Rural Health Policy Update

Update provided by Andrew Coats, NOSORH Legislative Liaison 

Senate GME Working Group Releases Policy Proposal:
On May 24, the Senate Finance Committee’s Bipartisan Medicare GME Working Group released a proposal aimed at addressing physician shortages in rural areas through GME policy reforms. The proposal includes draft legislation that would: 

• Add additional Medicare GME slots from FY 2027 through FY 2031, with 25% of these new slots reserved for primary care and 15% reserved for psychiatry and psychiatry subspecialties.  
• Amend the Section 126 formula for distribution of GME slots to include a set-aside for rural hospitals. 
• Allow additional sole community hospitals and Medicare-dependent hospitals to receive IME payments to support the cost of training residents in rural areas. 
• Extend telehealth flexibilities for supervising resident physicians beyond December 31, 2024. 

Senate Holds Markup on Key Health Care Bills: On May 23, the Senate HELP Committee held a markup on a number of health care bills, including the Dr. Lorna Breen Health Care Provider Protection Act (S. 3679). The bill, introduced by Senator Tim Kaine (D-VA) and Senator Todd Young (R-IN), would reauthorize the distribution of grants for hospitals, medical professional associations, and other healthcare providers to improve mental and behavioral health services. 

House Holds Markup on 2024 Farm Bill: On May 23, the House Agriculture Committee held a markup on the 2024 Farm Bill proposal, which includes legislation related to rural health. The package, which the Committee passed on a 33-21 vote after 13 hours of debate, includes language and concepts from: 

• The Rural Hospital Technical Assistance Program Act (H.R. 4713), introduced by Representative Derek Kilmer (D-WA-6) and Representative Ronny Jackson (R-TX-13), would broaden the Program to include rural emergency hospitals, critical access hospitals, psychiatric hospitals, rural health clinics, community health centers, and home health agencies. 
• The Rural Health Care Facilities Revitalization Act (H.R. 5989), introduced by Representative Yadira Caraveo (D-CO-8), would allow eligible healthcare facilities to refinance debt obligations. 
• The Rural Telehealth and Education Enhancement Act (H.R. 5308), introduced by Representative Nick Langworthy (R-NY-23), would reauthorize the Distance Learning and Telemedicine Program at $82 million per year.  

Senate Holds Hearing on Rural Health: On May 16, the Senate Finance Committee held an oversight hearing on rural health. This was the second hearing the Finance Committee has held on rural health over the past year.   

• Chairmen Wyden, in his opening statement, emphasized the need to expand telehealth in rural communities, to update the GME program in Medicare to meet the needs of rural and “high-need” urban areas, and to provide support to “maternity deserts” experiencing shortages of obstetric care. 
• Ranking Member Crapo, in a statement for the record, said it is “critical” that rural programs within the Finance Committee’s jurisdiction ensure ample training opportunities exist for health professionals. He also urged Congress to prioritize the continuation of designations for special reimbursement programs that supplement payment rates in rural areas, which he described as essential to Medicare’s existing strategies to preserve access to health care in rural areas, and called on CMS to address staffing issues in rural areas. 
• Witnesses included Chartis Center for Rural Health Executive Director Michael Topchik, Grande Ronde Hospital President and CEO Jeremy Davis, Wisconsin Collaborative for Rural Graduate Medical Education Director Lori Rodefeld, and Rural Policy Research Institute Director Keith Mueller.  

Telehealth Waiver Bill Advances in House Committee:
On May 16, the House Energy and Commerce Health Subcommittee advanced H.R. 7623, the Telehealth Modernization Act of 2024. The bill would:  

• Ensure permanent access to telehealth flexibilities for Medicare beneficiaries.   
• Make permanent RHC and FQHC distant site status.   
• Continue flexibilities related to audio-only telehealth.   

Earlier in May, the House Ways and Means Committee advanced a handful of rural health bills out of committee, including telehealth legislation. Some of the bills advanced included: 

• The Rural Hospital Stabilization Act (H.R. 8245), introduced by Rep. Feenstra (R-IA), seeks to authorize the Rural Hospital Stabilization Program through 2029, increasing funds to rural hospitals for renovations, training, hiring, compensation, and equipment purchases.   
• The Preserving Telehealth, Hospital and Ambulance Act (H.R. 8261) would permanently expand the list of eligible practitioners who provide telehealth services to include qualified physical therapists, occupational therapists and speech pathologists.  
• The Rural Physician Workforce Prevention Act (H.R. 8235), introduced by Rep. Greg Murphy (R-NC), ensures unallocated GME slots created in the Appropriations Act of 2021 and 2023 go to hospitals in rural areas.   
• The Second Chances for Rural Hospitals Act (H.R. 8246) moves back the eligibility date for a closed hospital to convert to an REH, allowing previously closed rural hospitals to convert to REH.  

Rural Health Legislation Recently Introduced:
On May 14, Senator Moran (R-KS) and Senator Smith (D-MN) introduced a rural health bill, S. 4322, seeking to increase opportunities for CAHs to convert to a Rural Emergency Hospital and make technical improvements to the designation. Specifically, the bill would:  

• Allow previously closed rural hospitals to re-open and apply for the REH designation if they can demonstrate they met eligibility requirements between Jan 1, 2015, and Dec 27, 2020.  
• Direct HHS to create a waiver program for facilities operating similarly to an REH in order to convert to a REH.  
• Clarify that REH facilities are eligible for Small Rural Hospital Improvement Grants. 

On May 7, Senator Shelley Moore Capito (R-WV) and Senator Maria Cantwell (D-WA) introduced a bill, S. 4276, to reauthorize the Project ECHO grant program. The program distributes grants to build capacity to address Alzheimer’s disease and other dementias, among other purposes.