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Conference Concludes with Final Version of L-HHS Bill

The Senate and House Conference Committee on Minibus III (Defense/L-HHS) concluded their Conference meetings last night and filed the final version of the Defense/L-HHS Bill funding the departments for Fiscal Year 2019 (FY19).
As NRHA previously reported, both the House and Senate bills included robust funding, equal to or above NRHA’s requests, for rural health safety net programs housed at the Department of Health and Human Services (HHS), the Health and Research Services Administration (HRSA), and the Federal Office of Rural Health Policy (FORHP).
NRHA thanks the Members of the Conference Committee for their work to ensure that these funding levels were maintained throughout deliberations on the final bill, and we ask all Members of Congress to swiftly send this bill to the President’s desk for a signature, providing rural patients and providers the certainty they need for FY19.
The Senate is expected to vote on the bill next week while the House is recessed. The House will vote on the bill the following week when they return from recess.
All final rural spending levels are detailed below:
Rural Hospitals
  • Medicare Rural Hospital Flexibility Grants are used by each state to implement new technologies, strategies and plans in Critical Access Hospitals (CAH). CAHs provide essential services to a community. Their continued viability is critical for access to care and the health of the rural economy. The draft bill provides $53. 6 million dollars for these programs, a recognition of the importance of these grants and the work they allow CAHs to do. NRHA presented details of the work done with these grants, resulting in $3.2 million over our initial request of $50.4 million.
  • Of the funds made available under Rural Hospital Flexibility Grants, $19.9 million is specifically provided for the Small Rural Hospital Improvement Grant Program “for quality improvement and adoption of health information technology” and up to $1,000,000 may be used for funds “provided for grants for the purchase and implementation of telehealth services, including pilots and demonstrations on the use  of electronic health records to coordinate rural veterans care between rural providers and the Department of Veterans Affairs electronic health record system.”
State Offices of Rural Health (SORH)
  • Located in all 50 states, help their individual rural communities build health care delivery systems. They accomplish this mission by collecting and disseminating information, providing technical assistance, helping to coordinate rural health interests state-wide, and by supporting efforts to improve recruitment and retention of health professionals. The Committee has appropriated $10 million to help the SORH improve rural health care across our country.
Workforce and Opioids
  • Further, $10,000,000 will remain available through September 30, 2021, to support the Rural Residency Development Program, and $120 million, will remain available through September 30, 2023, for the Rural Communities Opioids Response Program.
  • $85,000,000 will remain available for the provision of primary health services, assigning National Health Service Corps (NHSC) members to expand the delivery of substance use disorder treatment services, notwithstanding the assignment priorities and limitations under sections and making payments under the NHSC Loan Repayment Program. An additional $20,000,000 will remain available under the NHSC Loan Repayment Program to individuals participating in similar programs who provide primary health services in Indian Health Service facilities and Tribally-Operated Health Programs.
  • In addition to the Rural Communities Opioids Response Program, critical funding for opioid misuse programs are housed at the Substance Abuse and Mental Health Administration (SAMHSA).
  • The legislation continues to prohibit the use of federal funds for the purchase of syringes or sterile needles, but does allow communities with rapid increases in cases of HIV and Hepatitis to access funds for substance-use counseling and treatment.
Telehealth Programs
  • The bill focuses resources toward efforts and programs to help rural communities, including $25.5 million, $2 million above FY2018, for Telehealth.  The Telehealth program expands the use of telecommunications technologies within rural areas that can link rural health providers and patients with specialists.
Maternity Care
  • The amendment offered by Senators Lisa Murkowski (R-AK) and Heidi Heitkamp (D-ND) to the Senate L-HHS bill to improve obstetrics care was included in the final report language of the Minibus III.
Relevant Agencies
  • Health Research and Services Administration (HRSA),which houses the Federal Office of Rural Health Policy is funded at $6.8 billion, which is $107 million above the Fiscal Year 2018 enacted level.
  • Agency for Healthcare Research and Quality (AHRQ) is funded at $338 million, which is the $4 million above the Fiscal Year 2018 enacted level.
  • Substance Abuse and Mental Health Administration (SAMHSA) is funded at $5.7 billion – $584 million above the Fiscal Year 2018 enacted level.

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