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Health Reform: A Rural Policy Prospective

Health Reform: A Rural Policy Prospective



Information on how the national health reform movement will impact rural America.

Information on how the national health reform movement will impact rural America.



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Health Reform: A Rural Policy Prospective Health Reform: A Rural Policy Prospective Presentation Transcript

  • A Rural Policy Prospective
    November 16, 2009
    Alan Morgan
    Chief Executive OfficerNational Rural Health Association
  • NRHA Mission
    The National Rural Health Association is a national membership organization with more than 20,000 members whose mission is to provide leadership on rural issues through advocacy, communications, education and research.
  • Medicare’s cost-based payments to CAHs were roughly $6 billion in 2006, representing 4 percent of all Medicare inpatient and outpatient payments to hospitals.”
  • Healthcare Critical to Rural Economy
    Healthcare is the fastest growing segment of rural economy.
    Each rural physician generates 23 jobs in the local rural economy
    In most rural communities hospitals are the largest or second largest employer
    Health care often represent up to 20 percent of a rural community's employment and income.
  • Appropriations and the Budget
    Looking great for 2010!
  • Rural Health Safety Net Programs
    Rural Outreach and Network Grants
    Rural Health Research
    State Offices of Rural Health
    Rural Hospital Flexibility Grants
    Rural and Community Access to Emergency Devices
    Rural EMS
    Community Health Centers
    National Health Service Corps
    Title VII and Title VIII
    Areas Health Education Centers
    Geriatric Programs
    Denali Commission
    Delta Health Initiative
  • House Acts
    House passes health reform.
    NRHA did not support House bill.
    Positive steps but falls
    short of significantly
    improving access crisis
    in rural America.
  • The Obama Team
    Gov. Kathleen Sibelius, HHS Sec. Designate
    Nancy-Ann DeParle, Health Reform Czar
    Mary Wakefield, HRSA Administrator
    Rep. Rahm Emanuel, WH Chief of Staff
  • Health Information Technology
    $2b for grants and office of HIT coord.
    Incentive payments for meaningful adoption:
    30% needy patients
    Medicaid cover no more than 85% of IT costs
    Eligible providers
    Medicare up to 41k
    Medicaid, if 30% Medicaid – 85% of IT costs
    • CAHs
    • Depreciation value of Medicare IP % plus 20%
    • Paid same yr. as becoming meaningful
    • PPS Hospitals
    • Base of 2m plus amount per discharge up to 23k
    • Paid over four year period
  • The Solution:
    To resolve the health care crisis in rural America, the rural health care safety net must be prevented from crumbling. Four reforms are crucial:
    The workforce shortage crisis must be abated;
    Equity in reimbursement must occur;
    Decaying rural health care infrastructure must be repaired and non-existent infrastructure must be created; and
    Health disparities among vulnerable populations must be corrected.
  • So Many Moving Parts…
    Senate HELP Committee - - insurance, workforce, non-Medicare
    Senate Finance Committee - - Medicare, Medicaid, Social Security, Graduate Medical Education
    House Ways and Means – Medicare, Graduate Medical Education
    Energy and Commerce - - Medicaid, Insurance, workforce
    Education and Labor - - Education loans
  • The President’s 8 Principles
    Reduce health care costs
    Protect families from bankruptcy and debt of medical costs
    Guarantee choice of doctors and health plans
    Invest in prevention and wellness
    Improve patient safety and quality of care
    Ensure affordable coverage for everyone
    Maintain coverage when you lose job
    End barriers to coverage for pre-existing conditions.
  • CAHs: What NRHA is fighting for…
    • Reinstatement of “Necessary Provider” for CAHs;
    • Extension of the Flex grant program;
    • Expansion of the 340B drug program to CAHs;
    • Equity for CAHs in Medicare stimulus dollars for health information technology;
    • Flexibility in stringent bed count requirements for CAHs;
    • Improving a CAH’s access to capital;
    • Elimination of CAH “Isolation Test” for ambulance reimbursement;
    • Ability for a CAH to negotiate reimbursement rates of a “public plan” health care option;
    • Greater ability for a CAH to recruit and retain physician residents and physicians; and
    • Ensuring equitable reimbursement for CAHs for anesthesia services.
  • Finance Rural Positives
    • Workforce Provisions
    • Expands Rural Residency Programs
    • Encouragement of Rural Training Track Programs
    • Bonus payments for primary care and general surgery
    • Workforce Shortage Advisory Committee
    • Medicare Provisions
    • Extension of Floor on Medicare Work Geographic Adjustment
    • Two-year extensions of important Medicare provisions for Rural Providers
    • Rural Hospital Flex Program
    • Therapy Cap Services
    • Physician Pathology Services
    • Ground Ambulance Services
    • Medicare Mental Health Services
    • Rural Hospital Flexibility Program
    • Lab Services
    • Medicare Dependent Hospital Program
    • Temporary Relief to Low-Volume Hospitals
    • Home health add-on for home health in rural areas.
  • Rural amendments passed
    • Bingaman – Ensuring GME redistribution is available to rural and other underserved states – 50% of redistributed slots to rural
    • Bingaman – Establishing “Teaching Health Centers” to increase number of primary care physicians – Grants to develop residency programs at ambulatory care centers (RHCs, FQHCs, etc)
    • Bingaman – Ensures Appropriate Consultation with Mental Health and Substance Abuse Experts
    • Conrad – Two-year extension of “super rural” bonus payment for ambulance services
    • Lincoln – To restore the ratios used in determining geographic hospital wage index reclassification to the pre-October 1, 2008 levels until the first fiscal year after the secretary makes a proposal(s) that considers the nine points specified in the Tax Relief and Health Care Act of 2006
    • Carper – Provides workplace wellness tax credits
    • Stabenow – To provide training for advance practice nurses
    • Stabenow – To establish a National Center on Hospital Quality
    • Rockefeller – Would add free clinics to list of provider eligible for Medicare and Medicaid incentives under the American Recover and Reinvestment Act of 2009
    • Technical Correction on page 121 of Mark – Clarifies that CAHs are eligible to receive 101% of reasonable cost for providing outpatient services regardless of billing method and for providing ambulance services.
    • Grassley - - GPCI
    • Rockefeller - - Medicare Commission
  • H.R. 3200/Rural Positives
    • 340B Drug Expansion – CAHs, MDH, SCH, RRC, expand to inpatient drugs.
    • Primary Care Investment
    • NHSC
    • GME grants for expanding residency programs to RHCs and FQHCs
    • Primary care payment increases – extra 10% bonus for primary care in HPSA.
    • IOM Study on Geographic Adjustment Factors
    • Medicare “Extenders” plus:
    • marriage and family therapists; and
    • Mental health counselors
  • Important Rural Amendments
    Bennet (D-CO)
    RHC 340B
    State Offices
    Pryor (D-AR)
    CAH 35-mile waiver
    Wyden (D-OR)
    CAH bed flex
    Wyden (D-OR)
    RHC cap
    Murkowski (R-AK)
    Frontier clinic grant program
    Udall (D-CO)
    Harkin (D-IA)
    Agriculture Safety Program
    Durbin (D-IL)
    Johanns (R-NE)
    MedPAC and Medicare Commission rural rep
    Nelson (D-NE)
    Rebasing for small hospital demo program currently in effect.
  • The Time Table
    Urgency to get bill done this year.
    So many delays. Goal was to finish committee work in June and have Floor debate in July.
  • We Need You!
    You are your own best voice
    Your member of Congress listens when you speak
    You will have more success than I
  • Join NRHA Today!
    Click button: Become a Member
    Access to Social Networking: NRHA Connect
    Regulatory and Legislative Guides
    E-news and Rural Roads
    Much, Much More