1. The Rural Policy Landscape August 22, 2006 Alan Morgan Chief Executive Officer

2. NRHA: Mission Statement The National Rural Health Association is a national membership organization whose mission is to improve the health of rural Americans and to provide leadership on rural issues through advocacy, communications, education and research.

3. NRHA Membership Reaches 10,000!

4. What’s New at NRHA? New for 2006: - New rural clinicians conference: Denver, July 28-29 - New national rural Medicaid initiative - New Rural Fellows Program New in 2005: - Association grew by 3,500 in 2005 - New website design (50,000 hits each month) - New rural health career center - New quality resource page

5. Recap of Last Year’s Budget Battle  President proposed to eliminate 8 programs worth $232 million and dramatically cut 3 others.  House of Representatives followed many of those recommendations; the Senate did not.  The first Conference Report eliminated 6 programs worth $134 million and dramatically cut several others. But it was defeated 209 to 224 in the House!  The final bill restored funding for research and policy and AHECS, and added money for outreach and community health centers. Unfortunately, some programs still got eliminated or cut (H. Ed Training Centers, Quentin Burdick, Geriatric Ed, EMS, CAP eliminated; AED, Nat’l Hlth Service Corps cut). Give yourselves a round of applause !

6. Timeline for Appropriations Process  House Committee action the week of June 13.  Senate Committee action the week of July 17.  Final Action -- After mid-term elections. Outlook for Appropriations: Appears that Congress has learned from what happened last year. Most rural health programs are level funded. We must push for the higher amounts in each bill and look toward advancing requests for funding increases and restoration of eliminated programs.

7. NRHA Legislative and Regulatory Agenda

8. “It is not that difficult, really. If it improves rural health, we support it. If it doesn’t, we don’t.” Val Schott, 2001 Former NRHA President

9. House Rural Health Care Coalition Bill Extends MMA Provisions Through 2011 (H.R. 5118)  Outpatient Hold Harmless (under current law phases out from 2006 to 2008)  Incentive payment for physicians in physician scarcity areas (expiring 12/31/07)  Work geographic adjustment 1.0 floor for rural physician payments, (expiring 12/31/06)  Two percent bonus payment for ambulance (expiring 12/31/06)  Reasonable cost payment for rural hospital clinical lab tests performed as part of outpatient services (expiring 6/30/06)  5% add-on payment for home health services (expiring 12/31/06)

10. Senate Rural Health Caucus Bill (S. 3500)  MMA Extenders  Remove cap on disproportionate share hospital payments  Rural Health Clinic Reimbursement – raise the all- inclusive payment rate to $82. Allow collaboration with community health clinics.  Home health telehealth demonstration program  Medicare coverage of marriage and family therapists for mental health services  Medicare coverage of hospice and home health when prescribed by nurse practitioner, physician assistant.

11. House Rural Health Care Coalition Bill Part Two Stay Tuned…

12. Timeline for Other Congressional Action “House Majority Leader John Boehner (R-Ohio) said he expects to adhere to the chamber’s published schedule for the duration of the 109th Congress but predicted that the House will reconvene following the November elections and remain in session until the Christmas holiday.” - CQ May 4, 2006 Physicians slated for a Medicare cut of 5.1 percent – that will drive action on Medicare. Rural advocates need to lay the groundwork for Congressional action later in the year.

13. Workforce Development  Conrad 30 reauthorization  Tax Credits for doctors in HPSAs, $1000 monthly for up to 5 years. (S. 824).  Tax credits for doctors in frontier areas (S. 2789). Source: The National Advisory Committee on Rural Health and Human Services, “Medicare Reform: A Rural Perspective,” May 2001.

14. Medicare Payment Advisory Commission (MedPAC) Federal law requires that MedPAC representation include “a balance between urban and rural representatives”. But only 1 out of 17 MedPAC Commissioners is Rural!

15. Additional Emerging Issues  Graduate Medical Education  Rural Veterans (H.R. 5524)

16. Health Care Quality  NRHA has launched a five-year initiative to improve the quality and safety of health care in rural America based on the Institute of Medicine’s recommendations.  NRHA/ORHP meeting June 23 rd to inform potential key stakeholders about IOM’s first recommendation, which calls for comprehensive health system reform demos in five rural communities. Demos will use innovative approaches to the financing and delivery of health services, including P4P and IT.  Goal of meeting was to identify possibilities for implementation and funding of these demonstration projects. Rural Can Lead on Quality!

17. Nearly 46 Million Uninsured  Rural residents are more likely to be uninsured than urban resident (24% without insurance in rural areas not adjacent to an urban area as compared to 18% in urban areas.) Sources: U.S. Census Bureau; Kaiser Family Foundation analysis of 1998 data.

18. NRHA Needs You… as Advocates!

19. The 1-2-3’s of Advocacy 1.Make your best case: Develop concise, credible, persuasive, fiscally responsible, but emotive arguments. 2.Make friends and form alliances: Find Congressional champions, develop agency contacts, form alliances with a diverse set of groups. 3.Make it happen: Use some or all of your advocacy tools – government relations, grassroots and media advocacy – based on your level of engagement.