Conrad State 30 & Physician Access Act introduced in Senate

The National Rural Health Association applauds the introduction of the bipartisan S.1189, the Conrad State 30 & Physician Access Act introduced by Sens. Jerry Moran (R-KS), Susan Collins (R-ME) and Heidi Heitkamp (D-ND).

This legislation will improve and make permanent the Conrad State 30 program, also known as the J-1 Visa Waiver program. This program was enacted in 1994 as a national initiative that permits states to recommend visa waivers for physicians recruited to care for patients in rural and underserved areas. The Conrad State 30 & Physician Access Act removes the sunset of the program, improves its functioning, and allows it to expand its scope to better meet the needs of rural America.

NRHA supports this legislation, which makes great strides in the recruitment of physicians to rural areas and the delivery of vital health care services in rural America. The Conrad State 30 program will help hospitals, clinics and group practices increase access to health care in rural America.

NRHA’s Rural Health Congress approves new policies

The Rural Health Congress recently approved five new policy papers.

The National Rural Health Association’s policy-making body, the Rural Health Congress, determines the association’s positions on public policy through a series of policy briefs and issue papers. The congress consists of elected representatives from each of the association’s constituency groups and councils as well as Board of Trustees officers.

The Comprehensive Quality Improvement in Rural Health Care policy paper is an update of the 2007 paper. It updates the definition of quality of care with a renewed focus that emphasizes patient and family engagement, care coordination, and population health. NRHA can play an essential role to ensure that local, state and federal partnerships are strong, committed and aligned to support comprehensive quality improvement strategies and infrastructure needed to promote continuous quality improvement in rural health care.

The Designation of Frontier Health Professional Shortage Areas policy paper demonstrates that the additional resources available to communities federally designated as Health Professional Shortage Areas (HPSA) are critical to allow safety net providers, including those serving populations in frontier areas, to serve their patients with adequate support staff, up-to-date equipment, and appropriate medications. The HPSA criteria currently in place does not ensure access to federal resources in areas with sparse or geographically isolated populations, which often experience the greatest challenges to recruiting health care professionals. The paper recommends the HPSA criteria take into account the unique characteristics and challenges of sparsely populated and geographically isolated areas. A separate designation of frontier HPSA would address many of these issues.

The Future of Rural Behavioral Health policy paper outlines the limits rural residents have in accessing behavioral health care. Attracting, broadening and training the workforce, addressing reimbursement and financing issues with appropriate compensation for professional behavioral health care providers and affordable options for patients, fostering the integration of health care services with care coordination and referral networks, being mindful of the changing cultural landscape in rural areas, and utilizing tele-behavioral health will all play essential roles in reducing health disparities in rural communities. Leadership is critically needed to advance comprehensive policies at every level that ensure the availability, accessibility, affordability and acceptability of quality behavioral health services for rural Americans.

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Senators, NRHA members speak against CAH cuts in president’s budget

Senators and testifying witnesses expressed concerned over the proposed cuts to critical access hospitals (CAHs) in the president’s budget, during today’s Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies hearing on rural health programs in the Health and Human Services fiscal year 2016 budget,

The budget calls for reducing reimbursement for all CAHs from 101 percent of “reasonable costs” to 100 percent of reasonable costs and eliminating the critical access designation for hospitals closer than 10 miles to the nearest hospital, regardless of community need, the type of facility less than 10 miles away, or the reason a governor designated the hospital as a necessary provider.

“I am concerned that some of the proposals within the department’s budget and recent regulations that have been issued would disproportionately affect rural health care and jeopardize health care access – and threaten the survival of small towns,” Chairman Roy Blunt (R-MO) said.

Sen. Jerry Moran (K-RS) raised many critical questions about the CAH program and effects such cuts would have on the rural health safety net. Moran quoted the National Rural Health Association in his exchange with Tom Morris, Federal Office of Rural Health Policy associate administrator, about the accelerated pace at which rural hospitals have been closing. Moran asked Morris for a report of not only what happens to a community when a hospital closes, but also what steps could have been taken to prevent the closure in the first place.

Morris said the department was going to continue to further study rural hospital closures. He said there isn’t a single factor behind the increase in closures, and it is very community specific.

“This is a real priority for us and we are going to work with colleagues across the department,” Morris added.

Several NRHA members testified before the committee today on the importance of rural programs and how cuts and regulations are burdening their facilities, including George Stover, CEO of Rice County Hospital District 1 in Lyons, Kan., and Tim Wolters, who serves as the director or reimbursement at Citizens Memorial Hospital and the reimbursement specialist for Lake Regional Hospital System in Missouri.

Stover said steps should be taken to minimize the regulatory burdens placed on rural health providers, adding that CAH reimbursement reductions and sequestration cuts would potentially exacerbate rural hospitals’ challenges.

Wolters also outlined challenges to rural hospitals, including patient volumes, Medicare utilization, the cumulative impact of Medicare reimbursement cuts and the increasingly complex regulatory environment.

NRHA applauds the witnesses and senators for supporting the rural health care safety net.

NRHA asks Congress to protect the funding these important rural programs receive, to protect the CAH designation and to protect the nearly 300 rural hospitals on the brink of closure.

NRHA supports reintroduction of Hospital Payment Fairness Act

The National Rural Health Association is pleased Sen. Claire McCaskill (D-MO) is reintroducing the Hospital Payment Fairness Act with Sen. Richard Burr (R-NC) as a push to repeal the piece of the Affordable Care Act that has resulted in a wage increase for all Massachusetts hospital physicians and staff at the detriment of rural hospitals across the nation.

The provision required Medicare reimbursements to all providers in a state be higher than the wage at the state’s rural hospitals. Massachusetts has only one “rural” hospital to set that floor, resulting in all wages in the state rising at the expense of other states. The Affordable Care Act establishes a pool of money for which hospital wages can be reimbursed via Medicare. Because of this, an increase for one state decreases the funds available for other states.

NRHA supported this legislation when it was previously introduced and will support it again.

NRHA applauds change in Veterans Choice Program

As of today, the Veterans Choice Program will begin using driving distance to determine the distance between a veteran’s residence and the nearest VA medical facility for the purpose of determining a veteran’s eligibility for the Veterans Choice Program based on a distance of greater than 40 miles from a VA facility. The Department of Veterans Affairs released an interim final rule making this important change.

The National Rural Health Association has been working on bringing attention to this importance issue since Congress began debating the Veterans Access, Choice and Accountability Act of 2014. While the clear Congressional intent of the law was to allow more veterans to receive care close to home, the use of a straight line distance was particularly concerning for rural communities where driving distances can be substantially longer than straight line calculations.

NRHA renewed its concerns about the 40 straight line mile in comments submitted last month in response to a VA proposed rule on the Veterans Choice Program.  NRHA is pleased the VA has made this change and will now begin allowing more rural veterans to receive the care they need.

NRHA has a strong interest in veterans care, as a disproportionate number of service men and women come from rural communities.  Similarly, a large number of veterans choose to return to rural communities at the conclusion of their service.

NRHA’s comment regarding the Veterans Choice program raised additional concerns, including the inclusion of all VA facilities in the distance calculation whether or not they provide the needed services, concerns about contracting requirements, and timeliness concerns regarding veterans application for services. The new rule will be published in the Federal Register, with comments accepted for 30 days. NRHA continues to monitor these issues.

Rural veterans face significant challenges in accessing health care services close to home.  Time, distance, and economic challenges prevent many rural veterans from receiving health care benefits through a VA facility. Preventative care and follow-up procedures are often impossible.  NRHA applauds removing barriers that prevent veterans from accessing health care services, and allowing rural veterans to have quality, timely care in their rural communities.

Help stop Medicare sequestration extension; contact Congress today

Right now, both the House and Senate are working on bills dealing with trade adjustment assistance (TAA). Essentially, these proposals pay for job training and other assistance for those who are displaced by trade.

While, the National Rural Health Association generally does not focus on trade issues, the House bill H.R. 1892 has snared health care into this bill as a pay-for. The bill, which is backed by House Ways and Means Chairman Paul Ryan, extends Medicare sequestration for one year and also cuts payments for dialysis treatments to pay for its trade adjustment assistance measures.

According to CBO, the bill would be a $700 million dollar cut to Medicare, by imposing a 0.25 percent cut in Medicare in fiscal year 2024.

Currently, the Senate version does not include these or any pay-fors. The Senate Finance Committee is scheduled to take up its own version of the legislation Wednesday.

Contact your members of Congress today and tell them not to pay for a trade bill by endangering access to care for seniors and the disabled. Rural providers and hospitals cannot continue to absorb the cuts without hurting rural America’s access to necessary health care.


NRHA applauds the Senate passage of SGR repeal

Last night, the Senate passed HR 2, the Medicare Access and CHIP Reauthorization Act, a passed by the House in March that repeals the Medicare Sustainable Growth Rate (SGR) and replace it with a payment system that promotes a higher quality of care. Six amendments were debated and rejected. The bill passed 92-8 with strong bipartisan support.

The passage of this bill marks the end of the need for an annual fix to the SGR formula that would have resulted in an over 21 percent decrease in physician reimbursement for caring for Medicare patients.

HR 2 includes multiple important programs for rural America. The bill includes a two-year extension of rural Medicare extenders such as the Low-Volume Hospital adjustments, Medicare-Dependent Hospital program, work geographic index floor under the Medicare physician fee schedule, current rural and super-rural ambulance add-on payments, and exceptions process for Medicare therapy caps. The bill also extends funding for two years to community health centers, National Health Service Corps and teaching health centers.

The National Rural Health Association applauds the inclusion of so many programs of importance to rural America. NRHA is pleased that Congress is hearing our message about the importance of rural health care and the need for robust support of programs targeting rural health care.

NRHA announces 2015 Rural Health Award recipients

The National Rural Health Association is proud to announce its 2015 Rural Health Award recipients. The following organizations and individuals will be honored April 16 during NRHA’s 38th Annual Rural Health Conference, which will attract more than 650 rural health professionals and students to Philadelphia.

“We’re proud of this year’s winners,” says Alan Morgan, NRHA CEO. “They have each already made tremendous strides to advance rural health care, and we’re confident they will continue to help improve the lives of rural Americans.”

And the winners are…

Outstanding Rural Health Program
Rural Behavioral Health Primary Care Collaborative at Western Montana Area Health Education Center

Outstanding Rural Health Program
Innovative Readiness Training Medical Mission, a Delta Regional Authority and U.S. Department of Defense collaborative

Outstanding Rural Health Organization
Sakakawea Medical Center and Coal Country Community Health Center

Louis Gorin Award for Outstanding Achievement in Rural Health
Steven R. Shelton

Rural Health Practitioner of the Year
Wendel Ellis, DO

Outstanding Educator Award
K. Bryant Smalley, PhD, PsyD

Outstanding Researcher Award
Mark Holmes, PhD

NRHA/John Snow Inc. Student Leadership Award
Alex Spencer

View the press release for more information on the honorees and Annual Conference details.

HIV outbreak calls for improved public health in rural America

By Michael Meit, NORC Walsh Center for Rural Health Analysis co-director and NRHA board member, and Brock Slabach, NRHA membership services senior vice president

The HIV outbreak in rural Scott County, Ind., took many by surprise last week. For others, the news was sad but not so surprising.

The combination of rural poverty, lack of rural public health resources and a high uninsured population is manifesting in an epidemic. The devastating truth is it has taken an HIV outbreak to point out these deficiencies. The proverbial chickens have come home to roost.

While rural communities have many assets, some also experience longstanding poverty that results in despair which often can lead to drug abuse. The 80 or more cases of HIV infection in Scott County has been linked to intravenous use of prescription pain medications. The drug of choice in this community was Opana, a long-acting form of Oxymorphone. When altered and injected it produces a powerful high. The chief Indiana health officer told the New York Times: “There’s a feeling of hopelessness within this community. They’re addicted, and they’re getting HIV because they’re addicted.”

While there is a critical need to address the underlying social conditions that lead to this sense of hopelessness, we also need to ensure that our rural communities have the health care, public health and social services resources necessary to prevent substance abuse, treat addiction, and identify and contain infectious and communicable diseases.

Our rural communities bring much to the table in addressing these challenges, including strong social networks, a culture of self-sufficiency, and robust faith communities. At the same time, however, America’s rural community systems need proper investment, training and technical assistance to effectively leverage these assets and ensure the health and wellbeing of the people they serve.

It is heartbreaking that a preventable disease like HIV has to be epidemic before it highlights what the National Rural Health Association and public health professionals have been saying for decades: Investment in both the economic and public health of rural communities is essential.

State and local governments have been slashing public health and social services funds for several years, particularly following the economic recession. At the same time, federal resources have also declined. This results in rural communities being more reliant on federal funds as an overall proportion of their budgets, even as their overall budgets have dwindled.

Together, these cuts have both decreased available funding to address social and public health issues in our rural communities, while impeding the flexibility rural areas have to address the unique issues they face. Yes, the chickens have come home to roost due to years of neglect. Let’s use this tragedy to change policy and ensure that this is the last epidemic we have to endure.

Help advance rural public health during NRHA’s Annual Rural Health Conference in two weeks, and learn about drug abuse intervention and HIV prevention and treatment efforts specific to rural areas.

Senate delivers rural hospital and VA victories, but punts SGR

Among the amendments passed to the Senate Budget Resolution (S. Con. Res. 11) early Friday, was the National Rural Health Association-supported amendment No. 356 to allow the VA to provide veterans access to non-VA health care services when the nearest VA medical facility within 40 miles from a veteran’s home is unable to offer appropriate care for the veteran.

The amendment, which passed 100-0, was authored by Sen. Jerry Moran (R-Kan.) and allows rural veterans to have quality, timely care in their rural communities.

The budget also included language to make permanent the Medicare-dependent hospital (MDH) program and the low-volume hospital (LVH) adjustments. The House passed its own budget this week, and the two versions will need to be reconciled.

NRHA is also pleased with this week’s passage of the Medicare Access and CHIP Reauthorization Act in the House, which was the first step to ensuring the seamless continuation of multiple programs of importance to rural America. The bill provides for a repeal of the flawed physician Medicare payment formula known as the Sustainable Growth Rate (SGR) and replaces it with a payment system that promotes a higher quality of care.

Of particular importance to rural America, the bill also includes a two-year extension of the LVH, MDH, work geographic index floor under the Medicare physician fee schedule, current rural and super-rural ambulance add-on payments, an exceptions process for Medicare therapy caps, community health centers, National Health Service Corps teaching health centers, and the Children’s Health Insurance Program (CHIP).

The Senate did not vote on the Medicare and CHIP Reauthorization Act before leaving for recess, but is expected to take action upon returning to Washington.  NRHA is disappointed with the Senate’s decision to punt the SGR vote and leave physicians facing a 21 percent cut in Medicare reimbursements at the end of the month. According to the Centers for Medicare and Medicaid Services, “services rendered on or before March 31, 2015, are unaffected by the payment cut and will be processed and paid under normal procedures and time frames.” NRHA urges Congress to ensure these cuts do not take effect.

NRHA will continue to advocate strong funding for the rural health safety net. Members of Congress just began a two-week recess, and the timing is crucial. Your elected officials must hear from you in support of critical rural health programs. Contact your senators and representatives today to set up a visit and invite them to your facility. Speak up at a town hall meeting, and let them know how vital these programs are to your facility and your community.

And register today to learn more about emerging issues in rural Medicare policy at NRHA’s 38th Annual Rural Health Conference in Philadelphia.