Author Archives: Erin Mahn

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.

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.

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.

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.

President’s FY 2016 calls for cuts to rural programs

President Obama’s budget proposal, released last week, continues to be a source of concern for many rural providers.

The White House’s FY 2016 budget calls for eliminating important rural health programs including the Area Health Education Centers (AHECs) and Rural Access to Emergency Devices.

President Obama again proposes cuts to Critical Access Hospitals (CAHs), including a cut in cost-based reimbursement and the elimination of the designated CAH status if another facility is within 10 miles, regardless of the care that the other facility offers.

Other programs facing cuts are the Health Information Technology Research, Rural Hospital Flexibility Grant, and the Preventive Health and Health Services Block Grant.

NRHA will continue its efforts to ensure that these cuts are not enacted. NRHA asks that members of Congress stand up for rural Americans and provide adequate funding to train and retain a quality workforce in rural America. NRHA’s funding requests for FY 2016 can be found here.

President Obama delivers State of the Union

President Obama is delivering his second to last State of the Union this evening, touting that 10 million uninsured Americans now have health insurance, that health care inflation is at its lowest rate in fifty years and his launch of a Precision Medicine Initiative to cure diseases.

The full text of the speech can be found here.

Following the State of the Union, the president is expected to release the budget in about two weeks. Stay tuned to this blog for the latest appropriations news.

Learn more about the White House’s initiatives by meeting with the Obama administration, as well as the 114th congressional members and national experts at NRHA’s 26th annual Rural Health Policy Institute Feb. 3-5 in D.C. Register here today.

Tavenner resigns from CMS

Marilyn Tavenner, the Administrator for the Centers for Medicare & Medicaid Services, is stepping down next month. In her role as administrator, Tavenner oversaw the implementation of the Affordable Care Act.  She will be replaced on an interim basis by Andrew Slavitt, the Principal Deputy Administrator at CMS.

Prior to CMS, Tavenner was the Commonwealth of Virginia’s Secretary of Health and Human Resources under former Governor Tim Kaine. She began her career working as a nurse in Richmond, Va.