Providers of rural health care ask for help from Congress.

FEDERAL LEGISLATION INTROduced last month would funnel more federal dollars to rural hospitals in the form of increased Medicare reimbursements, capital improvement loans and information technology grants.

However, the Health Care Access and Rural Equity Act--called H-Care for short--is unlikely to see any action this year despite cries for relief from rural health care providers.

Among its many provisions, H-Care would remove a cap on the amount of Medicare add-on payments for rural hospitals. The add-on payments are intended to help hospitals cover the costs of serving a high proportion of uninsured patients. While urban facilities can receive unlimited add-ons, rural add-ons are capped at 12 percent of the total amount of the inpatient payment.

H-Care would also establish a rural community hospital program similar to the critical access hospital program established in the federal Medicare Modernization Act of 2003.

To qualify, rural hospitals must have 50 or fewer acute beds and offer 24-hour emergency care.

Just as with critical access hospitals, rural community hospitals could be paid 101 percent of costs for inpatient and outpatient services provided to patients on Medicare.

Currently, Arkansas has 28 critical access hospitals, which are defined as having 25 or fewer acute care beds and being no closer than 35 miles to any other hospital. Before January, state governments could also designate a hospital as being critical access if it were deemed "medically necessary."

But this designation doesn't suit all rural hospitals, according to John Neal, CEO of Stuttgart Regional Medical Center.

"Some hospitals are in a position where, [because of] their medical staff, populated market area and demand, it is not to their favor to go to critical access because of the limitations on acute care and services that you have with critical care," Neal said.

Stuttgart Regional is one of seven hospitals that might be eligible for rural community hospital designation, according to statistics published by the Arkansas Hospital Association.

Neal said one of the biggest boosts H-Care in Brief

Remove cap on Medicare add-on payments for rural Ihospitats

Increase Medicare payments on lab and ambulance services for critical access hOSpitals

Establish rural communityhospital program, providing Medicare payments for in- and outpatient services for hospitals with 50 or fewer beds

Update cost base for Medicare payments to sole community hospitals to 2000 or 2001

Extend geographic reclassification of wage indexes for rural hospitals

Ensure proportional representation of rural beneficiaries on the Medicare Payment Advisory Commission

Authorize a rural hospital improvement loan program and information tecnology grants

Raise Rural Health Clinic reimbursements to appropriately cover costs

Require prompt payment to pharmacies by Medicare prescription drug plans

Establish a Rural Health Quality Advisory Commission and rural health quality demonstration projects for hospitals like his would be the Medicare payments recovered for outpatient services.

"The trend in hospitals today is to improve and expand your outpatient services for utilization in the outpatient area to prevent inpatient care, higher cost of care and long-term care," Neal said.

A couple of provisions of H-Care specifically target critical access hospitals.

For example, currently a critical access hospital can receive cost reimbursement for ambulance services only if it is the only provider of ambulance services within a 35-mile drive. The bill would eliminate that requirement.

Another provision of the bill aims at yet another designation that applies to rural health care providers: sole community hospitals. These hospitals are separated from any other hospital by at least 35 miles or geographic boundaries.

Arkansas has four such hospitals: White River Medical Center in Batesville, North Arkansas Regional Medical Center in Harrison, Baxter Regional Medical Center in Mountain Home and Stuttgart Regional.

Sole community hospitals receive cost-based supplemental payments if the costs of treating a Medicare inpatient exceed the prospective payment system. Under H-Care, the cost-based payments would be determined by using the hospital's costs from more recent years.

The relief that H-Care promises couldn't come at a more urgent time for rural health care providers, according to Neal.

"It needs to be passed this year," Neal said. "This is a drastic measure that can't be put off another year. It needs to be put on now, or you are going to see serious financial reimbursement problems in the next year."

But chances are it won't.

Congress adjourns on Friday and will not return until after the November elections. According to a Sept. 25 report in Congress Daily, Republican congressional leaders "have decided to dedicate the session's few remaining days on the most pressuring, high-profile issues, such as immigration, military spending and homeland security to the exclusion of almost everything else."

It is possible parts of H-Care will be tacked on to last-minute omnibus bills.

However, Paul Cunningham, senior vice president of the Arkansas Hospital Association, said the effectiveness of H-Care lay in its comprehensiveness.

"I don't know that any one of the provisions would have a major impact, but combined they would be very beneficial to rural hospitals," he said.

Reps. Mike Ross of Arkansas' 4th Congressional District and Marion Berry of the 1st District are among the original 60 bipartisan co-sponsors of the bill. Berry, a pharmacist, also included a provision on Medicare Part-D recovery by rural pharmacies.

A spokesman for Rep. John Boozman of the 3rd District said the congressman had not yet decided if he would endorse the bill, but he supports the concept of relief for rural health care providers.

Rep. Vic Snyder of the 2nd District said he found the bill "very thoughtful" but that he was waiting for it to be scored by Congressional Research Services to find out how much it would cost. Snyder, a physician, said he believed it could be more than $10 billion.

In the meantime, Snyder said, he was more focused on Medicare reimbursements for doctors. A 5.1 percent reduction in these reimbursements is scheduled to take effect Jan. 1.

"The bottom line is physicians are going to have a pay cut unless we address this problem before the first of next year," Snyder said.

The Sept. 25 Congress Daily report said the chances that Congress would stop the scheduled reduction appear "less promising."

BY James Gordon

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