• Ten-month extension of outpatient hold-harmless provision for hospitals under 100 beds.
• Ten-month extension of the current geographic practice cost index
• Ten-month update of the sustainable growth rate (SGR)
• Ten-month extension of the current payment levels for rural ambulance providers
• Four-month extension of current “508 Hospital” wage index reclassification
• Four-month extension of the current technical component for pathology lab services

While the inclusion of these provisions denotes a significant victory, NRHA remains concerned that some rural provisions, which expire at other points of 2012, were not included. NRHA is also concerned with reductions in “bad debt” reimbursements contained in this report. NRHA continues to fight for the permanent codification of all expiring provisions and will continue to work to make sure rural providers are adequately and equitably reimbursed within the Medicare program. Continued vigilance and advocacy by rural health advocates remains critical.  Please contact NRHA government affairs at (202) 639-0550 with any questions about the Conference Report.

Several critical rural Medicare provisions are included in a bill to be voted on by Congress as early as Friday.

Many of these provisions were seriously threatened in recent months but, because of your advocacy and persistence, NRHA was successful in making sure a number of these provisions were included in the final package, which temporarily addresses a number of tax and Medicare provisions.

Of particular importance, a ten-month extension of the outpatient hold-harmless provision to hospitals with less than 100 beds was included in the final compromise after being excluded in prior versions of the legislation.  If these hospitals were to lose hold harmless payments, their losses would prove catastrophic a number of hospitals currently participating in the program would have negative margins exceeding 50% while others would have negative margins exceeding 25%. Congress provides this outpatient payment because if these hospitals were to fail, residents of the communities they serve would be without hospital services.

Other provisions that were included in the package include:

• Ten-month extension of the current geographic practice cost index
• Ten-month update of the sustainable growth rate (SGR)
• Ten-month extension of the current payment levels for rural ambulance providers
• Four-month extension of current “508 Hospital” wage index reclassification
• Four-month extension of the current technical component for pathology lab services

The Fight Continues

While the inclusion of these provisions was a significant victory, some provisions which NRHA has long fought for were not included.  Specifically, the current payment increase for mental health providers was not included in the package and is set to expire on February 29.  Other provisions, which do not immediately expire, but will expire at various points in 2012, were also excluded in this deal including:

• Medicare Dependant Hospital classification (Expires October 1, 2012)
• The current Low-Volume Hospital adjuster (Expires September 30, 2012)
• Authorizing for funding the Rural Hospital Flexibility Program (Expires Sept. 30, 2012)
• Reasonable cost lab payments (Expires July 1, 2012)

NRHA continues to fight for the permanent codification of all these provisions and will continue to work to make sure these provisions are included in future legislation. Continued vigilance and advocacy by rural health advocates remains critical.  We encourage all those interested in rural health care to make your voice heard by calling your Senator or House Member today and asking for the FULL inclusion of all these provisions.

The Conference Committee was also tasked with considering a number of expiring rural Medicare “extenders”. Failure to extend these vital provisions will harm rural providers and the patients they serve. These “extenders” are vital to ensuring that rural hospitals, doctors and other professionals can provide needed emergency, primary and mental health care. NRHA members and staff have maintained constant contact with members of the Conference Committee and Congress to ensure these provisions are included in the final provision produced by the Committee.

While the specific details of this tentative agreement have not yet been released, NRHA will update this blog regularly throughout the day as such details become available.  If you have any questions on these provisions, please contact NRHA Government Affairs Staff at (202) 639-0550.

Failure to extend these vital provisions will harm rural providers and the patients they serve. These “extenders” are vital to ensuring that rural hospitals, doctors and other professionals can provide needed emergency, primary and mental health care. We encourage you to contact your Members of Congress and ask them to protect rural patients and providers by extending these vital Medicare provisions. A list and explanation of these programs can be found here.

Please ask your Members of Congress to contact conferees to express support for these vital provisions.

The Discretionary Program decreases in the budget include the Rural Health Flexibility Grant Funding Line, down $15 million. In 2012, Congress appropriated $41 million for the Rural Hospital Flexibility program, which consists of two grant activities – the Rural Hospital Flex program and the Small Hospital Improvement Program (SHIP). The Rural Hospital Flex program is fully funded in the 2013 budget at $26 million.

The President did not request funding for Area Health Education Centers (AHEC) and Rural & Community Access to Emergency Devices, according to Health Resources and Services Administration Justification for fiscal year 2013.

The Administration proposes to reduce payments to CAHs from 101 percent to 100 percent of reasonable costs, effective in 2013, and to eliminate the CAH designation for those that are fewer than 10 miles from the nearest hospital, effective in 2014. This will save $2 billion over 10 years, according to the Administration.

The National Rural Health Association strongly supports the rural health care safety net, and cuts to the above programs will be devastating to rural hospitals, clinics, health centers and other facilities, as well as recruiting a rural workforce. Cuts to the fragile safety net will cause hospital doors to close and eliminate access to rural health care for millions of rural Americans.

Please continue to monitor this blog for updates and developments.

The Administration proposes to reduce payments from 101 percent to 100 percent of reasonable costs, effective in 2013, and to eliminate the CAH designation for those that are fewer than 10 miles from the nearest hospital, effective in 2014.

This will save $2 billion over 10 years, according to the report.

The National Rural Health Association strongly disagrees with this reduction. Reducing or eliminating the CAH designation will be devastating to rural hospitals and facilities, as well as the rural economy. Currently, many CAHs are operating at a net financial loss. Even a 1 percent cut in Medicare reimbursement rates will put more CAHs into the red, inevitably causing hospital doors to close and eliminating access to health care for rural Americans.

Please continue to monitor this blog  for updates and developments throughout the day.

Please continue to monitor this blog for updates and developments throughout the day.

And we’re OK with that.

He worked in NRHA’s Washington, D.C., office for two years, during which he met hundreds of rural health’s finest and decided he could better serve rural America as a rural doc.

In Rural Roads magazine, Dustin describes his memorable-but-not-necessarily-in-a-good-way interview at the National Rural Health Association and recalls receiving 41 rejection letters from med schools before another memorable interview at Lincoln Memorial University in small-town Harrogate, Tenn.

“I never planned to begin medical school at 28. My envisioned path was straight and short, but my route would have never been as rich, as meaningful, and quite frankly, as fun as it has otherwise turned out,” he writes. “My time at NRHA, while brief, was what ultimately made it all possible.”

This bipartisan bill would help rural communities across America protect and expand access to quality health care.

“The quality of health care you receive should not depend on whether you’re from a big city or small town,” Thompson said. “Ensuring everyone has access to high quality, affordable health care isn’t a Republican priority or Democrat priority – it is a national priority. That is why I am proud to be working across the aisle with Congresswoman McMorris Rodgers to make sure that rural America has access to health care.”

The National Rural Health Association endorsed today’s bill.

“We commend Congresswoman Cathy McMorris Rodgers and Congressman Mike Thompson for the introduction of the Rural Hospital and Provider Equity Act of 2012,” said NRHA CEO Alan Morgan. “This legislation will go far in ensuring rural providers have the necessary tools to provide quality care for all rural Americans. We encourage the passage of this vital legislation.”

Both McMorris Rodgers and Thompson were honored yesterday with NRHA’s Congressional Leadership Award during its 23rd annual Rural Health Policy Institute.