Policy Analysis | November 2019

Federal Analysis: Rural Health Agenda

Nick Bowman

Rural hospitals have struggled to remain solvent in recent years. Since January 2010, 81 rural hospitals have closed in the SLC region. State and federal policy makers are working to mitigate this trend and promote the work of rural hospitals.* At the federal level, the recently introduced Rural Health Agenda offers potential assistance for rural hospitals and residents.

On July 31, 2019, U.S. Senator Marsha Blackburn (TN) introduced the Rural Health Agenda in the Senate to support the provision of rural healthcare. The agenda includes the Rural America Health Corps Act, Telehealth Across State Lines Act of 2019 and Rural Health Innovation Act of 2019. The three bills were each read twice and referred to the Senate’s Health, Education, Labor and Pensions Committee.

On October 29, 2019, U.S. Representative Phil Roe (TN) introduced companion bills for the Rural America Health Corps Act and Telehealth Across State Lines Act of 2019 in the House of Representatives. Both bills were referred to the House Energy and Commerce Committee; the latter was also referred to the Ways and Means Committee. That same day, U.S. Representative David Kustoff (TN) introduced a companion bill for the Rural Health Innovation Act of 2019, which was referred to the Energy and Commerce Committee.

The information provided is a summary of the three bills comprising the Rural Health Agenda. As the bills are in committee, they are subject to change. All information is current as of November 19, 2019.

Rural America Health Corps Act

Senate: S.2406 https://www.congress.gov/bill/116th-congress/senate-bill/2406/
House: H.R.4899 https://www.congress.gov/bill/116th-congress/house-bill/4899

The Rural America Health Corps Act would expand the existing National Health Service Corps (NHSC) program by creating the Rural America Healthcare Corps and NHSC Rural Provider Loan Repayment Program as a demonstration project. Currently, the NHSC Loan Repayment Program provides up to $50,000 annually to healthcare providers who serve urban or rural federally designated Health Professional Shortage Areas (HPSAs). The proposed NHSC Rural Provider Loan Repayment Program would be available to healthcare providers who agree to serve specifically in a rural HPSA for five years or more. To fund the new program, the bill would appropriate $25 million each year for fiscal years 2020 to 2024. Within three years of the bill’s passage, the secretary of the U.S. Department of Health and Human Services (HHS) would be required to submit a report to Congress evaluating the impact of the legislation.1

Telehealth Across State Lines Act of 2019

Senate: S.2408 https://www.congress.gov/bill/116th-congress/senate-bill/2408
House: H.R.4900 https://www.congress.gov/bill/116th-congress/house-bill/4900

The Telehealth Across State Lines Act of 2019 would direct the HHS secretary to issue uniform best practices to promote telehealth across state lines. The bill instructs the HHS secretary to consult with technology, data security and healthcare experts to develop and promulgate best practices regarding interstate telehealth within five years of the bill’s codification.

The bill also would direct the HHS secretary to award grants to healthcare providers seeking to expand the use of telehealth. Applicants would have to demonstrate that an effective telehealth program is already in use and describe how grant funding would be used to expand the program. The current version of the bill does not specify a maximum award amount. To fund the grant, the bill would appropriate $20 million each year for fiscal years 2020 through 2024.2

Rural Health Innovation Act of 2019

Senate: S. 2411 https://www.congress.gov/bill/116th-congress/senate-bill/2411/
House: H.R. 4898 https://www.congress.gov/bill/116th-congress/house-bill/4898/

The Rural Health Innovation Act of 2019 would establish a Rural Health Center Innovation Awards Program to award grants to existing and planned Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Table 1 provides information on these hospital designations. To qualify, facilities must serve individuals in a “covered rural area” as a walk-in urgent care center and as a triage center§ or staging facility for transport to an emergency department. Grants up to $500,000 would be available to existing facilities; grants up to $750,000 would be available to planned facilities. The HHS secretary would develop and implement a review process for grant applications, including an expedited review process for applications benefiting rural areas that have experienced a rural hospital closure in the previous seven years. To fund the Rural Health Center Innovation Awards Program, the bill would appropriate $25 million each year for fiscal years 2020 through 2024. At this funding level, as many as 50 grants could be approved each fiscal year.

The Rural Health Innovation Act also would establish the Rural Health Department Enhancement Program to award grants to assist health departments in a “covered rural area” meet urgent care and triage needs. As with the Rural Health Center Innovation Awards Program, the HHS secretary would develop and implement a review process for grant applications. Qualifying facilities would be eligible for grants up to $500,000. To fund the Rural Health Department Enhancement Program, the bill would appropriate $25 million each year for fiscal years 2020 through 2024. At this funding level, as many as 50 grants could be approved each fiscal year.3,4

Of note, two key differences between the Rural Health Department Enhancement Program and the Rural Health Center Innovation Awards Program are the facilities that are eligible for each program and the lack of an expedited review process for the Rural Health Department Enhancement Program.


Endnotes

* For more on this topic, see Rural Hospitals: Here Today, Gone Tomorrow (SLC, November 2019).

The federal fiscal year runs October 1 through September 30.

Covered rural area is defined as “a rural area that is located not less than 30 minutes by vehicle from the nearest emergency department or one from which an individual cannot access an emergency department by road.”

§ Triage is the process of prioritizing a patient’s treatment based on the severity of his/her condition.


Table 1: Medicare Hospital Designations

Hospital Type

Qualification Criteria

Federally Qualified Health Center

To qualify as an FQHC, a facility cannot be a Rural Health Clinic and must:

  • Serve an underserved population;
  • Charge patients on a sliding fee scale based on income;
  • Operate under a board of directors that includes patients;
  • Operate under the supervision of the Health Resources and Services Administration (subsection of the HHS);
  • Generate annual care reports;
  • Provide holistic healthcare (medical, dental, mental health and substance abuse treatment);
  • Offer social services; and
  • Employ an ongoing quality assurance program.5

Rural Health Clinic

Serves a rural area as defined by the U.S. Census Bureau; and resides in an area currently designated or certified by the Health Resources and Services Administration within the previous four years as one of the following:

  • Primary Care Geographic Health Professional Shortage Area (HPSA);
  • Primary Care Population-Group HPSA;
  • Medically Underserved Area; or
  • Governor-designated and Secretary-certified shortage area.6

References

1 “S.2406 - Rural America Health Corps Act,” July 31, 2019, U.S. Congress, https://www.congress.gov/bill/116th-congress/senate-bill/2406/, accessed November 15, 2019.

2 “S.2408 - Telehealth Across State Lines Act of 2019,” July 31, 2019, U.S. Congress, https://www.congress.gov/bill/116th-congress/senate-bill/2408, accessed November 15, 2019.

3 “S.2411 - Rural Health Innovation Act of 2019,” July 31, 2019, U.S. Congress, https://www.congress.gov/bill/116th-congress/senate-bill/2411, accessed November 15, 2019.

4 “Blackburn Unveils Rural Health Agenda to Bring Care to Underserved Areas,” August 1, 2019, Marsha Blackburn, U.S. Senator for Tennessee, https://www.blackburn.senate.gov/blackburn-unveils-rural-health-agenda-bring-care-underserved-areas, accessed November 15, 2019.

5 “What is a Federally Qualified Health Center?,” Continuum, https://www.carecloud.com/continuum/federally-qualified-health-center/, accessed November 15, 2019.

6 “Rural Health Clinic,” Medicare Learning Network, Centers for Medicare and Medicaid Services, https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/RuralHlthClinfctsht.pdf, accessed October 25, 2019.