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Legislative and Policy Updates – June, 2021

Federal Updates

The Biden administration initially chose Memorial Day as the target date to decide which route to take on infrastructure: bipartisan or through reconciliation (the process to pass legislation in the Senate by 50 votes). On Thursday, a group of Senate Republicans announced a counterplan for $928 billion in infrastructure spending, much lower than the president’s $2.2 trillion plan. It is unclear which route the administration and Congress will take. NRHA continues to talk with offices on both sides of the aisle about the needs of rural providers. Key issues include the need for capital for rural hospitals, 100 percent broadband connectivity in rural areas, and the need for additional investment in the health workforce. You can read NRHA’s full letter to Congressional leadership here. NRHA will keep members up to date on infrastructure talks as they develop on Capitol Hill. 

Chiquita Brooks-LaSure Sworn in as CMS Administrator 

On Thursday, Chiquita Brooks-LaSure was sworn in as the Administrator of the Centers for Medicare and Medicaid Services (CMS).  She was confirmed by the full Senate on Tuesday by a vote of 55-44.

Senate HELP Committee Passes Rural MOMS Act

The Senate Committee on Health, Education, Labor, and Pensions (HELP) passed Senators Tina Smith (D-MN) and Lisa Murkowski’s (R-AK) Rural Maternal and Obstetric Modernization of Services (Rural MOMS) Act during this week’s executive session. Unfortunately, in rural America, pregnant women and new mothers have a significantly higher chance of dying from causes related to pregnancy and childbirth compared to their urban counterparts. This legislation provides needed investment in training and technology to offer greater maternal health services in rural America while taking significant strides to address the maternal mortality rate.

Important Federal Legislation to Watch

•          H.R. 341: Ensuring Telehealth Expansion Act of 2021- Williams (R-TX)

•          H.R. 769/S. 1491: Rural MOMS Act – Newhouse (R-WA); Smith (D-MN) 

•          H.R. 853: Closing Loopholes for Orphan Drugs Act – Welch (D-VT)

•          H.R. 1538: Binational Health Strategies Act of 2021 – Escobar (D-TX)

•          S. 104/H.R. 379: Improving Social Determinants of Health Act – Smith (D-MN); Barragan (D-CA)

•          S. 54: Strengthening America’s Health Care Readiness Act- Durbin (D-IL)

•          S. 368: Telehealth Modernization Act – Scott (R-SC)

•          S. 644/H.R. 1639: Rural Hospital Closure Relief Act – Durbin (D-IL); Kinzinger (R-IL)

•          H.R. 1887: Rural Hospital Support Act – Reed (R-NY)

•          H.R. 1783: Accessible, Affordable Internet for All Act – Clyburn (D-SC)

•          S. 773: A bill to enable certain hospitals that were participating in or applied for the drug discount program under section 340B of the Public Health Service Act prior to the COVID-19 public health emergency to temporarily maintain eligibility for such program, and for other purposes – Thune (R-SD)

•          S. 924: Rural America Health Corps Act – Blackburn (R-TN)

•          H.R. 2228: To allow for payment of outpatient critical access hospital services furnished through telehealth under the Medicare program – Kildee (D-MI)

•          H.R. 3259/S. 586: NOPAIN Act – Sewell (D-AL); Capito (R-WV)

•          S. 999: Save Rural Hospitals Act of 2021 – Warner (D-VA)

•          S. 1024/H.R.2255: Healthcare Workforce Resilience Act – Durbin (D-IL); Schneider (D-IL)

•          S. 620: KEEP Telehealth Options Act of 2021 – Fischer (R-NE)

•          H.R. 2454: To amend title XVIII to strengthen ambulance services furnished under part B of the Medicare program – Sewell (D-AL)

•          S. 1512/H.R. 2903: CONNECT for Health Act – Schatz (D-HI); Thompson (D-CA)

•          S. 165/H.R. 588: Stopping the Mental Health Pandemic Act – Smith (D-MN); Porter (D-CA) 



Funding Opportunities

HRSA Releases Rural Health Clinic Vaccine Confidence Program NOFO

On May 4, the White House announced they will make over $100 million available to support rural health clinics across the country to support vaccine outreach in rural communities. The Health Resources and Services Administration (HRSA) has announced the availability of the notice of funding opportunity announcement titled the Rural Health Clinic (RHC) Vaccine Confidence Program. The purpose of the program is to support rural health clinics as they work towards improving vaccine confidence, counter vaccine hesitancy, and help with access to the vaccination in rural communities that are experiencing low COVID-19 vaccination rates. Eligible applicants include Medicare-certified RHCs and organizations that own and operate Medicare-certified RHCs. HRSA has streamlined the application process. Every eligible RHC that applies will be funded. For further information on the NOFO, please visit Grants.Gov and for additional information regarding the program, please email RHCVaxConfidence@hrsa.gov.

HRSA Community-Based Workforce to Increase Vaccine Access

HRSA expects 121 awards with total funding of $121 million to expand the public health workforce at the local level in response to COVID-19. This includes mobilizing community health workers, patient navigators, and social support specialists to conduct face-to-face outreach to community members. Eligible applicants are local and/or regional community-based organizations applying as a single entity or as a network of partnering organizations. Applications are due June 9.

New Funding Available for the HRSA Telehealth Technology-Enabled Learning Program

HRSA expects to make nine awards of up to $475,000 each to connect specialists at academic medical centers with primary care providers in rural areas to improve patient care in their communities via new funding for the administration’s Telehealth Technology-Enabled Learning Program. More specifically, these learning opportunities will address unmet needs for their target population, which could include populations who have historically suffered from poorer health outcomes. Applications from public, private, and nonprofit entities are due on June 25. 

FDA  Approves Storage of Pfizer Vaccine for Up to One Month

The Food and Drug Administration (FDA) updated its guidance for healthcare providers administering the vaccine and allows for undiluted, thawed Pfizer-BioNTech COVID-19 Vaccine vials to be stored in refrigeration for up to one month. The previous time span was up to five days. 

RHC Payment Increase and Sequestration Delay

Beginning on April 1st, the Rural Health Clinic (RHC) per visit upper payment limit increased from $87.52 to $100. The increased upper payment limit is a direct result of the payment changes included in Section 130 of the Consolidated Appropriations Act of 2021. Some Medicare Administrative Contractors have already sent out letters to RHCs informing them of the increased upper limit and how it will affect their All-Inclusive Rate payments.

Meanwhile, on Capitol Hill, the House is expected to pass legislation after they return from recess (April 12th) that includes a grandfathering fix for RHCs and delays the resumption of a 2% Medicare sequestration cut until the end of 2021 that affects all providers.  The likely vehicle to do this is H.R> 1868.

While H.R. 1868 is not yet law, the expectation that this bill will pass is so strong that CMS announced that they will temporarily hold claims with dates of service on or after April 1, 2021, pending Congressional Action. This includes RHC claims that would have otherwise been subject to the 2% sequester reduction.

For context, when COVID-19 began last year, Congress temporarily waived the standing 2% across-the-board reduction in Medicare reimbursement (the sequester) until the end of 2020, and then later through March 31, 2021. H.R. 1868 will now extend this waiver through the end of 2021.

Specifically, section 2 of the Senate-passed version of H.R. 1868 contains the RHC grandfathering fix which will:

– Fix the grandfathering date for under 50-bed hospital RHCs from December 31, 2019, to December 31, 2020;

– Allow under 50-bed hospital entities that submitted applications to become an RHC by December 31, 2020, to be grandfathered-in; and

– Establish a methodology for setting the upper payment limits for grandfathered RHCs that did not have reimbursement in 2020.

USDA investing over $3M to improve distance learning and telemedicine in Alabama

The United States Department of Agriculture (USDA) announced an investment of over $3 million in rural Alabama on Tuesday.

Five Alabama projects related to telemedicine or distance learning will receive a share of the investment, which was publicized by the Department’s Office of Rural Development in Montgomery.

“USDA is helping rural America build back better using technology as a cornerstone to create more equitable communities. With health care and education increasingly moving to online platforms, the time is now to make historic investments in rural America to improve quality of life for decades to come,” said Agriculture Secretary Tom Vilsack in a release.

Vilsack, once a governor of  Iowa, was President Barack Obama’s Agriculture secretary from 2009-2017. He was confirmed this week to that same position under President Joe Biden. Both of Alabama’s U.S. Senators supported Vilsack’s confirmation.

All projects being funded in Thursday’s announcement are a part of the Agriculture Department’s Distance Learning & Telemedicine Grants program. The organization requesting the grant had to provide a 15% match.

USDA Rural Development provided a summary of each of the projects in Alabama:

In west Alabama, USDA’s investment of $916,948 will be used by the University of Alabama to connect 23 ambulances to seven hospitals in eight different rural counties in west-central Alabama. This network of ambulances will be equipped with telemedicine services to relay patient data to emergency room physicians. This technology will allow emergency room physicians to interact with emergency medical technicians, which will help to provide more efficient care for patients.

In Lauderdale County, USDA’s investment of $245,618 will be used by the Lauderdale County Board of Education to install distance learning systems in Lauderdale County’s elementary and secondary schools, as well as at the Board of Education’s offices. The Board will purchase mobile carts, bridging software and wireless access points to create a remote teaching system. The distance learning system will enable teachers to provide lessons and educational opportunities to more students.

In Clarke, Marengo, Wilcox and Monroe counties, USDA’s investment of $744,150 will be used by Physicians Care of Clarke to create a telehealth system across several regional healthcare systems. Leveraging primary health care sites, school-based health care sites, and administrative sites, rural residents in the region will now have access to primary and specialist physicians. This project will help install telemedicine carts and videoconferencing equipment at each clinic to capture diagnostic information, provide clinical supervision, and consultation services. This will help rural residents who are geographically isolated and have difficulty accessing serving primary and specialty care providers.

In Bibb, Dallas, and Talladega counties, USDA’s investment of $580,308 will be used by the University of Montevallo to establish a telemedicine system to provide access to mental health through its Community Counseling Clinic. Telemedicine end-user units will be installed in high schools in Bibb, Dallas and Talladega counties that will be used to offer telemental health services to students, teachers and community members. The University will also use distance learning equipment to offer distance education for professional educators and instructional leaders, as well as high school students in dual-enrollment courses.

In Bibb, Perry, Chilton, and Jefferson counties, USDA’s investment of $789,150 will be used by the Cahaba Medical Care Foundation for teleconferencing equipment, to offer distance learning for its family medicine residents. This program helps medical school graduates achieve medical licensure or board certification, while applying their skills in rural areas. In addition to educational uses, the equipment will also be used to provide telemedicine services in response to the influx of patients due to the COVID-19 pandemic.

Click here to view the news story.

RURAL HEALTH CLINIC CHANGES INCLUDED IN FINAL COVID BILL

During the final negotiations of the COVID relief package from late December, 2020, Sen. Chuck Grassley (Iowa) led efforts to include modified language from the Rural Health Clinic Modernization Act. This language was included in the final bill, which does the following:

  • Raises the Independent RHC cap to $100 on April 1, 2021, and set to rise each year thereafter to $190 by 2028.
  • Newly established RHCs would now also be subject to the increased cap, which means that no new RHCs (even those purchased or established by hospitals with less than 50 beds) could receive uncapped cost-based reimbursement.
  • Uncapped RHCs in existence today would be grandfathered-in at their current All-Inclusive Rate and would still see year-over-year increases but would be constrained to their current AIR plus an adjustment for MEI (the Medicare Economic Index).
  • RHCs will now be allowed to bill for hospice attending physician services.

Although this is great news for independent RHCs, this may come at the cost of our provider-based RHCs. It does not appear that any clinics will have a reduction in their all-inclusive rate, which is a very important positive factor. But, this new language will prevent hospitals from establishing new RHCs and receiving the more lucrative uncapped AIR. Again, it’s important to note that this will not affect the AIR that any provider-based clinics are currently receiving…they are grandfathered-in to this new policy.

The board and legislative committee of the Alabama Rural Health Association will examine this language more closely and determine its effects to Alabama clinics. Stay tuned for more information.

HRSA E-mail to RHCs for COVID Reporting

We have received word that RHCs throughout Alabama recently received this notification from HRSA via e-mail. This is a follow-up to the requested attestation for funding received by RHCs from the CARES Act. Please be sure to comply with the reporting requirements in order to not jeopardize the funding that you received earlier this year in support of COVID response.


Dear Rural Health Clinic Administrators and Managers,

You are receiving this email because the Federal Office of Rural Health Policy (FORHP) within the Health Resources and Services Administration (HRSA), recently compiled an email list (RHC-COVID-19-TESTING-PROGRAM) of Rural Health Clinic (RHC) administrators and managers in order to better communicate Rural Health Clinic COVID-19 Testing Program information and updates.

The Paycheck Protection Program and Health Care Enhancement Act authorized the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), to provide $225 million to RHCs for COVID-19 testing and related expenses. Beginning May 20, 2020, HRSA issued funding as one-time payments to RHC organizations of $49,461.42.

The terms and conditions for this program specify that, “The Recipient shall submit reports as the Secretary determines are needed to ensure compliance with conditions that are imposed on this Payment, and such reports shall be in such form, with such content, as specified by the Secretary in future program instructions directed to all Recipients.”  

To monitor and assess the program, HRSA has established a set of proposed measures that funded RHCs report back to HRSA at the Tax Identification Number (TIN) level. This brief set of proposed measures includes basic information on the RHC organization, the number of and location of testing sites (active and inactive), information on the use of funds, the total number tests conducted, and the number of COVID-19 positive tests. 

HRSA proposes to use this information to evaluate the effectiveness of the program at an aggregate level. As proposed, funded organizations must report the number of tests conducted and the number of positive tests on a monthly basis for the duration of the reporting period retroactively to May 2020. No personally identifiable, patient-level information is being requested.  

HRSA will be in contact with RHCs in the coming weeks with more information on the RHC COVID-19 Testing Reporting (RHC CTR) website, upcoming webinar, and other additional information. Please forward the email to the best contact for your RHCs COVID-19 Testing Program and cc: RHCCOVID-19Testing@hrsa.gov if you are the incorrect recipient. HRSA has funded the National Association of Rural Health Clinics to provide technical assistance to RHCs on the RHC COVID-19 Testing Program. If you have additional questions you may emailRHCcovidreporting@narhc.org.