Big rural health advocacy wins in FY23 appropriations bill
The FY 2023 appropriations bill was recently released as an omnibus bill. Overall, it includes several victories for rural health, due in part to the significant advocacy efforts of NRHA members at the association's 2022 Policy Institute and beyond.
In all, NRHA is pleased with the provisions included in this year-end package. The funding levels for important rural health programs were either increased or maintained, and non-appropriations provisions were in line with NRHA's requests.
This fall, NRHA made a concerted effort to see the PAYGO sequester waived, the continuation of the LVH/MDH and ground-ambulance programs, telehealth flexibilities continued past the PHE, and for mental health services to be enhanced. These were all included, as well as language standing up an Office of Rural Health at CDC. This is proof that rural health advocacy works, especially in person, so join us at NRHA’s 34th Rural Health Policy Institute to continue our momentum in the new year Feb. 7-9 in D.C.
See below for a full summary of what is included in this year-end package:
Creation of a CDC Office of Rural Health
Given the devastating outcome of COVID-19 in rural areas, NRHA has been committed to working with Capitol Hill to see an Office of Rural Health created at the Centers for Disease Control and Prevention (CDC). Included in the FY 2023 appropriations bill was $5 million to establish an Office of Rural Health at CDC. The text dictates that the ORH will enhance implementation of CDC's rural health portfolio, coordinate efforts across CDC programs, and develop a strategic plan for rural health that maps the way forward both administratively and programmatically. This is a massive victory for rural health, and NRHA is looking forward to working with CDC to see this stood up quickly, to ensure rural representation in America's public health infrastructure.
NRHA thanks our Congressional champions Senator Jeff Merkley (D-OR), Senator Cindy Hyde-Smith (R-MS), Representative Michael Guest (R-MS), and the late Representative Donald McEachin (D-VA) for their tireless work to see this office stood up.
Support for Rural Hospitals
- $3.45 billion for the Rural Community Facilities Program and $2 million for the Rural Hospital Technical Assistance Program through the United States Department of Agriculture Rural Development (RD) programs. NRHA is happy to see maintained funding for these critical programs and will continue advocating for additional funding toward these programs in FY 2024, and in next year's reauthorization of the Farm Bill.
- $64.3 million for the Medicare Rural Hospital Flexibility Grants Program, an increase of more than $2 million over FY 2022 funding levels. The $64.3 million includes $21 million for the Small Rural Hospital Improvement Grant Program and $5 million to continue funding the Rural Emergency Hospital (REH) TA Program which NRHA advocated to be created in FY 2022.
Continuation of Core Rural Health Care Programs
- $12.5 million for State Offices of Rural Health (level funding)
- $145 million for the Rural Communities Opioids Response Program ($10 million increase)
- $12.5 million for the Rural Residency Development Program ($2 million increase)
- $125 million for the National Health Service Corps ($3 million increase)
- $8 million for the Rural Maternity and Obstetrics Management Strategies (RMOMS) Program at HRSA ($2 million increase)
Originally set to go into effect in January 2022, Congress kicked the four percent PAYGO sequester triggered by the American Rescue Plan until January 2023 last year. In this bill, the PAYGO sequester is now deferred until January 2025-a massive victory for providers to avoid a disastrous four percent cut to Medicare reimbursement.
The legislation authorizes current telehealth flexibilities until December 31, 2024. In the FY 2022 omnibus appropriations bill, telehealth flexibilities were continued for 151 days post-PHE. The bill extends these critical PHE provisions, including audio-only flexibilities through December 31, 2024.
- Low-Volume Hospital (LVH) and Medicare-Dependent Hospital (MDH) designation both extended through September 30, 2024.
- Ground Ambulance add-on payments extended for two years through December 31, 2024.
- Physician add-on payments for services furnished in calendar year 2023, the add-on payment will be 2.5 percent for physicians. For services furnished in calendar year 2024, the add-on payment will be 1.25 percent.
- Home health rural add-on payment at one percent through the end of 2023.
Mental Health Provisions
- Coverage of Marriage and Family Therapists (MFT) and mental health counselors (MHC) under Medicare. The allowance of MFT and MHCs under Medicare, beginning in 2024, will have a real impact on mental health care delivery in rural communities.
- Inclusion of 200 new residency slots for psychiatry or psychiatry subspecialties. In FY 2026, the Secretary shall begin distribution of these slots, with a minimum of 10 percent going toward hospitals located in rural areas.
- Inclusion of the Restoring Hope for Mental Health and Well-Being Act that passed the House of Representatives earlier this year. This language includes new grant and funding opportunities related to mental health and substance use disorder treatment. Additionally, it includes language to remove the buprenorphine X-Waiver, which NRHA supports.
NRHA will continue monitoring the path forward for this bill. It is expected that final passage will occur this week. As we look forward to the 118th Congress, NRHA will continue our strong advocacy presence, and incorporate additional ways for members to get involved including at NRHA's 34th Rural Health Policy Institute Feb. 7-9 in D.C.
NRHA will alert via our NRHA Advocacy social media channels when passage is imminent. Please email Josh Jorgensen with any questions. We hope everyone is doing well and having a great start to the holiday season with this early gift.