Rural Specific Provisions in Health Reform Bills

America's Affordable Health Choices Act of 2009 - H.R. 3200
Subtitle F-Medicare Rural Access Protections
Sec. 1191. Telehealth expansion and enhancements.
Sec. 1192. Extension of outpatient hold harmless provision.
Sec. 1193. Extension of section 508 hospital reclassifications.
Sec. 1194. Extension of geographic floor for work.
Sec. 1195. Extension of payment for technical component of certain physician pathology services.
Sec. 1196. Extension of ambulance add-ons.

Subtitle A-Drug Discount for Rural and Other Hospitals
Sec. 2501. Expanded participation in 340B program.
Sec. 2502. Extension of discounts to inpatient drugs.
Sec. 2503. Effective date

Affordable Health Choices Act - S 1679
Expanded participation in 340B program

America's Healthy Future Act of 2009 - Chairman's Mark
September 16, 2009
      Rural Protections

o Extend Medicare Rural Hospital Flexibility Program: through 2010 includes SHIP grants
o Extend Hospital Outpatient Department Hold Harmless for Small Rural Hospitals; 85% of difference through CY 2011. Extend and Expand Hospital Outpatient Department Hold Harmless for Sole Community Hospitals < 100 or > 100 beds at 85% of the difference through CY 2011.
o Extend Reasonable Cost Reimbursement for Laboratory Services in Small Rural Hospitals; for qualifying rural hospitals with < 50 beds from July 1, 2010 - July 1, 2012.
o Extend Rural Community Hospital Demonstration Program: for 2 years and up to 30 sites through January 1, 2012.
o Extend Medicare Dependent Hospital Program; for 2 years until Sept. 30, 2013
o Temporary Improvements to the Medicare Inpatient Hospital Payment Adjustment for Low-Volume Hospitals; in FY 2011-12 for those 15 miles away and < 2000 Medicare discharges
o Revisions to the Demonstration Project on Community Health Integration Models in Certain Rural Counties; improves eligibility in frontier states for primary care providers
o MedPAC Study on Adequacy of Medicare Payments for Health Care Providers Serving Rural Areas; to review payment adequacy for rural health care providers by January 1, 2011.

Other Rural Hospital Relevant Provisions
o Reinstatement of Rural Home Health Payment Adjustment; 3% add-on for CY 2010-15.
o National Pilot Program on Payment Bundling - Rural consultation
o Reducing Avoidable Hospital Readmissions - Rural consultation
o Primary Care/General Surgery Bonus - HPSA consideration
o Redistribution of Unused GME slots to Increase Access to Primary Care and Generalist Physicians - Rural < 250 beds exempt
o Proposal on Development of a National Workforce Strategy - Including Rural Populations
o Extension of Floor on Medicare Work Geographic Adjustment
o Extension of Treatment of Certain Physician Pathology Services under Medicare
o Extension of Increased Payments for Ambulance Services under Medicare
o Extend Section 508 Reclassifications
o Limitation on Medicare Exception to the Prohibition on Certain Physician Referrals for Hospitals
o Plan to Reform Medicare Hospital Wage Index
o Medicare Commission - protect beneficiary access to care, including in rural and frontier areas

America's Healthy Futures Act of 2009
Rurally Relevant Hospital Modifications to the Chairman's Mark
September 22, 2009

To clarify in Title III, Subtitle B: Rural Protections
On page 121 of the Mark:
Insert new section entitled, - Technical Correction related to Critical Access Hospitals (CAHs), which clarifies that CAHs are eligible to receive 101 percent of reasonable costs for providing outpatient services regardless of billing method and for providing qualifying ambulance services.

To accept with Modification Lincoln Amendment #D6:
Amend Title III, Subtitle D to restore the ratios used in determining geographic hospital wage index reclassification to pre-October 1, 2008 levels until the first fiscal year one year after the Secretary submits the Plan to Reform the Medicare Hospital Wage Index to Congress as required in the Mark. It also would ensure that any applications for reclassification for fiscal year 2011 and subsequent years denied on the basis of the changed ratios would be reconsidered using the pre-existing ratios, and approved, if the applicant meets the pre-existing ratios. This amendment would be implemented in a budget neutral manner.

To Accept Conrad Amendment #D5:
Adds a new section to Title III, Subtitle B, Part I
The provision extends until January 1, 2012 the bonus payments under Medicare to ambulance service providers which serve the most rural quartile of counties (-super rural areas as originally defined in Section 414(c) of the Medicare Modernization Act (MMA)).


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