Washington
DC Office
307 Dirksen Senate
Office Building
Washington, D.C. 20510
Phone: 202-224-6441
Fax: 202-224-1724
Wyoming Office
P.O. Box 22201
Casper, WY 82602
307-261-6413
|
|
| |
 |
 |
 |
 |
Contact: Cameron Hardy
202-224-6441 |
 |
|
| |
Thomas: R-HoPE Keeps Rural America in Mind
Rural Health Caucus Chairman’s bill takes up Medicare payment disparities |
| |
 |
| Dr. Sara Hartsaw of Gillette visited with Senator Craig Thomas on June 13, 2006 about physician payments under Medicare. Thomas' rural health care bill, R-HoPE, was introduced in the Senate today. |
June 13th, 2006 - WASHINGTON – U.S. Senator Craig Thomas continued his efforts to strengthen the Medicare payment system for rural health care providers with today’s introduction of his Rural Hospital and Provider Equity Act of 2006 (R-HoPE).
“Rural folks get pinned with bigger health care bills due to the tremendous inequity between what rural and urban providers get paid under Medicare,” Thomas said.
Thomas’ leadership through the Senate Rural Health Caucus has started to erase the inequities that exist between rural and urban health care providers in the Medicare program. The Wyoming senator’s provisions in the Medicare Modernization Act (MMA) were the biggest steps ever taken by Congress to address rural provider payments. The MMA was signed into law in 2003.
“While the MMA began to put rural providers on a level playing field with their urban counterparts, R-HoPE strengthens the rural health care safety net even further,” Thomas said.
“Without greater equity, providers are forced to pass along additional costs to consumers – driving up health care costs for rural America.”
Senators Kent Conrad (D-N.D.), Tom Harkin (D-Iowa), and Pat Roberts (R-Kan.) joined Craig Thomas (R-Wyo.) with the introduction of R-HoPE. The bill not only extends expiring rural provisions included in the MMA, but also takes steps to address inequities that remain in the Medicare payment system placing rural providers at a disadvantage.
“Rural health care legislation has a long history of bipartisan support. In the 108th Congress we reaped unparalleled successes with our rural health care legislation. I was proud to lead the effort to put rural providers on a level playing field with their urban neighbors. However, our mission is not complete. Several of the MMA’s rural health provisions have expired, or are set to expire this year. The Rural Hospital and Provider Equity Act will finish the work we started three years ago,” Thomas said.
“Rural hospitals are more dependent on Medicare payments as part of their revenue. In fact, Medicare accounts for almost 70 percent of total revenue for small, rural hospitals. With lower patient volumes, rural hospitals must compete nationally to recruit providers – a tough row to hoe because of a shortage of nurses and other health professionals,” Thomas said.
“Additional burdens are placed on rural hospitals and providers because of higher uninsured and underinsured rates in rural America. And seniors living in rural areas tend to be poorer and have more chronic conditions than their urban and suburban counterparts,” he said.
Most of the extensions to expiring provisions in the rural equity package are ones which Thomas included in the Medicare Modernization Act (MMA). In addition, R-HoPE incorporates rural health provisions Thomas included in the Senate passed version of the MMA, but that were stripped in conference with the House.
Thomas is the Republican Co-Chairman of the Senate Rural Health Caucus.
Below is a thumbnail sketch of the provisions included in the bill:
Rural Hospital and Provider Equity (R-HoPE) Act
I. Equalize Medicare Disproportionate Share Hospital Payments
Hospitals receive additional payments to help cover the costs to serve a high amount of uninsured patients. Urban hospitals can receive unlimited additional payments, but rural payments are capped at 12 percent. Senator Thomas’ bill removes this cap for rural hospitals, brining their payments in line with the benefits urban facilities get.
II. Reinstate Hold Harmless Payments for Small, Rural Hospitals and Sole Community Hospitals (SCHs)
The Deficit Reduction Act of 2005 reduced payments for rural hospitals and eliminated payments for Sole Community Hospitals (there are 13 SCHs in Wyoming). This was not a recommendation from the Medicare Payment Advisory Commission (MedPAC). Senator Thomas’ bill reinstates the hold harmless temporarily, until analysts find out why some rural hospitals do not perform as well under Medicare.
III. Assistance for Low-Volume Hospitals
Medicare inpatient payments have placed rural hospitals at a disadvantage. Data shows that small rural and frontier hospitals have a higher cost per case which contributes to a rural hospital’s negative operating margins. This provision would require Medicare give graduated adjustment payments to account for the higher unit costs. Thomas introduced legislation with Senator Conrad regarding low-volume hospitals last Congress which was included in the Medicare bill – but the provision was significantly scaled back. The Thomas bill this year finishes the job.
IV. Medicare Rural Hospital Reclassification Extension
The Medicare bill included a provision allowing hospitals in sparsely populated states to re-classify their wage index to another area if they can prove their labor costs are more reflective of another market. There was a concern that many rural hospitals had to compete with large, urban markets which drove up their costs. This provision expires this year, so the Thomas bill would extend the reclassification program.
V. Reasonable Lab Costs Payment Extension for Rural Hospitals
Often, a local rural hospital is the only lab facility in the area. Even though performing lab work is the same in the hospital or in the nursing home, the hospital is reimbursed at a lower rate if the lab specimen is not drawn at the hospital. This drives up costs and may lead to access issues. The Medicare bill provided reasonable cost reimbursement for rural hospitals performing outpatient clinical lab tests (i.e.: test for folks in nursing homes). This provision is set to expire this year. The Thomas bill extends this program for two years.
VI. Critical Access Hospital (CAH) Improvements
A. Critical Access to Clinical Lab Services
The Centers for Medicare and Medicaid Services (CMS) require a Medicare patient be “physically present” in a CAH when a lab specimen is collected in order for the CAH to receive cost-based payment. Many CAHs offer lab services through contracts with Rural Health Clinics and nursing homes in neighboring communities. So, folks can be forced to travel to a CAH to have blood drawn because the hospital employee cannot travel to their town. This policy burdens patients and limits access. The Thomas bill reinstates cost-based reimbursement to CAHs to provide lab services to patients not physically present in the hospital.
B. Eliminate the CAH Ambulance “Isolation Test”
Under current law, CAHs can only receive cost-based reimbursement for ambulance services if they are the only provider within a 35-mile drive. This provision would eliminate the 35-mile requirement, ensuring CAHs are appropriately reimbursed for providing emergency medical services. This provision was included in the Senate passed version of the MMA, but was stripped in conference.
VII. Capital Infrastructure Loan Program
This program would make loans available to help rural facilities improve crumbling buildings and infrastructure. In addition, rural providers could apply to receive planning grants to help assess capital and infrastructure needs. This provision was part of Thomas’ rural hospital bill last Congress that never made it into the Medicare bill.
VIII. Extend the Medicare Incentive Payment Program
The Medicare Incentive Payment (MIP) Program provides 10 percent bonus payments to physicians practicing in Health Professional Shortage Areas (HPSAs). The MMA built upon this program by requiring CMS to identify eligible rural providers and automatically provide the 10 percent add-on payment to all Medicare claims. This legislation would extend the MIP program until January 1, 2009.
IX. Extend the Geographic Practice Cost Index Adjustment for Rural Physicians
Medicare payments for physician services are based upon a fee schedule. There are three components of this fee schedule – liability, practice, and work. CMS defines “physician work” as the amount of time, skill, and intensity necessary to provide services. The geographic index as it relates to “physician work” is lower in rural areas than in urban areas. Thus, although rural physicians put in as much or even more time, skill, and intensity into their work as physicians in urban areas, rural physicians are paid less for their work. The MMA increased the work geographic index to a base of one over a two year period for any locality for which such index was below one. Those fee schedule areas that are currently at or above one are not affected. This section extends current law until January 1, 2009.
X. Nurse Practitioners, Physician Assistants, and Clinical Nurse Specialist Improvements
Under existing Medicare policy, physician assistants, nurse practitioners, and clinical nurse specialist are not allowed to directly prescribe home health or hospice care. This restriction limits these provider groups’ ability to offer needed services to patients, especially those living in rural and frontier areas. The Thomas bill would allow physician assistants, nurse practitioners, and clinical nurse specialists – who have no financial relationship with a home health or hospice agency and are legally authorized to perform the services – to directly prescribe home health and hospice care.
XI. Rural Health Clinic Reimbursement
Rural Health Clinics (RHCs) receive an all-inclusive payment rate that is capped at approximately $63. Various analyses have suggested that payment rate does not appropriately cover the cost of services for most RHCs and that the cap should be raised to address the shortfall. This provision would raise the RHC cap to $82 making it comparable to the payment rate Community Health Centers (CHC) receive. Thomas helped include this provision in the Senate passed version of the Medicare bill. It was stripped in conference.
XII. Rural Health Clinic and Community Health Center Collaborative Access Expansion
Current CHC legislative and regulatory requirements mandate these facilities offer a single model to deliver essential health care services. While this model works in urban areas, it does not always work well in rural and frontier communities. Building facilities offering a full range of services is ideal, but can be impractical for many small rural towns. The current delivery system often puts up barriers or prevents collaboration, networking, innovation, and sharing of resources. This makes accessing care much more difficult. This provision would make it easier for RHCs and CHCs who choose to work together to share services, coordinate care, and combine financial resources to improve patient care in rural, underserved areas.
XIII. Rural Home Health Add-On Payment Extension
The Deficit Reduction Act extended a 5 percent add-on payment increasing reimbursements to home health agencies for services furnished in rural areas. This provision would extend this additional payment through January 1, 2008.
XIV. Coding Ambulance Services
This section would mandate the Secretary use condition codes to determine ambulance claims payments. Condition codes can help reduce the number of legitimate claims that are denied by carriers and eventually overturned on appeal. CMS has only implemented a voluntary coding system for carriers and intermediaries. This provision will decrease the administrative burden of the appeals process, which can prove to be especially difficult and costly for low-volume rural providers.
XV. Temporary Ground Ambulance Payment Extension
Rural ambulance providers have found it difficult to keep their doors open due to inadequate Medicare payments and inappropriate payment denials by Medicare claims processors. To help alleviate this situation, the MMA increased payments by 2 percent for rural ground ambulance services. This section would extend current law for one year through January 1, 2008.
XVI. Create Appropriate Definition of “Rural” for Ambulance Reimbursement
Medicare currently uses Metropolitan Statistical Area (MSA) county level designations as the method to determine “rural” and “urban” areas for purposes of reimbursement. Under this system, many rural squads are determined to be urban because of their proximity to an MSA or a micropolitan area, despite the fact that they are rural. This section creates a new definition of rural based on Rural-Urban Commuting Areas (RUCA) designations developed by the Department of Agriculture and the Department of Health and Human Services (HHS).
XVII. Mental Health Provider Reimbursement
This section is the text of S. 784, a bill Thomas introduced with Senator Lincoln which would allow marriage and family therapists and licensed professional counselors to bill Medicare for their services. Thomas included this measure both in the Senate passed Medicare bill and the Senate passed Deficit Reduction Act. Both times it was stripped in conference.
XVIII. Technology Projects to Make Home Health Services More Efficient
This section would require the Secretary of HHS to create pilot projects providing incentives for home health agencies to purchase and utilize home monitoring and communications technologies. These pilot projects must use technology to enhance health outcomes for Medicare beneficiaries and reduce spending under the Medicare program.
XIX. Facilitating the Provision of Telehealth Services Across State Lines
Telehealth has helped to bring health care into rural areas that otherwise lack access to such services. Medicare has recognized the value of telehealth and provides reimbursement for certain providers and services. However, a problem exists when telehealth services are provided across state lines because of individual state licensure laws. This provision would direct the Secretary of HHS to work with stakeholders to adopt regulations allowing for multistate practitioner licensure across state lines for the purposes of providing telehealth services.
###
|
|
|
|
|
