NRHA Supports Bipartisan Legislation to Eliminate Mileage Limitation for Critical Access Hospital Designation
NRHA strongly supports the bipartisan Rural Health Care Access Act introduced today by Rep. Mark Green of Tennessee’s 7th District and Rep. Bennie Thompson of Mississippi’s 2nd District, which proposes removing the mileage limitation that restricts hospitals from receiving Critical Access Hospital (CAH) designation. Currently, hospitals are unable to receive CAH designation if they are less than 35 miles (or 15 miles if meeting the criteria for mountainous terrain or secondary roads) from another hospital, but the Rural Health Care Access Act seeks to eliminate that requirement.
CAHs are a unique rural hospital designation that were created through the Balanced Budget Act of 1997 in response to the hospital closure crisis of the 1980s and 90s. Similarly, Rep. Green and Rep. Thompson have introduced the Rural Healthcare Access Act because they recognize that hospitals are rapidly becoming more vulnerable to closure and too many are closing across the country. 106 rural hospitals have closed since 2010, and 735 rural hospitals are currently vulnerable to closure. 46% of rural hospitals are operating at a loss, and this percentage is greater for non-CAH rural hospitals. Tennessee has experienced the second greatest number of hospital closures since 2010 among states, and over half of Mississippi’s rural hospitals are at risk of closing. Considering the series of hospital closures in rural communities across the nation, this legislation could not be more important.
CAHs were designed to sustain access to care in rural America by ensuring that providers are compensated via cost-based reimbursement under Medicare and by allowing greater staffing flexibility. Congress allowed rural hospitals these benefits in recognition that the challenges faced by health care providers in rural America are different than in urban environments. For example, hospitals in rural communities face a challenging payer mix, since rural Americans are more likely to rely on Medicare or Medicaid. Ultimately, the CAH designation has provided hospitals greater viability than other rural hospitals in the most recent wave of closures. CAHs only comprise 36% of the 106 rural hospital closures since 2010. Additionally, this legislation will provide relief to states that are doing everything in their power to support their rural hospitals and maintain access. The Rural Health Care Access Act will enable more hospitals to receive CAH designation by eliminating the mileage limitation, which will allow hospitals to keep their doors open to serve their rural communities.
In addition to serving as a necessary provider of healthcare services in rural communities, hospitals are often a vital component of rural economies. The closing of the Lower Oconee Community Hospital in Glenwood, Georgia is a prime example of this reality. The rural hospital served as Wheeler County’s largest health care provider and a major local employer. The hospital itself once provided approximately 120 jobs, but upon being forced to close in June 2014, the county’s entire economy suffered. Business after business on Glenwood’s main street began to close, and without another hospital in the county, it became difficult to incentivize companies to establish new business in the town. Now, residents of Wheeler County must drive an average of 30-45 minutes to the nearest hospital, and some are forgoing necessary care due to provider shortages. Rural hospital closures have dire impacts on the health of rural Americans as well as on rural economies, including stifling future economic growth opportunity. Efforts to sustain rural hospitals are crucial to supporting rural patients and their rural communities.
NRHA supports the Rural Health Care Access Act, and we are proud that Rep. Green and Rep. Thompson have introduced legislation that will allow struggling rural hospitals to address the health care needs of their community while remaining economically viable by becoming CAHs.