Author Archives: Erin Mahn

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.

Rural Americans see high insurance premiums

Rural Americans are seeing the highest premiums through insurance marketplaces created by the Affordable Care Act, according to a new study released by the Kaiser Family Foundation.

The top ten highest premiums include Alaska ($488), Wyoming ($440), rural Nevada ($418) and inland California ($410). Ithaca, N.Y. ($459) and Bay St. Louis, Miss. ($456) were the two highest cities.  The lowest premiums were in Phoenix, Ariz. ($166), Albuquerque, N.M. ($167) and Louisville, Ky. ($167).

The Kaiser Family Foundation found that the national premium for a 40-year-old is $269.

The full report can be found here.

Learn the latest news about the Affordable Care Act, and meet with the Obama administration, 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.


Critical Access Hospital Relief Act Introduced

Representatives Adrian Smith (R-NE), Greg Walden (R-OR), David Loebsack (D-IA) and Todd Young (R-IN) have introduced the H.R. 169, the Critical Access Hospital Relief Act. This bill would eliminate the current Condition of Payment requirement that physicians at Critical Access Hospitals certify, at the time of admission, that Medicare and Medicaid patients will not be at the facility for more than 96 hours. This important legislation will go far in helping alleviate unnecessary red-tape for Critical Access Hospitals throughout the nation.  NRHA commends these rural health champions for their leadership and encourages Congress to act quickly to pass this legislation.

114th congress convenes

Today marks the first day that the 114th Congress takes office. Republicans control both chambers for the first time in eight years.

As members of Congress begin work, so does our work at the National Rural Health Association. Last year, rural health care faced its greatest challenge:  Forty-three rural hospitals have closed; 283 more are on the brink of closure.  Continued cuts in hospital payments have taken their toll, forcing far too many closures and leaving some of our nation’s most vulnerable populations without timely access to care.

What can the new Congress do to protect the 20 million rural Americans dependent on these rural hospitals for care? Stop the hundreds of millions of dollars in cuts to rural hospitals and providers.

Urge members of Congress to protect the rural health care safety net. Don’t miss the chance to meet with the Obama administration, 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.

President Obama signed into law H.R. 4067

President Obama signed into law H.R. 4067, which will extend to all of calendar year 2014 the enforcement moratorium on the outpatient therapeutic services “direct supervision” policy for Critical Access Hospitals (CAHs) and rural prospective payment system hospitals with 100 or fewer beds.

H.R. 4067 was introduced by Senator Jerry Moran (R-KS) and Congresswoman Jenkins (R-KS) and passed both the House and Senate. The National Rural Hospital applauds the leadership of Sen. Moran and Rep. Jenkins for this important bill for CAHs and small rural hospitals.