[Congressional Record Volume 141, Number 149 (Friday, September 22, 1995)]
[Senate]
[Pages S14133-S14134]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. THOMAS (for himself, Mr. Grassley, Mr. Jeffords, Mr. 
        Frist, Mr. Simpson, and Mr. Burns):
  S. 1268. A bill to provide assistance for the establishment of 
community rural health networks in chronically undeserved areas, to 
provide incentives for providers of health care services to furnish 
services in such areas, and for other purposes; to the Committee on 
Finance.


                    the rural health development act

  Mr. THOMAS. Mr. President, I rise today to introduce the Rural Health 
Development Act, an act that I have worked on for some time, to help 
rural communities design a delivery system that fits their unique 
health care needs. It has been a project, in fact, that I have worked 
on since the day I arrived in the House, more than 5 years ago. This 
issue and these items continue to be a top priority for me here in the 
Senate. I am pleased that my colleagues, Senators Grassley, Jeffords, 
Simpson, Burns and Frist, have joined me in this effort. They, too, 
have worked feverishly on behalf of the rural communities in their 
States.

  Rural health care, Mr. President, as you know from your State, is at 
a crossroads. My bill provides for an infrastructure needed to create a 
system of quality health care for rural families. There are a number of 
problems that are unique to rural areas--the lack of physicians, 
nurses, health care extenders, nurse practitioners, and physician 
assistants. We are troubled by the closure of small hospitals where the 
utilization has been relatively low, and leaves a community without 
some kind of emergency medical service.
  Inadequate and unequal Medicare reimbursement is a problem today. So 
we have what we think is a solution. It helps communities develop their 
own health care delivery system. It assists in recruiting and retaining 
physicians. It improves educational opportunities for nurses, 
physicians, physician extenders, and other kinds of health 
professionals. It allows hospitals to downsize without losing their 
emergency room capacity. In short, it is a long-term solution tailored 
to the needs of rural areas.
  Specifically, it provides technical assistance. Small grant funds are 
provided to help communities to design their own network, not one 
designed by outside consultants who are only familiar with the 
characteristics of larger places. Second, these funds can be used for 
two purposes--to build telemedicine systems to assist rural areas, and 
coordinate arrangements between primary care clinics, emergency medical 
centers, and tertiary care facilities.
  Finally, the result to rural individuals, families and employers is 
the ability to take advantage of cost savings that occur elsewhere, 
which has not been able to occur in rural America.
  We equalize the Medicare reimbursement rates. Rural counties receive 
significantly less reimbursement from 

[[Page S 14134]]
Medicare managed care programs. For example, Fall River County in South 
Dakota, receives $177 per month, per beneficiary versus $678 for Bronx 
County in New York--a 367 percent difference.
  My bill reduces this variation and reimburses rural providers 
relative to their metropolitan counterparts. The result, of course, is 
that Medicare beneficiaries in rural areas will have the opportunity to 
participate in managed care plans.
  Third, it improves the educational opportunities for nurses. Nurses 
are a critical component to rural health care. My bill guarantees that 
20 percent of all scholarships offered through the National Health 
Service Corps go to nurses in rural areas. Since 1972, over 70 health 
care providers have served in Wyoming through the services of the 
National Health Service Corps Program. So we put greater emphasis 
there.
  Regarding recruiting and retaining physicians, Medicare currently 
provides a 10 percent bonus in rural areas. Ten percent is not much of 
an incentive. So it is increased to 20. To compensate for the increase, 
the bonus is restricted to primary care physicians in rural areas.
  In addition, the bill guarantees 24-hour emergency care. Medicare 
currently restricts States from establishing limited-service hospitals. 
As a result, many facilities either have to operate as full-service 
hospitals, with very low utilization, or close. We are suggesting they 
be recategorized as a rural emergency access care hospital so that 
indeed they can be reimbursed from HCFA for these emergency services.
  In conclusion, Mr. President, as we search for solutions to deliver 
health care throughout the country, the Rural Development Health Care 
Act is one proposal that should be added to the list. Many of the 
provisions have received a favorable response--so much so that they are 
likely to be folded into the reconciliation package.
  More important, the Rural Development Health Care Act provides the 
answer to rural communities that are looking to keep up with the 
rapidly changing health care environment.

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