Advancing Health Innovation

For rural communities to survive and thrive, they need access to many of the same resources larger cities do—groceries, energy, broadband, and health care among them. To address the health care needs of rural seniors, Medicare has numerous special provisions, including a hospital category for Critical Access Hospitals (CAH)—facilities with 25 or fewer beds in communities distant from the next-closest hospital. This week I met with the Nebraska Hospital Association and the Critical Access Hospital Coalition to discuss how we can ensure Nebraskans have access to quality health care services. Nebraska's Third District has the second most Critical Access Hospitals in this country, and my constituents rely on the care CAH facilities provide. Without CAHs, Nebraskans would not receive the same level of care.

Nearly one in five Americans live in rural areas, but these communities are too often overlooked when it comes to health care. Since 2010, 138 rural hospitals have closed in the United States, with a record 20 closures in 2020 as health providers battled the difficulties of COVID-19. These are especially concerning numbers as rural Americans are, on average, older and have higher rates of chronic health conditions.

Running a rural hospital can be very challenging, and unnecessary or outdated regulations can have a burdensome impact on operations. I have worked for years to eliminate the worst of these regulations to ensure the federal government is not standing between providers and their patients. Earlier this year I partnered with Rep. Terri Sewell (D-AL) to reintroduce our bipartisan bill to repeal the Centers for Medicare and Medicaid Service's (CMS) 96-hour rule.

This rule—requiring physicians at CAHs to certify at the time of admission a patient on Medicare will not be admitted longer than 96 hours—has not been enforced for the last several years because of conscious enforcement stays initiated by the Trump administration and subsequent waivers related to the COVID pandemic. However, without action this rule could easily come back into force following the end of the COVID Public Health Emergency. This is a real-life example of how unnecessary red tape can impact the kind of care patients receive. Providers should not have to pause doing what they do best to navigate a complicated maze of bureaucracy that contributes nothing to patient care.

One of the few silver linings from the COVID pandemic is telehealth. The flexibilities and waivers provided during the Public Health Emergency have helped expand access to new technologies and increased care options for patients in rural America and beyond. It has also shown telehealth can be delivered in a cost-effective way that works for patients. This is why I was pleased Congress acted to extend some of these flexibilities by 151 days through the last funding bill. Unfortunately, 151 days is not enough to give health providers the certainty needed to focus on what matters: delivering quality care to patients, often the most underserved and vulnerable patients.

In a Ways and Means Committee hearing this week, I expressed my concern to Health and Human Services Secretary Xavier Becerra that telehealth provisions were not included in the President's budget proposal this year, despite how many Americans are utilizing and counting on telehealth services.

Rural health providers have effectively demonstrated how successful the telehealth flexibilities implemented during the COVID-19 crisis can be in improving rural access to care. By making these rules permanent we can build on such success to further enhance health access in rural communities.

That's why I am working on a bipartisan bill to further extend these waivers for another two years to provide patients and providers more certainty while Congress works to make them permanent. My bill also includes important provisions left out of the original extension—such as provisions to ensure CAHs are included in the post-Public Health Emergency telehealth future. This will allow Congress to chart a responsible and long-term path forward on telehealth so Americans can access cutting-edge health care, no matter where they live.

As a member of the Ways and Means Subcommittee on Health, I will continue working with my colleagues to promote solutions to expand health options for all Americans.