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Rural Advocates Stand Up for CAHs in Letter to Ways and Means Committee

Representative Evan Jenkins (R-WV) and Representative Tom O'Halleran (D-AZ) wrote a bipartisan letter this morning to the Chair and Ranking Member of the Ways and Means Committee opposing using Critical Access Hospital (CAH) cuts as a pay-for in the Committee's Rural Medicare Extenders package. NRHA's Government Affairs team has been working to oppose this proposed pay-for since the idea was introduced in a Ways and Means Committee press release just a few weeks ago. We commend our rural advocates, Rep. Jenkins and Rep. O'Halleran, and we look forward to continuing to fight this dangerous and harmful proposal. Members of Congress have until 12 p.m. on Friday, December 8th to sign on the letter. The full text is below. 

Stand Up for Rural Patients: Oppose Cuts to Critical Access Hospitals in Medicare Extenders Legislation

Deadline to Sign Bipartisan Letter: NOON, FRIDAY 12/8

Dear Colleague,

Recently, the House Ways and Means Committee announced an agreement to fund critical Medicare extenders that provide needed relief to beneficiaries and the providers who treat them. While we are encouraged that bipartisan efforts are being made to pass these important extenders, we are concerned about a pay-for included in the legislation.

Included in the agreement as an offset is a harmful provision that will disproportionately impact rural communities. A proposed cut to reimbursement rates for Critical Access Hospital (CAH) swing-beds would hurt rural hospitals that are already operating under significant constraints. Swing-beds allow patients in CAHs who meet strict Medicare criteria to receive post-acute care services, including rehabilitation, before transitioning home. These facilities are currently not receiving 100% of reimbursement for swing-bed services due to sequestration. Any further cuts would push more hospitals closer towards closure at a time when our communities need more – not less – access to care. Medical deserts exacerbate unique health care challenges in vulnerable communities, forcing patients to travel further for needed treatment and services.   

The proposal is based on a flawed analysis from HHS OIG in 2015, which was refuted at the time by the Centers for Medicare and Medicaid Services (CMS). We believe robust analysis and oversight from Congress needs to be conducted before moving forward with a change that would impact care in rural areas so significantly.

Please join us in sending a letter to Chairman Brady and Ranking Member Neal opposing this pay-for in the extenders package. Patients in rural America simply cannot afford more hospitals closing in their back yards. To sign on, please contact Xenia Ruiz (Xenia.Ruiz@mail.house.gov) in Rep. O’Halleran’s office.


Member of Congress
Member of Congress

December XX, 2017

The Honorable Kevin Brady
Chairman, House Ways and Means Committee
1102 Longworth House Office Building
Washington, D.C. 20515

The Honorable Richard Neal
Ranking Member, House Ways and Means Committee
1139E Longworth House Office Building
Washington, D.C. 20515

Dear Chairman Brady and Ranking Member Neal,

As Members who represent rural communities that depend on Critical Access Hospitals (CAHs) for access to needed care, we write to express our grave concerns with the proposed policy to modify payments for CAH swing-beds included as an offset in the draft Medicare extenders package announced by the House Ways and Means Committee. If adopted, any cuts from current reimbursement levels would devastate hospitals that serve our communities and not only impact families’ ability to receive needed services but also thousands of jobs across rural America.

We understand that the Committee is basing its inclusion of this change on a 2015 report from the Department of Health and Human Services Office of the Inspector General (HHS OIG). As you may know, the Centers for Medicare and Medicaid Services (CMS) disagreed with the report’s findings. We agree with CMS’s response to the report stating that OIG recommendation “overestimates savings by failing to incorporate important factors such as the level of care needed by swing-bed patients, transportation fees to alternative facilities, and the use of point-to-point mileage distances instead of road miles.” Point-to-point measurements may seem like a reasonable way to determine distances between facilities. However, the reality of life in rural America is that roads don’t always take the most direct path. Our constituents often must spend hours driving because roads simply must go around certain types of terrain. Swing-beds allow rural patients to receive medically necessary services closer to home instead of  forcing their families to travel long distances and incur higher costs.

The OIG report also does not take into account the resources that CAH’s must utilize to treat patients in swing-beds, nor the unique market conditions in rural communities. In many of our states, CAH’s previously operated skilled nursing facilities (SNFs) but had to close them due to lack of financial viability in remote regions. Currently, CAH’s are only reimbursed 99% of cost due to sequestration. Further cuts would force hospitals to make difficult decisions that would harm patient access to critical services or shut down altogether. Since 2010, 82 rural hospitals have closed across the nation and only 1,300 CAHs provide these lifesaving services to vulnerable communities.

As with any policy change that impacts the care of millions of Americans, proposals to modify swing-bed payments must be thoughtfully considered and reviewed with the input of rural stakeholders through additional analysis and public hearings. While we applaud the Committee for working together on a bipartisan basis to move forward important Medicare extenders, we do not believe costs should be disproportionately shouldered by patients and providers in rural communities. As such, we respectfully urge you to abandon proposed cuts to Critical Access Hospitals as you move forward with this important package.

Tom O’Halleran
Member of Congress  

Evan Jenkins
Member of Congress

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