Rural Health Bills

RURAL HOSPITAL LEGISLATION

AHA POSITION

The AHA is focused on ensuring all hospitals have the resources they need to provide high-quality care and meet the needs of their communities. That means:

• Advocating for appropriate Medicare payments;
• Working to extend expiring Medicare provisions;
• Improving federal programs to account for special circumstances in rural communities; and
• Seeking adequate funding for annually appropriated rural health programs.

In addition, existing special rural payment programs - the CAH, sole community hospital (SCH), Medicare dependent hospital (MDH), and rural referral center (RRC) programs - need to be reauthorized, updated and protected.

KEY PRIORITIES

Rural Legislation
Recently, Congress passed the American Taxpayer Relief Act of 2012, which contained many provisions important to rural hospitals and beneficiaries. The AHA is working to extend beyond 2013 the law's rural extender provisions, plus several others. Key rural hospital provisions are:

• MDH program (expires Sept. 30);
• Low-volume hospital payment adjustment (expires Sept. 30);
• Ambulance add-on payments (expires Dec. 31).
• 508 geographic reclassifications (expired March 31, 2012);
• Medicare reasonable cost payments for certain clinical diagnostic laboratory tests for patients in certain rural areas (expired June 30, 2012);
• Direct billing for the technical component of certain physician pathology services (expired June 30, 2012);
• Outpatient hold harmless payments (expired Dec. 31, 2012, although for SCHs with more than 100 beds, it expired March 1, 2012); and

The AHA will work with Congress to:

• Extend expiring provisions;
• Allow hospitals to claim the full cost of provider taxes as allowable costs;
• Ensure CAHs are paid at least 101 percent of costs by Medicare Advantage plans;
• Ensure that the Centers for Medicare & Medicaid Services (CMS) appropriately addresses the issue of direct supervision for outpatient therapeutic services for rural hospitals and CAHs;
  
• Ensure rural hospitals and CAHs have adequate reimbursement for certified registered nurse anesthetist and stand-by services;
• Exempt CAHs from the Independent Payment Advisory Board;
• Provide small, rural hospitals with cost-based reimbursement for outpatient laboratory services and ambulance services;
• Provide CAHs bed size flexibility;
• Reinstate CAH necessary provider status;
• Remove unreasonable restrictions on CAHs' ability to rebuild; and
• Extend 340B drug discount program to additional hospitals and for the purchases of drugs used during inpatient hospital stays, and oppose any attempts to scale back this vital program.