Chuck Grassley

United States Senator from Iowa





Grassley Works to Boost Support for Rural Hospitals, Increase Options for Medicare Patients

Feb 26, 1997

Grassley Works to Boost Support for Rural Hospitals, Increase Options for Medicare Patients

Jill Kozeny


Seeking to boost support for small, rural hospitals which depend on Medicare Patients and also lower barriers for physician assistants and nurse practitioners who wish to serve Medicare patients, Sen. Chuck Grassley of Iowa today introduced legislation designed to throw a lifeline to Americans living in rural areas where access to quality health care is a growing concern

. "Access to quality health care is a serious concern for people living in rural areas," Grassley said. "Furthermore, rural areas tend to have high concentrations of older Americans. It is essential for us to maintain and work to increase the availability of quality health care options in rural areas."

Grassley said the first step is to reinstate the Medicare Dependent Hospital (MDH) program which lapsed in 1994. "Without this program many small, rural hospitals will have a difficult time continuing to exist. When a community hospital does close, the next available hospital may be 30 to 60 miles away. If we lose those hospitals, we're also likely to have a hard time keeping physicians in our rural communities. We are literally talking about a life threatening situation," he said.

The MDH program is designed to assist rural hospitals with 100 beds or less which can attribute not less than 60 percent of inpatient days or discharges to Medicare. The Grassley proposal would allow those hospitals to select more beneficial reimbursement arrangements with Medicare. When the program expired in 1994, 29 of Iowa's 122 community hospitals were taking part.

Grassley said the second step that must be taken is to lower barriers preventing nurse practitioners (NP) and physicians assistants (PA) from serving rural areas. "Currently, Medicare requires a supervising physician to be present when most services are performed in order to quality for reimbursement, even when it's not a requirement of state law."

Grassley's two bills -- the Primary Care Health Practitioner Incentive Act and the Physician Assistant Incentive Act -- would require the Medicare program to reimburse NP, clinical nurse specialists and Pas at 85 percent of the physicians' rate in all treatment settings. The payment would go directly to the nurses and to the PA's employer. Both bills also include a 10 percent bonus payment for those who practice in underserved areas. This legislation would encourage NP and PAs to locate in rural areas which might not be served by a full-time physician. Under current law they would be unable to collect reimbursement from Medicare for services they are licensed to perform under state law.

"The prospects are very good for passage of all three bills," Grassley said. "The Congress passed them during the last session. The President supports them this year. Together, they would be a giant step forward in ensuring access to quality health care for all Americans." The three Grassley bills were passed by Congress in 1995 as part of the comprehensive balanced budget act which President Clinton vetoed. This year, however, the proposals were part of the President's budget recommendations to Congress.

  Grassley serves as Chairman of the Senate Special Committee on Aging. He also is a senior member of the Finance Committee, which must consider all legislation affecting the Medicare program.