On the week of October 28, the Senate began deliberation on a Labor-HHS appropriations bill for fiscal year (FY) 2020. Senate Majority Leader McConnell filed cloture on the motion to proceed to the House-passed Labor-HHS spending bill (H.R. 2740). However, on October 31, the vote to pass the House bill and begin floor debate failed in a 51-41 vote.
Congress has a November 21, 2019 deadline to enact funding for FY 2020. If a bill is not passed by then another continuing resolution will need to pass. Members indicated this week that a continuing resolution could extend into early spring of 2020.
NOSORH is working with Congress to ensure the State Offices of Rural Health line is funded at the House-passed level of $12,500,000 for FY ’20. The current Senate measure only includes $10,000,000 in funding.
Telehealth Package Introduced:
On October 30, a bipartisan group of lawmakers reintroduced the CONNECT for Health Act, a bill intended to expand payment for telehealth services. The comprehensive telehealth package would remove geographic restrictions on payment for various services, including for virtual mental health treatment.
The bill, S. 2741, would also allow patients to get coverage for treatment they receive at home. The bill would also encourage CMMI to test out a new telehealth payment model for Medicare and allow some restrictions on telehealth coverage to be waived during national and public health emergencies.
The bill was introduced by Senators Brian Schatz (D-HI) and John Thune (R-SD). A companion measure, H.R. 4932, was introduced on the House side by Rep. Mike Thompson (D-CA). While the telehealth package is unlikely to pass as a stand-alone package, a number of provisions from the bill could be advanced in other legislative vehicles. Last Congress a number of provisions included in the CONNECT Act made it into the 2018 Bipartisan Budget Act.
Trio of Rural Health Bills Introduced:
On October 29, three rural health-related bills were introduced in the House.
Companion bills were introduced in the Senate earlier this year by Senator Marsha Blackburn (R-TN). Earlier this summer, Senate Finance Committee Chairman Chuck Grassley (R-IA) indicated the committee may look to advance a more comprehensive rural health bill. Were that to occur, these bills could be in consideration.
Action Needed for SORH Appropriation
NOSORH is asking State Offices to contact their Senate members and request that House and Senate conferees agree to the House appropriated and Congressional authorized number for the SORH. In 2018, Congress passed and the President signed into law (Public Law 115-408), the State Offices of Rural Health Reauthorization Act of 2018 (S. 2278). The law authorizes the appropriation of $12,500,000 for the SORH grant program for each of fiscal years 2018 through 2022. Feel free to share this SORH Appropriations Factsheet.
Senate Releases FY 2020 Labor-HHS Appropriations Bill
On September 18, Senate appropriators released a draft FY 2020 appropriations bill for the departments of Labor, Health and Human Services (HHS), Education and related agencies. The draft Senate Labor-HHS bill included reductions in overall rural health spending compared to its House counterpart.
The Senate bill would fund the State Offices of Rural Health (SORH) at $10 million annually compared to the $12,500,000 the House appropriated. If the Senate bill passes in its current form, the two chambers would need to reconcile a number of substantive differences on both spending levels and policy provisions including the SORH line.
Congress Averts Shutdown, Passes CR
On September 26, the Senate passed a continuing resolution (CR) that funds the federal government at the Fiscal Year (FY) 2019 rate until November 21, 2019 and avoids a government shutdown. Senate passage of H.R. 4378 clears the way for President Trump to sign the bill by September 30, the final day of FY 2019.
The CR delays the $4 billion Medicaid disproportionate share hospital (DSH) payment cuts scheduled to take effect October 1. This is especially timely as earlier this week, CMS finalized its rule implementing cuts to state Medicaid DSH allotments by $4 billion next year. Under this rule, DSH payments will set cuts worth $8 billion for the following five years. These cuts are set to take effect November 22, 2019. Additionally, it extends the Certified Community Behavioral Health Clinic demonstration program through November 21. The legislation also extends funding for Community Health Centers, the National Health Service Corps, Teaching Health Centers that operate graduate medical education programs, among others.
Lawmakers from both parties are optimistic that this will be the only continuing resolution needed for funding fiscal year 2020, which begins October 1. However, ongoing disputes on issues including abortion policy, the border wall, and spending levels for non-defense programs could lead to several more stopgap measures.
In the past few years it has become evident how much Rural Health Clinics (RHCs) want advice on strategy, finance, operations and regulations. To address that need, Lilypad, one of NOSORH’s strategic partners and developer of the POND tool, has developed an approach to get that information out to the RHCs in a way that is simple, quick and focused.
These 30-minute, monthly webinars will be hosted by Lilypad and other subject matter experts in partnership with NOSORH — and they are available at no cost to the participating organization. The webinar series was developed specifically for RHC practice managers and providers with topics focusing on financial and operational improvement strategies.
Check out the POND Webinar flyer outlining FREE 30-minute webinars happening every month over the next year presented by rural-focused industry experts! Click on the link beside the topic you would like to attend to reach registration for each session.
Favorite thing about working at a SORH: The SORH “family”. NOSORH does an excellent job in building a community among the SORHs. I feel very grateful to have developed deep professional and personal relationships with many SORH personnel across the nation over the last ten years.
What I’m working on right now: Launching the Rural Communities Opioid Response Program – Implementation funding. MCRH facilitated forming the Northern MI Opioid Response Consortium, covering 16 rural counties, under the RCORP-Planning funding and are now able to move the work forward with the implementation funding!
Best advice I ever received: “Good for her! Not for me.” Very helpful as a fairly new mom navigating everything you are “supposed” to be doing.
“Be part of the solution. Don’t sit around being negative and pointing out obstacles.”
“Surround yourself with good people.”
Oh, and “Enjoy the WOW that is happening now.” That last one is from my three year old’s favorite show, Daniel Tiger.
What I’m currently reading: I just finished “Love Thy Neighbor” and “In Shock” – Both excellent books focused on aspects of healthcare. I am excited to dive into “Save Me the Plums” which is Ruth Reichl’s (former food magazine editor) memoir.
3 great things about rural health in Michigan: 1) The MICAH QN. This impressive group of quality leaders take pride in improving not only their organization, but work together to lift all CAHs in Michigan. 2) The collaborative nature among organizations and stakeholders focused on improving the health of rural MI residents and teams. 3) My colleagues. The MCRH team is strong in their commitment to assisting rural communities on everything rural health. I’m so proud to work with each and every one of them.
Last place I traveled to: The beautiful Upper Peninsula of Michigan. If you haven’t been, it is worth a trip. I was reminded how accessible it was to see truly beautiful scenery, and how much of it there is in Michigan!
Who inspires you? At this phase in life, I’m really inspired by strong women who are making it work (whatever that means for them). This includes the likes of women like RBG, but also the women in my life who are navigating their own journeys and figuring out what happiness means for them. There are quite a few NOSORH women on that list!
RHIhub has published four new Rural Monitor stories highlighting the great things that are happening in rural communities across the nation:
We have published several new Models & Innovations:
In June we released a video, Preventing Farmer Suicide: Collaboration and Communication. In it experts discuss warning signs of suicide and how communities can help farmers and their families address mental health concerns.
We also published two new videos in July about philanthropies supporting rural health.
We have updated two of our topic guides:
Save the dates for our upcoming webinars:
Did you know? There’s an easy way to get information about rural health topics straight to your inbox. Sign up to receive RHIhub Updates & Alerts!
On July 25, the House of Representatives passed a two-year budget agreement (H.R. 3877) that establishes the framework for Congressional spending over the next two fiscal years and suspends the debt limit through July 31, 2021. The Senate is set to pass the House agreement this week and will be signed into law. With the budget in place, Congress will begin work on passing fiscal 2020 spending bills. The Senate Appropriations Committee has yet to release any of the 12 annual spending bills and is expected to introduce the bills in September.
The Republican-controlled Senate will need to pass, and then reconcile differences with the Democrat-controlled House, who has already passed 10 of 12 FY ’20 spending bills. In order to pass the often partisan Labor-HHS-Education spending bill, Congress could pair it with the traditionally more bipartisan Defense spending bill, similar to last Congress (PL 115-245). Fiscal Year 2020 begins October 1, 2019, leaving Congress only 15 legislative days to fund the federal government.
Earlier this year, the House passed their version of the House Labor-HHS-Education bill which included a $2.5 million increase in State Office of Rural Health grant funding over FY ‘19. Also included in the spending bill is $59 million for Medicare Rural Hospital Flexibility Grants and $19,942,000 for the Small Rural Hospital Implementation Grant Program.
Congress and Administration Focus on Rural Health Delivery:
On July 16, the House Ways and Means Committee announced the creation of the “Rural and Underserved Communities Health Task Force.” The purpose of the task force is to discuss the challenges of delivering health care in rural and underserved areas and explore holistic bipartisan policy options that could improve outcomes and care in these communities. The four co-chairs leading the panel will be Reps. Danny Davis (D-IL), Terri Sewell (D-AL), Brad Wenstrup (R-OH) and Jodey Arrington (R-TX). The Task Force held its first meeting on Thursday, July 25.
Also in July, the Health Resources and Services Administration (“HRSA”) awarded approximately $20 million in Rural Residency Planning and Development Program (“RRPD”) grants. Recipients across 21 states will receive up to $750,000 over a three-year period to develop new rural residency programs while achieving accreditation through the Accreditation Council for Graduate Medical Education. The RRPD program is part of HRSA’s multi-year initiative to expand the physician workforce in rural areas by developing new, sustainable residency programs in family medicine, internal medicine and psychiatry.
Rural Health Bills Introduced in July:
Sen. Robert P. Casey Jr. (D-PA) introduced S. 2157 to amend Title XI of the Social Security Act to expand the use of global payments to hospitals in rural areas.
Rep. Anthony Brindisi (D-NY) introduced H.R. 3672 to provide relief for small rural hospitals from inaccurate instructions provided by certain Medicare administrative contractors.