Rural health care leaders say the recently-passed Phase 3 coronavirus legislation and any potential phases to come need to better address the concerns of rural hospitals.
In a letter to Congress and the Trump administration, the National Rural Hospital Association (NRHA) says the increase of COVID-19 cases is weighing heavily on health care facilities in rural areas which are becoming further stressed due to the lack of revenue being brought in from the stoppage of providing nonemergency care.
“So often we get the response from Capitol Hill and the Administration ‘Yes, we understand rural. We know it’s tough out there. We will get you taken care of in the next package. We’ll get you taken care of soon,'" Maggie Elehwany, NRHA vice president of government affairs and policy, said. "We just can’t be pushed to the back burner any more. It is a critical situation out there in rural areas.”
According to NRHA, the COVID-19 pandemic has spread to more than 1,000 rural communities.
Before the COVID-19 outbreak, nearly half of all rural hospitals were operating at a financial loss. Now COVID-19 is expediting the process of these closures due to the lack of funds and resources available to rural hospitals further destabilizing core health services in rural America.
While some hospitals are struggling financially to stay open, others lack appropriate amounts of resources and beds for patients. NRHA pointed to Blaine County, Idaho, and its more than 351 positive COVID-19 patients, but the area's small rural hospital has only 25 beds. It’s the same predicament with Eagle County, Colo., where a county hospital with 56 beds is up against 314 positive cases in the area.
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NRHA says language in the third relief package is forcing smaller rural providers to compete for loans with the larger urban hospitals; they suggest a handful of changes could bring immediate relief to help keep rural hospitals operating:
- The $100 billion provider grant must be made proportionally available to rural health providers. Rural communities include older populations with higher percentages of individuals with more than one underlying health condition, making them more susceptible to COVID-19. The NRHA is asking for at least 20% of the funds to be set aside for rural facilities to make sure they have access to the funds before they are depleted by other facilities.
- Tweaks to Medicare advance payments to "allow loan forgiveness comparable to SA loans." The letter says some rural facilities "that likely have negative operating margins on the last several cost reports will not risk being indebted" due to issues repaying the advance payments that are "loans that will have to be repaid."
- Ensure that county and publicly owned rural hospitals can access the Paycheck Protection Program in CARES. Right now, NRHA says "it is unclear" if one-third of all rural hospitals can access this program.
- Include two pieces of legislation in future coronavirus relief packages: one bill to provide immediate funding for rural health care providers and another to deem the most vulnerable rural hospitals as critical access hospitals.
Rep. Kim Schrier, D-Wash., and Rep. Phil Roe, R-Tenn., introduced H.R.6365, the Immediate Relief for Rural Facilities and Providers Act of 2020, on March 24. The Senate version of the Immediate Relief for Rural Facilities and Providers Act of 2020 was introduced by Senators John Barrasso, R-Wyo., and Michael Bennet, D-Colo., on March 21.
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