Rural Health Policy Frequently Asked Questions
Question: What types of issues does rural health policy address?
Answer: Rural health policy shares
many concerns with the broader realm of health policy, such as the availability
of and access to health services, health care quality, health care costs,
and Medicare and Medicaid reimbursement. Some of the health policy issues
that are more specific to rural areas include:
Question: Who is involved in the rural health policy process?
Answer:
The formulation of health policy relies on input from various parties,
each of whom contribute information and expertise needed to understand
health care concerns of rural communities. The formal part of policymaking
is conducted by the Executive and Legislative branches of the government,
through the passage of legislation that impacts rural health. The Senate
Rural Health Caucus and House
Rural Health Care Coalition,
which are informally organized, bipartisan membership organizations,
focus attention and act on behalf of rural concerns. Federal agencies
involved in rural health work to inform policymakers about the issues
and needs of rural health communities and are also called upon to
issue and enforce regulations and implement rural relevant legislation.
Interest groups, such as membership organizations, advocate for the
concerns of their members, typically through their Government Affairs
sections. Interest groups, state offices of rural health, and researchers
produce reports, gather data, and otherwise inform policymakers about
rural health issues.
Question: What
is the process that takes an idea or issue and effects change to improve
rural health care?
Answer: An issue or idea related to rural
health may come to light through research findings or concerns expressed
by groups or individuals. Membership organizations such as the National
Rural Health Association produce policy briefs that express the concerns
of their members on rural health issues.
Once an issue and potential policy solution is identified, lawmakers
in the U.S.
Senate and House of Representatives craft
legislation intended to address the issue, with input from a variety
of experts and concerned parties. If the legislation is passed and
becomes law, then federal agencies with jurisdiction over the related
policy or program will be called upon to issue regulations and enforce
the law.
The process of identifying and addressing issues is iterative. Each
time a change is made, lawmakers, researchers and interested parties
examine the results, look for methods that might improve the situation,
suggest possible legislation to modify the policy or program, and track
the results.
Question: How do regulatory agencies implement changes to rural health programs based on federal laws?
Answer:
Federal agencies that are tasked with enforcing a law addressing rural health may need to further define how the law will be enforced by issuing a regulation. The regulation is first issued as a proposed rule in the Federal Register. A request for comments by a specific deadline is included with the proposed rule. Once comments have been considered, a final rule is issued, again in the Federal Register. Final Rules typically include detailed guidelines for how a law will be enforced, along with the deadlines for parties to meet each aspect of the regulation. The Final Rule will also contain the specific changes to the Code of Federal Regulations (CFR), which will be effective on the date indicated in the Final Rule, regardless of whether or not they appear in the printed or online version of the CFR.
An example of how this process works can be seen in the Medicare
Prescription Drug Improvement and Modernization Act (MMA), which
was passed by the U.S. Congress in November 2003 as Public Law 108-173.
One of the provisions of the MMA concerned the requirements for rebuilding
or relocating a Critical Access Hospital (CAH) that is designated as
a Necessary Provider. The Proposed Rule to address this issue was issued
in the Federal
Register on May 4, 2005 in the Medicare
Program; Proposed Changes to the Hospital Inpatient Prospective Payment
Systems and Fiscal Year 2006 Rates. Comments for this Proposed
Rule could be submitted through June 24, 2005 to an address included
in the Federal Register notice.
There were concerns in the rural health community that the Proposed Rule
would limit the ability of hospitals that were Necessary Providers to
replace their facilities as needed in the future. The Final Rule, which
was issued in the Federal Register on August 2, 2005,
allows for relocation for facilities that meet specific criteria. The Medicare
Program; Changes to the Hospital Inpatient Prospective Payment Systems
and Fiscal Year 2006 Rates Final Rule addresses the Necessary
Provider requirements on pages 779-793 and 867-869. The Centers for
Medicare and Medicaid Services (CMS) subsequently issued interpretive
guidelines that tightened the criteria allowing for relocation of CAHs
in a November 14, 2005 letter from CMS to State Survey Agency Directors
titled Location
and Relocation of CAHs and Relocation of Necessary Provider CAHs.
The November 14, 2005 letter was superseded by a September
7, 2007 letter from CMS to State Survey Agency Directors addressing the
topic, Critical
Access Hospitals (CAHs): Distance from Other Providers and Relocation
of CAHs with a Necessary Provider Designation.
Question: What is the role of the Health Resources and Services Administration’s Office of Rural Health Policy?
Answer:
The Office of Rural Health Policy (ORHP) helps shape rural health policy in a variety of ways. The Office advises the Secretary of Health and Human Services on major issues such as the effects of Medicare and Medicaid on rural citizens' access to health care. Since its inception, ORHP staff have worked with Centers for Medicare & Medicaid Services on the development and review of Medicare and Medicaid regulations. The Office also has established working relationships with other federal agencies in the development of policy and regulatory decisions. For more information, please see ORHP’s Policy Development information.
Question: What is the role of the National Advisory Committee on Rural Health & Human Services?
Answer:
The National Advisory Committee on Rural Health and Human Services (NACRHHS) is a 21-member citizens' panel of nationally recognized experts that provides recommendations on rural health and human services issues to the Secretary of the Department of Health and Human Services. The Committee issues annual reports that focus on key issues impacting rural health and human services. NACRHHS is staffed by the Office of Rural Health Policy.
Question: What is the Medicare Payment Advisory Commission, and how is it involved in rural health policy?
Answer:
The Medicare Payment Advisory Commission
(MedPAC) is an independent, 17-member group that advises the U.S.
Congress on issues affecting the Medicare program. MedPAC has a broad
statutory mandate to consider issues related to Medicare, including
access to care, quality of care, and other issues. Medicare reimbursement
in rural areas and how these payments influence rural Medicare beneficiary
access to quality care is one area that MedPAC addresses in its reports.
Question: Which federal agencies address rural health policy issues?
Answer:
These are some of the federal agencies that, along with the Office of Rural Health Policy (ORHP), work to address rural health policy issues:
- The Health Resources and
Services Administration (HRSA), through ORHP and HRSA’s
other bureaus and offices, including the Bureau
of Primary Health Care (BPHC), which funds Community
Health Centers (CHCs), the Bureau
of Health Professions (BHPr), which addresses healthcare
workforce issues, and the Bureau
of Clinician Recruitment and Service (BCRS), which coordinates
the recruitment and retention of health professionals.
- The Agency for Healthcare Research and Quality (AHRQ) works to improve the quality, safety, efficiency, and effectiveness of health care for all Americans, including those who live in rural areas.
- The Centers for Medicare
and Medicaid Services (CMS) implements Medicare and Medicaid
regulations that impact rural beneficiary coverage and provider
reimbursement.
- Indian Health Service (IHS) focuses on the availability of health care services to American Indian and Alaska Native people, many of whom live in rural areas.
- The Veteran’s Administration (VA) provides health care services to veterans, including those who live in rural areas.
- The U.S. Department of Agriculture (USDA) supports the rural health care infrastructure through the USDA Rural Development’s Community Facilities program.
- The U.S. Department of Housing and Urban Development (HUD) supports rural hospitals through the HUD 242 capital financing program.
Question: How do researchers support rural health policy?
Answer:
Rural health researchers focus their research on topics that highlight
problems with the provision of health care in rural communities and
identify recommendations that may influence public policy formulation.
Findings from rural health research may help inform policymakers about
issues that should be addressed and methods that may be particularly
effective. Researchers may also be tasked with evaluating programs
that the government has put in place to address an issue or problem.
The federal government supports a number of rural research and policy
analytic centers through the Office of Rural Health Policy's Rural
Health Research Centers program. For information about current
rural health research projects, please see Rural
Health Research Gateway.
Question: How can rural communities and individuals influence rural health policy?
Answer:
Rural communities and individuals can voice their concerns about health
care issues to their state and federal Congressional Representatives
and to local officials. They can also offer comments on proposed rules
that appear in the Federal Register, and can contact federal
agencies such as the Centers for
Medicare and Medicaid Services with their concerns. Rural health
care stakeholders may also choose to join an organization, such as
a rural health association or hospital association, which can give
a broader voice to their concerns.
Question: What role do membership organizations play in advocating for rural health issues?
Answer:
Membership organizations, such as the American
Hospital Association's Section for Small or Rural Hospitals, the National
Rural Health Association (NRHA) and the state
rural health associations,
work with legislators to make them aware of the concerns specific to
the rural health community. Organizations may produce publications supported
by their membership to help inform policymakers about important rural
health issues.
Membership organizations also keep their members informed about legislation under consideration that may impact them and the implications of laws and regulations that have been passed. Along with informing their members, these organizations help mobilize members by connecting them to their state and federal legislators so they can influence the outcome of any policies under consideration.
Membership organizations involved in rural health often join forces on issues where they can work effectively to address common goals. On issues where the needs of their constituents diverge, these same groups will choose to pursue their goals separately, coming together again on the next issue where collaboration will be effective.
Question: What are some membership organizations that advocate for rural health?
Answer:
These are some of the key membership organizations that are concerned with rural health issues:
Question: What role do states play in rural health policy?
Answer: The federal government encourages
innovation at the state-level by granting waivers or demonstration projects
that allow interested states the latitude to experiment with different
approaches to address a specific issue. The Center for Medicare and Medicaid
Services' Medicaid
State Waivers and Demonstration Programs, for example, lists a number
of options that allow states to try new approaches to delivering Medicaid
benefits, including the 1115
Waiver Research and Demonstration Projects. Another example of using
states as a laboratory to test new approaches is the Frontier
Extended Stay Clinic (FESC) program, which is being used to examine
the effectiveness and appropriateness of a new type of provider, the
FESC, in providing health care services in certain remote locations.
States play a role in rural health policy through their responsibility for survey and certification of health care facilities. States also control the practice of health care providers through state scopes of practice. States provide significant support for workforce training, and some states have targeted policies to encourage placement of clinicians in rural areas through state scholarship and loan repayment programs.
Credits
Last revised 10/29/2009
