Recap of the December COVID-19 relief and appropriations package 

The appropriations portion of this large package was largely in-line with what had been introduced in the House and Senate earlier last year. The legislation included $329 million for carrying out rural health programs within HHS, $120 million allocated for the National Health Service Corps, $43 million allocated for Area Health Education Centers, and $975 million for Maternal and Child Health Programs. For the fiscal year (FY) 2022 appropriations process, NRHA will continue to advocate for the inclusion of the creation of an Office of Rural Health within the Centers for Disease Control and Prevention (CDC) and specified funding for the Rural Maternal and Obstetric Management Strategies (RMOMS) program during the FY 2022 appropriations process.

Included in the text was $69 billion for the Public Health and Social Services Emergency Fund (PHSSEF). Within the PHSSEF, $9 billion is directed to the CDC for vaccine distribution, $22 billion for testing, tracing, and mitigation programs – including a $2.5 billion set aside for rural health providers – and $3 billion for the Provider Relief Fund. The language also included $250 million for the FCC COVID-19 Telehealth Program, the extension of Medicare sequestration relief until March 31, 2021, a moratorium on Disproportionate Share Hospital (DSH) reductions through FY 2023, a moratorium on recent cuts in the most recent Physician Fee Schedule final rule until 2024, a three-year extension for important public health provisions, a five-year extension of the rural community hospital demonstration program, an extension of the Frontier Community Health Integration Program (FCHIP) Demonstration, and the injection of $3 billion into the current Physician Fee Schedule for enhanced reimbursement until the funding runs out.

The legislation also includes an agreement as to how to handle ‘surprise’ medical and air ambulance bills using the independent dispute resolution (IDR) methodology, the creation of the Rural Emergency Hospital (REH) model, and changes to the payment model for rural health clinics (RHC). The legislation also makes rural friendly changes to the Medicare Graduate Medical Education (GME) rural training tracks (RTT) programs providing greater flexibility urban and rural hospitals to partner, expands Medicare telehealth to allow mental health services to be furnished, and allows for the direct payment under Medicare to physician services furnished to beneficiaries beginning in 2022.