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

1. A Rural Policy Prospective November 16, 2009 Alan Morgan Chief Executive OfficerNational Rural Health Association

2. 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.

5. HEALTH REFORM FOR RURAL AMERICA

7. 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.”

8. 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.

9. Appropriations and the Budget Looking great for 2010!

10. 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

11. 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.

12. 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

14. Depreciation value of Medicare IP % plus 20%

15. Paid same yr. as becoming meaningful

16. PPS Hospitals

17. Base of 2m plus amount per discharge up to 23k

19. 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

20. 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.

22. Extension of the Flex grant program;

23. Expansion of the 340B drug program to CAHs;

24. Equity for CAHs in Medicare stimulus dollars for health information technology;

25. Flexibility in stringent bed count requirements for CAHs;

26. Improving a CAH’s access to capital;

27. Elimination of CAH “Isolation Test” for ambulance reimbursement;

28. Ability for a CAH to negotiate reimbursement rates of a “public plan” health care option;

29. Greater ability for a CAH to recruit and retain physician residents and physicians; and

31. Expands Rural Residency Programs

32. Encouragement of Rural Training Track Programs

33. Bonus payments for primary care and general surgery

35. Extension of Floor on Medicare Work Geographic Adjustment

36. Two-year extensions of important Medicare provisions for Rural Providers

37. Rural Hospital Flex Program

38. Therapy Cap Services

39. Physician Pathology Services

40. Ground Ambulance Services

41. Medicare Mental Health Services

42. Rural Hospital Flexibility Program

43. Lab Services

44. Medicare Dependent Hospital Program

45. Temporary Relief to Low-Volume Hospitals

47. Bingaman – Establishing “Teaching Health Centers” to increase number of primary care physicians – Grants to develop residency programs at ambulatory care centers (RHCs, FQHCs, etc)

48. Bingaman – Ensures Appropriate Consultation with Mental Health and Substance Abuse Experts

49. Conrad – Two-year extension of “super rural” bonus payment for ambulance services

50. 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

51. Carper – Provides workplace wellness tax credits

52. Stabenow – To provide training for advance practice nurses

53. Stabenow – To establish a National Center on Hospital Quality

54. Rockefeller – Would add free clinics to list of provider eligible for Medicare and Medicaid incentives under the American Recover and Reinvestment Act of 2009

55. 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.

56. Grassley - - GPCI

57. Rockefeller - - Medicare Commission

59. Primary Care Investment

60. NHSC

61. GME grants for expanding residency programs to RHCs and FQHCs

62. Primary care payment increases – extra 10% bonus for primary care in HPSA.

63. IOM Study on Geographic Adjustment Factors

64. Medicare “Extenders” plus:

65. marriage and family therapists; and

67. 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.

68. We Need You! You are your own best voice Your member of Congress listens when you speak You will have more success than I

69. Join NRHA Today! www.ruralhealthweb.org Click button: Become a Member Access to Social Networking: NRHA Connect Regulatory and Legislative Guides E-news and Rural Roads Much, Much More