The National Rural Health Association submitted its comment letter this week in response to CMS' proposed changes affecting Hospital and Critical Access Hospital (CAH) Conditions of Participation (CoPs) Credentialing and Privileging of Telemedicine Physicians and Practitioners.  The letter voices the NRHA's gratitude that CMS is seeking to lessen the duplicative burdens associated with credentialing and privileging professionals performing telemedicine services via larger distant "hub" hospitals, but also our concern that its limited scope does not reach far enough to include accredited non-hospital telemedicine services.  Under the proposed guidance, hospitals utilizing accredited non-hospital telemedicine services, for instance smaller ambulatory care or tele-radiology centers, will still be required to perform credentialing and privileging services even if those distant-site professionals are accredited through the service from which they operate. 

HHS Secretary Kathleen Sebelius announced today a revised membership list for the Health Resources and Services Administration's (HRSA) Health Professional Shortage Area (HPSA) and Medically Underserved Areas/Populations (MUA/P) negotiated rulemaking committee. 

The new list, which has increased from 24 to 28 members, includes National Rural Health Association CEO Alan Morgan as a participant.  Previously excluded from the committee, the NRHA fought to fix this obvious oversight by HRSA.  This effort's success was due in large part to the help of the numerous NRHA members and friends who offered to call and write Dr. Wakefield and their Congressional representatives to ensure broad rural representation on the committee.  For this, we are extremely grateful.  Additionally, the NRHA greatly appreciates Dr. Wakefield and HRSA for their willingness to reassess the committee makeup and their continued commitment to improving health care in rural America.   

The National Rural Health Association (NRHA) congratulates HHS on today's release of final rules regulating criteria for the electronic health record incentive program or 'meaningful use,' and the release of final criteria for EHR standards necessary for vendor products to meet meaningful use certification.  The final rule adopts significant changes and reflects many of the concerns raised by the NRHA during the comment period.

On Wednesday, the White House appointed Donald M. Berwick to the position of Administrator of the Center of Medicare and Medicaid Services.  The Obama administration is using this week's congressional recess to bypass a Senate confirmation hearing in a move known as a "recess appointment."  However, since Mr. Berwick's appointment comes without congressional confirmation, the appointment only lasts one calendar year. 

NRHA has nominated a number of qualified members to serve on the National Health Care Workforce Commission. This Commission, created by the PPACA, will develop a national strategy for increasing and strengthening the health care workforce in a sustainable way. Rural areas are a high-priority issue for the Commission, and the presence of individuals on the Commission with experience in the unique challenges in rural health care delivery will ensure that the policies and strategies developed are effective across the nation. Click here to see the nomination letter.

The NRHA submitted the following comments to the Centers for Medicare and Medicaid Services (CMS) regarding its proposed changes to the 2011 Inpatient Prospective Payment System for acute and long-term care hospitals, and its supplemental proposed rule based on the recent health reform bill's requirements. 

On Tuesday, June 16, the Obama Administration announced details of two important provisions of the health care reform law, the Affordable Care Act, which will improve primary care workforce shortages. During the health care debate, NRHA strongly supported each provision:

1. The allocation of $250 million to strengthen and grow the primary care workforce
2. New tax cuts for health professionals working in underserved areas.

The newly created National Healthcare Workforce Commission is charged with the task of analyzing, coordinating and recommending national strategies to meet demand for services in the reformed health care system.  The Independent Payment Advisory Board (IPAB) is a newly created federal commission similar to MedPAC but with the ability to put its recommendations into action.  While the law mandates a balance between urban and rural representation on both bodies, there are still concerns that, given the precendent of under-representation or rural on MedPAC, there will also be underrepresenatation on this new Commission.  In response to this concern, Senators Franken (D-MN), Roberts (R-KS), Harkin (D-IA), Murray (D-WA), Thune (R-SD) and Bingaman (D-NM), along with many of their colleagues, sent a letter to Secretary Sebelius urging that careful consideration be made when selecting members of the Comission to avoid the same kind of under-representation problems that have plagued MedPAC in the past.

To see a copy of the letter click here.

The Government Accountability Office has announced its most recent appointments and re-appointments to the Medicare Payment Advisory Committee (MedPAC). Included are the re-appointments of strong rural advocates Dr. Tom Dean, a family physician from Wessington Springs, South Dakota, and Herb Kuhn, the president and CEO of the Missouri Hospital Association. Both commissioners have served as strong advocates for rural America on the MedPAC board and will hold their current appointments until at least 2013. Their expertise and continued insight on MedPAC's recommendations to Congress will prove invaluable to ensuring the welfare of rural America's patients and providers.

On April 28, NRHA CEO Alan Morgan joined Senate Democratic leaders and former President Bill Clinton for the first Senate Democratic Rural Summit.  The summit, held on Capitol Hill, brought together a diverse cross section of rural advocates and leaders to share ideas on how to revitalize rural America through economic development and job creation.

On April 15, President Obama signed into law a piece of legislation known as the "Doc fix" that would prevent 21% cuts  to the Medicare Physician Fee Schedule until May 31, 2010.  Additionally, this law will be retroactive to April 1, 2010.

On Tuesday, March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act.  He was joined by Speaker of the House Nancy Pelosi, Senate Majority Leader Harry Reid, other Congressional leaders on health care, and others with important investments in the legislation for a signing ceremony at the White House.  The health reform legislation includes numerous provisions dedicated to addressing the access crisis in rural America by bolstering the health care workforce and improving rural Medicare reimbursement.  Additionally, the insurance coverage provisions will dramatically affect the lives of the disproportionately large number of rural uninsured.

Yesterday the Senate passed H.R. 4213, The Tax Extenders Act of 2009.  The bill, which would primarily extend unemployment benefits to jobless Americans, was amended by Senator Max Baucus to include the extensions of the Medicare add-on payments for rural America that NRHA has been fighting for over the past year.  Also included in the bill was the SGR “Doc Fix” a provision that would prevent 21% cuts in Medicare reimbursement for doctors.  Most of the add-on payments have been extended until December 31, 2010 or January 1, 2011 while the “Doc Fix” has is only extended through September 31, 2010 when Congress will presumably work to find a permanent solution to this problem.  H.R. 4213 passed the senate by a final vote of 62-36, garnering the votes of six Senate Republicans.  The bill must now go back to the House of Representatives and be passed as amended by the Senate before it can be signed into law. 

NRHA continues the fight to reinstate serveral crucial Medicare programs that expired at the end of 2009.  If these programs are not renewed it will result in health care access problems in rural America.  NRHA and 13 other health care associations have sent a letter to both Senate and House leadership urging immediate action to reauthorize these important Medicare Extenders. To see the letter please click here.

Today, the President released his health care reform proposal in preparation for the upcoming health care summit.  To see a summary of  the Administration's proposal click here.

The National Rural Health Association (NRHA) is pleased to announce the winners of the 2010 NRHA Legislative Awards, which recognize outstanding leadership on rural health issues by both U.S. Congressional members and Congressional staff. This year's recipients are Chairman Max Baucus, Rep. Earl Pomeroy, Rep. Greg Walden and Congressional staffers Erik Komendant and Hayden Rhudy. Additionally, Chairman Edward M. Kennedy received NRHA's Lifetime Achievement Award. Award winners were honored during NRHA's 21^st Annual Policy Institute in Washington, D.C.

The Senate voted for passage of the Patient Protection and Affordable Care Act at 7am by a party-line vote of 60-39.  The bill must now be combined the the House's Affordable Health Care for America Act in conference and will then be voted on again before it could be ready for the President's signature.  A tentative goal to have the bill on President Obama's desk before the State of the Union address has been discussed, but Congress is on recess until January.

On December 16, President Obama signed into law the Fiscal 2010 Consolidated Appropriations Act, funding the rural health programs for the rest of the fiscal year.  The legislation would provide $446.8 billion in discretionary spending (and $1.1 trillion overall) for the six bills funded by the measure: Commerce-Justice-Science, Financial Services, Labor-HHS-Education, Military Construction-VA, State-Foreign Operations, and Transportation-HUD.

The bill included increases for rural programs of about 7% over FY 2009.

The Office of the National Coordinator for Health Information Technology (ONCHIT) announced Dec. 2 the creation of the Beacon Community Program, which will provide $235 million in grants for HIT incentive payments to eligible providers. The ONC will begin accepting letters of intent to apply for the program, funded through the American Recovery and Reinvestment Act (ARRA), immediately, with the deadline for this set at January 8. Actual grant applications are due on February 1. Awards will be announced in March, with the program's official start set for April.

The Senate has finally released their blended version of the health reform bill, HR 3590. While there are many positive provisions for rural America, NRHA still believes there are additonal steps that need to be taken for health reform to be effective in rural America. The access to care crisis must first be resolved; it does not matter if patients have access to insurance if they do not have access to a provider. To resolve the access to care crisis in rural America, health reform must resolve the workforce shortage crisis in rural areas and eliminate long-standing payment inequities for rural providers. 

Rural America has historically been underrepresented on the Medicare Payment Advisory Commission (MedPAC) despite a statutory requirement for proportional rural representation on its board. Recognizing this inconsistency, Congressman Greg Walden (R-OR) successfully added two amendments to the House Energy and Commerce Committee's markup of H.R. 3200, the House Tri-Committee's original health reform legislation. The amendments were to ensure proportional representation on both the MedPAC board of Commissioners as well as the Health Benefits Advisory Committee proposed in the current bill.

In response to the recent H1N1 (swine flu) outbreak, President Obama and HHS Secretary Kathleen Sebelius have officially declared a national state of emergency, which, among other things, will allow critical access hospitals (CAHs) to file a request to CMS that would temporarily waive the daily limit of twenty-five occupied beds for CAHs.

On Sept. 25, the Senate Finance Committee continued marking up the America’s Healthy Future Act. NRHA scored several victories with the acceptance of rural amendments.

On Aug. 18, USDA rolled out the new rural tour web site to enhance public engagement and share information from the road. There has been such positive reception for the rural tour events that USDA needed an additional way to connect with individuals across the nation. 

Each year the NRHA membership produces a Legislative and Regulatory Agenda that details the policy agenda of the association. As we prepare for 2010, we ask all members to take some time to read the 2009 Agenda and suggest any needed additions, changes or amendments. You can submit these changes via an online form.  Submissions are due September 3.