Historic rural spending in stimulus heads to President Obama's desk
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. We anticipate the President signing the stimulus package into law by early next week.
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 within appropriations or funding programs. Highlighted rural health appropriated funding includes:
- $2 billion to the Office of the National Coordinator of HIT to make sure that providers, especially in underserved communities, have money to invest and implement HIT in their facilities
- $500 million for health workforce programs
- $1 billion to fund prevention and wellness programs
- $500 million for the Indian Health Services medical facilities
- $1 billion for the Veterans Administration construction, including medical facilities
- $2 billion for Section 330 facilities, including Community Health Centers
- At least $3.5 billion for rural broadband implementation programs (half of the overall pot) to develop the next generation broadband networks in rural America through a series of programs
- $130 million for rural community facility development, which will translate to well over $1 billion in guaranteed loans for rural facilities, including health care facilities
- $1.1 billion for health care comparative effectiveness research
- $1.38 billion for waste and waste water programs for rural
In addition, the stimulus package includes numerous tax and entitlement programs, including $87 billion for Medicaid to assure needed health care coverage and incentive payments for meaningful adopters of health information technology and electronic health records. The NRHA successfully secured incentive payments starting in 2011 for most rural providers that become meaningful adopters by 2015. This is a historic investment in rural America. More details on these incentive programs are below:
- Critical Access Hospitals (CAH) - While we have concerns about the effectiveness of the final language (it differs from the Senate language), the inclusion of CAHs was always a must for the NRHA and we are very pleased that they are included. CAHs will get HIT depreciation amounts in the same calendar year as the purchase of HIT for their Medicare inpatient percentage plus 20 percent of HIT costs.
- Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) - Medicaid incentive payments not in excess of 85% of net allowable EHR costs for those facilities that have at least 30% of their patients on either Medicaid, SCHIP, sliding fee scale or uncompensated care. The NRHA was pleased that the 30% of patients was expanded from previous versions of the bill as it should allow more RHCs and FQHCs to participate.
- Rural PPS hospitals or tweeners - Medicare incentive payments to rural PPS hospitals that meaningfully adopt HIT systems will be based on a formula. That formula gives each hospital a base $2 million amount and then adds additional payments per each discharge up to 23,000. After 2015, if the hospital has not meaningfully adopted HIT, they will begin to receive a penalty on their Medicare payments.
- Physicians and other eligible health professionals - The stimulus gives eligible health professionals the choice of either a Medicare incentive payment formula or a Medicaid incentive payment formula for meaningful EMR adoption. The Medicaid formula is similar with the RHC and FQHC Medicaid incentive, except the 30% has to be Medicaid patients. Under the Medicare incentive payments, eligible professionals can each receive up to $41,000. After 2015, eligible providers receive a penalty on Medicare payments if they do not adopt.
You can read the language online:
