The following update is provided by Hall Render:

Reminder:  Contact your legislators to support Bipartisan Bill Introduced to Strengthen Rural Healthcare Networks and Reauthorize SORH Program

 On April 29, Reps. Cresent Hardy (R-NV) and Terri Sewell (D-AL) introduced a bill (H.R. 5133) to improve rural health services by providing support to existing rural hospitals, incentivizing the construction of new rural facilities, and directing HHS to monitor health disparities in rural areas.

The Rural Health Enhancement and Long Term Health (HEALTH) Act of 2016 would reauthorize the State Offices of Rural Health (SORH) grant program, which has not been reauthorized since it was enacted in 1992, at $15 million for 5 years to improve state rural health delivery systems. The legislation would establish a provision within the SORH program that would allow matching grants up to $100,000 for updating existing hospitals and building new facilities in rural areas.

The Rural HEALTH Act also requires HHS to submit a report annually on the state of the country’s rural healthcare system to Congress and all 50 SORHs. The agency must review each special hospital designation and include in its report the number and cause of rural hospital closures within the last year. HHS has not issued a report on rural health to Congress and the SORHs since 2003.

House Committee Advances Hospital Payment Bill which includes Rural Provisions

On May 18, the House Ways and Means Committee released the Helping Hospitals Improve Patient Care Act (H.R. 5273) that reforms how hospitals are paid for inpatient and outpatient services. The bipartisan House bill was subsequently advanced by the Ways and Means Committee on May 24 and could be passed by the full House during the week of June 6.  Among other provisions, the 30-page legislation would amend the Bipartisan Budget Act of 2015 to reverse the site-neutral pay cuts for hospital outpatient departments that were “mid-build” when the bill passed last year. The measure moves the date of grandfathered status for hospital outpatient department rates from November 2, 2015, to December 31, 2016.

The House bill would also create equal payments for certain surgical procedures rendered in hospital inpatient or outpatient facilities. It would adjust the Hospital Readmissions Reduction Program to account for patients’ socioeconomic status. It extends the Rural Community Hospital Demonstration Extension Act (S. 607) from five to 10 years and exempt ambulatory surgical centers from electronic health record meaningful use penalties. The legislation also includes a requirement that CMS report Medicare enrollment data by Congressional district.

In the Senate, 51 Senators wrote to CMS in May asking that the site-neutral payment reductions not affect existing off-campus Hospital Outpatient Departments that relocate, rebuild, change ownership or types of services and should not affect services provided by a dedicated emergency department. However, the Senate Finance Committee has given no indication that it intends to pass H.R. 5273 or move companion legislation.  In the meantime, CMS is in the process of writing the regulations that will implement the site-neutral payment changes in the Bipartisan Budget Act, which will be released as part of the Physician Fee Schedule Proposed rule later this year.

House Holds Hearing on MACRA Implementation – Discusses Technical Assistance for Rural Providers

On May 11, the House Ways and Means Subcommittee on Health hosted CMS Acting Administrator Andy Slavitt to discuss the Administration’s implementation plan for the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA). At the hearing, Slavitt and committee members discussed the first MACRA-related proposed regulation which was issued on April 27 and how the proposed rule can be improved before it is finalized later this year. Slavitt highlighted the technical assistance that MACRA provides to small practices, rural practices, and practices in medically underserved health professional shortage areas. This technical assistance could be provided by a host of national and regional entities to offer guidance and assistance to physicians and other clinicians. Slavitt also discussed how CMS would like to see the incorporation of unique device identifiers in electronic records and medical billing claims.

New Legislation Would Remove Direct Supervision Requirement for Rural Hospitals

On May 3, Rep. Lynn Jenkins (R-KS) introduced the Rural Hospital Regulatory Relief Act (H.R. 5164) to permanently prohibit the enforcement of direct supervision requirements for outpatient services provided in critical access and rural hospitals with 100 or fewer beds. CMS currently requires hospitals to perform most outpatient therapeutic services under the direct supervision of a physician or other qualified healthcare provider. The Jenkins bill would extend the enforcement moratorium of CMS’ direct supervision policy and adopt a general supervision standard for critical access and small rural hospitals to account for the shortage of healthcare providers in such facilities.

Other Rural Health Related Bills Introduced in May

Rep. Tom Price (R-GA) introduced a bill that seeks to prevent cuts to Medicare Durable Medical Equipment (DME) reimbursement rates scheduled to take effect July 1, 2016.  The bill (H.R. 5210) would extend the current reimbursement rates of DME in non-competitively bid areas in order to provide Congress with additional time to monitor its effects in rural areas.  A companion bill (S. 2736) was introduced in the Senate by John Thune (R-SD).

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