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Ways and Means Protects and Expands Telehealth Access, Health Care in Rural and Underserved Communities

May 08, 2024

WASHINGTON, D.C. – Today, the Ways and Means Committee took action to protect and expand health care for millions of seniors and for Americans directly in the communities where they live and work. The Committee approved six bills that address a wide range of pressing health care issues, particularly those facing rural communities. The package of bills preserves vital telehealth and health-at-home access, helps prevent rural hospital closures and bring back others already shuttered, incentivizes greater access to ambulance services, and expands the number of doctors and nurses in rural communities.

Click here to watch Chairman Smith’s opening statement.

In his opening statement, Ways and Means Committee Chairman Jason Smith (MO-08) drew the connection between the growing gaps in health care access and higher mortality rates in rural America: 

“One of our top priorities on this Committee is helping every American access health care in the community where they live, work, and raise a family. 

“In rural America and small towns, families often struggle to get health care.

“600 rural hospitals are on the brink of closing forever. People in remote areas sometimes have to wait up to 30 minutes after dialing 9-1-1 before an ambulance arrives. Small towns are facing a severe shortage of doctors and nurses, and patients have to disrupt their lives to drive hours to routine appointments.

“The lack of access to emergency and outpatient services and preventative care is one of the reasons why rural Americans have a 43 percent higher mortality rate than urban Americans. Congress has a responsibility to the millions of patients living in rural America to make sure they have access to reliable, quality, lifesaving care.”

This legislation follows a series of hearings, including a field hearing in Texas on access to emergency care, a hearing on advancing health-at-home options, as well as visits to rural hospitals in North Carolina which exposed the shortage of health care options in rural America and highlighted the need for legislative solutions.

The Preserving Telehealth, Hospital, and Ambulance Access Act (H.R. 8261)
Introduced by Rep. David Schweikert (AZ-01) and Rep. Mike Thompson (CA-04), H.R. 8261 protects and expands Medicare telehealth for two years, Hospital-at-Home flexibilities for five years, and Medicare supplemental payments for rural hospitals and ambulance services.

  • Preserves Medicare patients’ access to vital telehealth for two years and Hospital-at-Home services for five years.
    • Telehealth: 25 percent of adults report having utilized telehealth in the past month and 78 percent are likely to complete a medical appointment via telehealth again. 
    • Hospital-at-Home: 300 hospitals in 37 states now participate in Hospital-at-Home and 99 percent of patients were “satisfied” or “very satisfied” with Hospital-at-Home.
  • Preserves essential Medicare programs that sustain rural and low-volume hospitals expiring in 2024.
    • Nearly 4.5 million Americans live in counties without an acute care hospital.
    • Rural hospitals have low patient volumes and rely more on federal health programs, contributing to unique care delivery and financial challenges.
  • Preserves Medicare add-on payments for urban, rural, and super-rural areas to preserve access to crucial emergency ambulance services expiring in 2024.
    • 84 percent of rural counties and 77 percent of urban counties have “ambulance deserts” where access to an ambulance station is more than 25 minutes away.

Read the one pager here.

The Preserving Emergency Access in Key Sites (PEAKS) Act (H.R. 7931)

Introduced by Rep. Carol Miller (WV-01) and Rep. Yadira Caraveo (CO-08), H.R. 7931 permanently expands Medicare emergency ambulance coverage for mountainous communities.

  • To be designated a Critical Access Hospital (CAH), a facility must either be a 35-mile drive from another hospital or a 15-mile drive if the hospital is accessible only by secondary roads or located in mountainous areas.
  • Medicare pays the CAH rate for ambulance services, but only if it is the sole provider within 35 miles.
    • There is no 15-mile provision for ambulances, like the one for hospitals.
  • The bill helps seniors in mountainous communities by covering emergency ambulance services provided by Critical Access Hospital-ambulances located a 15-mile drive in mountainous areas or areas accessible only by secondary roads, at the higher CAH rate. 

Read the one pager here.

The Rural Hospital Stabilization Act (H.R. 8245)

Introduced by Rep. Randy Feenstra (IA-04), H.R. 8245 establishes grants to help rural hospitals stabilize their finances and remain open to serve patients.

  • Critical Access Hospitals (CAHs), small rural hospitals, and Rural Emergency Hospitals are important rural facilities that, due to their location and patient population, have unique Medicare reimbursement structures.
    • While rural hospitals have special payment mechanisms, low patient volume and reliance on government health programs contribute to significant financial challenges.
    • A majority of CAHs have an average of less than five inpatient patients each day.
    • From 2005 to 2022, 186 rural hospitals closed nationwide.
  • The bill authorizes stabilization grants for rural hospitals on the brink of closure.
    • These grants may be used for minor renovations, care delivery training, hiring new staff or supplementing compensation of existing staff, and equipment acquisition.
    • Requires reporting on the rural hospitals and technical assistance providers receiving stabilization grants.

Read the one pager here.

The Ensuring Seniors’ Access to Quality Care Act (H.R. 8244)

Introduced by Rep. Ron Estes (KS-04) and Rep. Gerry Connolly (VA-11)H.R. 8244 provides more training opportunities for Americans working to become Critical Nursing Aides (CNAs).

  • 99 percent of nursing homes currently have job openings and 46 percent of nursing homes have had to limit new patient admissions due to lack of staff.
  • The Biden Administration’s recently finalized nursing home staffing mandate will require nursing homes, already struggling to hire and retain staff, to hire more than 100,000 new nurses and nurse aides. 
  • Medicare makes the shortage worse by forcing nursing homes to shut down CNA training programs if the facility is fined a certain amount, even if unrelated to direct resident care.
  • The bill allows nursing homes to continue operating their CNA training program if they incur fines, so long as the fines are unrelated to direct resident care.

Read the one pager here.

 The Rural Physician Workforce Preservation Act (H.R. 8235)

Introduced by Dr. Greg Murphy (NC-03), H.R. 8235 allows more medical students to complete their graduate medical education (residency) in rural hospitals.

  • 65 percent of rural areas have a shortage of primary care physicians. 
  • Family medicine residents who train in a rural area are six times more likely to practice medicine in rural areas.
  • Congress created a total of 1,200 new Medicare-funded Graduate Medical Education (GME) residency slots in 2020 and 2022 with 10 percent of the slots allocated to rural hospitals.
    • Urban hospitals exploit a loophole that allows them to reclassify their facility to be “treated as rural” if they meet certain criteria.
    • As a result, of the 93 slots classified as “rural,” only twelve of those slots are at truly rural hospitals, while 81 are at hospitals reclassified as rural.
  • The bill closes this loophole to ensure 10 percent of the 1,200 Medicare GME slots dedicated to rural hospitals go to truly rural hospitals. 

Read the one pager here.

The Second Chances for Rural Hospitals Act (H.R. 8246)  

Introduced by Rep. Jodey Arrington (TX-19), H.R. 8246 brings back critical emergency and outpatient care to rural communities who had their local hospitals close down by converting to the new federal Rural Emergency Hospital (REH) designation.

  • In 2020, Congress created the REH designation to allow low-volume rural hospitals at risk of closure to eliminate underused inpatient beds but keep needed emergency and outpatient services.
  • Restrictive eligibility reserves this model only to current hospitals, not those who recently shuttered prior to December 2020.
  • The bill expands the eligibility requirements by allowing hospitals that have been closed since 2014 to become a Rural Emergency Hospital and receive the additional funding included with the designation.

Read the one pager here.