Grassley Works To Strengthen Rural Health Care System

Press Release

Senator Chuck Grassley introduced legislation this week to strengthen the health care delivery system in rural America.

Grassley's Medicare Rural Health Access Improvement Act of 2009 would improve Medicare payments to rural doctors, ambulances and mid-size hospitals. The bill also works to protect access for rural residents to home medical equipment and supplies, to continue to lend support to rural hospitals such as critical access hospitals, and to provide additional authority for physician assistants who provide valuable extended care and hospice services.

"The policy changes in this legislation go directly to the special challenges facing the health care system in rural America," Grassley said. "They recognize the high quality of health care delivered by rural providers, embrace common sense solutions, and seek equitable treatment from payment systems."

Grassley's legislation would give what are known as 'tweener hospitals in Spencer, Spirit Lake, Fort Madison, Muscatine, Carroll, Grinnell, Newton and Keokuk, Iowa better treatment by the Medicare program and put them in a stronger position to provide health care services to people in their communities and local areas. 'Tweener hospitals are too large to be designated as critical access hospitals but too small to be financially viable under the Medicare hospital prospective payment system which is designed for larger operations.

"These hospitals are part of the backbone of the rural health care system and local rural economies. There's no justification for Medicare not recognizing their unique situation and vital role," Grassley said. "I'm committed to doing everything I can to make sure they're treated fairly and not left in a perilous situation."

Grassley is a long-time leader in expanding access to health care in rural America. He was the principal sponsor of the legislation that was enacted in 2003 to create the prescription drug benefit in Medicare, and the comprehensive proposal contained major improvements for the rural health care delivery network. Two years later, he won passage of major improvements for Medicare Dependent Hospitals in legislation that was enacted to reduce the deficit. Grassley has repeatedly worked to extend temporary provisions for rural health care, including geographic adjusters to improve physician pay and help keep doctors in rural areas. Last year, he helped win passage of a measure to protect rural health clinics from having to close by reconciling inconsistent time frames from the Department of Health and Human Services for certification requirements. Grassley is the Ranking Member of the Senate Committee on Finance, which is responsible for Medicare and Medicaid. He has been a member of the Senate's Rural Health Caucus for many years

A summary of the new Grassley legislation is below, along with the text of his floor statement marking introduction of the bill and a description of the bill by title.

Summary of the Medicare Rural Health Access Improvement Act of 2009

While the bill would benefit different types of rural hospitals, it would especially benefit tweener hospitals.

Tweener Hospital Improvements

* Most tweener hospitals currently are designated under the Medicare program as Medicare Dependent Hospitals (MDHs) and Sole Community Hospitals (SCHs)

* The bill would provide temporary and permanent improvements so that payments to these hospitals would better reflect the cost of providing inpatient and outpatient services

* Provisions assisting tweeners include:
*
o Improving the ways MDHs are paid for inpatient services
o Temporarily improving the hospital inpatient low-volume adjustment so that more rural hospitals benefit
o Enabling both MDHs and SCHs to benefit from the same outpatient payment hold harmless protection and add-on payments
o Temporarily lifting the disproportionate share hospital payment cap for rural hospitals
* Many of these provisions were recommended by tweener hospitals in Iowa and are supported by the Iowa Hospital Association and American Hospital Association

Critical Access Hospital Provisions

* For Critical Access Hospitals (CAHs), the Medicare Rural Hospital Flexibility Grant Program would be extended for a year,

Physician Payment Incentives and Improvements

* The bill would reduce disparities in physician payment that adversely affect physicians in Iowa and other rural states known as geographic adjustments or GPCIs ("GYPSEES").

* Iowa physicians provide some of the highest quality health care yet they also receive some of the lowest Medicare reimbursement due to the GPCI adjustments.

* This is a significant disincentive for physicians who practice in Iowa, and it is fundamentally unfair.

* I share the goal of Iowa physicians and the Iowa Medical Society to reduce geographic disparities and establish more equity in Medicare payment.

* Physicians deserve equal pay for equal work, regardless of where they practice.

* The bill makes fundamental changes in the work and practice expense GPCIs to reduce geographic payment disparities.

* It would eliminate the work GPCI in 2010 by creating a national value of 1.0.

* It would also establish a practice expense floor of 1.0 and reduce the practice expense GPCI adjustment by 50 percent, as of 2010.

* Iowa physicians deserve fair treatment, and I will continue working to achieve that goal.

Rural Extensions:

* The bill would extend the existing payment arrangements which allow independent laboratories to bill Medicare directly for certain physician pathology services through 2010.

* The bill would extend and increase rural ambulance payments by five percent for 2010.

Improve beneficiary access to health care services.

* It would permanently increase the payment limits for rural health clinics.

* It would also allow physician assistants to order post-hospital extended care services and to serve hospice patients.

Rural Exemption from Competitive Bidding

* The bill would protect rural areas from being adversely affected by the new Medicare competitive bidding program for durable medical equipment. Rural areas and metropolitan statistical areas (MSAs) with a population of 600,000 or less would be exempt from competitive bidding.

* We must ensure that beneficiaries in rural areas continue to have access to necessary home medical equipment and supplies.

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