Each year the NRHA membership produces a Legislative and Regulatory Agenda that details the policy agenda of the association.  As we prepare for 2011, we ask all members to take some time to read the 2010 agenda and suggest any needed additions, changes or amendments.  You can submit these changes via an online form by clicking here.

Submissions are due October 15.

Up to $250 Million Available to Support More than 350 New Service Delivery Sites in FY 2011

U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced today the availability of up to $250 million in grants for New Access Points for the delivery of primary health care services for underserved and vulnerable populations under the Health Center Program.  The funds, made available by the Affordable Care Act, will be awarded by the Health Resources and Services Administration (HRSA).

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.

On July 24, the House passed H.R. 3293, the appropriations bill for the Departments of Labor, Health and Human Services, and Education by a vote of 264 to 153. The bill matched NRHA’s requests for rural programs and also provided increases for other programs important to rural health. Longtime rural champion Dave Obey (D-WI-07), chairman of the House Appropriations Committee, said that the bill “makes vital investments to train people for jobs, shores up health and social safety nets to provide relief for millions of hard-working Americans caught in a struggle for economic survival, and provides the educational opportunities that are critical to the nation’s longer-term prosperity.”

The National Rural Health Association attended the Obama Administration’s Rural Community Health Forum on July 20 in St. John Parish, Louisiana. The forum, which is a part of the larger Rural America Tour, was hosted by four of the Administration’s top secretaries: Kathleen Sebelius, Department of Health and Human Services; Tom Vilsack, Department of Agriculture; Hilda Solis, Department of Labor; and Eric Shinseki, Department of Veterans Affairs. The purpose of this forum was for government officials to hear the perspectives of local residents and discuss solutions to the health care problems our nation’s rural communities face. 

The National Rural Health Association is pleased to express support for Dr. Regina Benjamin, President Obama’s recent selection for the position of United States Surgeon General. Benjamin, a family doctor from the small town of Bayou La Batre, Alabama, is a nominee who brings a wealth of experience working in many facets of health care to this position. As founder, CEO and family physician at Bayou La Batre Rural Health Clinic, Benjamin knows the challenges rural health care providers face and has the skills to help overcome them.

On June 25, Senator John Barrasso (R-WY) and Senator Ron Wyden (D-OR) introduced S. 1355, the Rural Health Clinic Patient Access and Improvement Act of 2009. The bill addresses long-standing underpayments to rural health clinics, introduces a quality improvement program to RHCs, and provides incentives to recruit and retain medical professionals to rural areas.

On June 24, the National Rural Health Association held one of its three annual Government Affairs Committee meetings in Washington, D.C. The timing for the meeting couldn't have been better, with Congress currently debating monumental health reform legislation.

The Senate Health, Education, Labor and Pensions (HELP) Committee began today what is expected to be a three-day hearing to markup its health reform legislation, the Affordable Health Choices Act. NRHA sent comments to Chairman Ted Kennedy (D-MA) and Ranking Member Mike Enzi (R-WY), as well as the other Committee members, commending and suggesting improvements to the bill’s rural health workforce provisions. The letter urges all Committee members to ensure the unique health needs of rural America are not forgotten during the bill's deliberations. 

For a copy of the letter, please click here.

For a summary of the bill, please click here.

For a full text version of the bill, please click here.

Senator Ted Kennedy (D-MA), chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, released a draft this week of his health reform legislation, the "Affordable Health Choices Act." Included in the draft are strong provisions supporting much-needed rural health services, with increased funding for the National Health Service Corps, Federally Qualified Health Centers, Area Health Education Centers, and the 340B prescription drug program. Additionally, the bill's workforce component (Title IV) provides many improvements to rural America's health care infrastructure, but NRHA believes it can do better to support these crucial services. For this reason, we have provided comments to key HELP Committee members asking for a stronger emphasis on the unique health needs of rural America.

NRHA applauds House and Senate rural health champions for recent comprehensive bipartisan legislative efforts aimed at stabilizing our nation's rural health care infrastructure.  S. 1157, theCraig Thomas Rural Hospital and Provider Equity Act of 2009 (R-HOPE) and the Health Care Access and Rural Equity (H-CARE) Act, soon to be introduced in the House, would correct deficiencies that jeopardize rural health care systems and beneficiaries.

On Wednesday, June 3, legislation was introduced in both the Senate and the House to allow states to waive the mileage designation to grant critical access hospital (CAH) status to hospitals that meet all other criteria. Senators Mark Pryor (D-AR) and Sam Brownback (R-KS) introduced S. 1171, "The Critical Access Flexibility Act of 2009," and Congressman Mike Ross (D-AR) and Congressman William "Mac" Thornberry (R-TX) introduced H.R. 2692, "The CAH Designation Waiver Authority Act of 2009." The legislative language is the same in each bill.

National Rural Health Association, in partnership with AgriSafe Network, the National Association of Rural Health Clinics, the National Association of Rural Mental Health, the National Cooperative of Health Networks, the National Organization of State Offices of Rural Health, and the National Rural Recruitment and Retention Network, has sent a letter to the Chairmen and Ranking Members of the Senate Finance Committee, Senate Health, Education, Labor and Pensions Committee, the House Ways and Means Committee and the House Energy and Commerce Committee to urge them to remember to "champion rural America within Congressional health reform discussions." They also pledge to provide Congress with the data, background information and research that they need to make the case that rural America can lead in health care reform.

To read the letter to Senate Finance, click here.   

The Senate Finance Committee has released three papers summarizing possible options for health system reform, coverage reform and financing reform. Finance Committee Chairman Max Baucus (D-MT) said,“Health care reform must preserve the things Americans like about our health care system, but it must also begin to slow the rapid increases in health care costs that take up more and more of the budget for American families and businesses.” The papers, which summarize a large variety of potential reform mechanisms, are part of Chairman Baucus' and Ranking Member Chuck Grassley’s (R-IA) health reform effort. 

The summaries of the American Recovery and Reinvestment Act of 2009 offered at NRHA's "Accessing Stimulus for Your Community" mini-conference May 5 are now available online.  

For the rural health provisions booklet, click here.

For the full summary,  click here.

On May 7, President Obama released the details of his FY 2010 spending request, including increases to rural health programs. To reflect the president's belief in increasing access to health care and improving the quality of health care in rural areas, the budget includes $73 million for a new "Improve Rural Health Care" initiative. This initiative includes such vital rural health programs as the Rural Health Outreach and Network grants ($55 million), the State Offices of Rural Health ($9 million) and the Telehealth grants ($8 million).

On May 4, the White House Office of Health Reform hosted a Health Care Stakeholder Discussion concerning rural health. NRHA was invited to participate, and President-elect Denny Berens and CEO Alan Morgan represented the Association. Director of the White House Office of Health Reform Nancy-Ann DeParle, HRSA Administrator and former NRHA member Mary Wakefield, and Representatives Ross and Pomeroy met with farmers, ranchers and fishermen to discuss their struggles accessing high-quality, affordable health care in America's rural heartland.

Participants, including NRHA, discussed the high cost of health care and health insurance for small businesses and the independently employed and the challenge of the lack of access to local health care providers in rural communities. They also offered ideas and suggestions on how to reform the health care system.

On April 29, the House adopted the conference reporton the $3.5 trillion budget resolution by a 233-193 vote, with the Senate later agreeing to the measure 53-43. The five-year spending and tax blueprint, which most importantly sets congressional spending and other budgetary limits for fiscal 2010, does not have to be signed by the president. The House and Senate had previously passed their own budget resolutions and reached a compromise on April 27. The budget includes language creating a health care reserve fund intended to serve President Obama's priorities in health reform. It also includes significant increases for Community Health Centers, health professions, and the National Health Service Corps within HRSA.

On April 22, Hilda Heady, NRHA board member and Associate Vice President of Rural Health at the Robert C. Byrd Health Sciences Center at West Virginia University, testified before the Senate Committee on Veterans’ Affairs (VA) on the health care needs of rural veterans.

On April 2, the Senate approved Amendment #799 to the Budget Resolution, S. Con. Res. 13, to create a budget-neutral reserve fund to address the systemic inequities of Medicare and Medicaid reimbursement that lead to access problems in rural areas, including access to primary care and outpatient services, hospitals and an adequate supply of providers in the workforce. The amendment also prioritizes eliminating those inequities as a part of health care reform - a very positive step toward achieving equity for all who call rural America home. The amendment was introduced by Senator Bennet (D-CO) and Senator Roberts (R-KS) and will not only protect the fragile rural health care safety net, it will make health care more accessible and affordable for all rural Americans. After voting on all the amendments, both the House and Senate are expected to adopt budget resolutions later today. 

Graham Adams, NRHA board member and South Carolina Office of Rural Health CEO, testified before the Health Subcommittee of the House Committee on Veterans' Affairs on March 19. Adams recommended ways of closing the gaps in health care for rural veterans. These recommendations included building on current success, collaborating with non-VA facilities, increasing mental health access, targeting care and strengthening the Office of Rural Veterans.

To read the NRHA press release, click here.

To read the full written testimony, click here.

On March 11, President Obama signed into law H.R. 1105, a $410 billion appropriations package that includes funding for critical rural health programs. The omnibus includes $53.9 million for rural outreach and network grants, $9.7 million for rural health research/policy, $9.2 million for state offices of rural health and $39.2 million for rural hospital flexibility grants. It also includes $2.2 billion for community health centers, $134.96 million for the National Health Service Corps and $32.5 million for area health education centers, as well as funding for other programs important to rural America. This adds up to a more than $10 million increase over the FY2008 funding levels for the rural health safety net programs alone. NRHA is thrilled to see such strong numbers in support of rural health and will begin now to look forward to the FY 2010 appropriations process. 

On Feb. 26 President Obama released his budget overview, outlining his priorities including a "historic commitment to comprehensive health care reform." According to Obama, "We must make it a priority to give every single American quality, affordable health care... It's a step that will not only make families healthier and companies more competitive, but over the long term it will also help us to bring down our deficit." 

The NRHA is very supportive of funding for critical rural health programs and awaits details on funding for those programs. The NRHA appreciates Obama's recognition of the unique challenges inherent in providing quality health care in rural America and support for the dedicated individuals and programs that ensure that rural Americans receive the care they need. We will continue to advocate on behalf of these programs as the president's final budget is developed. 

On March 4, NRHA CEO Alan Morgan joined U.S. Senators Jack Reed (D-RI) and Michael Bennet (D-CO) for a press conference on the importance of passing a federal spending bill that contains strong funding levels for critical rural health care safety net programs.

On Friday, February 13th, both the House of Representatives (246 to 183) and Senate (60 to 38) passed the final package of a massive stimulus package containing historic levels of spending for rural America.  Previously, both the House and Senate had passed stimulus packages (NRHA summary on the House package / NRHA summary on the Senate package) that were combined in the final conference agreement. The NRHA won a large victory for rural health with the inclusion of $500 million for health workforce training and $1 billion for prevention services, in addition to health information technology incentives for many rural providers.

Earlier today, the Senate voted to approve their version of the stimulus package by a vote of 61-37. The NRHA has worked to advance numerous provisions for the betterment of rural health care in both the Senate and House stimulus bills. Funding included in the House and Senate bills compute to the greatest dollars amounts invested in rural health care and infrastructure in the nation's history.  We are happy to report that the Senate version includes significant financial investment in rural health.

This week the Senate is debating the American Recovery and Reinvestment Act, worth over $850 billion. This bill includes significant investment for rural communities and rural health providers. In fact, the bill provides more money for rural America, dollar for dollar, than any previous federal investment. The NRHA is working with our congressional champions to ensure that the package is fully supportive of rural health, and we will need your help to gain final passage.

On Wednesday, February 4, President Obama signed the Children's Health Insurance Program Reauthorization Act of 2009, surrounded by families whose children rely on the program for their health coverage. President Obama referred to SCHIP as a "lifeline for millions of children" and said that it was a "down payment on [his] commitment to cover every single American." The NRHA has been strongly supportive of the SCHIP reauthorization, as rural children are proportionally more reliant on SCHIP and Medicaid.   

On January 15, the House Democratic leaders detailed a historic $825 billion economic stimulus package, featuring $550 billion in spending and $275 billion in tax breaks. The proposal would provide a total of $124.1 billion for health care programs, including $87 billion to help states with Medicaid costs.  The proposed bill also contains numerous investment projects for rural workforce, IT and infrastructure.  The NRHA anticipates a final stimulus bill in February.

Legislation to reauthorize and expand SCHIP is headed to the Senate floor, after the Senate Finance Committee approved a draft bill by a vote of 12 to 7 on January 15.  This comes one day after the House overwhelmingly voted to pass on the heals of H.R. 2, the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).  The bill is very similar to two House bills during the 110th Congress, which will cover an additional four million children, that led to Presidential vetoes. 

Tuesday, January 20, 2009 was a historic day in our nation's history. Barack Obama was inaugurated in Washington, D.C. as the 44th President of the United States of America, the third president from Illinois and the first African American to assume our nation's highest office. The NRHA congratulates the President, the first lady Michelle Obama, their children, and Vice President Joe Biden and his family and looks forward to working closely with them and their staffs to improve the health of 62 million rural Americans.

Senator Hillary Rodham Clinton has introduced legislation that would increase investment in the training and education of health care professionals.  The Health Professional and Primary Care Reinvestment Act would expand health care training by improving recruitment and retention efforts and by increasing incentives for health professionals working in community settings, with a strong focus on rural needs.    

NRHA submitted questions on issues important to the rural health community to the candidates for President of the United States. This week, Sen. Obama sent NRHA his response. His responses are available by clicking on the full story link. Sen. Obama also sent a letter last week to attendees of the Rural Health Clinic and Critical Access Hospital conferences. If NRHA receives a response from Sen. McCain, his answers will be posted as well.

Both the House and Senate have passed legislation that will prevent group health plans from charging higher out-of-pocket costs and applying stricter treatment limits for mental health care than any other medical care. However, because the House and Senate used different legislative vehicles to pass the bill, final enactment of the bill is not assured. Congress must still take the final steps necessary to send the bill to the president for his signature. Fortunately, President Bush, business groups, insurance companies and mental health advocates all support the measure. The bill passed both houses overwhelmingly, and we expect that it will be enacted.

Thanks to the support of Congressional champions and our longstanding partners, the NRHA was able to secure the inclusion of language correcting a technical issue impacting most rural health clinics (RHCs) that could pass the Senate as soon as today and the House by early next week. The bill is the overall Health Care Safety Net Act (H.R. 1343) that includes Community Health Centers, the National Health Services Corps and Rural Health Outreach Grants. We still need your help to assure passage of these vital programs and that Congress and the Administration support additional RHC issues.

The NRHA applauds the passage of S. 901, the Health Care Safety Net Act which provides $12.9 billion dollars for rural and medically underserved areas. On July 22, the U.S. Senate unanimously passed S. 901; the House of Representatives earlier passed a similar bill. The act reauthorizes and strengthens three programs which together provide a safety net will help millions of rural Americans each year access needed health care services.

On July 23, Wayne Myers of the Maine Health Access Foundation testified on behalf of NRHA before the House Agriculture Subcommittee on Specialty Crops, Rural Development and Foreign Agriculture. The hearing was held to explore rural health disparities and found that critical telecommunication and work force challenges contribute to greater disparities in access to health care in rural areas. Subcommittee Chair Mike McIntyre (D-N.C.) said, "With limited dollars available for rural health care programs, we must ensure they are used in ways that address the challenges and with sufficient federal coordination." Dr. Myers discussed the importance of quality health care in rural America to both the community's citizens and the community's economy.

On the same day President Bush vetoed H.R. 6331, Congress overwhelmingly overrode that veto. The House of Representatives voted 383-41 and the Senate voted 70-26. Both the House and Senate had more votes to override the veto than were originally cast to send the bill to the president. The NRHA strongly supported passage of the bill, which provides nearly $2 billion critical dollars to rural America and eliminates the pending 10.6 percent cut in Medicare payments to physicians through December 2009.

Today, President Bush vetoed H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008. The legislation had previously passed both the Senate and the House with overwhelming support. H.R. 6331 would provide $2 billion in needed rural health care dollars and temporarily eliminate the 10.6 percent cut to Medicare reimbursement rates for physicians. Overriding the veto will require a two-thirds majority in both the House and Senate. The NRHA needs your immediate help to ensure that this bill will become law.

On June 26, the Senate failed to act on H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008, which would have halted the scheduled 10.6 percent payment cut and extended a number of vital rural provisions that approximately totaled $2 billion over 18 months.The vote to close debate failed by a single vote. The NRHA was disappointed by the Senate's inability to pass Medicare legislation before the July 1 deadline.

On June 24, 2008, the House of Representatives passed H.R. 6331, The Medicare Improvements for Patients and Providers Act of 2008, by a vote of 355 to 59. The NRHA endorsed this bill as it provides a number of improvements for rural seniors and providers.  Now the Senate must act.  Read on to find out how you can help rural health.

Providers paid under the Medicare physician fee schedule will receive 10.6 percent payment cuts on July 1st if Congress does not act. Both the House and Senate are working frantically to provide a package that will protect providers from this payment cut. On June 20th, NRHA staff met with House Democratic leadership on a proposed Medicare package. This comes as Senate Democrats and Republicans work on their own compromise package.

On June 18, after a long journey, the Senate voted 80 to 14 to override the President's veto of the Food Conservation, and Energy Act of 2008, the "Farm Bill." Earlier in the day, the House also voted to override the President's veto by a vote of 317 to 109. The Farm Bill is now officially law. 

On June 11, Senate Finance Committee Ranking Member Charles Grassley (R-IA) introduced the "Preserving Access to Medicare Act of 2008". The bill contains provisions to prevent rural providers from receiving the cuts in Medicare reimbursements scheduled for July 1. Several other provisions critical to rural America are also contained, but Congress must do more. 

On June 6, Senate Finance Committee Chairman Max Baucus (D-MT) introduced S. 3101, the “Medicare Improvements for Patients and Providers Act of 2008.”  In addition, on June 11, Senator Charles Grassley (R-IA) is introduced a similar bill, “Preserving Access to Medicare Act of 2008.” Both bills contain provisions to prevent rural providers from receiving the cuts in Medicare reimbursements scheduled for July 1.

May 2, 2008 - Senate and House negotiators announced today that they have reached a comprise on a new Farm Bill. Staff for the Senate and House agriculture committees and for conferees will continue to work on finalizing a few remaining issues and obtaining official budget scoring from the Congressional Budget Office, but the main issues have been agreed to. The completed legislation will have to be approved by both the Senate and House before being sent to the White House.

On April 23rd, the House of Representatives passed, by a veto proof majority of 349 to 62, legislation that prevent states from losing billions in federal dollars by placing a one-year moratorium on seven new Medicaid regulations. Earlier this week, the Bush Administration issued a formal veto threat against the legislation. The legislation moves to the Senate where its fate is less certain as it is not clear whether the votes are there to overturn a Presidential veto.

On March 13, Paul Moore testified on behalf of the NRHA before the House Appropriations Committee, Subcommittee on Labor, Health and Human Services, Education and related agencies on the rural health safety net, a group of programs that strengthen and build upon our rural health delivery system.

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.