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Government Affairs News

2007

NRHA Testifies on Health Care's Impact on Economic Development -

June 28, 2007

NRHA Board Member Greg Dent testified to the House Appropriations Agriculture Subcommittee as part of the National Rural Assembly held June 25-27. The hearing was held to discuss efforts to improve the economy of our rural communities. Dent's testimony focused on the importance of health care to the overall economic health of a community. Studies have shown that as much as twenty percent of a rural community's economy is directly tied to the health sector. Recommendations included:

• Congress supporting the infrastructure of rural health providers by making available infrastructure and IT grants.
• Federal support and expansion of efforts to cover the uninsured, which rural America has a disproportionate number of, including the State Children's Health Insurance Program.
• Strengthening the reimbursement structure for rural providers from Medicare.

View the full testimony

H-CARE Act of 2007 Introduced-

June 28, 2007

Over 50 members of the House of Representatives joined Representatives Earl Pomeroy (D-ND) and Greg Walden (R-OR) in introducing the Health Care Access and Rural Equity (H-CARE) Act of 2007. NRHA is very supportive of this bill and will work to pass this important legislation. If passed, the bill, HR 2860 will:

• Authorize health information technology grants for rural practitioners.
• Require prompt payment to rural pharmacies by Medicare prescription drug plans.
• Ensure adequate rural representation on the Medicare Payment Advisory Commission.
• Establish a Rural Heath Quality Advisory Commission.
• Allow flexibility in the number of beds Critical Access Hospitals (CAH) may provide.
• Raise Rural Health Clinic reimbursements to more appropriately cover costs.
• Expand the 340B discount drug program to cover rural entities.

View our Press Release to view a full list of provisions of the bill

Pat Roberts Named Chair of the Senate Rural Health Caucus -

June 20, 2007

Senator Pat Roberts (R-KS)is the new co-chair of the Senate Rural Health Caucus. Roberts replaces Senator Craig Thomas (R-WY) who passed away earlier this year after serving as the co-chair for many years. Senator Roberts has been a champion of rural health concerns over the years, earning NRHA's legislative award in 2001. In addition, Senator Roberts was a main driver of legislation introduced earlier this year named in honor of Senator Craig Thomas. That legislation is the Senate companion bill of the H-CARE Act. We look forward to working with both co-chairs Senator Roberts and Tom Harkin (D-IA) in the months and years to come.

The Craig Thomas Rural Hospital and Provider Equity Act Introduced -

June 13

In the Senate, a major comprehensive rural health care bill has been introduced. Senators Conrad, Roberts, Harkin, Domenici and others introduced a large package of provisions for rural health. This package, the Craig Thomas Rural Hospital and Provider Equity Act, honors Senator Thomas, who passed away recently. He spent his career as a champion of rural health care and served as a co-chair of the Senate Rural Health Caucus.

Some of the provisions include:

• Hospital Reimbursement Improvements - removal of the DSH cap, Critical Access Hospital improvements, rebasing the Sole Community Hospital formula, and the creation of the Rural Community Hospital program
• Physician Reimbursement Improvements - mental health, physician pathology services, ambulatory trips, and the work geographic adjustment to a 1.0 floor
• Raises the Rural Health Clinic encounter rate cap
• Prompt payment of pharmacists by Medicare Prescription Drug Plans and MA-PD plans under Medicare Part D
• Extension of 5% Medicare adjustment payment for home health services provided in rural areas
• Grants for Health Information Technology, Quality Improvement, and the reauthorization of the Outreach and Network grant programs

NRHA Mourns the Loss of Senator Craig Thomas -

June 4, 2007

Rural health care has lost a true champion and statesman with the passing of Senator Craig Thomas(R-WY). Senator Thomas was a steadfast advocate for rural America. He was a gentle giant among Senators who championed access and quality issues for rural communities across the nation. His passionate and tireless fight for rural patients and their providers was at all times dignified and thoughtful. His legacy will be lasting, not only in Wyoming but throughout rural America. NRHA had honored Senator Thomas as the legislator of the year in 1998. Senator Thomas, thank you. You will be truly missed.

HIT and Quality Grants in Farm Bill

The NRHA has been a leading voice in the Campaign for a Renewed Rural Development to support passage of a flexible and fully funded Rural Development Title in the next Farm Bill. In addition, we have been working with Congressional leaders to make sure the Farm Bill includes provisions that will help strengthen the rural health system. Studies have shown that strengthening health care in rural America can have a major impact on the economic viability of our communities. The NRHA is pleased to see that the House Agriculture Subcommittee, working on the next Farm Bill, has included grants for the purchase of Health Information Technology and Quality Improvement. We will be working with the full committee and the Senate to include similar provisions.

To read more, visit the Campaign for a Renewed Rural Development

SCHIP Dollars Critical to Rural Children

A higher percentage of children in rural areas depend on Medicaid or the State Children's Health Insurance Program (SCHIP) for health insurance than children in urban areas, according to a new study by the Carsey Institute at the University of New Hampshire.

The Carsey Institute found that 32 percent of children in rural areas relied on SCHIP or Medicaid, compared to 26 percent of children in cities. The report also found more rural children living in economically vulnerable families, with 47 percent of rural children living in low-income families, compared with 38 percent of urban families.

SCHIP must be reauthorized by Congress this year before September 30th. We anticipate the Senate Finance Committee to work on the legislation in early July with the House to follow. We will be working with our rural champions to make sure that there are significant dollars to help with outreach to rural children.

For more on SCHIP and a larger health package, visit NRHA's SCHIP and Health Package website.

Congressional Rural Veterans Caucus Established

The NRHA applauds Representatives John Salazar (D-CO) and Adrian Smith (R-NE) in establishing the Rural Veterans Caucus. The central purpose of the Caucus is to address issues affecting veterans in rural areas. The caucus will also explore opportunities to enhance access to health care for rural veterans, as well as provide a forum for the exchange and discussion of ideas on how best to improve services for these veterans.

NRHA has played a critical role in advocating for rural veterans. Already this year, NRHA has testified before the House VA Committee and submitted written testimony for a second hearing. As well, NRHA updated its policy paper on the issue in February.

NRHA Testifies on Medicare Advantage PFFS Plans

NRHA Board Member Brock Slabach testified on May 22, 2007 before the powerful U.S. House Ways and Means Subcommittee on Health that the growth of Medicare Advantage Private Fee-for-Service plans (PFFS) in rural America may negatively effect rural providers and Medicare beneficiaries. Mr. Slabach outlined several of the NRHA's concerns that Medicare Advantage PFFS plans harm rural seniors' access to care, including concerns that such plans often reimburse providers at rates far lower than under traditional Medicare, that the plans are often confusing, can contain gaps in coverage, and are sold with questionable marketing tactics. Mr. Slabach outlined the NRHA's recommendations to the committee, including:

• Ensure that rural providers receive equitable reimbursements in amounts no less than they would be paid by traditional Medicare;
• Require CMS to engage with rural health experts regarding how to determine and enforce rural community access standards and mandate MedPAC, which advises
  Congress on Medicare, to have proportional rural representation; and
• Provide
  the Federal Office of Rural Health Policy expanded authority to provide technical assistance and outreach on ways rural providers can collaborate in the review of MA contracts.

For complete testimony of the NRHA and other witnesses, visit the Ways and Means website

NRHA Past President Tom Dean Appointed to MedPAC

It was announced that Thomas M. Dean, MD, from Wessington Spring, South Dakota, was appointed to the Medicare Payment Advisory Commission (MedPAC) on Monday, May 21. Dr. Dean has served rural Americans in a variety of clinical settings for more than thirty years, and has been a leader in the national quality movement. He served as the tenth NRHA President in 1990, and been honored by the National Health Service Corps for "for improving access to those most in need." Dr. Dean represents a second rural voice on the MedPAC Commission, which had only one rural representative until his appointment. Though Dr. Dean's appointment is a great success for rural health, the NRHA remains concerned that rural interests on MedPAC continue to be underrepresented, and will continue to advocate for rural representation on the Commission that is proportional to the 27% of Medicare beneficiaries who live in rural America.

For more information, visit NRHA's MedPAC page.

War Supplemental has Important Health Provisions

President Bush signed a $120 billion fiscal year 2007 supplemental appropriations bill on Friday, May 25, 2007, for military operations in Iraq that also includes funding for nonmilitary programs, such as the State Children's Health Insurance Program (SCHIP) and a moratorium on certain Medicaid provisions that the NRHA pushed for. The House and Senate on Thursday approved the legislation, which includes $97.8 billion requested by President Bush for military operations and $22.2 billion proposed by Democrats for non-military programs.

The bill includes the following health provisions:

• $650 million for SCHIP to cover the expected shortfalls in the program before the end of the fiscal year (September 30th)
• $1.9 billion for military health care
• $1.8 billion to help reduce a backlog of health care claims for veterans who return from Iraq and Afghanistan
• A two-year extension of federal funds for SeniorCare, a Wisconsin prescription drug program for low-income seniors
• A one-year delay of a rule proposed by CMS under which state Medicaid reimbursements to health care providers operated by local governments could not have exceeded actual costs that would have saved the program $3.8 billion over five years
• A one-year delay of a rule proposed by CMS that would have reduced federal Medicaid reimbursements for graduate medical education and saved the program $1.8 billion over five years.

The last two provisions have been fought by the NRHA to protect Medicaid dollars for rural America. The rule, now delayed, was proposed by CMS earlier in the year and would have impacted the more than 57 million Americans who rely on the Medicaid program, as well as health care providers who deliver essential services to them. The rule (CMS-2258-P) would have imposed cost limits for public health care providers and altered the definition of "public" status. Specifically, the proposed rule would limit payments to government safety-net providers by capping reimbursement payments, redefining eligible public providers, and imposing new restrictions on non-federal funding sources.

On March 19, the NRHA formally commented on the proposed CMS rule, stating the organization had "significant concerns that the Proposed Rule will have a very serious effect on the ability of rural safety net providers to serve Medicaid patients and the uninsured," and that it would "negatively impact" the unique circumstances of rural public health providers. We will now consider working with our partners to seek a permanent moratorium on the proposed rule.

Read NRHA's comments on the Proposed Rule.

NRHA Launches Capitol Hill Newsletter

On May 3, 2007, the NRHA launched Amber Waves, a semimonthly "e-newsletter" geared towards Capitol Hill staff. In an effort to help Congressional Staff identify important legislation that impacts rural health in their respective states and districts, each issue of Amber Waves will include a list of highlighted legislation that is of particular interest to rural health providers and patients. For more information about Amber Waves, and to see the first issue, please visit Amber Waves.

CMS Announces to NRHA-Relocation Rule for CAHs Will Be Revised

On Tuesday, May 1, 2007, representatives from the Centers for Medicare and Medicaid Services (CMS) announced to the NRHA that CMS will "revise" the Critical Access Hospital (CAH) relocation interpretive guidelines by mid-summer. The announcement was made during a conference call where five CAH administrators detailed to CMS how the guidelines restricted their ability to rebuild their facilities and provide quality care in their respective communities. For more information, visit our Regulatory Affairs page.

NRHA Testifies on Veterans Affairs Health

On Wednesday, April 18, 2007, Andy Behrman testified to Congress on rural veterans’ access to care in the VA system. The testimony took place during the Health Subcommittee of the House Committee on Veterans’ Affairs oversight hearing on "Access to VA Health Care: How Easy is it for Veterans? Addressing the Gaps." Behrman addressed the necessity to improve and strengthen access points for veterans in rural communities as there are more veterans in rural areas than the national average and they have less care available in their communities. This imbalance will only grow, as 44 percent of current recruits come from rural America. Behrman’s testimony included recommendations approved by the Rural Health Policy Board in February to strengthen the rural VA delivery system, including increasing the number of Community Based Outreach Centers in rural areas, allowing the VA to contract with local providers, and fully implementing the functions of the newly created Office of Rural Veterans.

Read the full testimony.

Read the NRHA response to questions from the hearing.

Read submitted testimony to a June hearing.

The MedPAC Rural Representation Act of 2007 is Introduced

Thanks to the efforts of NRHA members, 45 original cosponsors introduced the MedPAC Rural Representation Act of 2007 (HR 1730) on Wednesday, March 28th. Since that time another three members of Congress signed on as co-sponsors. Thanks to your efforts, there is a great mix of both Democratic and Republican Members of Congress and a number of members from the important health authorizing committees, Energy and Commerce and Ways and Means.

This legislation would require proportional representation in prospective MedPAC appointments based on the number of rural Medicare beneficiaries in the Medicare program. Currently, rural beneficiaries constitute nearly 28 percent of the Medicare population, so this bill would require that 28 percent of the MedPAC Commissioners have a professional background that makes them familiar with the unique nature of health care delivery in rural America. This is essential to make sure that rural voices are heard on MedPAC, since currently only one of the seventeen Commissioners has solid rural professional experience.

The following members of Congress are cosponsor of this important legislation:

If your member is not a co-sponsor, it is not too late to ask them to become one. Go to our action center and contact your member to become a co-sponsor today!

Senators Feingold and Collins Introduce Rural Medicare Equity Act

Feb. 8, Senators Feingold (D-WI) and Collins (R-ME) introduced S. 498, the Rural Medicare Equity Act. If passed, this legislation would:

• Ensure adequate representation of rural beneficiaries and providers on the Medicare Payment Advisory Commission (MedPAC).
• Provide $50 million for quality demonstration projects, focusing on innovative uses for health information technology to improve access and quality of care.
• Eliminate the geographic physician work adjustment factor in the Medicare physician fee schedule.
• Provide $20 million over a five year period for a clinical rotation demonstration project for hospitals in underserved areas.

NRHA endorses this legislation and asks that you contact your Senators to ask that they cosponsor this legislation by clicking here:

State of the Union

President Bush promoted two health proposals in his State of the Union address. The first would offer a federal tax deduction of $7,500 for individuals and $15,000 for families who obtain health insurance on their own or through an employer. Health insurance above the deduction level would no longer receive tax preferred treatment. The Administration estimates that this policy will result in new health insurance coverage for 3 million individuals. Some criticisms of the plan are that it will shift more costs to individuals over time, since the value of the deduction will not keep pace with increases in medical costs, and does little to benefit individuals who do not have sufficient tax liability to take advantage of the tax benefit.

The President also proposed an "Affordable Choices Initiative" that would redirect portions of existing federal health care funding to "help the states that are coming up with innovative ways to cover the uninsured." The proposal would redirect about $30 billion in federal Medicare and Medicaid funding currently designated for disproportionate share hospitals.

While not mentioned in the State of the Union, there have also been press reports that the President's budget will propose $90 billion in cuts to Medicare over five years.

Bush Administration Proposes $1.6 Billion in Loans for Critical Access Hospitals

On Wednesday, January 31, the Bush Administration released details of their rural development proposal for the reauthorization of the Farm Bill. While NRHA staff is still reviewing the proposal, the Administration's recommendations include an investment of $85 million to support $1.6 billion in guaranteed loans and $5 million for grants. The purpose of this proposal according to the recommendation would be, "Complete the reconstruction and rehabilitation of all 1,283 certified rural Critical Access Hospitals." A copy of the summary recommendations can be found at: http://www.nrharural.org/advocacy/pdf/rd-title-7.pdf

First 100 Hours

The 110th Congress convened on Thursday, January 4, 2007. The House of Representatives spent the first few days passing a series of rule changes including ethics reform, the requirement to disclose the sponsor of an earmark (or members' pet projects), and the addition of a spending restraint measure known as PAYGO, or pay-as-you-go. Under PAYGO, any new spending for mandatory programs such as Medicare or Medicaid must be offset by spending cuts elsewhere, or tax increases. This change imposes new fiscal restraints. The Senate Democratic leadership has proposed a similar requirement via legislation, and will likely implement PAYGO as a change to the Senate rules later this spring. Meanwhile, Democratic leaders are in the middle of what they are calling their first "100 hours," dedicated to six legislative priorities. Two priorities of interest to health providers and the research community are: expanding stem cell research and negotiating lower prescription drug prices in the Medicare program:

• The House passed legislation on Thursday, January 11th that would allow federal funding for stem cell research involving embryos under certain conditions. The Senate is expected to pass a similar bill. The President has vowed to repeat his veto of a similar measure that passed the House and Senate last year.
• The House passed legislation on Friday, January 12th that would require government negotiation of Medicare drug prices. The Senate is expected to give the administration more flexibility and simply allow the government to negotiate prices. The 2003 Medicare overhaul law that created the drug plans did not allow any government negotiations.

110th Congress

The 110th Congress was sworn in Wednesday, January 3, 2007. Caucus totals are 233 Democrats and 202 Republicans in the U.S. House of Representatives and 49 Democrats, 49 Republicans and 2 Independents (who plan to caucus with Democrats) in the U.S. Senate. Leadership in the House includes:

Leadership in the Senate includes:

2006

Final Action for the 109th Congress

Congress wrapped up its lame duck session the week of December 8th, 2006 and adjourned the 109th Congress. The 110th Congress will be sworn in on Wednesday, January 3, 2007.

Medicare Legislation

House and Senate negotiators agreed on a Medicare package that will avert a scheduled 5.0 percent payment cut to physicians, and make other changes to Medicare. Thanks to the hard work of so many NRHA members, the package does extend some expiring provisions for rural providers. The Tax Relief and Health Care Act of 2006 (H.R. 6111) includes the following key health components:

• Provides a zero percent update for physicians in 2007. Starting July 1, 2007, eligible professionals who report quality measures, as identified under the CMS Physician Voluntary Reporting System, will receive a bonus payment of 1.5 percent.
• Extends the floor on the work component of the physician geographic adjustor through 2007. The extension of this provision is an important victory for rural providers in the fight for payment equity, as it continues a hard-fought provision that helps to level the playing field for rural physician payments.
• Extends cost-based reimbursement for lab tests furnished in small rural hospitals (under 50 beds) in low density population rural areas through cost reports beginning before July 1, 2007.
• Continues direct billing for the technical component for pathology services by independent laboratories through 2007.
• Provides for a technical correction to the rural Program of All-Inclusive Care for the Elderly (PACE) provider grant program that allows the program to retain funds provided for outlier payments through 2010. The NRHA was a major sponsor of the rural PACE program's inception.
• Extends the Section 508 wage index reclassifications for six months, through September 30, 2007.
• Other provisions include: a 2 percent reduction in payments for outpatient services provided by hospitals and ambulatory surgical centers that do not report certain quality measures, starting in 2009; a 1.6 percent update to End State Renal Disease facilities for 2007; payments to providers for administering Part D vaccines in 2007 and subsequent years; an extension through 2007 of an exception allowing additional reimbursement of outpatient therapy services not performed in a hospital; and setting a maximum Medicaid provider tax of 5.5 percent, to name a few.

Additional information on the Tax Relief and Health Care Act of 2006 can be seen at: http://waysandmeans.house.gov/ResourceKits.asp?section=2544

Reauthorization of Conrad 30

On Wednesday December 6, the House passed a two-year extension of the Conrad 30 program (H.R. 4997) up to June 30, 2008. The Senate followed suit on Saturday, December 9. This program lets foreign doctors who work in underserved areas remain in the country after they complete their medical training under a J-1 visa waiver. The bill is expected to be signed by the President.

Rural Veterans Health Care

Before the Congress adjourned, a catch-all veterans bill passed the House by voice vote and the Senate by unanimous consent. The bill authorizes medical projects and mandates an information technology overhaul at the Veterans' Affairs Department. The legislation (S. 3421) establishes a VA Office of Rural Health Care, and requires the VA to develop a plan to improve the access and quality of care for enrolled veterans. The legislation also requires an outreach program to veterans who reside in rural communities who served in Iraq and Afghanistan. The bill now goes to the President for his signature.

To view older news, visit our Government Affairs News Archive.