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AHA briefs Congress on extending rural Medicare payment provisions

July 26, 2013

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The AHA July 22 participated in a “Rural 101” policy briefing for congressional staff on Capitol Hill about extending several lapsed or soon-to-expire Medicare payment provisions that help rural hospitals and other providers maintain essential health care services to the people and communities they serve.

Lisa Kidder, the AHA’s vice president of legislative affairs, explained why the AHA and rural hospitals are pressing Congress to extend the Medicare-dependent hospital (MDH) program and low-volume hospital payment adjustment, and to reinstate the so-called “hold harmless” transitional outpatient payments – or TOPs – programs that recognize the special challenges rural hospitals face in delivering health care services. MDH and low-volume payments are set to expire Oct. 1, while TOPs expired last year.

In addition to the AHA, representatives from the Office of Rural Health Policy and National Association of Rural Health Clinics participated in the briefing, which was sponsored by the House Rural Health Coalition. The coalition is co-chaired by Rep. Cathy McMorris Rodgers, R-WA, and Ron Kind, D-WI.

Sens. Charles Schumer, D-NY, and Charles Grassley, R-IA, and Reps. Tom Reed, R-NY, and Peter Welch, D-VT, introduced in April the “Rural Hospitals Access Act,” S. 842/H.R. 1787, which would extend MDH and low volume hospital payments through fiscal year 2014. (See table below for list of senators who support S. 842). Rep. Bruce Braley, D-IA, last month introduced the “Rural Hospital Fairness Act,” H.R. 2178, which would reauthorize the TOPs program through the end of this fiscal year. The AHA supports these bills.

More than 200 hospitals receive MDH payments, and more than 600 rural hospitals receive the low-volume adjustment. These rural hospitals are too big to be critical access hospitals and so are ineligible for cost-plus reimbursement. But they are too small to manage under the traditional Medicare prospective payment system.