Approximately 57 million Americans live in rural areas and depend upon the hospitals in their communities. Remote geographic location, small size, limited workforce, physician shortages and often constrained financial resources pose a unique set of challenges for rural hospitals. Rural hospitals’ patient mix also makes them more reliant on public programs and, thus, particularly vulnerable to Medicare and Medicaid payment cuts.
Medicare and other federal programs must account for the special circumstances of rural communities. The AHA focuses on protecting vital funding, securing the future of existing special rural payment programs – including the critical access hospital (CAH), sole community hospital (SCH), Medicare-dependent hospital (MDH) and rural referral center (RRC) programs – and relieving regulatory burden. With congressional budget crises a continued threat in Washington, the continued viability of small and rural health care providers remains in jeopardy.
Hospitals are transforming the way health care is delivered in their communities, working with other providers and community leaders to build a continuum of care to make sure every individual gets the right care at the right time in the right setting. In order to continue this transformation, and to provide patients with the access to care they need and expect, hospitals need a supportive and modernized public policy environment. Below are some of the key areas of focus for AHA’s advocacy agenda.
AHA is working with Congress to:
- Extend funding for the Children’s Health Insurance Program (CHIP), which covered roughly 5.6 million children as of February. Without an extension, states began to run out of federal funds in October, according to the Medicaid and CHIP Payment and Access Commission.
- Reject reductions in Medicare funding for indirect medical education and direct Graduate Medical Education (GME) and pass the Resident Physician Shortage Reduction Act (S. 1301/H.R. 2267), which would increase the number of Medicare-funded residency positions.
Rural Hospital Advocacy Agenda
Medicare and other federal programs must account for the special circumstances of rural communities. The AHA works to ensure they do so by focusing on protecting vital funding, securing the future of existing special rural payment programs – including the critical access hospital (CAH), sole community hospital (SCH), Medicare-dependent hospital (MDH) and rural referral center (RRC) programs – and relieving regulatory burden. AHA’s advocacy agenda for rural hospitals targets several priorities. Key areas of focus for rural hospitals and CAHs are included in the AHA’s 2017 rural advocacy agenda.
- Pass S. 1130, the Rural Emergency Acute Care Hospital (REACH) Act, which would allow CAHs and small rural hospitals with 50 or fewer beds to convert to rural emergency hospitals and continue providing necessary emergency and observation services (at enhanced reimbursement rates); but stop inpatient services. The legislation also provides enhanced reimbursement rates for the transportation of patients to acute care hospitals in neighboring communities.
- Pass the Rural Hospital Regulatory Relief Act of 2017 (S. 243/H.R. 741), to make permanent the enforcement moratorium on CMS’s “direct supervision” policy for outpatient therapeutic services provided in CAHs and small, rural hospitals.
- Pass the Rural Hospital Access Act of 2017 (S. 872/H.R. 1955), to permanently extend the Medicare-dependent hospitals and enhanced low-volume adjustment programs.
- Pass the Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2017 (S. 967), to permanently extend the ambulance add-on payment adjustment.
- Pass the Medicare Access to Rehabilitation Services Act of 2017 (S. 253/H.R. 807), to repeal the outpatient rehabilitation therapy caps.
- Pass the Telehealth Innovation and Improvement Act (S. 787), to allow eligible hospitals to test offering telehealth services to Medicare patients and evaluate these services for cost, effectiveness and quality of care.
- Pass the Conrad State 30 and Physician Access Reauthorization Act (S. 898/H.R. 2141), which extends and expands the Conrad State 30 J-1 visa waiver program, which allows physicians holding J-1 visas to stay in the U.S. without having to return home if they agree to practice in a federally-designated underserved area for three years.