Grassley said he developed the comprehensive rural health package with Sen. Max Baucus of Montana and Senate Minority Leader Tom Daschle. "Our goals are to improve Medicaid and Medicare reimbursement to rural providers, strengthen health professional recruitment programs and encourage the development of telehealth," Grassley said. The Iowa senator has long been active on rural health issues and is a senior member of the Senate Finance Committee, which maintains jurisdiction over Medicare and Medicaid.
Reimbursement - One big problem for rural areas is that reimbursement systems favor urban areas or they do not take into account the special needs of rural providers.
1)The Promoting Health in Rural Areas Act of 1999 would correct Medicare payment formulas that discriminate against rural areas in order to pay hospitals and other rural health care providers more fairly. The bill also includes several provisions targeted at smaller rural hospitals and the particular problems they face.
2)The rural health bill would guarantee that Medicare+Choice plans in rural counties get the increased reimbursement promised in the Balanced Budget Act of 1997 (BBA). Grassley said this provision is important to ensure that beneficiaries in rural areas have some of the health plan choices available to urban seniors.
3)In the BBA, Medicaid funding for Community Health Clinics and Rural Health Clinics was changed, leaving no guarantee that states will adequately fund these essential facilities. The legislation introduced today would create a new adequately funded payment system for these clinics.
Recruitment - Rural communities also face difficulty recruiting and retaining health care providers. About 22 million rural Americans live in areas that are considered Health Professional Shortage Areas because they do not have enough doctors to serve their community.
1)Currently, communities must actually lose a physician before they qualify for recruitment assistance to replace that provider. The Promoting Health in Rural Areas Act would let communities get assistance for up to 12 months in advance when they know someone is going to retire or resign.
2)Another provision in the bill ensures that new Medicare reimbursement rules for medical residents, enacted as part of the BBA, do not discriminate against areas that train residents in rural health clinics or other settings outside a hospital.
Technology - Telemedicine is another promising tool to bring medical expertise to rural communities. Through telemedicine technology, rural patients can significantly shorten their travel time to see specialists, and they can have access to doctors they would otherwise never encounter.
1)The Promoting Health in Rural Areas Act would expand Medicare reimbursement for telemedicine to all rural areas, and to all Medicare services. Any health care practitioner could present a patient to a specialist on the other side of the video connection, which would make the technology more convenient.
2)The bill also includes a grant program to help communities establish an infrastructure for effective telemedicine applications.Earlier this year, Grassley also introduced legislation to correct a problem created by the BBA for beneficiaries needing occupational, physical and speech therapy. The BBA included a $1,500 cap on Medicare coverage of these therapies received in all settings except hospital outpatient departments. However, stroke victims and those with illnesses such as Parkinson's will quickly exceed the cap. Grassley's Medicare Rehabilitation Benefit Improvement Act of 1999 would establish exceptions to the $1,500 cap for beneficiaries who need more intensive treatment than the cap would allow.
In addition, Grassley introduced the Hospital Transfer Penalty Repeal Act of 1999 which would repeal an ill-considered BBA provision that penalizes hospitals that move patients to other care sites in a timely and cost-effective manner. The BBA penalty is especially harmful to hospitals in low- cost regions, such as Iowa. Because Iowa's hospitals practice efficient medicine, they have average lengths of stay well below the national average. Payments are based on the national average, so these hospitals are hit especially hard, Grassley said.