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Frontier Extended Stay Clinics (FESC)

In remote frontier areas of the country, weather and distance can prevent patients who experience severe injury or illness from obtaining immediate transport to an acute care hospital. For residents in some of those communities, providers offer observation services traditionally associated with acute care inpatient hospitals until the patient can be transferred or is no longer in need of transport. Providing these services requires additional staffing equipment and facility capacity. However, extended stay services are not currently reimbursed by Medicare, Medicaid or other third-party payers. For several years, the Department of Health and Social Services, State Office of Rural Health, and providers have been exploring strategies that would enable reimbursement of these services. The Frontier Extended Stay Clinic (FESC) model is a result of those discussions.

The Medicare Modernization Act of 2003 authorized the Centers for Medicare and Medicaid Services (CMS) to conduct a demonstration program in which FESCs would be treated as Medicare providers. We anticipate that CMS will release a request for proposals for this demonstration program sometime this spring.

The Health Resources and Services Administration’s Federal Office of Rural Health Policy has initiated an additional demonstration program related to FESC. This demonstration program was established by the Consolidated Appropriations Act of 2004, and has funded both the Alaska FESC Consortium and DHSS to provide separate but related work on establishing a FESC. The FESC Consortium is working on operational viability and financial sustainability while DHSS continues to work on policy issues and proposed licensing and survey procedures.

The FESC Consortium is led by SouthEast Alaska Regional Health Consortium, and includes members representing Iliuliuk Family and Health Services in Unalaska, Cross Road Medical Center in Glennallen, the Friday Harbor Clinic in Friday Harbor , Washington and the Native Village of Eyak in Cordova. Evaluation of the model is being led by the Alaska Center for Rural Health at the University of Alaska in Anchorage with support from the Cecil G. Sheps Center for Health Services Research at the University of North Carolina in Chapel Hill . The FESC Consortium has established a website ( that posts minutes from each of the workgroups associated with FESC.

There are several FESC working groups, each with a particular focus and membership. The FESC Consortium Steering Committee meets monthly via teleconference and quarterly in person at one of the proposed FESC sites. The steering committee provides oversight and direction for all aspects of the FESC Consortium.

DHSS hosts the Alaska FESC Workgroup composed of a broad array of agencies or individuals who are particularly interested or impacted by the development of the FESC. The focus of this group is information sharing and the public interface of those actively working on FESC issues. Those agencies that are involved include ASHNHA, Tribal health corporations, representatives from Medicaid, Office of Rate Review, DHSS Tribal Liaison group, UAA Alaska Center for Rural Health, Alaska Primary Care Association as well as clinic directors.

The FESC National Partners includes representation from the Office of Rural Health Policy (ORHP), the Center for Medicare and Medicaid Services (CMS), the Rural Health Resource Center, the Indian Health Service, the Frontier Education Center, the Alaska FESC Workgroup, and other national, regional, and state representatives.


Pat Carr
phone: (907) 465-8618
fax: (907) 465-6861