1. Lisa Kilawee 2016 NRHA President National Rural Health Association Rural Health Care and NRHA

2. Improving the health of the 62 million who call rural America home.

3. National Rural Health Association Membership 2015

4. Support the Rural Health Foundation. NRHA introduced the Rural Health Foundation in 2012 to establish a permanent endowment for rural leadership development for generations to come. To give, visit RuralHealthWeb.org/donate.

5. Destination NRHA Plan now to attend these upcoming events. Policy Institute- Feb. 2-4, Washington, DC 21 st Health Equity Conference, May 10 th, Minneapolis, MN 39 th Annual Conference, May 10-13, Minneapolis, MN Visit RuralHealthWeb.org for details and discounts.

6. National Rural Health Day/ Importance of Advocacy Federal Government’s big impact on rural health care Appropriations Medicare/Medicaid Regulations Great challenges of today Health disparities on the rise Federal funding in jeopardy Medicare cuts continue; sequestration extended for yet another year. Federal appropriations uncertainty Access to care for rural patients significantly impeded Workforce shortages Rural hospital closure crisis United voice is needed Even if you can’t advocate - - you can educate Join NRHA’s monthly grassroots calls

7. 15 More Closures since Last National Rural Health Day

8. A Rural Hospital Closure Crisis 59 rural hospitals have closed since 2010; 15 have closed since our last National Rural Health Day; Rate will likely double in 2015-16; 283 rural hospitals are vulnerable. Nye Regional Medical Center, Tonopah, NV, the only hospital in a 100-mile radius, closed August 21, 2015. This was a Sole Community Hospital (SCH). Nye Regional Medical Center In Oct 2014, 283 rural hospitals identified as statistically clustered in the bottom tier of performance by iVantage

9. The Save Rural Hospital Act: 1. Stops the bleeding. Halt additional proposed cuts to rural hospitals from the Administration and Congress immediately. Support pro-rural provisions such as Medicaid expansion, elimination of the 2% sequestration cuts and 101% reimbursement for CAHs to stabilize the rural safety net. 2. Builds bridge to the future. Promote new provider payment models to create a new rural reality. We ask you to join our campaign: #SaveRural

10. Save Rural Hospitals Act, HR 3225 Rural hospital stabilization (Stop the bleeding)  Elimination of Medicare Sequestration for rural hospitals;  Reversal of all “bad debt” reimbursement cuts (Middle Class Tax Relief and Job Creation Act of 2012);  Permanent extension of current Low-Volume and Medicare Dependent Hospital payment levels;  Reinstatement of Sole Community Hospital “Hold Harmless” payments;  Extension of Medicaid primary care payments;  Elimination of Medicare and Medicaid DSH payment reductions; and  Establishment of Meaningful Use support payments for rural facilities struggling.  Permanent extension of the rural ambulance and super-rural ambulance payment. Rural Medicare beneficiary equity. Eliminate higher out-of pocket charges for rural patients (total charges vs. allowed Medicare charges.) Regulatory Relief  Elimination of the CAH 96-Hour Condition of Payment (See Critical Access Hospital Relief Act of 2014);  Rebase of supervision requirements for outpatient therapy services at CAHs and rural PPS See PARTS Act);  Modification to 2-Midnight Rule and RAC audit and appeals process. Future of rural health care (Bridge to the Future) Innovation model for rural hospitals who continue to struggle.

11. The Save Rural Hospitals Act – Join NRHA efforts. SRHA is not legislation for rural hospitals that struggle. SRHA will mean millions of dollars to your facility. SRHA will offer key regulatory relief. Current Status House: Introduced - - Reps. Graves (R-MO), Loebsack (D-IA), July 31, 2015. Senate: Not yet introduced. We need you grassroots efforts. We need your hospital boards and your community to be involved.

12. “Rural hospitals and the rural economy rise and fall together” On average, 14% of total employment in rural areas is attributed to the health sector. Natl. Center for Rural Health Works. (RHW) The average CAH creates 107 jobs and generates $4.8 million in payroll annually. (RHW) Health care often represent up to 20 percent of a rural community's employment and income. (RHW) A rural physician generates 23 jobs in the local economy “Three years after a rural hospital community closes, it costs about $1000 in per capita income.” Mark Holmes, professor, University of North Carolina

13. National Rural Health Association Go Rural!