NRHA applauds House passage of vital rural health programs, asks Senate to act now

Today, the House passed HR 2, the Medicare Access and CHIP Reauthorization Act, with a strong bipartisan vote of 392 to 37. The President has indicated he will sign this bill into law when it reaches his desk.

Though strong support for the bill is building in the Senate, they have yet to schedule a vote. And they will begin a two-week recess this week, not returning until the after the March 31 deadline has passed on these programs that are critical to rural patients and providers.

The passage of HR 2 in the House is the first step to ensuring the seamless continuation of multiple programs of importance to rural America. The bill provides for a repeal of Medicare’s Sustainable Growth Rate (SGR) and to replace it with a payment system that promotes a higher quality of care.

Of particular importance to rural America, it also includes a two-year extension of 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, exceptions process for Medicare therapy caps, community health centers, National Health Service Corps teaching health centers, and the Children’s Health Insurance Program (CHIP).

But we need the Senate to act quickly. Call your senators today. Let them know just how important these programs are for rural Americans. Tell Congress to pass HR 2 before recess.

SGR replacement package continues to move forward

The House rules committee met this afternoon to discuss HR 2, the Medicare Access and CHIP Reauthorization Act. This bipartisan bill will repeal Medicare’s Sustainable Growth Rate (SGR) and replace it with a payment system that promotes a higher quality of care, developed as a result of bipartisan, bicameral agreement. It extends important rural Medicare extenders and the Children’s Health Insurance Program (CHIP) for two years.

H.R. 2 is expected to be on the House floor first thing tomorrow, with a vote anticipated just after noon. The President has said he’s ready to sign this bill into law. The Senate has yet to schedule a vote.

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.

Without congressional actions, these extenders expire on March 31. 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 has diligently worked to get the message to Congress of the importance of rural health care. And based on the inclusion of so many programs of importance to rural America, Congress has heard us.

Now, we need your help. Contact your member of Congress today. Let them know just how important these programs are for rural Americans. Tell Congress to act before the March 31 deadline to pass HR 2.

Rural Medicare extenders to expire next week

Today, the House released HR 2, the Medicare Access and CHIP Reauthorization Act, which includes important rural provisions. This bipartisan bill will repeal Medicare’s Sustainable Growth Rate (SGR) and replace it with a payment system that promotes a higher quality of care, developed as a result of bipartisan, bicameral agreement. It extends important rural Medicare extenders and the Children’s Health Insurance Program (CHIP) for two years. The House is expected to vote on H.R. 2 this week.

In the past 12 years, Congress has passed 17 temporary patches of the SGR. And again, without congressional action by March 31, the SGR will slash physician payments by nearly 22 percent.

A number of important Medicare extenders will also expire March 31 if Congress doesn’t act soon. Of particular concern for rural providers are 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 National Rural Health Association has been actively working with Congress to ensure these important Medicare extenders are included in legislation related to the SGR. The legislation released today extends these vital rural programs for two years. This extension is in line with the CHIP extension, providing an important legislative vehicle for future extensions. The bill also extends funding for two years to Community Health Centers, National Health Service Cops, and Teaching Health Centers. Clearly, Congress has heard NRHA’s message.

But the work isn’t finished yet. Contact your member of Congress today. Let them know just how important these programs are for health care in rural America. Tell Congress to act before the March 31 deadline to pass HR 2.

And join NRHA for a grassroots advocacy webinar on HR 2 and more at 11 a.m. CDT Wednesday, March 25.

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

Permanent extension of MDH, LVH programs included in Senate budget

The National Rural Health Association is pleased that the proposed Senate Republican budget released this week included several important rural provisions, including an amendment introduced by Senator Chuck Grassley (R-IA) that would make the Medicare Dependent and Low-Volume Hospital programs permanent. Unless Congress acts, these important rural designations expire at the end of the month.

Another important rural provision in the budget would allow for Medicare payments for pharmacists to offer health and wellness screenings, immunizations, and diabetes management where pharmacists are already licensed under state law to provide these services. This important change championed by Sen. Grassley would expand health services in rural America by using health professionals already practicing in rural communities.

NRHA applauds the efforts of Sen. Grassley, a true champion of rural. NRHA supports a budget that promotes important rural health care programs.

House to vote on bipartisan health care bills important for rural health

This evening, the House is set to vote on a number of health care related bills from the Ways and Means and Energy and Commerce committees. Of particular interest for rural health care are two trauma bills and one about volunteer firefighters and emergency first responders.

We all know that rural populations are less likely to have access to trauma care locally. Yet, access to trauma care can be the difference between life and death. Today the House is expected to pass under suspension of the rules two important bills to improve access to trauma care: H.R. 647 – Access to Life-Saving Trauma Care for All Americans Act and H.R. 648 – Trauma Systems and Regionalization of Emergency Care Reauthorization Act. With these bills the House explicitly affirms the importance of access to trauma care for rural Americans.

With so many rural communities relying heavily on volunteer firefighters and emergency responders, H.R. 1191 provides an important exemption from counting these volunteers as employees under the Affordable Care Act. This bill will protect local communities that rely on their volunteer emergency service providers from paying penalties or having to find money in already tight local government budgets to provide an offer of health insurance to volunteers that often already have insurance offered through their employers. This protection was passed by the House in the 113th Congress but failed to make it to the President’s desk.

Three additional bills will improve regulatory transparency for new medical therapies (H.R. 639), ensure Medicare beneficiaries are aware when they are on observation stay (H.R. 876), and addressed certain issues with durable medical equipment bidding (H.R. 284).

After passage in the House, these bills will hopefully be quickly taken up in the Senate.

Contact your members of Congress today and let them know how important these bills are for Rural America.

Former NRHA member takes No. 2 spot at HHS

wakefieldThe National Rural Health Association is pleased that former NRHA member and longtime rural health advocate Mary Wakefield will serve as acting deputy administrator of the Department of Health and Human Services (HHS).

“We are thrilled to see such a strong rural advocate assume a key position within HHS,” said Alan Morgan, NRHA CEO. “Dr. Wakefield is a stalwart champion for rural health within the administration.”

Just after Thursday’s announcement, Wakefield, a nurse from North Dakota, confirmed that rural health will continue to be one of her priorities.

She has led the Health Resources and Services Administration for the past five years.

HHS Secretary Sylvia Mathews Burwell praised Wakefield’s ability to lead “through a time of marked transformation.”

“She has improved access to health for millions of patients, strengthening America’s health care workforce,” she wrote.

Jim Macrae, currently the associate administrator for primary health care, will serve as HRSA’s acting administrator.

“He will certainly be a great person to work with as we move forward,” Morgan said.

Here we go again: HHS attacks rural hospitals

As rural hospitals rapidly close across the nation, the National Rural Health Association is appalled by yet another attempt by HHS’ Office of Inspector General (OIG) to limit rural patients’ access to health care by calling for even more payment cuts to critical access hospitals (CAHs).

NRHA calls upon the Administration and Congress to stop the flood of rural hospital closures and protect access to care for millions of rural Americans.

This morning (Monday), HHS’ OIG released a report suggesting the return of a failed payment system that led to the closure of 440 rural hospitals across the nation in the 1980s and ’90s.

In 1997, Congress created the CAH payment system to provide equitable payments to keep rural hospital doors open and preserve access to care. Now, OIG calls for a return to the failed Medicare reimbursement system (the prospective payment system) for post-acute care patients in swing beds, resulting in over a billion dollars in cuts to CAHs, the smallest of all hospitals.

Swing beds foster quicker recovery times, provide physician choice and can be the only option for rural patients who want or need to receive care close to home.

Due to numerous Medicare and Medicaid cuts and burdensome regulations, 48 rural hospitals have closed since 2010. Nearly 300 more are on the brink of closure. Acting on the OIG’s poorly reasoned recommendations will exponentially escalate the number of rural hospital closures.

Medicare could save money in many ways. But that’s not the question; the question is what is right for our rural patients and their access to high-quality services.

Contact your members of Congress today. Protect rural patients’ access to care. Support critical access hospitals. #SaveRural

NRHA monitors ACA case

Today, the Supreme Court heard oral arguments in King v. Burwell. The question before the court was whether subsidies for the purchase of health insurance on an insurance exchange can be legally provided to people in the states that have not established state exchanges, relying instead on the federal health insurance marketplace. The Affordable Care Act (ACA) stipulates that subsidies are only available for exchanges “established by the state.”

President Obama and HHS Secretary Burwell have expressed confidence the court will rule in favor of the government and find that subsides are permissible in both state and federally established exchanges. Republican members of Congress have proposed multiple contingency plans.

As many rural Americans live in states using the federal exchange, the National Rural Health Association will continue to monitor this case and its potential effects on rural health care.

The justices will meet to discuss the case privately Friday, though a decision is not expected until June.

NRHA calls for Congress to protect important rural programs

Millions of rural Americans, and rural Medicare beneficiaries, depend on their local hospitals to access primary, acute, and emergency care.

If the Medicare Dependent Hospital and Low-Volume Hospital programs expire, hundreds of rural communities will be exposed to a reduction of services in their local facility, job loss, or worse —closure of their local hospital.

Because they serve this uniquely vulnerable population, these rural hospitals operate on razor thin margins. Already 48 hospitals have closed since 2013 and right now 283 teeter on the brink of closure.  Without these vital Medicare rural health programs, rural hospitals are in even greater danger.

Expiration of other programs such as the rural work floor in the geographic practice cost index and rural ambulance payments will further hurt rural Americans’ access to health care. NRHA calls on Congress to act to avoid these dire outcomes by permanently extending the Medicare Dependent Hospital designation, Low-Volume Hospital adjustment, the current rural and “super-rural” ambulance payments, and the rural work floor in the Geographic Practice Cost Index (GPCI) now.

If these programs are allowed to expire, rural Medicare beneficiaries’ access to primary, emergency and hospital care is in serious jeopardy. Call your members of Congress today and tell them to protect these critical rural health programs.

NRHA applauds Ways and Means Committee for Medicare markup

The Ways and Means Committee favorably reported four Medicare bills in a markup held today. In his opening statement, Chairman Paul Ryan (R-Wis.) emphasized the bipartisan nature of the bills, saying  “when we have a chance to find common ground – to move our country forward – we shouldn’t shy away from that.”

The bills addressed Medicare fraud (H.R. 1021, Protecting the Integrity of Medicare Act of 2015), addressed certain issues with durable medical equipment bidding (H.R. 284, the Medicare DMEPOS Competitive Bidding Improvement Act of 2015), require patients be informed when they are held more than 24 hours on observation status (H.R. 876, the NOTICE Act), and exclude patient encounters in ambulatory surgical centers (ASC) from counting for meaningful use until EHRs are certified for use in an ASC (H.R. 887, the Electronic Health Fairness Act of 2015).

The National Rural Health Association is pleased to see the committee marking up important bipartisan legislation and continues to work with the Ways and Means Committee on issues of rural health.

Learn more about Medicare bills and other legislation impacting rural health at NRHA’s 38th Annual Rural Health Conference April 14-17 in Philadelphia.