The American Hospital Association (AHA) supports legislation that improves and strengthens health care delivery in rural America.

American Recovery and Reinvestment Act (H.R.1) (P.L.111-5)
On February 17, President Obama signed into law the American Recovery and Reinvestment Act of 2009 (ARRA). The $787 billion legislation includes measures to preserve and improve health care, modernize infrastructure, enhance energy independence, expand educational opportunities, and provide tax relief.   The ARRA provides more than $19 billion in grants and loans for infrastructure and incentive payments under Medicare and Medicaid to help physicians and hospitals (adopt and use) health IT. The ARRA provides for the creation of federal grant and loan programs through the states to kick-start investment in health IT. It establishes payment incentives for eligible acute-care hospitals, including Critical Access Hospitals. PPS hospitals that are meaningful users of EHR are eligible for incentives beginning in fiscal year 2011 for up to four years using a formula referenced in the ARRA. For CAHs, these payments build off of the current cost-based payment system that pays CAHs 101 percent of their Medicare allowed costs. Under the incentive, a CAH that is determined to be a meaningful user can fully depreciate certified EHR costs beginning in FY 2011. A hospital is eligible for Medicare incentives if it demonstrates that it is a "meaningful user of certified EHR technology," which will be determined by the Secretary of the Department of Health and Human Services.

The ARRA also provides grants for broadband education, awareness, training, access, equipment and support to medical and health care providers to facilitate greater use of broadband services to enhance health care delivery. Many agencies are still in the process of determining how they will distribute the funds they have received and, in some cases, have to provide reports to Congress regarding their plans before any distributions may begin. Their Web sites will have the most up-to-date information. For health-specific information, visit http://www.hhs.gov/recovery/. The government also has established a general Web site, http://www.recovery.gov that can be used to track information about ARRA activity across agencies as it becomes available.

AHA ARRA Legislative Advisories

The 2009 Children's Health Insurance Program Reauthorization Act: of 2009 (H.R. 2) (P.L.111-3) - Renews and expands health insurance coverage to children. CHIP allows about 7 million children to continue receiving coverage and extends the program to an additional 4 million children.  In addition, the bill removes the five-year waiting period to optionally cover legal immigrant pregnant women and children; covers dental services; and strengthens mental health services.

J1-Visa Waiver Program (H.R 1127 and S. 628) - Currently, the Conrad State 30 program allows physicians on J-1 visas to waive the J-1 requirement to return to their home country for two years if they agree to serve for three years in a U.S. underserved area. Each state is allowed 30 such waivers.  H.R. 1127, a bill to extend the program beyond the March 6, 2009 expiration date was signed into law and the program is extended through Sept. 30, 2009.  S. 628 has been introduced by Senator Kent Conrad (D-N.D.) and is co-sponsored by Senators Sam Brownback (R-Kan), Susan Collins (R-Maine), Tim Johnson (D-SD) and Patty Murray (D-Wash.). S. 628 would permanently authorize the Conrad State 30 program; allow physicians on H-1B visas to enter the program; exempt physicians who participate in the program from green card caps; and provide a mechanism by which the per state caps can increase beyond 30 waivers. S. 628 would also prohibit H-1B visa physicians from serving in "flex-slots," positions located outside underserved areas. Additionally, it would reset H-1B visa physicians' visa expiration to 6 years from the time they enter the Conrad State 30 program.

Critical Access Hospital Flexibility Act of 2009 (S. 307/HR. 668) - Would provide flexibility in the manner in which beds are counted for purposes of determining whether a hospital may be designated as a critical access hospital under the Medicare Program and to exempt from the critical access hospital inpatient bed limitation the number of beds provided for certain veterans.  Legislation was introduced by Senators Ron Wyden (D-Ore.), Mike Crapo (R-Idaho) and Representative Greg Walden (R-Ore.)

  • Letter: AHA to Sen. Mike Crapo Re: Support for the Critical Access Hospital Flexibility Act of 2009
    January 23, 2009 AHA letter to Sen. Mike Crapo Re: Support for the Critical Access Hospital Flexibility Act of 2009
  • Letter: AHA to Rep. Greg Walden Re: Support for the Critical Access Hospital Flexibility Act of 2009
    January 23, 2009 Letter from AHA to Rep. Greg Walden Re: Support for the Critical Access Hospital Flexibility Act of 2009
  • Letter: AHA to Sen. Ron Wyden Re: Support for the Critical Access Hospital Flexibility Act of 2009
    January 23, 2009 AHA Letter to Sen. Ron Wyden expressing strong support for the Critical Access Hospital Flexibility Act of 2009.

Rural Hospital Assistance Act of 2009 (H.R. 362) - Introduced by Reps. Boswell (D-IA) and Emerson (R-MO) this bill provides for Medicare inpatient payment adjustments for low-volume PPS hospitals more than 15 miles from another PPS hospital and having less than 1,500 discharges of Medicare Part-A beneficiaries. It provides for the use of the non-wage adjusted PPS rate under the Medicare-dependent hospital (MDH) program and eliminates the Medicare hospital exception for physician-owned hospitals, but provides a limited exception for existing facilities.

  • Letter: AHA to Rep. Boswell Re: AHA's Support of H.R. 362, the Rural Hospital Assistance Act of 2009
    February 09, 2009 AHA letter to Rep. Boswell expressing support of H.R. 362, the Rural Hospital Assistance Act of 2009

Medicare Rural Health Access Improvement Act of 2009 (S. 318) - Introduced by Sen. Charles Grassley (R-IA), this bill would eextend Medicare FLEX Grants; improve MDH Program payments to hospitals without regard to any adjustment for different area wage levels; redefine a low-volume PPS hospital as located more than 15 road miles from another PPS hospital and having less than 2,000 discharges of Medicare Part-A beneficiaries; extend and expand the Medicare hold-harmless for Outpatient PPS and SCH adjustment; extend treatment of physician path services under Medicare; extend rural ground ambulance bonus; improve payment to RHCs at $92 per visit; and exempt DME supplies in small MSAs and rural areas.

Letter: AHA to Sen. Grassley Re: AHA's Support of S. 318, the Medicare Rural Health Improvement Act of 2009
February 09, 2009 AHA letter to Sen. Grassley expressing support of S. 318, the Medicare Rural Health Access Improvement Act of 2009

Testimony on ARRA: The AHA asked Congress to consider the impact of the president's budget outline on small and rural hospitals, which face unique challenges including lower patient volume, geographic isolation and a high proportion of Medicare patients. Testifying before the House Small Business Committee, Ed Hannon, chairman of the AHA's Small or Rural Hospital Governing Council and CEO of The McDowell Hospital in Marion, N.C., emphasized the AHA's "steadfast" commitment to health care reform, but urged Congress to consider the impact on small and rural hospitals of proposals to bundle Medicare payments for hospital and post-acute care, reduce payment for hospitals with high readmission rates, and pay for performance. He also expressed strong support for the president's proposals to permanently reform the Medicare physician fee schedule, address the shortage of health care providers in medically underserved areas, and ban physician self-referral to hospitals in which they have an ownership interest.

  • Testimony: AHA before the House Committee on Small Business: The President's Budget and Medicare...
    March 18, 2009 Testimony of the American Hospital Association before the Committee on Small Business of the U.S. House of Representatives: "The President's Budget and Medicare: How Will Small Providers be Impacted?"

Craig Thomas Rural Hospital and Provider Equity Act (S.1157) or R-HoPE - Sens. Kent Conrad (D-ND), Pat Roberts (R-KA), Tom Harkin (D-IA) and John Barasso (R-WY) have introduced AHA-supported legislation that would improve Medicare reimbursements to rural hospitals. The Craig Thomas Rural Hospital and Provider Equity Act (S.1157) or R-HoPE would provide a temporary payment increase for hospitals with low-volume inpatient discharges. The bill also would continue allowing direct payments to independent laboratories for the technical component of pathology services, and the 5% rural add-on payment for home health services. In addition, the bill would extend the outpatient hold-harmless provision for sole community hospitals and rural hospitals with fewer than 100 beds, remove the cap on disproportionate share adjustment percentages for all hospitals and improve payments for ambulance services in rural areas.

America's Affordable Health Choices Act of 2009 (H.R. 3200.) - The House Ways and Means Committee approved the "tri-committee" health care reform bill that is the product of the leaders of three key House committees: Ways & Means, Energy & Commerce and Education & Labor.   It creates a public plan that would pay Medicare rates to hospitals and impose some $155 billion in hospital cuts over the next decade.  An estimated $19 billion of those cuts would be the result of an aggressive and problematic readmissions policy.

Please go to the www.aha.org and click on the “Health Reform Update” button to see the AHA’s July 16 Legislative Advisory summarizing H.R. 3200.

Rural Community Hospital Demonstration Extension Act (H.R. 3256) - Would extend and expand the Medicare Rural Community Hospital Demonstration. Scheduled to wind down this year, the demonstration establishes rural community hospitals and tests the feasibility and advisability of cost-based reimbursement for eligible hospitals. The demonstration would be extended for five more years, expand eligibility to rural areas in any state, and increase the number of hospitals participating in the demonstration.  The bill was introduced by Reps. Adrian Smith (R-NE) and Don Young (R-AK).


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