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A bill introduced in April seeks to expand telehealth services offered by the nation’s 4,300 rural health clinics by enabling them to be qualified through Medicare as distant site providers.

By Eric Wicklund

May 15, 2019 – Congress is considering a bill that would enable rural health clinics to support – and be reimbursed for – more telehealth and telemedicine programs.

The Rural Health Clinic Modernization Act of 2019 (S 1037), introduced in April by Sens. John Barrasso (R-WY) and Tina Smith (D-MN), aims to expand the services offered by rural health clinics to improve access to care and close coverage gaps in underserved areas of the country.

The bill calls for RHCs, which can now serve as originating sites for connected care services, to also be classified by Medicare as distant site providers, enabling them to expand their telehealth platform to include more professional services. It would also give them more flexibility in contracting with physician assistants and nurse practitioners and improve reimbursement.

“We need to do everything we can to make sure that people in rural areas are able to get healthcare,” Smith said in a joint press release. “While there have been significant changes in the health care system, many of the laws focusing on Rural Health Clinics haven’t been updated in over 40 years. Our bipartisan bill would fix some of the old rules that are in need of these upgrades. … This legislation is really about making sure at the end of the day people are going to be able to get the vital care Rural Health Clinics provide in underserved, rural areas.”

There are more than 4,300 rural health clinics in the US, according to an August 2018 census by The Centers for Medicare & Medicaid Services’ Quality, Certification & Oversight Reports (QCOR). The clinics are reimbursed by Medicare and Medicaid, but Barrasso and Smith note those reimbursement guidelines haven’t been modified since 1988.

Established by the Rural Health Clinic Services Act of 1977, certified clinics must be located in rural, underserved areas; are required to use a team approach of physicians working with non-physician providers such as nurse practitioners (NP), physician assistants (PA) and certified nurse midwives (CNM); and must be staffed at least half the time with an NP, PA or CNM.

This isn’t the first effort to bring the nation’s networks of rural health clinics up to date. In 2017, the National Advisory Committee on Rural Health and Human Services issued a report calling for several modifications to the RHC program, including designating them as distant site providers for telehealth and telemedicine services.

“With increased focus on value-based care in the Medicare and Medicaid programs, there are growing concerns about the viability of RHCs and the extent to which RHCs are improving access to care,” the committee reported. “While there has been a significant growth in the number of RHCs over the past three decades, RHCs continue to face challenges related to services provided, their payment structure, and workforce. These providers play an important role in ensuring access to care in rural communities, particularly for Medicare and Medicaid beneficiaries, but as health care evolves the Committee believes these clinics are increasingly being limited by an outdated regulatory structure.”

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