Policy

Policy Update

i Apr 1st No Comments by

The NOSORH Policy Committee asks that all SORH and their partners reach out to their members on appropriations.  NOSORH is seeking an increase in appropriations for the SORH line to $12.5 million to match the SORH authorization language. Please check in with your members of the appropriations committee to ensure their support of increased appropriation, determine the deadline for any requested submission and ask for their support. Please contact Andrew Coats, Legislative Liaison, if you need assistance or with any questions. 

President Releases Fiscal Year 2020 Budget Proposal
On March 11, President Trump released his administration’s fiscal year 2020 budget. As it goes for every presidential budget, the proposal stands zero chance of being implemented in its entirety.  The condensed version of the budget can be found here.

The Health Resources and Services Administration’s (HRSA) budget request does not request funding for the Rural Hospital Flexibility program, State Office of Rural Health, and the Rural Residency Planning and Development. The lack of the funding has been consistent with HRSA budget requests in recent years. With Congress passing into law the Reauthorization of the SORH program at the end of the 2018, we remain hopeful that Congress will fund the SORH line as called for in recent law.

Other health care priorities include: 

Medicaid: The budget calls for trillions in cuts to the growth of Medicaid (and Medicare). The administration is seeking to overhaul Medicaid through block grant funding. By implementing block grant or per capita caps, this would cut $1.5 trillion over 10 years in Medicaid spending.

340B: The budget also calls for giving HRSA more control over 340B by asking for “broad regulatory authority for 340B to set enforceable standards of program participation.” The budget requests Congress require hospitals to report their 340B savings and explain how the money is used. This was included in last year’s budget, and there were a couple bills introduced last Congress mirroring this. If Republicans couldn’t move this last year, there is little chance in the new Congress.

Bad Debt and Uncompensated Care: The budget calls for bringing “transparency to several Medicare payments to hospitals.” The proposal calls for reducing the reimbursement for bad debt from 65 percent to 25 percent over three years starting in fiscal year 2021. Rural hospitals with fewer than 50 beds, critical access hospitals, rural health clinics and FQHCs would be exempt. The budget also proposes to cut uncompensated care payments. Starting in fiscal year 2021, uncompensated care payments would be made to hospitals based on their share of charity care and non-Medicare bad debt, as included on their Medicare cost-reports. The bad debt proposal would save $38.5 billion over 10 years and the uncompensated care proposal would save $98 billion over 10 years.

Others: Another hospital-related proposal of note would consolidate the Hospital Value-Based Purchasing Program, Hospital-Acquired Condition Reduction Program and Hospital Readmissions Reduction Program into a single program.

House Democrats Unveil Single-Payor Legislation
House Democrats introduced sweeping “Medicare for All” legislation, providing the most detailed plan to overhaul the current healthcare system by enrolling all U.S. residents in a single-payer, government-run health plan. It would cover a more expansive set of benefits than the current Medicare program and restructure payment for institutional healthcare providers such as hospitals and skilled nursing facilities. The measure does not include a price tag or specific proposals for financing the new system, which analysts estimate would cost tens of trillions of dollars over a decade. The lead sponsor, Rep. Pramila Jayapal (D-WA), said she will release a separate list of suggested funding mechanisms.

The single-payor, government-run healthcare system under Medicare for All would cover a range of services at no out-of-pocket cost to patients. The measure would not only cover primary and preventive care, as well as inpatient and outpatient hospital services, but also long-term care support services that are not currently covered by Medicare. Every insurance program in the U.S. would be changed, leaving only the veterans’ health program and the Indian Health Service in place. Providers such as hospitals or skilled-nursing facilities would be paid through a global budget so that hospitals would receive a quarterly lump sum to cover items and services. Additionally, individual providers would be paid based on a national fee schedule set by the HHS secretary. A section-by-section summary of the bill, along with other information on the legislation, can be found here.


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Policy Update

i Mar 4th No Comments by

Senator Pat Roberts (R-KS) was recently recognized as the NOSORH 2018 Legislator of the Year for his sponsorship of the SORH reauthorization bill. Cynthia Snyder, Director of the Kansas Office of Primary Care and Rural Health, and Teryl Eisinger, NOSORH Executive Director, presented his award at the NRHA Policy Institute last month. Senator Roberts met with NOSORH representatives and shared his experiences and vision for rural health.  “Senator Roberts has been a champion for rural health throughout his career,” said Snyder. “He has made tremendous strides to improve the quality of rural health care and access to it. I’m pleased that NOSORH has recognized his numerous achievements in this area.”

Other State Offices of Rural Health were also well represented at the Policy Institute. A NOSORH members meeting at the Institute included updates from FORHP with information on upcoming new programs, discussion of the NOSORH request for additional appropriation and a toast to Andrew Coats and the Policy Committee for their efforts in achieving SORH reauthorization.


The following update was provided by Hall Render, NOSORH Policy Liaison:

Federal Budget Season Heats Up
With the 35-day shutdown throughout January, funding for the fiscal year 2020 budget and appropriations cycle has been pushed back a month.  The President’s budget request, which is normally released in early February, should be released by mid-March. The late release date provides Congress with a tightened window to pass FY 2020 spending bills by the start of the new fiscal year, October 1, 2019. It has been reported that President Trump will propose a five percent cut to non-defense discretionary spending in his upcoming budget proposal to Congress. “With House Democrats supporting spending increases to non-defense spending, the President’s proposal won’t survive Congress,” said Andrew Coats, NOSORH’s Legislative Liaison.

HRSA Announces Upcoming Rural Grant Funding Opportunity
On February 4, the Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy announced plans to award approximately 75 grants of up to $1 million. The grants would seek to expand opioid and other substance use disorder services in high-risk rural communities. The grant award will cover a three-year period and require awardees to implement a set of core substance and opioid use disorder prevention, treatment and recovery activities that align with HHS’s Five Point Strategy to Combat the opioid crisis. All domestic public and private entities, nonprofit and for-profit, will be eligible to apply. The services must be provided in a HRSA designated rural area. HRSA intends to release a notice of funding opportunity in the coming weeks.

CMS Unveils Overhaul of Medicare Payment for Emergency Treatment
On February 14, CMS launched a voluntary payment experiment, the Emergency Triage, Treat and Transport (“ET3”) model, allowing first responders more flexibility to treat patients on the scene, through telehealth or at an urgent care clinic. CMS will pay participating ambulance teams to transport patients to hospital emergency departments, transport patients to other settings like a primary care physician’s office, use telehealth or provide care on the scene under supervision of a qualified practitioner. Currently, Medicare reimburses ambulance providers if they transport patients to the hospital, skilled nursing facility or dialysis center. The voluntary demonstration will likely begin in 2020 and run for five years. CMS will phase in the model across the country and will phase it to 30 percent of emergency room visits.

ACE Kids Act Reintroduced in the Senate
On February 5, Senate Finance Chairman Chuck Grassley (R-IA) reintroduced a bipartisan bill intended to provide states with the option of providing coordinated care for children with complex medical conditions through Medicaid.

The Advancing Care for Exceptional Kids Act is intended to make it possible for home health providers to coordinate care, lower costs and improve quality outcomes for children with complex medical conditions on Medicaid who require specialized care. The bill (S. 317) was referred to the Senate Finance Committee, which has jurisdiction over Medicaid.


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Policy Update

i Feb 4th No Comments by

The following update was provided by Hall Render, NOSORH Policy Liaison:

Short-Term Funding Deal Reached to End Government Shutdown
On January 18, President Trump announced a deal to temporarily reopen the federal government and end the longest shutdown in U.S. history. The deal funds the remaining federal agencies until February 15, giving lawmakers more time to try to work out a compromise on the immigration and border security issues. President Trump called on the Senate to bring the proposal to the floor for a vote immediately. The House is hoping to clear the bill by unanimous consent. The agreement is considered the product of negotiations between the Senate’s top leaders, Majority Leader Mitch McConnell (R-KY) and Minority Leader Chuck Schumer (D-NY), who met on Thursday following the failure of two measures in the Senate to reopen the government.

While the shutdown did not impact HHS-related programs, some rural health programs and projects could be delayed due to the month-long shutdown. Projects including hospitals and addiction treatment facilities backed by grants awarded last fall by the USDA’s rural development program could be impacted. Congress now has less than three weeks to come up with a solution for a border security deal, however most lawmakers believe another shutdown this year is unlikely.

Senate Clears Medicaid Extenders Measure
On January 17, the Senate passed by voice vote legislation to extend certain Medicaid policies known as “extenders.” The measure will go to the president’s desk for signature since the House passed the bill. The extenders were passed late last session by both the House and the Senate but through different bills that were never signed into law.

This bill alters several Medicaid programs and funding mechanisms. Specifically, the bill includes $112 million for a roughly three-month extension of the Money Follows the Person demonstration, which helps state Medicaid programs transition older adults and people with chronic illnesses back into their communities. It also temporarily extends the applicability of Medicaid eligibility criteria that protect against spousal impoverishment for recipients of home- and community-based services. Additionally, it reduces the federal medical assistance percentage (i.e., federal matching rate) for states that have not implemented asset-verification programs for determining Medicaid eligibility and reduces funding available to the Medicaid Improvement Fund beginning in FY 2021.

Rural Health Related Bill Introduced

On January 18, Senate Health Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) introduced legislation that extend community health centers and four other federal health programs. The legislation (S. 192) would provide five years of mandatory funding for the Community Health Center Program, National Health Service Corps, Teaching Health Center Graduate Medical Education Program, Special Diabetes at the NIH, and Special Diabetes for Indians. Mandatory funding for the programs is set to expire after September 30, 2019. The Senate HELP Committee is scheduled to hold hearings on the programs and will likely vote to advance the bill later this year.


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Resources Available for 2019 NRHA Policy Institute

i Jan 14th No Comments by

The 2019 National Rural Health Association Policy Institute is in Washington, D.C. on February 5-8, and NOSORH has resources to help you prepare for the conference. NOSORH will be hosting the webinar “Preparing to Engage with Legislators & Policymakers” on January 17th at 1:00 pm ET. This webinar will focus on understanding the environment on Capitol Hill, SORH legislative priorities for the new Congress, and how to “orient” new congressional members (and resources available) and conduct a Hill visit with state partners. Click here to register for the webinar.

In addition, one-page state profiles, like this one from South Carolina, are available to help SORH document the impact of their work. For help in completing your state’s profile, please contact Donna Pfaendtner at donnap@nosorh.org no later than Friday, January 25, 2019. A SORH factsheet will be provided for your use at the Policy Institute and Hall Render staff will be available to join you on Hill visits.

While in D.C., be sure to attend the NOSORH Members Meeting on Tuesday, February 5th at 6:00 pm ET in the Capitol Room. Stay tuned for more details about this meeting.

For more information, please contact Matt Strycker at stryckerm@nosorh.org


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Policy Update

i Dec 6th No Comments by

Last month, State Rural Health Associations were invited to join the NOSORH Policy Committee. The committee heard about the election results, an FORHP regulatory update and a preview of the work of the Policy and Program Monitoring Team. For more information or to join the Policy committee, please contact Matt Strycker.

The following update was provided by Hall Render, NOSORH Policy Liaison:

Democrats Set to Control Key Health Committees in Next Session of Congress
The Democratic takeover of the House of Representatives following the recent midterm elections will significantly change the political landscape for healthcare issues when lawmakers return for the 116th Session of Congress next year. Overall, the election results will mean divided government and a return to the era when little is accomplished legislatively. Lawmakers are expected to go from one “fiscal cliff” to another as they struggle to pass funding bills that will keep the government open.

The main focus of House Democrats is expected to be oversight of the Trump administration’s implementation of health policies but could extend to the idea of “Medicare-for-all” or other programs that would move the country towards universal health care.

Shoring up the Affordable Care Act (“ACA”), drug pricing and surprise medical bills are also anticipated to be some of the major healthcare issues tackled during the new Congress. After Republicans’ unsuccessful efforts to repeal and replace the ACA, House Democrats will be looking to pass legislation bolstering the ACA’s insurance markets and cementing the law’s provisions on pre-existing conditions. They will also look to fixing the cost-sharing reimbursement issue, which saw some bipartisan support in the Senate last year and could be one of the few pieces of legislation that makes it to the president’s desk. By contrast, the Senate, which will remain under Republican control, is expected to focus more broadly on health care.

Both parties are in alignment as to the necessity of lowering drug pricing. House Democrats will try to reign in pharma by making drug pricing one of their top issues. Incoming House Energy and Commerce Health Subcommittee Chairman Anna Eshoo (D-CA) said she wants to hold hearings before developing her prescription drug policy priorities. Meanwhile, Energy and Commerce leadership staff have signaled that 340B drug pricing program reform will no longer be a high priority for the committee. In addition, House Democrats are expected to conduct oversight of issues such as Medicaid work requirements and the Justice Department’s decision to back anti-ACA lawsuits.

At the committee level, Rep. Richard Neal (D-MA) will become the chairman of the full House Ways and Means Committee, which is expected to add at least four new Democratic members. On the Ways and Means Health Subcommittee, Chairman Peter Roskam (R-IL) and Health Subcommittee member Erik Paulsen (R-MN) both lost their races for reelection. With the retirement of Reps. Sam Johnson (R-TX), Lynn Jenkins (R-KS) and Diane Black (R-TN), Republicans will see very large changes in their membership on this subcommittee. Since Republicans currently hold an 11-7 majority on the subcommittee, these losses and retirements should mean no Republican will be removed from the subcommittee and one will be added. As for who will take the gavel as the subcommittee’s next chairman, Rep. Lloyd Doggett (D-TX) is currently expected to get the nod over Rep. Mike Thompson (D-CA) because he has more overall seniority in Congress.

At the House Energy and Commerce Committee, Rep. Frank Pallone (D-NJ) will become the full committee chairman and Rep. Greg Walden (R-OR) will become the Ranking Minority Member. Pallone has a reputation for “doing deals” across the aisle, which could make additional opioid funding a possibility. The change in control of the House means Rep. Michael Burgess (R-TX) will become the Energy and Commerce Health Subcommittee’s Ranking Minority Member once Rep. Eshoo takes the gavel. In addition to drug pricing, Eshoo’s agenda is expected to include coverage of pre-existing conditions and investment in biomedical research and development.

On the Senate side, drug pricing and additional opioid legislation could make some progress, but little else is expected to happen on the healthcare front. Senate Republicans, such as Bill Cassidy (R-LA), will continue to push for 340B reform, but any 340B legislation that passes the Senate should die in the Democratically controlled House. At the committee level, the Health Education Labor and Pensions Committee will see no loss in its membership. Sen. Lamar Alexander (R-TN) will remain chairman and Sen. Patty Murray (D-WA) will remain the Ranking Member.

At the Senate Finance Committee, Sen. Chuck Grassley (R-IA) is expected to become the next chairman. Sen. Grassley says he wants to work “on improving the affordability, quality and accessibility of health care, including in rural America.” Sen. Ron Wyden (D-OR) will remain the committee’s Ranking Member. Losses by Sen. Claire McCaskill (D-MO) and Sen. Dean Heller (R-NV) open one seat on the Democratic side of the committee aisle and one on the Republican, which are expected to be filled before lawmakers return for the 116th Session of Congress in January.

Congress Unlikely to Make Progress on Health Care Bills Before Year-End
As government funding battles overtake Capitol Hill, it appears Congress will not use the lame duck to resolve outstanding healthcare issues. While the desire to steer clear of health are fights is something different from prior years, outgoing House Ways and Means Committee Chairman Kevin Brady (R-TX) said this week that healthcare legislation will not be a priority during what’s left of the lame duck session.

Furthermore, Democratic control of the House of Representatives that comes in January has caused many Democratic lawmakers to push their healthcare priorities into the New Year. However, some policy changes could still surface as additions to a year-end spending package that must be passed before December 7 in order to avoid a partial government shutdown.

Luckily for a majority of healthcare programs, funding for most agencies within the Department of Health and Human Services (HHS) was included in a giant spending package Congress passed in September. Those that remain to be funded include the FDA, which receives its funding through a separate bill and user fees. A House Republican tax bill was released on November 26, but it did not address any of the Affordable Care Act’s taxes, such as the medical device tax and the “Cadillac” tax on health plans.

CMS to Expand Medicaid Covered Mental Health Treatment
On November 14, CMS announced that states can soon begin applying for waivers to expand treatment capacity for serious mental health issues. HHS Secretary Alex Azar highlighted the effectiveness of waivers for substance abuse treatment citing Virginia as an example. Virginia received approval for a waiver in 2016 and subsequently saw a 39 percent decrease in opioid-related emergency room visits.

Waivers will allow states to lift the “IMD exclusion.” The IMD exclusion prohibits the use of federal Medicaid funds to pay for substance use disorder treatment for patients age 21-64 at inpatient mental health treatment facilities that have more than 16 beds. It also prohibits Medicaid beneficiaries who are receiving treatment at IMDs from receiving additional Medicaid-covered care elsewhere. Many experts state the IMD exclusion is a large hindrance to treatment for low income people.

Health-Related Bills Introduced This Month
Sen. Orrin Hatch (R-UT) introduced S.3693 to amend Title XVIII of the Social Security Act to provide for the treatment of certain cancer hospitals.

Sen. Todd Young (R-IN) introduced S.3685 to amend the Public Health Service Act to expand the authority of the Secretary of Health and Human Services to permit nurses to practice in healthcare facilities with critical shortages of nurses through programs for loan repayment and scholarships for nurses.

Sen. Jeff Merkley (D-OR) introduced S. 3680 to require the Secretary of Health and Human Services to establish references prices for prescription drugs for purposes of federal health programs.

Rep. Erik Paulsen (R-MN) introduced H.R. 7177 to amend Title III of the Public Health Service Act and Titles XI and XVIII of the Social Security Act to accelerate the adoption of value-based payment and delivery arrangements among health care stakeholders intended to coordinate care, improve patient outcomes, share accountability or lower costs.

Sen. Bill Cassidy (R-LA) introduced S. 3619 to amend Title XVIII of the Social Security Act to restructure the payment adjustment for non-emergency ESRD ambulance transports under the Medicare program.

Rep. Erik Paulsen (R-MN) introduced H.R. 7122 to amend Title III of the Public Health Service Act and Titles XI and XVIII of the Social Security Act to accelerate the adoption of value-based payment and delivery arrangements among healthcare stakeholders intended to coordinate care, improve patient outcomes, share accountability or lower costs.

Sen. Rand Paul (R-KY) introduced S. 3610, known as the Medicare Patient Empowerment Act of 2018, to amend Title XVIII of the Social Security Act to establish a Medicare payment option for patients and eligible professionals to freely contract, without penalty, for Medicare fee-for-service items and services while allowing Medicare beneficiaries to use their Medicare benefits.


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SORH Resources Available for NRHA Policy Institute

i Dec 6th No Comments by

NOSORH has resources to help you and your state partners prepare for the National Rural Health Association Policy Institute being held February 4-7, 2019, in Washington, D.C. One-page state profiles, like this one from South Carolina, are available to help State Offices of Rural Health (SORH) document the impact of their work. . For help in completing your state’s profile, please contact Donna Pfaendtner at donnap@nosorh.org no later than Friday, January 11, 2019. A SORH factsheet will be provided for your use at the Policy Institute and Hall Render staff will be available to join you on Hill visits. While in D.C., be sure to attend the NOSORH Members Meeting on Monday, February 4th at 6:00 pm ET. We do not have a room assignment yet but be looking for more information to come next month. Lastly, NOSORH will be hosting the webinar “Preparing to Engage with Legislators & Policymakers” on January 17th at 3:00 pm ET to help you get ready. Stay tuned for more details.

For more information, please contact Matt Strycker at stryckerm@nosorh.org


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Policy Update – Coats, Davis and Daniels

i Nov 5th No Comments by

Policy Update – Coats, Davis and Daniels

Policy Update

i Oct 31st No Comments by

The Policy Committee invites all State Rural Health Associations to join the monthly meeting of the NOSORH Policy Committee. Updates will be provided on federal regulatory issues, efforts to reauthorize the SORH program and other policy issues.

SORH Reauthorization Bill Update

While the House and Senate were out of session for most of October, the House version of the State Office of Rural Health Reauthorization bill (H.R. 5641) continued to gain momentum picking up three new cosponsors. In addition to gaining House Energy and Commerce member Morgan Griffith (VA), Reps. Steve Russell (OK) and Elise Stefanik (NY) also signed on a cosponsor. NOSORH met with the Energy and Commerce Committee this fall and believes it is likely the SORH reauthorization bill advances next time the committee addresses public health legislation. The Senate has already passed the reauthorization bill. If there is a House member of the Energy and Commerce Committee in your state, please contact their staff and urge them to cosponsor H.R. 5641.

President Signs Opioid Reform into Law

On October 3, 2018, the “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act” or short hand—the SUPPORT for Patients and Communities Act (the “SUPPORT Act”)—was approved by the Senate and sent to the President. The President has now signed the SUPPORT Act into law. The SUPPORT Act is the compromise version of the opioid response bills approved by the House and Senate earlier this year.

The bill package includes a broad array of new programs and reforms specific to the opioid crisis and substance use disorders (SUDs) generally advocated by the healthcare industry. The final compromise opioid package contains over 70 opioid-related bills. For a comprehensive summary of the package’s provisions, see the section-by-section summary at: https://tinyurl.com/y9vlrsmy. Some of the key issues addressed in the SUPPORT Act are:

  • Partial repeal of the “IMD exclusion”: This provision partially lifts the ban on use of federal Medicaid program funding for SUD treatment at facilities that are an institute for mental disease (IMD) with more than 16 beds (commonly known as the “IMD exclusion”). Under the provision, Medicaid programs may pay for care at an IMD facility for up to 30 days of residential SUD treatment annually per beneficiary, regardless of severity of diagnosis. The partial lifting of the IMD exclusion is only effective for the next five years. This provision does not mandate the coverage benefit by the states. It remains to be seen whether SUD treatment providers will enroll in the Medicaid program for such limited relief from the IMD exclusion.
  • CAREER Act and Telehealth: The CAREER Act provides a grant program to incentivize initiatives that support individuals in SUD treatment and recovery to live independently and participate in the workforce. Grant funding is earmarked for defined activities, including promoting telemedicine infrastructure and technology adoption, as well as case management, case coordination, or peer recovery support services. Grant funds will be awarded to the states based upon the rate of drug overdose deaths, rate of unemployment, and rate of labor force participation in the state. In addition to expanding some access to SUD treatment to Medicare beneficiaries via telehealth services, the bill also directs CMS to issue guidance to states on options for providing services via telehealth that address SUDs under Medicaid, including for federal reimbursement of services addressing high-risk individuals, for provider education, and for telehealth services to students in school-based health centers.
  • Medicare SUD Treatment Access: The bill creates a four-year demonstration project, to be developed by CMS in consultation with specialists in the field of addiction, clinicians in primary care, and a beneficiary group, that would allow Medicare beneficiaries to receive MAT and certain wraparound services at an Opioid Treatment Program (OTP). Currently, OTPs are not recognized as Medicare providers, meaning that Medicare beneficiaries receiving MAT at OTPs must pay out-of-pocket.

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Policy Update

i Oct 1st No Comments by

SORH Reauthorization Bill Update

The House and Senate returned to Washington in September for their final legislative work period before the 2018 mid-term elections. With the Senate having already passed the State Office of Rural Health (SORH) Reauthorization bill, the focus shifted to the House. The House bill, H.R. 5641, picked up a critical cosponsor with Rep. Morgan Griffith (R-VA) agreeing to sign-on. Griffith is a member of the House Energy and Commerce Health Subcommittee which has primary jurisdiction over SORH legislation.

NOSORH met with the Energy and Commerce Committee during September and believes there is a good chance the Committee advances the SORH reauthorization bill the next time the committee addresses public health legislation.

SORH Funding Remains Unchanged

On September 13, the House and Senate conferees approved the conference report for the FY 2019 DoD and Labor-HHS spending bill (H.R. 6157). Five days later, the Senate passed the conference report by a 93-7 vote . On September 26, the House easily passed the conference report thus sending the FY 19 spending bill to the President which he is expected to sign.

The SORH number for FY 19 came in at $10,000,000 which is the same number as FY 18. When the House originally passed the FY 19 Labor-HHS bill, the funding was $11,000,000 for SORH. The Senate passed version was at $10,000,000. Conferees went with the Senate number.

Other rural health related items included in the conference report were Medicare Rural Hospital Flexibility grants which were funded at $53,609,000. This is a four million dollar increase over FY 18. Small Rural Hospital Improvement Grant Program was funded at $19,942,000 for FY 19. This is also a four million dollar increase over FY 18.

Lisa Davis (far right) speaks on a panel at a Rural Summit held by Senate Democrats.

NOSORH Speaks Before U.S. Senate

On September 27, Lisa Davis, Director of the Pennsylvania Office of Rural Health, spoke before the U.S. Senate Democratic Steering and Outreach Committee at their annual Rural Summit. The Summit was kicked off by Senate Democratic Leader Chuck Schumer (D-NY) and featured Senators and participants from across the county addressing issues facing rural America.

Lisa Davis spoke on a panel addressing health care issues in rural America. The panel was led by Senators Bob Casey (D-PA) and Tina Smith (D-MN) and moderated by Sen. Jeanne Shaheen (D-NH) and Heidi Heitkamp (D-ND).  Senators Smith and Heitkamp were original cosponsors on the SORH Reauthorization bill.  Davis thanked the Senate for passing the State Offices of Rural Health Reauthorization Act of 2018 and spoke passionately about the challenges facing rural health.


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Policy Update

i May 1st No Comments by

The following update was provided for our members by Hall Render, NOSORH Legislative Liaison:

House Introduces Rural Health Reauthorization Bill

On April 26, House Energy and Commerce members Markwayne Mullin (R-OK) and Kurt Schrader (D-OR) introduced the State Offices of Rural Health Reauthorization Act of 2018.  The bill (H.R. 5641) is the companion bill to S. 2278 which was passed in March by the Senate Health Education Labor and Pensions Committee.  The Senate bill, which was introduced by Senators Roberts (R-KS) and Heitkamp (D-ND), has been cleared for full Senate passage.  The next step for H.R. 5641 will be a mark-up before the Energy and Commerce Committee.

Congress Tackles Opioid Epidemic

The Senate Finance Committee held in April to address opioid and substance-abuse disorders in Medicare, Medicaid and other HHS-related programs. The hearing addressed how the programs can adapt and be improved to address the crisis, as well as what the Trump administration and Congress can do to fight the opioid crisis together. The Committee, through feedback from stakeholders and its members, identified areas of bipartisan support. These include the need to evaluate access to and utilization of non-opioid treatment options for managing pain; enhancing data-sharing to promote appropriate health care interventions and strengthen program integrity; and ensuring evidence-based care is available for patients to identify and treat opioid use disorders.

On April 24, the Senate HELP Committee held a markup for a number of opioid-related bills. Legislation that passed the Senate committee includes: S. 2680, the “Opioid Crisis Response Act of 2018”; S. 2315, the “Over-the-Counter Drug Safety, Innovation, and Reform Act”; S. 2597, the “Children’s Hospital GME Support Reauthorization Act of 2018”; and S. 382, the “Firefighter Cancer Registry Act.”  The following day, the House Energy and Commerce Committee advanced a 60-bill package that touches on everything from FDA approval of pain medicines to how government programs pays for addiction treatment.  Congress hopes to pass comprehensive opioid reform before Memorial Day.

MedPAC Recommends Cut to Urban Off-Campus Hospital Pay

The Medicare Payment Advisory Commission (MedPAC) recommended Congress to cut pay by 30 percent for certain off-campus emergency departments in urban areas. Off-campus stand-alone emergency departments that are within six miles of an on-campus hospital emergency department would be subject to the cuts. To support this recommendation, MedPAC claims these off-campus facilities have lower patient severity and standby costs than on-campus emergency departments therefore the Medicare payments are askew. In contrast, MedPAC supported the recommendation to allow isolated rural stand-alone emergency departments, or those that are more than 35 miles away from another emergency room, to bill standard outpatient prospective payment fees and Congress provide annual payments to assist with fixed costs.

Additionally, the payment advisers discussed a recommendation to make the four current value-based payment programs into a single initiative. This new initiative would judge hospitals on readmissions, mortality, spending, and how patients’ rate their stay. Depending on performance, two percent of a hospital’s Medicare payments would be withheld or earned back. This plan was cited as a good way to simplify hospital reporting programs and move to outcome-based measures. However, the Commission also raised several concerns such as questions on how to weigh the categories, if two percent is enough of an incentive, etc. MedPAC will continue discussions on this recommendation in the fall.

Rural Health Related Bills Introduced in April

Rep. Collin Peterson (D-MN) introduced H.R. 5498 to amend title XVIII of the Social Security Act to extend the floor on the area wage index under the inpatient prospective payment system to certain sole community hospitals and to amend the Public Health Service Act to provide eligibility for certain sole community hospitals to discounted drug prices under the 340B drug pricing program.


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