Policy Update

i May 3rd No Comments by

Last week, NOSORH leaders visited congressional staffers from eight states. Among those in attendance were Mark Schoenbaum (MN), Policy Committee Co-Chair; John Barnas (MI), Policy and Program Monitoring Team Co-Chair; Teryl Eisinger, NOSORH Executive Director; and Andrew Coats, Legislative Liaison.

“We certainly heard support from nearly every office, and in fact, that support was evident in the passing of the Continuing Resolution with an increase to SORH,” said Eisinger. This is the first increase seen in many years, and it’s not yet clear how those funds will be granted. The funding is in place for this year’s budget. “It’s quite evident we must be able to help policy makers understand the needs of rural people and providers as they address making changes to current law. Andrew and the staff at Hall Render are a great asset to us as we continue to work to grow the capacity and resources for SORH.”

The NOSORH Policy Committee meets the third Tuesday of every month to hear Washington updates, discuss strategy for growing SORH appropriations and reauthorization, and for regular updates from federal partners. Any SORH staff is welcome to join the call.

The following update was provided by Hall Render, NOSORH Legislative Liaison, on April 27th:

Congress Reaches Funding Agreement for FY 2017

On April 30, House and Senate leaders reached an agreement on the Fiscal Year (FY) 2017 funding through September 30. The deal will be finalized by the House and Senate during the first week of May.

The FY 2017 appropriations bill included $10 million in funding for the State Offices of Rural Health, an increase of almost $500,000 from FY 2016. Rural Outreach, Rural Hospital Flexibility Grants and Telehealth all received increased funding in the discretionary funding. More broadly, the Labor-Health and Education bill includes $161 billion in discretionary funding a reduction of $934 million below fiscal year 2016 and $2.86 billion less than what the Obama administration had sought. It includes no discretionary Affordable Care Act funding.

Congressional appropriators will now turn their focus to the FY 2018 spending bill which will need to be enacted by October 1, 2017.

TeleHealth Bill Introduced in the Senate

Leaders of the Senate Finance Committee introduced a bipartisan bill that would allow more Medicare dollars to flow into telemedicine. Among other provisions included in the chronic care legislation, the bill would provide ACOs more flexibility to provide telehealth services, allow beneficiaries receiving dialysis treatments at home to do their monthly check-in with their doctor by way of telehealth, rather than travelling to the doctor’s office or hospital. The bill would also expand the availability of telehealth to ensure individuals who may be having a stroke receive the right diagnosis and treatment.

The bill stems from the Senate Chronic Care working group which originally introduced this bill at the end of last Congress. Last week, Senator Gardner (R-CO) introduced a different telehealth bill (S. 787) that would require HHS to allow eligible hospitals to test telehealth services through CMMI.

House Bill Seeks to Extend Access to Physicians in Rural, Underserved Areas

Legislation was introduced in the House this week that would extend the Conrad State 30 program until 2021. The House bill would expand the number of J-1 visa waivers a state health department could request from 30 to 35 per year to work in federally designated Health Professions Shortage Areas or Medically Underserved Areas. The House bill (H.R. 2141) was introduced by Rep. Brad Schneider (D-IL) and Darrell Issa (R-CA). The bill is a companion to S. 898 which was introduced in the Senate in early April.

House Delays AHCA Vote

On April 27, House leadership delayed a vote on the American Health Care Act (AHCA) until at least next week. As of now, at least 15 House Republicans remain opposed, with another 20 undecided. Without Democrat support, House Republicans can only lose 22 votes.

Earlier in the week, several conservative groups including the House Freedom Caucus, dropped their opposition to the ACA repeal and replace bill as a result of compromise language being added to a revised version of the AHCA. The new language allows states to seek federal waivers from complying with certain insurance protections (essential health benefits, age rating, and medical underwriting under certain conditions).

However, ongoing concerns from more moderate House Republicans coupled with a lack of enthusiasm from a number of Republican governors kept the AHCA off the House floor for at least another week. Also, the Congressional Budget Office (CBO) has not scored the new language which could increase the number of uninsured. Were a House bill to pass, a number of Senate Republicans have indicated it will take at least a month for the Senate to pass their version of the AHCA. So, as the calendar turns to May, the effort to repeal and replace the ACA is still in a precarious spot.

Rural Health Related Bills Introduced this Month

Senator Shelley Moore Capito (R-WV) introduced a bill (S. 980) that would allow rural health clinics and federally qualified health centers to bill Medicare under Part B for hospice, which they currently can’t do. A similar bill (H.R. 1828) was introduced by Lynn Jenkins on the House side.

Rep. Tom Reed (R-NY) introduced the Rural Hospital Access Act (H.R. 1955) that seeks to make permanent the extension of the Medicare-dependent hospital program and the increased payments under the Medicare low-volume hospital program. A companion version was introduced in the Senate by Senators Charles Grassley (R-IA) and Chuck Schumer (D-NY).

Senator Cory Gardner (R-CO) introduced a bill that would require the Center for Medicare and Medicaid Innovation (CMMI) to test the effect of including telehealth services in Medicare health delivery reform models. According to the press release, the bill would require HHS to allow eligible hospitals to test telehealth services through CMMI.


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