CHANGING LEGISLATIVE LANDSCAPE FOR RURAL HEALTHCARE

Rural health legislation is constantly in flux. This short document is intended to help you understand some of the key legislation that has changed, stayed the same, or might be adopted that could affect your rural health practice. This is not intended to be an exhaustive list but instead can be thought of as a starting point for detailed understanding of the changing tide of rural health policy.

EFFECTED CHANGES

The following is a list of key rural health legislation that has been enacted or extended as of August 2019. It is imperative for your practice to stay up to date with legislation as it moves through the legislative process, so that you are always prepared for and not blinded to required procedural changes.

• Low-volume-hospital (LVH) program now reimbursed on a sliding scale (until 2022)

• • https://www.federalregister.gov/documents/2018/04/26/2018-08704/medicare-program-extension-of-the-payment-adjustment-for-low-volume-hospitals-and-the
• Medicare-Dependent Hospital (MDH) extended for five years (until 2022)
  • https://www.law.cornell.edu/cfr/text/42/412.108
• 340(b) changes: cuts were made to reimbursement rates in 2018, but a federal court put an injunction in place against further cuts in late 2018

• • https://www.mwe.com/insights/court-issues-permanent-injunction-blocking-medicare-340b-payment-cuts/

• Uncompensated care DSH payments changes (based on charity care and bad debt rather than number of Medicaid, dual eligible, and disabled patients)
  • Changes might cut revenue for hospitals reliant on Medicaid and dual eligible patients.
  • https://www.healthcaredive.com/news/hospitals-prepare-for-uncompensated-care-payment-change/530719/
  • https://www.macpac.gov/subtopic/disproportionate-share-hospital-payments/
• Patient Driven Payment Model (PDPM) for post-acute care: prospective payment system based on patient diagnoses instead of volume of services
  • https://www.ahcancal.org/facility_operations/medicare/Pages/PDPM-Resource-Center.aspx
• Movements supporting rural ACOs (public and private)
  • https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/program-statutes-and-regulations.html

PROPOSED CHANGES

There are currently a few policies in the legislative pipeline that might affect your health practice; these are national level programs and do not account for legislation that might be taking place within your state legislature. Up to date monitoring of both federal and state regulations is critical to a successful health practice.

• Save Rural Hospitals Act: Introduced in the House June 2017
  • Includes financial stabilization measures for rural hospitals, such as reversal of bad debt reimbursement cuts, extension of LVH and MDH payment levels, elimination of DSH cuts
  • Establishes the Community Outpatient Hospital (COH) as a new Medicare payment designation, allowing CAHs to convert to an ED/outpatient care model at hospital cost-based reimbursement rates
  • Current Status: https://www.congress.gov/bill/115th-congress/house-bill/2957
• Rural Emergency Medical Center Act of 2018 (REMC): Introduced to the House in May 2018
  • Creates a new payment designation under Medicare that allows hospitals (not just CAHs) to convert to an ED/outpatient care model with transport to inpatient hospitals as needed.
  • Reimbursement would be an adjusted PPS.
  • Detailed Explanation: https://www.aha.org/issue-brief/2018-05-07-overview-rural-emergency-medical-center-act-2018
  • Current Status: https://www.congress.gov/bill/115th-congress/house-bill/5678/all-info
• Rural Emergency Acute Care Hospital Act (REACH): Introduce to the Senate in May 2017
  • Creates a “rural emergency hospital” designation for cost-based care
  • Senator Grassley, who sponsored the bill, has become Chairman of Senate Finance Committee in 2019
  • Current Status: https://www.congress.gov/bill/115th-congress/senate-bill/1130