending upon the medal.
Teck Resources, the Vancouver-based company that extracted the metals used to make the medals, noted in a press release that it used a number of different recovery processes. The company shredded computers, monitors, printers and glass and then separated out steel, aluminum, copper, glass and other usable substances. The leftover shredded components were fed into a furnace operating at a temperature of 1,200 degrees Celsius in order to remove the metals that could not be recovered simply by shredding the electronic devices.
Press Release - 2/16/2010 Sebelius, Solis Announce Nearly $1 Billion Recovery Act Investment in Advancing Use of Health IT, Training Workers for Health Jobs of the Future
Grant Awards to Help Make Health IT Available to Over 100,000 Health Providers by 2014, Support Tens of Thousands of Jobs Nationwide
WASHINGTON, DC - Health and Human Services Secretary Kathleen Sebelius and Labor Secretary Hilda Solis today announced a total of nearly $1 billion in Recovery Act awards to help health care providers advance the adoption and meaningful use of health information technology (IT) and train workers for the health care jobs of the future. The awards will help make health IT available to over 100,000 hospitals and primary care physicians by 2014 and train thousands of people for careers in health care and information technology. This Recovery Act investment will help grow the emerging health IT industry which is expected to support tens of thousands of jobs ranging from nurses and pharmacy techs to IT technicians and trainers.
The over $750 million in HHS grant awards Secretary Sebelius announced today are part of a federal initiative to build capacity to enable widespread meaningful use of health IT. This assistance at the state and regional level will facilitate health care providers' efforts to adopt and use electronic health records (EHRs) in a meaningful manner that has the potential to improve the quality and efficiency of health care for all Americans. Of the over $750 million investment, $386 million will go to 40 states and qualified State Designated Entities (SDEs) to facilitate health information exchange (HIE) at the state level, while $375 million will go to an initial 32 non-profit organizations to support the development of regional extension centers (RECs) that will aid health professionals as they work to implement and use health information technology - with additional HIE and REC awards to be announced in the near future. RECs are expected to provide outreach and support services to at least 100,000 primary care providers and hospitals within two years.
"Health information technology can make our health care system more efficient and improve the quality of care we all receive," said Secretary of Health and Human Services Kathleen Sebelius. "These grant awards, the first of their kind, will help develop our electronic infrastructure and give doctors and other health care providers the support they need as they adopt this powerful technology."
The more than $225 million in DOL grant awards Secretary Solis announced will be used to train 15,000 people in job skills needed to access careers in health care, IT and other high growth fields. Through existing partnerships with local employers, the recipients of these grants have already identified roughly 10,000 job openings for skilled workers that likely will become available in the next two years in areas like nursing, pharmacy technology and information technology. The grants will fund 55 separate training programs in 30 states to help train people for secure, well-paid health jobs and meet the growing employment demand for health workers. Employment services will be available via the Department of Labor's local One Stop Career Centers, and training will be offered at community colleges and other local education providers.
“The Recovery Act’s investments are making a positive difference in the lives of America’s working families,” said Secretary of Labor Hilda L. Solis. “The investments announced today will ensure thousands of workers across the nation can receive high-quality training and employment services, which will lead to good jobs in healthcare and other industries offering career-track employment and good pay and benefits.”
The HHS and DOL awards are part of an overall $100 billion investment in science, innovation and technology the Administration is making through the Recovery Act to spur domestic job creation in growing industries and lay a long-term foundation for economic growth. In addition to the 10,000 jobs the DOL grantees expect to fill with freshly trained workers, the health IT extension centers are expected to hire over 3,000 technology workers nationwide in the months ahead. Overall, the Administration investments in health IT and training will help significantly expand an emerging industry expected to support tens of thousands of secure, well-paid jobs nationwide.
A complete listing of the state HIE, REC and job training grant recipients is as follows:
State HIE Awards:
State HIE Awardee
Award Amount
Alabama Medicaid Agency
$10,564,789
Arizona Governor's Office of Economic Recovery
$9,377,000
Arkansas Dept of Finance and Administration
$7,909,401
California Health and Human Services Agency
$38,752,536
Colorado Regional Health Information Organization
$9,175,777
Delaware Health Information Network
$4,680,284
Government of the District of Columbia
$5,189,709
Georgia Department of Community Health
$13,003,003
Office of the Governor (Guam)
$1,600,000
The Hawaii Health Information Exchange
$5,602,318
Illinois Department of Health care and Family Services
$18,837,639
Kansas Health Information Exchange Project
$9,010,066
Cabinet for Health and Family Services (Kentucky)
$9,750,000
State of Maine/Governor's Office of Health Policy & Finance
$6,599,401
Massachusetts Technology Park Corporation
$10,599,719
Michigan Department of Health
$14,993,085
Minnesota Department of Health
$9,622,000
Missouri Depart of Social Services
$13,765,040
Nevada Department of Health and Human Services
$6,133,426
New Hampshire Department of Health and Human Services
$5,457,856
Lovelace Clinic Foundation, New Mexico
$7,070,441
New York eHealth Collaborative Inc.
$22,364,782
Commonwealth of the NMI, Department of Public Health
$800,000
North Carolina Department of State Treasurer
$12,950,860
Ohio Health Information Partnership LLC
$14,872,199
Oklahoma Health Care Authority
$8,883,741
Pacific Ecommerce Development Corporation (American Samoa)
$600,000
State of Oregon
$8,579,992
Governor's Office of Health Care Reform Commonwealth of Pennsylvania
$17,140,446
Oticina del Gobernador La Fortaeza (Puerto Rico)
$7,770,980
Rhode Island Quality Institute
$5,280,000
State of Tennessee
$11,664,580
Utah Department of Health
$6,296,705
Vermont Department of Human Services
$5,034,328
Virgin Islands Department of Health
$1,000,000
Virginia Department of Health
$11,613,537
Health Care Authority (Washington)
$11,300,000
West Virginia Department of Health and Human Resources
$7,819,000
Wisconsin Department of Health and Family Services
$9,441,000
Office of the Governor (Wyoming)
$4,873,000
Total Award Amount
$385,978,640
Regional Extension Center Awards:
RECs Awardee
Award Amount
Altarum Institute, Michigan
$19,619,990
Arkansas Foundation For Medical Care
$7,400,000
CIMRO of Nebraska
$6,647,371
Colorado RHIO
$12,475,000
District of Columbia Primary Care Association
$5,488,437
Fund for Public Health New York
$21,754,010
Greater Cincinnati HealthBridge (Ohio-Kentucky)
$9,738,000
Health Choice Network, Inc.,Florida
$8,500,000
HealthInsight, Utah-Nevada
$6,917,783
Iowa IFMC
$5,508,019
Kansas Foundation for Medical Care Inc.
$7,000,000
Key Health Alliance (Stratis Health), Minnesota – North Dakota
$19,000,000
Lovelace Clinic, New Mexico
$6,175,000
Massachusetts Technology Park Cooperation
$13,433,107
MetaStar, Inc, Wisconsin
$9,125,000
Morehouse School of Medicine, Inc., Georgia
$19,521,542
New York eHealth Collaborative (NYeC)
$26,534,999
University of North Carolina, Chapel Hill
$13,569,169
Northern California Regional Extension Center
$17,286,081
Northern Illinois University
$7,546,000
Northwestern University
$7,649,533
OCHIN Inc. (Primary), Oregon
$13,201,499
Ohio Health Information Partnership
$28,500,000
Oklahoma Foundation for Medical Quality, Inc.
$5,331,685
Purdue University
$12,000,000
Qsource (Tennessee)
$7,256,155
Qualis Health, Washington - Idaho
$12,846,482
Rhode Island Quality Institute
$6,000,000
Southern California Regional Extension Center
$13,961,339
Vermont Information Technology Leaders, Inc.
$6,762,080
VHQC and the Center for Innovative Technology, for The Virginia Consortium
$12,425,000
West Virginia Health Improvement Institute Inc.
$6,000,000
Total Award Amount
$375,173,281
Job Training Awards:
Healthcare / High Growth Grant Recipient
Award Amount
Calhoun Community College
$3,470,830
Mid-South Community College
$3,391,053
South Arkansas Community College
$3,520,612
Kern Community College District (KCCD)
$2,768,572
Los Rios Community College District
$4,988,561
Mt. San Antonio Community College District
$2,239,714
San Diego State University Research Foundation
$4,953,575
San Jose State University Research Foundation
$5,000,000
San Bernardino Community College District
$4,260,863
Youth Policy Institute
$3,623,473
Spanish Speaking Unity Council
$3,559,139
Otero Junior College
$4,999,350
National Council of La Raza
$3,457,516
Providence Health Foundation of Providence Hospital
$4,953,999
DeKalb Technical College (DTC)
$2,043,859
Governors State University
$4,994,686
Indianapolis Private Industry Council, Inc.
$4,885,812
Ivy Tech Community College of Indiana
$5,000,000
Iowa Workforce Development
$3,403,164
Maysville Community and Technical College
$2,007,637
Louisiana Technical College, Greater Acadiana Region 4
$4,859,040
Southern University at Shreveport
$4,296,308
Maine Department of Labor
$4,892,213
The Community College of Baltimore County (CCBC)
$4,928,654
Macomb Community College
$4,971,642
American Indian Opportunities Industrialization Center
$5,000,000
Northland Community and Technical College
$4,996,844
MN State Colleges & Universities DBA Pine Technical College
$4,230,950
South Central College
$4,506,101
The Montgomery Institute
$4,519,625
Full Employment Council
$4,998,344
Crowder College
$3,576,760
Maryville University - St. Louis
$4,699,354
University of New Hampshire
$2,944,732
Passaic County Community College
$4,475,041
Fulton Montgomery Community College (FMCC)
$2,865,657
Hudson Valley Community College (HVCC)
$3,382,200
University Behavioral Associates, Inc.
$5,000,000
Workforce Investment Board of Herkimer, Madison, and Oneida Counties
$2,700,096
Goodwill Industries, Inc., Serving E. Neb and SW Iowa
$2,007,846
Nevada Cancer Institute
$3,262,676
Berea Children’s Home
$4,927,843
BioOhio
$5,000,000
Cincinnati State Technical and Community College
$4,935,132
Columbus State Community College
$4,605,303
Enterprise for Employment and Education
$2,373,073
Trident Technical College
$2,624,532
Florence-Darlington Technical College (FDTC)
$4,346,351
The University of South Dakota
$5,000,000
Centerstone of Tennessee, Inc.
$5,000,000
North Central Texas College
$4,150,005
San Jacinto Community College District
$4,722,919
The University of Texas Medical Branch at Galveston (UTMB)
$4,655,799
Shenandoah Valley Workforce Investment Board, Inc. (SVWIB)
$4,951,991
Workforce Training and Education Coordinating Board
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