This summer, a bipartisan team of Representatives and Senators introduced the Rural Health Clinic Burden Reduction Act to modernize Rural Health Clinics(RHC) regulations to help ensure they are able to effectively treat patients. The legislation introduced by Representatives Jill Tokuda (D-HI), Adrian Smith (R-NE), Earl Blumenauer (D-OR) and Kelly Armstrong (R-ND) in the House and Senators John Barrasso (R-WY), Tina Smith (D-MN), Marsha Blackburn (R-TN), and Michael Bennet (D-CO) in the Senate would provide regulatory relief and increase operational flexibility for clinics.
RHCs are currently under unique regulations, some of which have not been updated since the RHC program started in 1977, including requirements of onsite laboratory equipment. The legislation would remove a regulatory barrier that limits the RHCs ability to provide behavioral health services in areas with a shortage of such services and allow RHCs to be located in an area that is not an urban area of 50,000 or more. Currently there are limits on the percent of patients that a rural health clinic can treat for mental health, including substance abuse disorders, the bill eliminates those restrictions.
The bill would allow non-physician-directed clinics so long as the facility has an arrangement consistent with the provisions of State and local law relative to the practice, performance, and delivery of health services, with one or more physician assistants or one or more nurse practitioners. The delivery of those health services would have to be in accordance with the State law or State regulatory mechanism that governs the practice of physician assistants or nurse practitioners. The law would further allow for independent contracts with physician assistants and nurse practitioners, instead of mandating employment.
If passed in the current format, the legislation would take effect on January 1, 2024, and would apply to any services furnished on or after that date.
Reactions
“When the RHC program was created in 1977, it was the first place where PAs and NPs could bill Medicare directly for their services,” said Nathan Baugh, Executive Director of the National Association of Rural Health Clinics. “Because they were blazing new territory here, Congress mandated in the RHC statute that these PAs and NPs still have a physician medical director that supervises their work. Flash-forward to 2023 and there are a majority of states with full practice authority for Nurse Practitioners, but if an NP in one of those states works in a RHC, the old 1977 federal scope of practice rules still apply. We think that fixing this issue by aligning RHC scope of practice and state scope of practice rules is a commonsense solution that would save both RHCs and Medicare money.”
“The National Rural Health Association (NRHA) applauds Representatives Smith and Blumenauer for their work to provide regulatory relief Rural Health Clinics. The Rural Health Clinic Burden Reduction Act makes critical efforts to modernize the 30+ year old law governing rural health clinics across the country, removing unnecessary and outdated regulations that impact access. This legislation is a common-sense step to enhance health care in rural areas throughout our country,” said Alan Morgan, Chief Executive Officer of the National Rural Health Association.