Sunday, February 3, 2008

NRHA's Health Policy Institute

The attendees at the NRHA 19th Annual Rural Health Policy Institute 2008 held on January 28th and 29th came to Washington D.C. to learn about Federal agency initiatives and to meet with Senators and Representatives to discuss critical health needs in rural areas. According to Tim Fry, Government Affairs Manager, National Rural Health Association, healthcare issues are not at the top of the agenda due to all of the other issues our country faces such as the war, energy policies, and the economy.

Marcia Brand PhD, Associate Administrator, Bureau of Health Professions, announced that Tom Morris is now the Acting Director for the Office of Rural Health Policy. She recounted how ORHP worked on several programs with several agencies. For example, the ORHP staff discussed interpretive guidelines with CMS, communicated with SAMHSA on mental health research, collaborated on a special project with the HIV/AIDS Bureau to coordinate care, and worked with the VA to help rural veterans. In addition, the staff at ORHP worked on quality issues and opportunities, focused on HIT models, highlighted workforce needs, and expanded research on rural pharmacy issues.

Dr. Brand mentioned several meetings that will take place in the next few months. The National Advisory Committee on Rural Health and Health Services will meet February 20-22, 2008 in Washington D.C. to discuss new programs. The Bureau of Health Professions will hold a meeting February 25-27, 2008 to bring grantees together to discuss national health professions education and workforce needs, plus an All Advisory Committee meeting will be held in May.

The major NRHA 2008 Policy Institute goals are to have Medicare provide key rural provisions, achieve proportional representation on MedPAC, protect the physician fee schedule from devastating cuts, provide adequate funding for the rural health safety net, and provide the means to train future rural health professionals.

NRHA Policy Institute presented their 2008 legislative and regulatory agenda at the meeting so that Congress, Federal regulatory agencies, the White House, States, and the healthcare industry will be able to address the issues.

The NRHA legislative and regulatory agenda includes areas related to telemedicine and telehealth include:

  • Reimbursement for telehealth should be made based upon medical effectiveness and utilization and not upon particular delivery programs or locations. The NRHA supports Medicare reimbursement for telehealth consults using store-and-forward technology

  • Medicare should reimburse telehealth when it is provided by licensed or credentialed provider otherwise eligible for Medicare reimbursement

  • Telemedicine payments should provide for delivered services including a technical fee to help facilities cover costs associated with the technology used

  • Regional and National Telehealth Resources funded by the Office for the Advancement of Telehealth should be supported and expanded

  • Federal and state funding needs to address strengthening and integrating emergency medical services with rural healthcare services and providers. Federal funding needs to support innovative demonstrations, improved training, research activities, telehealth, address preventive health, and provide personnel recruitment for rural and frontier areas

  • NRHA supports expanding the Universal Service Program to more appropriately fund telehealth

  • The NRHA supports the VA’s efforts to increase care for rural veterans through telehealth systems especially for sub-specialty care as in the case of mental health services. NRHA supports full funding for the Office of Rural Health in the VA

NRHA supports other technology issues related to rural health:

  • Federal agencies should support providers, state EMS, and state offices of rural health through policy development, data systems, appropriate curricula, and access to grans

  • Congress should require vendors of information systems used in rural communities to incorporate national standards for HIT into their systems

  • Federal and state government should provide for the infrastructure and policy framework needed to allow for regional networks

  • Liberalization of the Stark Laws should be considered to allow rural hospitals to serve as the hub for a rural network

  • Existing and new funding mechanisms need to be put into place. Funding should be provided to support the expansion, upgrading and/or renovation of rural health facilities, including HIT and ambulance services

  • A strong public health infrastructure should be developed with access to advanced communications systems and technologies to serve rural communities in the event of a bioterrorism event, for disease surveillance, and to better manage public health emergencies.

  • NRHA wants to see proportional rural representation on all federal healthcare related commissions, task forces, and advisory groups

  • Funding needs to be provided to support demonstrations, and to perform comprehensive evaluations of state efforts to expand access to oral health services to rural and frontier populations

    For more information, go to or email Tim Fry at