AHA, others sue HHS over two midnight rule

Yesterday, the American Hospital Association and several other health care groups and individual hospitals filed two suits against the Department of Health and Human Services over the long-term legality of the two midnight rule.  Among other items, the suits allege that the rule is arbitrary, places undue burdens on hospitals based on unlawful standards, requires documentation that is not authorized by law and refuses proper Medicare reimbursements for some inpatient stays.  The suit, filed in the DC Federal District Court, is yet to be scheduled for motions or trial.

NRHA has long sought Congressional intervention for this problematic standard, in addition to regulatory relief for Critical Access Hospitals from the 96-hour condition of payment issue and will continue to work with Capitol Hill to ensure that all rural hospitals are able to provide appropriate, local care.

Senate Finance Committee holds hearing with Secretary Sebelius

Earlier today, the Senate Finance Committee held a hearing with Secretary of Health and Human Services Kathleen Sebelius regarding the President’s fiscal year 2015 budget request.  During the hearing, Senator Pat Roberts (R-KS) questioned Secretary Sebelius on the President’s call to reduce reimbursement to Critical Access Hospitals and expel certain facilities from the program. He also asked for regulatory relief for CAHs from the 96-hour condition of payment that has caused difficulty for many facilities.  NRHA thanks Senator Roberts for his work to protect rural health care and rural hospitals.

The House of Representatives was also active this morning, passing Representative Paul Ryan’s budget proposal for FY 2015.

Senate passes one year SGR patch

Minutes ago the Senate passed a 12 month delay of cuts scheduled to take affect under the Medicare Sustainable Growth Rate.  In addition to the delay of these cuts, the bill (H.R. 3402) would extend the Medicare Dependent Hospital Program, Low-Volume Hospital adjustment, current rural and “super-rural” ambulance payment rates, and the rural “work floor” in the geographic practice cost index.  NRHA is appreciative of efforts made to extend these programs permanently in the Senate as well as the one year extension of the programs.

NRHA also sought to include regulatory relief as part of this bill, including addressing issues with the 96-hour condition of payment rule currently experienced by Critical Access Hospitals as well as mandating that supervision levels for outpatient therapy services be reverted to a level of “general”. While these issues were not included in the package passed today, NRHA will continue to advance these efforts through NRHA-supported legislation that has already been introduced in both the House and Senate.

Senate to vote tonight on SGR

Now that the House has passed the one-year SGR patch, the Senate is scheduled to vote on the 12-month patch around 5 p.m. tonight. While NRHA is appreciative of the work done on the temporary patch, with the inclusion of many rural Medicare extenders, we continue to push for a full repeal of the SGR and a permanent extension of all rural extenders.

NRHA urges members of Congress to extend the Low-Volume Hospital adjustment, the Medicare Dependent Hospital, the work geographic index floor under the Medicare physician fee schedule, the current rural ambulance payments and the exceptions process for Medicare therapy caps.

Rural America faces significant barriers in providing access to health care, including higher percentages of Medicare beneficiaries, under-insured, and self-payer patients than their urban counterparts.  In recognition of these challenges, Congress has enacted a number of programs that help rural providers meet their distinct challenges.  However, these Medicare extenders that are critical to the rural health safety net were not made permanent.  Without the permanency of these programs, many rural hospitals will have to close their doors.

For more information on these important Medicare extenders visit NRHA’s Congressional Action Kit.

Grassroots Support Needed for Medicare Extenders

S. 2110, the Medicare SGR Repeal and Beneficiary Access Improvement Act of 2014 will likely come to the Senate Floor next week.  This bill, introduced by Senate Finance chairman Ron Wyden late last week, is modified from previous Senate legislation but is similar to a strong rural bill that was reported out of the Senate Finance committee last December.  S. 2110 contains a permanent fix to the SGR and includes all rural Medicare extenders (the Work geographic adjustment, Medicare payment for therapy services, Medicare ambulance services, the Medicare Dependent Hospital program and the Low Volume Hospital adjustment) and make all but the ambulance provisions permanent.

The bill’s passage is in doubt and strong grassroots support is needed.  A likely partisan fight will occur over how to pay-for the bill.  (Democrats support using savings from the scaling down of overseas conflicts and Republicans support eliminating the health insurance mandate in the ACA).  Ranking Finance member, Orrin Hatch introduced a Republican bill (S.2122) which also contains the rural Medicare extenders but utilizes the ACA cuts as a pay-for.

Sixty Senators will be needed to support this bill for passage.  NRHA continues to work with Members of Congress to ensure that these important rural Medicare programs are continued in legislation aimed at updating the SGR and that any future offsets do not harm rural providers.

NRHA requests you contact your Senators while they are in their states during this week’s congressional recess.  Urge your Senator to support legislation that contains permanent extension of critical rural health Medicare funding; and not “pay-for” the SGR fix out of the pocket of rural providers.  Attend town halls or other public meetings or simple call or go to their district offices. For more additional information visit our Congressional Action Kit.



House passes bill to repeal SGR, delay Individual Mandate

Earlier today the House of Representatives passed a bill to repeal the Medicare Sustainable Growth Rate (SGR), the problematic payment formula that has been in place for several years.  The bill would move payments made to physicians and other providers to “alternative payment models” or APMs and away from traditional fee-for-service payments. This bill did not include many important rural provisions, known as the rural Medicare extenders.

To pay for this repeal, the House bill would delay the penalty portion of the individual mandate until 2019.  Senate Majority Leader Harry Reid has indicated that the Senate will not consider this offset and the President has vowed to veto the bill over this provision.

NRHA continues to work with Members of Congress in both chambers to ensure that these important rural Medicare programs are continued in legislation aimed at updating the SGR and that any future offsets do not harm rural providers. For more information on the rural Medicare extenders, please visit the government affairs section of NRHA’s website.

Rural March Madness is here

The end of March brings the expiration of the Sustainable Growth Rate (SGR) moratorium, as well as expiration of important Medicare payments (including Medicare Dependent Hospitals and the Low Volume Hospital adjustment). This means only two weeks remain until rural providers lose hundreds of millions of dollars.

Members of Congress will be back in their states next week and they need to hear from you. Contact your member of Congress, attend a town hall meeting and invite them to your facility.

NRHA is working hard to ensure Congress passes a permanent repeal of the SGR and the permanent extension of critical Medicare programs without any “pay-fors” that harm rural providers. Cuts to Critical Access Hospitals and other rural providers would be devastating for the rural health safety net.

As we count down the days until March 31 your participation in our advocacy campaign is vital. Join NRHA Monday, March 17 at 12 p.m. ET for an advocacy call to discuss strategies on how to reach your members during their District Work Period.

Don’t forget to join NRHA in Las Vegas on April 22-25 for the 37th Annual Rural Health Conference, the nation’s largest gathering of rural health professionals. Learn the latest on policy, rural research and education, hospital and clinic management, state health resources and more.

NRHA signs letter to FCC Chairman Wheeler

The National Rural Health Association joined 34 other organizations and entities in sending a letter to Federal Communications Commission (FCC) Chairman Thomas Wheeler urging the FCC to move forward as quickly as possible to implement a Connect America Fund (CAF) mechanism for small, rural, rate-of-return-regulated carriers that will provide sufficient and predictable support for broadband-capable networks across rural America.

Read the full letter here.

Life and death in a small town

life expentencyJohn Cougar Mellencamp sang in his 1985 hit song Small Town, “I was born in a small town… probably die in a small town.”

Unfortunately for John, it also appears that he will probably die sooner in a small town.

A study published last month in the American Journal of Preventative Medicine by Dr. Gopal Singh examines the trends in life expectancy disparities between rural and urban areas in the United States between 1969 and 2009. The article finds that the disparity has increased since 1990, because life expectancy has grown more rapidly in urban than in rural areas.

“Between 1969 and 2009, residents in metropolitan areas experienced larger gains in life expectancy than those in nonmetropolitan areas, contributing to the widening gap,” Singh stated in his conclusion.

According to the research findings, the life expectancy disparity of urban over rural areas stood at 2.4 years in 2005-2009. Furthermore, the findings indicate that mortality from cardiovascular diseases, injuries, lung cancer and COPD is much higher in rural than in urban areas. For more data on this, visit NRHA’s “What’s Different About Rural Health.”

“The rural poor and rural blacks currently experience survival probabilities that urban rich and urban whites enjoyed four decades earlier,” according to the report’s conclusion. Four decades. Another way of saying this is that advances in public health and preventative care are not reaching rural communities.

Life expectancy estimates are routinely available for gender, racial/ethnic and socioeconomic groups. However, few articles have looked at how disparities in life expectancy have changed over time. Zip codes should never be a predictor of life expectancy. And this recent study points to a disturbing trend that certainly merits more research and a closer look at national policies that are leading toward longer, healthier lives in cities over small towns.

The Rural Health Impact of the President’s FY 2015 Budget

President Obama’s budget proposal, released earlier this morning, continues to be a source of concern for many rural health providers.  While the non-binding budget proposal is unlikely to be adopted by Congress, the President again proposes cuts to the Critical Access Hospital (CAH) system and other members of the rural health safety net.  As in years past, the President’s proposal suggests cutting all CAH reimbursement from 101% of cost to 100% while completely excluding current CAHs that are within 10 miles of another health care facility, regardless of the care that other facility offers or who it is intended to serve.  Additionally, the budget proposal calls for additional cuts to bad debt reimbursement for all providers.  Even discretionary programs designed to help CAHs are being cut; the Rural Health Flexibility Grant line is cut by 15 million dollars.

The President’s proposal is not all bad, though.  As part of an effort to expand access to primary care providers, the President has proposed a significant investment in the National Health Service Corps (NHSC). In addition to nearly 310 million dollars in mandatory funding for the NHSC enacted as part of the Affordable Care Act (ACA), the budget asks for an additional 100 million dollars in FY 2015 to train more primary care providers to serve newly insured populations throughout rural America. Similarly, the Teaching Health Center program would continue to receive significant funding, as mandated by the ACA.

While NRHA is appreciative of this funding, a number of other programs are targeted for cuts in the President’s budget.  Area Health Education Centers would see their federal funding completely eliminated. A grant program designed to help rural communities acquire emergency medical devices would also be left without funds.  Taken in concert with the cuts proposed to CAHs, these sections of the President’ budget would severely damage the rural health safety net.  NRHA will continue our efforts to ensure that these cuts are not enacted while working with the Administration and Congress to adequately train and retain a quality workforce in rural America.  If you have any questions, please contact NRHA Government Affairs Staff at (202) 639-0550.