NARHC-News | Fall 2019
RHC Articles in This Newsletter

• Healthcare Policy Work Continues Despite Impeachment Talk
• Final Rule 0938-AT23
• Medicare For All
• CMS Relaxes Policy on Emergency Drugs & Biologicals for RHCs
• Stay Informed. Like Our FB Page.
• Certified RHC Professional Course (CRHCP)
• The Pediatric Heart of Northwest Oregon
• Suicide in Rural Communities is on the Rise
• How Are Providers Faring With The Uptick in Consolidation?
• The Power of 340B
Healthcare Policy Work Continues Despite Impeachment Talk

RHC Modernization Act
Window of Opportunity Remains

While your cable news channel of choice may be offering near 24/7 coverage of impeachment, Congress and Capitol Hill continue to work on several key pieces of healthcare legislation outside of the limelight. In wonky health policy circles, of which I happen to dabble occasionally, two topics have been taking up a lot of attention: 1) Drug Pricing and 2) Surprise Medical Billing.

A bipartisan package on drug pricing, led by Senator Grassley and Senator Wyden, has emerged out of the Senate Finance Committee and a version of that package may have a good chance to pass by the end of the year. There is also broad consensus that Congress needs to pass something to protect patients from surprise medical billing. The specific solution is still being furiously debated in Congress and there are several proposals floating around. One solution is supported by the insurance companies, while other solutions are supported by provider groups. These competing interests have set up PACs and are blanketing the airwaves with commercials (at least in Washington DC) advocating for their preferred solution.  Read More
CMS Issued Final Rule...
Transparency, Burden Reduction, Innovation, etc.

CMS has issued final rule  RIN 0938-AT23 , which affects CAHs, RHCs, FQHCs, and other facility types. The following summary is taken in whole from the parts affecting RHC   §491 in the rule:

"Medicare and Medicaid Programs: Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Fire Safety Requirements for Certain Dialysis Facilities; Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care"

Effective November 30, 2019:
"This final rule reforms Medicare regulations that are identified as unnecessary, obsolete, or excessively burdensome on health care providers and suppliers. This final rule also increases the ability of health care professionals to devote resources to improving patient care by eliminating or reducing requirements that impede quality patient care or that divert resources away from furnishing high quality patient care" Read More
Medicare For All
If Enacted, What Effect
Could It Have on RHCs?

We’ve all heard the stories in the national media about the closures of rural hospitals. By last count, over 100 rural hospitals have closed since 2010. But did you know that between 2012 and 2018, more than 380 RHCs have closed? And, another 300 have converted from “independent” to “provider-based”. 

This, all in an environment where more people are insured than at any time in our nation’s history due to passage of the Affordable care act nine years ago.

But despite passage of the ACA, the cost, quality and availability of healthcare remains a top concern for most voters heading into the 2020 elections. 

One of the most frequently discussed ideas is legislation referred to as “Medicare for All”. Or, its close cousin – Medicare for All Who Want It.   Read More
CMS Relaxes Policy on Emergency Drugs & Biologicals for RHCs

Sept. 16, 2019  -- NARHC is happy to report that CMS is significantly altering their guidance policy regarding emergency drugs and biologicals required in Rural Health Clinics. This change is effective immediately.
Previously, RHCs were required to stock drugs and biologicals from each of the following categories: 1-Analgesics; 2-Local Anesthetics; 3-Antibiotics; 4-Anticonvulsants; and 5-Antidotes, emetics, serums & toxoids. However, as of September 3rd, 2019, RHCs will only be required to consider each category when they craft their written policies. This means that RHCs will not be required to stock snake antidote, emetics, or anticonvulsants! Here is the key line from the new policy:
While each category of drugs and biologicals must be considered, all are not required to be stored…
We will still be required to store drugs and biologicals for emergencies, but now, CMS is allowing us to determine which drugs and biologicals are most appropriate for our communities. Read More
Stay Informed.
Like Our Facebook Page!

Connecting with the National Association of Rural Health Clinics on Facebook is a great way to keep in touch with like-minded people! Help support NARHC while also staying connected all year round through the latest national news specific to rural health clinics.  Click Here to be taken to the FB page.

Next Session of NARHC's...
 Certified RHC Professional Course (CRHCP)
Registration Opens: January 2nd
In-Person Final Exam in San Antonio on March 20, 2020

ONLINE TRAINING* will prepare you to successfully manage and run an RHC. Learn the latest information on RHC rules, regulations, and laws. Study nights, weekends, or whenever your schedule permits! Course takes approximately 30 hours. No prerequisite! Coursework is broken into 4 modules with video presentations & a series of short knowledge-based tests for each module. This course is designed to give you a well-rounded, ground level knowledge base of the major facets of RHC management. Read More

  • Module 1: Administration & Finance
  • Module 2: Billing & Coding
  • Module 3: Human Resources
  • Module 4: Regulatory Compliance & Quality
The Pediatric Heart of Northwest Oregon

In the early 1970’s, there was a change. The medical class completing their residency requirements for pediatrics were ready to help the world. Most graduates stayed in their respective states but one; a young highly motivated New Yorker, decided to move with his family from the comforts of the east coast to the shores of the Pacific Northwest.

Dr. Richard Steinberg was a newly formed clinician with a heart of gold. Amazingly, he chose what was considered a rural market and the local community health clinic as his starting point. The children of Woodburn, Oregon had no idea what level of special was now in the community. Over the course of a few years, Dr. Steinberg created a name and a know-how, and he started what is now called Woodburn Pediatric Clinic on Progress Way in Woodburn, Oregon. Read More
Suicide in Rural Communities
is On The Rise

The Rural Health Information Hub (RHIhub) has partnered with the NORC Walsh Center for Rural Health Analysis and the University of Minnesota Rural Health Research Center, to create the Rural Suicide Prevention Toolkit. This toolkit includes resources and program models designed to help rural communities implement suicide prevention programs and make a change. Read More
New HCPCS Code J0642 for Levoleucovorin Injection

For dates of service on or after October 1, use HCPCS code J0642 for Levoleucovorin injection products marketed under the brand name of Khapzory.


How are Rural Health Care Providers Faring With the Uptick in Consolidation?

As rural health care providers cut back on services--or close altogether—RHCs face pressures to provide expanded care and “old fashioned” approaches, including doulas and promotoras, gain popularity when any facility is simply too far away.

Consolidation hurts access to care, especially in rural communities. That, frankly, is a no-brainer for anyone who works in a rural or any other underserved community. Large health systems acquire small rural hospitals and either shutter them or close several service lines, usually including obstetrics. The result: decreased access for those in rural areas. But this realization has done nothing to slow the pace of mergers and acquisitions.

Here’s the real kicker: Consolidation continues to gain steam because of the belief that consolidation creates economies of scale that lead to better care. But in many instances, it’s a mistaken belief; in fact,  many experts  report just the opposite. These “economies of scale” often don’t control  costs . Read More

The Power of 340B

Last week I sat in the office of a rural hospital administrator who had been electrocuted in a farming accident. His doctors gave him a one in three million chance of surviving. But like the phoenix he survived and now has the job of reviving a small rural hospital. Sadly, the odds of surviving electrocution seem higher than keeping a small, rural hospital operating in the current environment. To survive in today’s environment, hospital administrators need powerful tools. One of those tools is the 340B program for hospitals with provider-based clinics. That day we called Dr. LeeAnn Scheer PharmD, MBA-HCA, 340B-ACE from Elite 340B Solutions ( ) and received a primer on the 340B program. Here is an outline of the 340B program as presented to us by Dr. Scheer.

The 340B program is becoming an increasingly common topic in today’s healthcare landscape. The federal program is based on the idea of stretching scarce resource dollars as far as possible, by allowing eligible entities access to reduced drug prices (a discount of 30% to over 50%). Eligible hospital types include certain disproportionate share hospitals (DSH); children’s hospitals; rural hospitals, including critical access hospitals (CAHs), rural referral centers (RRCs) and sole community hospitals (SCHs); and free-standing cancer hospitals. If your facility falls into one of these categories, you then have two more requirements to meet.   Read More
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