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Conference Committee Releases Final Farm Bill

We are excited to share with our members that the Conference Committee on the 2018 Farm Bill has finally concluded and released their report late last night. We are even more excited to share that the 2018 Farm Bill includes new programs and opportunities for the future of health care in rural communities.

Rural America encompasses more than 90% of the nation’s land area, houses 60 million residents, and 20% of our nation’s population. Still, rural communities make up just 3% of job growth since the Great Recession, and many rural areas continue to see increasing unemployment. Throughout the Great Recession, more rural businesses closed than open, and this trend continues today.

Rural hospitals and providers are a critical part of the rural community, and often are the backbone of the rural economy. 93 rural hospitals have closed since 2010, and nearly 700 are vulnerable to closure. If all vulnerable hospitals close, we will lose 99,000 direct health care jobs, 137,000 community jobs, and $277 billion in GDP. Per-Capita annual income in rural communities will decrease by $703, while rural employment would increase by 1.6 percentage points.

The Farm Bill is a critical piece of legislation to help all rural Americans, regardless of occupation or location, and an opportunity for us to advance innovative reforms. This Farm Bill includes provisions to ensure the financial viability of rural hospitals by providing opportunities for stabilization and innovation:

For the first time in the Farm Bill’s history, there is a rural health section under the Rural Development Title.  Subtitle A—Improving Health Outcomes in Rural America includes three sections:
  • Sec. 6101. Combating substance use disorder in rural America; prioritizations.
  • Sec. 6102. Distance learning and telemedicine.
  • Sec. 6103. Refinancing of certain rural hospital debt.

Sec. 6101: Combating substance use disorder (SUD): For FY19- FY25, the Secretary of Agriculture will set aside no less than 20% of funding for Distance Learning and Telemedicine Grants for addressing SUD in rural areas. Under the Community Facilities Direct Loans and Grants Program, the Secretary will give preference to those applicants focusing on developing facilities that will focus on SUD treatment, prevention, and recovery services. Rural Health and Safety Education Applicants will also receive prioritization if they are applying for a loan supporting services that will address SUD.

Additionally, the Conference Report for the 2018 Farm Bill provides the Secretary of Agriculture the authority to temporarily prioritize certain rural development applications to assist rural communities in responding to a significant public health disruption. NRHA members may remember that the House version of the Farm Bill originally included a “Rural Health Emergency Declaration” for the Secretary of Agriculture.

This reinterpreted and improved version of the declaration still allows the Secretary to prioritize the needs of rural communities struggling with SUD through an analysis and announcement of community needs but does not place the same concerning time constraints that the original emergency declaration provision did. The final bill allows the Secretary to reprioritize funds for up to four years.

Sec. 6102: Distance learning and telemedicine: This section simply increases the amount of money provided for this program from $75,000,000 for each fiscal year 2014 through 2018 and inserting $82,000,000 for each of fiscal years 2019 through 2023.

Sec. 6103: Refinancing of certain rural hospital debt: The House bill authorized assistance for a community facility to include the refinancing of a debt obligation of a rural hospital as an eligible loan or loan guarantee purpose if the assistance would help preserve access to health service in a rural community and meaningfully improve the financial position of the hospital. The Senate did not include this provision, but the Conference Committee kept the amendment, while adding that it must require rural hospitals seeking refinancing to meet USDA’s financial feasibility and adequacy of security requirements.  The Managers emphasize the necessity that USDA work with rural hospitals to improve their financial health as a part of a refinancing agreement.

The Managers also encourage USDA to build on its current technical assistance efforts to improve the long-term operations of rural hospitals in order to continue providing vital services to rural communities. NRHA is working in partnership with the USDA on a new program to provide struggling rural hospitals with USDA loans with technical assistance to preserve access to care in rural America while also ensuring these important rural lending programs remain available for future rural health care providers. This language will support continuing and building upon this program in the future.

Additionally, Subtitle D - Department of Agriculture Reorganization Act of 1994 Amendments, includes Sec. 12409. Rural Health Liaison. For those of you who were able to join us at the 29th Annual Rural Health Policy Institute last February, you were there when Representative Cheri Bustos (D-IL) announced the introduction of her legislation with Representative Doug LaMalfa (R-CA) to create a Rural Health Liaison position at the USDA. Rural health advocates Senators Doug Jones (D-AL), Mike Rounds (R-SD), and Tina Smith (D-MN) also introduced this legislation in the Senate.

Though it was not included in the House Bill, the Rural Health Liaison was included in the Senate legislation and made it into the final bill. The Rural Health Liaison will, “in consultation with the Secretary of Health and Human Services, coordinate the role of the Department with respect to rural health;  integrate across the Department the strategic planning and activities relating to rural health; improve communication relating to rural health within the Department and between Federal agencies; and advocate on behalf of the health care and relevant infrastructure needs in rural areas.”

Finally, the bill includes the reauthorization of the Farm and Ranch Stress Assistance Network (FRSAN), which will support agricultural workers and their families in rural communities by providing easily obtainable resources for mental health services.. NRHA previously supported a bill from Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA), the  Farmers First legislation, which  was included as part of the farm bill that was passed yesterday. The Farm Bill includes an authorization of $10 million for each year of the farm bill (five years). 

As the clock ticks down on the 115th Congress, passing this legislation is of paramount importance. The Conference Committee has produced legislation that will guarantee rural Americans five years of continued support for rural development from Congress and the United States Department of Agriculture. From support to those struggling with Substance Use Disorders to technical assistance for rural hospitals fighting to keep their doors open, this legislation will take critical steps forward in ensuring a healthy future for rural communities.

NRHA thanks the Conference Committee, and many members in both chambers, for their work on this legislation. Now, we ask that Congress pass this bill quickly to keep their commitments to rural America.

You can see the full report from the Conference Committee here.

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