LHA Center for Rural Health
	The Center was created especially to provide specialized assistance and services for our state’s rural hospitals. This LHA section is for our members seeking the latest news affecting rural and critical access hospitals.
	Meeting Dates and Materials
		Rural Hospital Leadership Forum
	Mid-South CAH Conference
	LHA Rural News
		Tuesday, August 24 - The LHA submitted a request to our Congressional Delegation for their assistance in asking the Centers for Medicare and Medicaid Services (CMS) to re-evaluate its proposed outpatient prospective payment system (OPPS) rule regarding new coverage requirements for direct supervision of outpatient therapeutic services.  The LHA is extremely concerned that the currently proposed regulation will jeopardize access to outpatient therapeutic services in hospitals, particularly for small and rural facilities.  CMS’ proposed policy requires direct supervision for even the lowest risk services, such as simple injections of pain medication, minor wound debridement and drainage of wounds.  While we in the hospital community do recognize the need for direct supervision for certain outpatient services that pose high risk or are very complex, there are a multitude of procedures that can be, and are, safely furnished in hospital outpatient departments under the general supervision of a physician.
		Wednesday, March 10, 2010 - The LHA submits a comment letter, on behalf of our member hospitals, to the Centers of Medicare and Medicaid Services (CMS) in reference to the Notice of Proposed Rule Making (NPRM) on the Medicare and Medicaid electronic health record (EHR) incentive programs, published by the Centers for Medicare & Medicaid Services (CMS) in the Federal Register on January 13, 2010.  All comments on this proposed rule are due to CMS by March 15, 2010.
		Friday, February 5, 2010 - In efforts to assist our hospitals with digesting the Centers for Medicare and Medicaid Services (CMS) proposed rule making Medicare and Medicaid Programs: Electronic Health Record Incentive Program published to the Federal Register January 13, 2010, the LHA is providing a summary of the proposed rule.  The purpose of this rule making is aimed at adding clarity to the definition of "meaningful use" and to outline eligibility requirements for incentive payments to hospitals and providers.
		Thursday, December 10, 2009 - House and Senate negotiators reached an agreement late last night on a fiscal year 2010 omnibus spending package, the Consolidated Appropriations Act, H.R. 3288, that combines six unfinished appropriations bills and includes funding for the U.S. Department of Health and Human Services. The legislation appropriates $11.8 million for telehealth programs, up from $7.5 million in fiscal year 2009; $2.29 billion for the Ryan White AIDS program, up from $2.2 billion in FY 2009; and $317 million for the Children’s Hospitals Graduate Medical Education program, a $7 million increase over last year’s funding level. The legislation also provides $498 million for the health professions workforce program, up $105 from FY 2009; $244 million for nurse training, $73 million above 2009; and $420 million for bioterrorism hospital preparedness grants, up from $370.7 million last year.  The AHA has provided a spreadsheet that details the list of rural health programs that are also included in the legislation.  Now the agreement has to be approved by the House and Senate.
		Monday, November 2, 2009 - The Louisiana Hospital Association (LHA) submitted a letter to U.S. Department of Health & Human Services (HHS) Secretary Kathleen Sebelius on behalf of our member hospitals, to express LHA’s concerns over the implementation of the DSH Audit Final Rule.  In the letter, LHA President & CEO John Matessino addressed the fact that the Medicaid disproportionate share hospital (DSH) adjustment was established in 1981 to give states the ability to set Medicaid reimbursement rates for hospital inpatient services that take into account the situation of hospitals that serve a disproportionate number of low-income patients with special needs.  Since Louisiana has such a high rate of uninsured citizens living in poverty in our rural areas, special legislation was adopted to assist our rural hospitals that provide safety net services to this portion of our population.  These safety net providers play a vital role in the delivery of timely and efficient care, which is not otherwise readily available in many areas.  It is with these facts in mind that the LHA, on behalf of our rural hospital members, has expressed our concerns over the implementation of the DSH Audit Final Rule.
		The Joint Commission’s CAH program receives CMS deeming authority -The Joint Commission announced that they have once again received deeming authority from the Centers for Medicare & Medicaid Services (CMS) for the accreditation of critical access hospitals (CAH), according to an official announcement by The Joint Commission. With this approval, any critical access hospital the Joint Commission has accredited may choose to be "deemed" as meeting Medicare and Medicaid certification requirements.
		Bill would improve rural hospital Medicare payments - Sens. Kent Conrad (D-ND), Pat Roberts (R-KA), Tom Harkin (D-IA) and John Barasso (R-WY) have introduced legislation aimed at improving Medicare reimbursements to rural hospitals. The Craig Thomas Rural Hospital and Provider Equity (R-HOPE) Act (S.1157) would provide a temporary payment increase for hospitals with low-volume inpatient discharges. The bill would also continue allowing direct payments to independent laboratories for the technical component of pathology services, and the 5% rural add-on payment for home health services. In addition, the bill would extend the outpatient hold-harmless provision for sole community hospitals and rural hospitals with fewer than 100 beds, remove the cap on disproportionate share adjustment percentages for all hospitals and improve payments for ambulance services in rural areas.
		Medicare rules CRNA On-Call Cost Not Reimbursable - On Monday, May 4, 2009 the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Charlene Frizzera ruled last week that on-call, or standby, costs for certified registered nurse anesthetists (CRNA) at critical access hospitals (CAH) are not reimbursable under Medicare. This ruling reverses a recent decision by the Medicare Provider Reimbursement Review Board (PRRB), which the LHA had submitted a letter urging Frizzera to affirm. The PRRB is in place to hear appeals of final reimbursement determinations by CMS and fiscal intermediaries and has twice concluded that CRNA standby costs are allowable costs for CAHs.  CMS has reversed both of the PRRB's decisions on this matter.  The LHA is working with the AHA on a possible legislative fix to this issue as this avenue seems to have run its course.
		New legislation facilitates nationwide adoption of EHRs - Senator John D. (Jay) Rockefeller IV (D-WV) introduced legislation, SB 890 titled The Health Information Technology Public Utility Act of 2009 on April 23 aimed at facilitating nationwide adoption of EHRs, particularly among small, rural providers.  Specifically, the Act would: Create a new federal Public Utility Board within the ONC for health information technology (HIT) to direct and oversee formation of this HIT Public Utility Model, its implementation, and its ongoing operation Implement and administer a new 21st Century HIT Grant program for safety-net providers to cover the full cost of open source (i.e., a computer program with unrestricted source code that does not limit the use or distribution by any organization or user) software implementation and maintenance for up to five years, with the possibility of renewal for up to five years if required benchmarks are met  Facilitate ongoing communication with open source user groups to incorporate improvements and innovations from them into the core programs Ensure interoperability between these programs, including as innovations are incorporated, and develop mechanisms to integrate open source software with Medicaid and CHIP billing Create a child-specific EHR to be used in Medicaid, CHIP, and other federal children’s health programs Develop and integrate quality and performance measurement into open source software modules "Open source software is a cost-effective, proven way to advance health information technology—particularly among small, rural providers. This legislation does not replace commercial software; instead, it complements the private industry in this field—by making health information technology a realistic option for all providers," Rockefeller said in the press release. [ via HIM Connection ]
		Thursday, March 26, 2009 - The LHA submitted a letter to the Centers for Medicare & Medicaid Services (CMS) on behalf of our member hospitals, urging CMS to affirm the latest certified registered nurse anesthetists (CRNA) standby cost ruling that recently came before the Provider Reimbursement Review Board (PRRB).  The ruling was released on Feb. 25 and CMS has 60 days to respond.  In the case of St. Luke Community Healthcare v. BlueCross BlueShield Association/Noridian Administrative Services the PRRB found that standby costs for CRNAs at CAHs are allowable costs under Medicare.
		On Friday, March 13, 2009, DHH officials informed the LHA that $800,000 will be available to pay DSH funds to hospital-based rural health clinics this fiscal year.  The funding is made available because of a provision included in the American Recovery and Reinvestment Act of 2009 that extends a moratorium until June 30, 2009 on the implementation of the final regulations that CMS issued relating to Clarification of the Definition of Outpatient Hospital Facility Services Under the Medicaid Program published on Nov. 7, 2008 (73 Federal Register 66187). Congressman Charlie Melancon and others have been working on this issue since it was introduced last year.  Since the moratorium only goes through June, the LHA will continue to work with our Congressional Delegation to address the permanent removal of this regulation.
		On Friday, Feb. 20, 2009, the LHA submitted letters of support to the Louisiana Congressional Delegation for H.R. 362, the RuralHospital Assistance Act of 2009 and S. 318, the Medicare Rural Health Access Improvement Act of 2009.  The LHA is proud to support legislation that assists our rural hospitals, as these bills do by improving Medicare payments to rural hospitals that are too large to be critical access hospitals but too small to be financially viable under the Medicare prospective payment system.  This legislation helps to support access to care in Louisiana’s many rural communities.
		Letter of Support for H.R. 362
		Letter of Support for S. 318
	Rural Health Links
	Rural Health Resource Center
	National Rural Health Association
	Federal Office of Rural Health Policy
	USDA Rural Information Center
	Rural Policy Research Institute
	Resources
		Map of Louisiana's Critical Access Hospitals
		MedPAC Study on Critical Access Hospitals
		MedPAC Transcript from Critical Access Hospital Hearing
		Medicare Guide to Rural Health Services Information for Providers, Suppliers and Physicians
		Medicare Advantage Payment Guide for Out of Network Payments
		AHA Rural Community Hospital Assistance Act
		Rural Community Hospital Assistance Act
	CMS Fact Sheets
	CMS Fact Sheet: Critical Access Hospital Program CMS Fact Sheet: Federally Qualified Health Centers CMS Fact Sheet: Medicare Disproportionate Share Hospital CMS Fact Sheet: Rural Health Clinics CMS Fact Sheet: Rural Referral Center CMS Fact Sheet: Sole Community Hospital
	LHA Rural Photo Gallery
	LHA Contact
		Rebecca Bradley, MBA, LHA Director of Rural Health Programs E-mail: rbradley@lhaonline.org Call: (225) 928-0026.