Wednesday, February 1, 2012

NRHA Seeks Help on Issues

The National Rural Health Association gathered January 30 to February 1 in Washington D.C. for their 23rd Annual Rural Health Policy Institute to discuss how their 2012 Legislative and Regulatory Agenda can be used to help rural communities. Help is needed from Congress, federal regulatory agencies, the White House, states, and from the healthcare industry. Issues that rural states and communities have are unique and very often voices from rural areas are not heard.

According to NRHA, Congress should require vendors of information systems in rural communities to incorporate national standards for health IT into their systems. This includes systems used in all care settings including both large and regional networks and within rural facilities.

Federal anti-kickback statutes and the Stark laws often limit adoption of health IT by limiting the ability of rural hospitals which many times are in the strongest position to invest in health IT. Stark and other applicable laws should be liberalized to allow rural hospitals to serve as a hub for rural networks.

To promote the seamless exchange of information among rural healthcare providers, incentive payments should include payments to home health agencies, hospices, skilled nursing facilities, emergency medical services, and any other providers eligible for Medicare and/or Medicaid payments.

Factors to be taken into consideration in federal broadband efforts need to include integrating broadband access and health IT in rural areas and providing wireless broadband access to rural health providers such as emergency medical services

Funding for the health infrastructure should be provided through a combination of grants, loan guarantees, and principal and interest forgivable loans. This is needed to support expansion, upgrade and/or renovation of rural health facilities including health IT and ambulance services.

Reimbursement for services provided through telehealth should be made based upon medical effectiveness and utilization and not based upon or limited to particular delivery platforms or locations. The NRHA supports Medicare reimbursement for telehealth consults utilizing store-and-forward technology.

The Medicare law should be expanded to allow anything currently covered by Medicare to be reimbursed when provided through telehealth by appropriately licensed or credentialed providers otherwise eligible for Medicare reimbursement.

A telemedicine payment methodology should be provided so that a professional fee is paid to all providers necessary to that particular encounter, including a technical fee to the facilities to cover costs associated with the technology at rates to be determined by the HHS Secretary. Additionally, a separate Medicare billing code for telehealth consultations should be implemented to assist in monitoring the use of telehealth.

A federal policy should be adopted to allow telemedicine providers to receive deemed status and to allow for healthcare facilities receiving telehealth services to perform credentialing by proxy. If a provider is already credentialed at a Medicare participating facility, that credential would be sufficient for providing telemedicine services at another facility.

The geographical patient requirements for receiving care in a Health Professional Shortage Areas (HPSA) and non-Metropolitan Statistical Areas (MSA) should be lifted. The current requirements have negative impacts on the access rural residents have to specialized medical services.

The NRHA supports the Veterans Administration’s efforts to increase access points for rural veterans through telehealth systems in order to access to sub-specialty care particularly for mental health services. The VA should increase access through contracts with local rural health providers as well as expand the outreach models of care.

Go to to view the “National Rural Health Association 2012 Legislative and Regulatory Agenda.”