Hospital leaders today urged the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies to eliminate unnecessary regulatory burdens and support federal programs critical to maintaining access to care in rural communities. Testifying at the hearing were rural hospital leaders from Missouri, Mississippi, Washington state and Kansas, as well as officials from the Centers for Medicare & Medicaid Services and Health Resources and Services Administration.

A call for making Medicare “extender” provisions permanent was voiced by hospital witness Tim Wolters, Lake Regional Health System’s head of reimbursement in Osage Beach, Mo.

He testified that rural hospitals reimbursed under Medicare’s prospective payment system (PPS) rely on such rural payment provisions as the Medicare-dependent hospital (MDH) program and low-volume adjustment to help maintain essential health care services to the people and communities they serve.

“For rural PPS hospitals to survive, we need Congress to continue to support these rural reimbursement programs … and make them permanent,” said Wolters, one of four rural hospital witnesses to testify before the subcommittee.

PMH Medical Center CEO Julie Peterson urged Congress to support the rural programs administered by HRSA. These include the Rural Hospital Flexibility Grant Program and the Small Rural Hospital Improvement Program, which Peterson said help small rural hospitals prepare for conversion to the ICD-10 coding system and adoption of quality improvement reporting measures. PMH Medical Center is a 25-bed critical access hospital (CAH) in Prosser, Wash. 

Kristi Henderson, the University of Mississippi Medical Center’s chief telehealth and innovation officer in Jackson, described how telehealth is changing rural health care by “increasing access to care, improving health outcomes and lowering costs.”

She called on Congress to increase Medicare reimbursement for telehealth, coordinate federal support for the technology and remove geographic barriers to reimbursement.

Rice County Hospital CEO George Stover’s testified about the federal regulatory burdens placed on his Lyons, Kan., CAH. He said CMS’s 96-hour physician certification requirement as a condition for reimbursing CAHs for patient care, and direct physician or non-physician practitioner supervision of outpatient therapeutic services divert resources from patient care and drown CAHs in unnecessary paperwork. Read the AHA News story on how these policies burden CAHs.

Echoing the hospital leaders’ concerns in a statement submitted for the record, the AHA urged Congress to support legislation to prevent CMS from enforcing the 96-hour physician certification requirement for CAHs; legislation to adopt a default standard of “general supervision” for outpatient therapeutic services furnished in CAHs and small rural hospitals with 100 or fewer beds; legislation to improve the efficiency and fairness of the Medicare Audit Contractor Program and how Medicare's recovery audit contractors are paid; and legislation to extend the Medicare Rural Community Hospital Demonstration Program.

In addition, the AHA urged Congress to make permanent the MDH program, Medicare low-volume adjustment and ambulance add-on payments; and support funding for telehealth opportunities and programs that improve access to health care for rural communities.