Rural hospitals flounder under heavy regulatory restrictions, ask for help

Critical access hospital (CAH) leaders from the Midwest are encouraging Congress to protect access to health care in rural communities. The leaders traveled from Kansas and Nebraska to request that the House Ways and Means Health Subcomittee support legislation to relieve CAHs from burdensome rules and conditions of payment that drain the resources of these hospitals. The hospital representatives pointed to several pieces of pending legislation that would either temporarily or permanently relieve these burdens.


The leaders pointed to two particular issues that make hospital operation difficult in rural areas. CAHs are subject to a condition of payment that requires physician certification that a beneficiary may be expected to be transferred or discharged within 96 hours. They are also required to have a physician or approved non-physician practitioners (NPP) particular routine outpatient services. This includes procedures such as applying a splint to a finger or administering nebulizer treatments. The physician or NPP must be immediately available for providing assistance and direction as the procedure is being performed.

According to Shannon Sorensen, CEO of Ainsworth, Nebraska’s Brown County Hospital, CAHs do not have manpower or resources available to meet these regulations. Carrie Saia, CEO of Holton Community Hospital in Kansas, stated that these regulations make it difficult for CAHs to budget and plan for the future. These hospitals are usually located in poor, rural areas with high dependence on Medicare and Medicaid. Those with a CAH designation and no more than 25 beds receive Medicare reimbursements for actual costs as opposed to a prospective payment system.


The Critical Access Hospital Relief Act, H.R. 169/S. 258, would remove the 96-hour certification requirement. The Protecting Access to Rural Therapy Services Act (PARTS Act), H.R. 1611/S. 257, would no longer require hospitals to have a physician directly present during outpatient therapeutic services, with exceptions for complex procedures. Other pending legislation, H.R. 2878/S. 1261 would continue a stay on the direct supervision requirement for the rest of the year for these hospitals, and the industry supports it as a stopgap measure. These bills are currently in the committee stage. The American Hospital Association (AHA) issued a statement on July 28 supporting the removal of these requirements. The AHA supports several pieces of proposed legislation that would assist rural hospitals in maintaining access to care.