RURAL HEALTH: Bipartisan Coalition Unveils Multi-Part Bill

The House Rural Health Care Coalition yesterday unveiled the "Triple A Rural Health Improvement Act," which would ease 1997 Balanced Budget Act restrictions that impact rural areas and boost funding for telemedicine. The bill will be formally introduced Thursday by Reps. Jim Nussle (R-IA) and Mike McIntyre (D-NC), co-chairs of the 146-member bipartisan coalition, which "has a long tradition of getting its policy goals enacted into law," CongressDaily/A.M. reports (Rovner, 3/23). The bill would:

Require HCFA to restore cost-based reimbursement for patients treated in rural health centers, forcing the agency to consider the health needs of rural areas as it constructs the prospective payment system for outpatient hospital care.
Restore the tax-free status of National Health Service Corps. scholarships and require that physicians assistants, nurse practitioners and other providers be reimbursed at the same rates as physicians in order to entice providers to work in rural areas.
Repeal the "budget neutrality" provision from the Balanced Budget Act and replace it with a "blend" of national and regional rates.
Facilitate telemedicine by addressing barriers such as cross-state licensure requirements and requiring HCFA to pay both physicians and facilities for using telemedicine to provide services otherwise covered by Medicare.
Make more rural hospitals eligible for the "Critical Access Hospital" program and remove the "rule penalizing hospitals for prematurely transferring patients"

(Rovner, Reuters Health, 3/24).

Outlook
Nussle said that "while the measure will be introduced as a single entity, it is likely that pieces could be taken out and inserted in other bills, particularly tax bills or a budget reconciliation measure." Although a CBO estimate is not available, McIntyre estimated the bill's total cost at up to $3 billion over five years, but he "stressed that numerous offsets are already on the table, including a change to Medicare's end-stage kidney disease program that could save $625 million on its own" (CongressDaily, 3/23).

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