As a voice within the Administration for the concerns of rural hospitals, clinics, and other health care providers, ORHP reviews and comments on regulations under development by HCFA. The Office has successfully pushed for higher annual Medicare payments for rural hospitals and higher payments for rural physicians, as well as protections for small and low-volume providers.

Through its work Departmental regulatory teams, ORHP staff pay particular attention to the potential impact of regulations on rural hospitals and on access to care for rural Medicare Medicaid beneficiaries.

The Office successfully advocated for the Montana demonstration of "Medical Assistance Facilities," a type of limited service hospital. It also supported and works to achieve greater flexibility in the implementation of the federal EACH/RPCH program ("Essential Access" and "Rural Primary Care Hospitals") to encourage rural hospital networks. Those efforts culminated in the passage of the Medicare Rural Hospital Flexibility Program, popularly known as the Critical Access Hospital Program, as part of the Balanced Budget Act of 1997. The program allows certain rural hospitals to be designated as Critical Access Hospitals while also creating a grant program to help states work with hospitals in the planning process. The Office was appropriated $25 million to run this program in the fall of 1998.

ORHP has been a strong promoter of rural health clinics -- clinics that are certified under a federal law to provide care in underserved areas, and therefore to receive cost-based Medicare and Medicaid reimbursements. These clinics, often located in remote areas, can be staffed by physician assistants, nurse practitioners, or nurse-midwives with periodic oversight by a physician. In 1999, there were approximately 3,500 rural health clinics across the United States. In a recent Department review of the program, ORHP was able to offer recommendations for regulatory modifications that would preserve and strengthen the ability of the program to continue supporting services where they are most needed. Meanwhile, a new Health Care Financing Administration report Rural Health Clinics: Improved Access at a Cost describes and increase in services, declines in emergency room usage, and a growth in the availability of mid-level providers under the federal Rural Health Clinic program. This study is available from the HRSA clearinghouse.

For more information, Contact:

HRSA, Federal Office of Rural Health Policy,
Room 9-A-55,
5600 Fishers Lane,
Rockville, MD., 20857.
Phone 301-443-0835.