Support Funding for Rural Health Care in FY22 Deadline: Friday, April 23, 2021

Dear Colleague:

Please join us in signing a letter to appropriators in support of key rural health care priorities. Rural health care providers ensure essential health care services are available to populations that are often older, sicker, and poorer those in urban centers. Rural populations are further impacted by dwindling access to care. Unfortunately, over 135 rural hospitals have closed since 2010 and nearly 450 additional facilities are vulnerable to closure. In order to ensure a healthy future for rural America, we need Congressional support.

We encourage you to support rural health care by joining this letter by COB on Friday, April 23. For more information or to sign onto this letter, please contact Jill O’Brien in Rep. Kind's office at [email protected] or Kristin Flukey in Rep. McMorris Rodger's office at [email protected].

Sincerely,

Ron Kind Cathy McMorris Rodgers Member of Congress Member of Congress

April 19, 2021

The Honorable Rosa DeLauro The Honorable Jr. Chairwoman Chairman Subcommittee on Labor, Health and Human Subcommittee on Agriculture, Rural Services, Education, and Related Agencies Development, Food and Drug House Appropriations Committee Administration, and Related Agencies United States House of Representatives House Appropriations Committee Washington, DC 20515 United States House of Representatives Washington, DC 20515

The Honorable The Honorable Jeff Fortenberry Ranking Member Ranking Member Subcommittee on Labor, Health and Human Subcommittee on Agriculture, Rural Services, Education, and Related Agencies Development, Food and Drug House Appropriations Committee Administration, and Related Agencies United States House of Representatives House Appropriations Committee Washington, DC 20515 United States House of Representatives Washington, DC 20515

Dear Chairwoman DeLauro and Ranking Member Cole, Chairman Bishop and Ranking Member Fortenberry:

As members of the House Rural Health Care Coalition, we ask that you consider continued support for rural health care programs as you move forward with the Fiscal Year (FY) 2022 Labor, Health and Human Services and Education funding measure. We thank you for your leadership and support for rural health care programs and hope that you will continue these important efforts.

It is crucial that the Committee support programs that seek to address the severe health care crises that are escalating in rural America. The rural hospital closure crisis continues to intensify. In 2020, the United States experienced the greatest number of closures in a single year since the beginning of the century. Over 135 rural hospitals have closed since 2010, and the most recent research suggests that 450 rural hospitals are currently at risk of closure. Additionally, health care workforce shortages continue to plague rural communities; over 75% of rural counties are designated Health Professional Shortage Areas (HPSAs). While approximately one fifth of the nation’s population lives in rural America, only 10% of the country’s physicians practice in these communities. We encourage the Committee to recognize that while innovations in health care, such as the implementation of telehealth technology, show promise in these areas, rural America is facing crises now and desperately needs immediate solutions.

While current spending for all rural health discretionary programs is relatively small, it plays a critical role in solidifying the fragile health care infrastructure in rural communities. We understand the current constraints of the federal budget and recognize the need to eliminate wasteful and inefficient programs. However, we also believe we must continue to support government policies that work and urge you to continue supporting programs that improve rural health outcomes and strengthen care delivery. Please take into consideration the effectiveness of the rural health programs listed below:

Health Professions: We ask the Committee to provide adequate funding for programs that further develop our national health care workforce, in particular the Rural Residency Planning and Development programs. Funds for this program support training in family medicine, internal medicine, public health, and general preventive medicine, psychiatry, general surgery, and obstetrics and gynecology. Providing training residency opportunities in rural settings are an essential source of education and training for rural health care providers and help to ensure that individuals living in rural communities have access to quality health care. We ask the Committee to provide robust funding to support the Rural Residency Development Program.

Rural Hospital Flexibility Grants: These grants are used by states to implement new technologies, strategies, and plans in Critical Access Hospitals (CAHs). CAHs provide essential services to communities and essential jobs to the rural economy. These grants provide crucial funding for updating equipment, implementing new sustainable care delivery models and enhancing the quality of care provided. New in FY22, the Flex line request includes support for the Rural Emergency Hospital (REH) Technical Assistance program to support facilities in transition to the new REH model. We ask the Committee to recognize the necessity of these grants and continue its support for this key rural health program with robust funding in FY22.

Rural Hospital Technical Assistance Program: Using discretionary funding, USDA created this program in 2018 through the Office of Rural Development. The program will provide technical assistance to rural hospitals with USDA loans to ensure their continued viability and financial success. We request Congressional support, building upon language in the 2018 Farm Bill, to slowly and responsibly grow this program as it demonstrates success to expand technical assistance to struggling rural providers. We request robust funding for FY22 to support this critical work.

Rural Maternal and Obstetric Care: The Rural Maternal and Obstetric Management Strategies (RMOMS) program aims to develop and test models that improve access to and continuity of maternal obstetrics care in rural communities. The program allows creation of a network-based approach that develops sustainable financing models while improving maternal and neonatal outcomes, that can be scaled to increase the delivery and access of these critical services. We request robust funding to support the RMOMS program in FY22.

Office for the Advancement of Telehealth (OAT): Telemedicine technologies are vitally important to the delivery of care in remote rural and frontier areas. The OAT promotes the use of telehealth technologies by fostering partnerships among federal agencies, states, and private sector groups to create telehealth projects; administering telehealth grant programs; providing technical assistance; and promoting best practices. We request the enhancement of the authority of OAT to provide a more significant leadership role in telehealth within the Department of Health and Human Services. Additionally, we urge the Committee to continue its support for this program by providing the OAT with robust funding in FY22.

State Offices of Rural Health: State offices of rural health exist in all 50 states and help rural communities build and maintain health care delivery systems. They accomplish this mission by collecting and disseminating information, providing technical assistance, helping to coordinate rural health interests state-wide and by supporting efforts to improve recruitment and retention of health professionals. We urge your continued support for this program by providing State Offices robust funding in FY22.

Rural Health Outreach Grant Program: These three-year grants fund community-based projects to increase access to care. Typical projects include efforts to address diabetes, obesity, health promotion, health screening and mental health. Programs have brought care that would not otherwise have been available to more than 2 million rural citizens across the country. In fact, this is the only federal health care program that allows rural communities to expand access, coordinate services, and improve the quality of health care services based on individual community need. We urge continued support for this essential grant program with robust funding for combined Outreach Grant and Network Development Grants in FY22.

Rural Network Development: This grant program provides support to multiple rural providers who work in formal networks to better integrate administrative, clinical, technological and financial functions. These funds have enabled grantees to improve coordination, increase efficiency and enhance the capability of rural networks to innovate and respond to payment and policy changes. We urge the Committee to support this important assistance that helps providers secure a viable future in delivering quality care. For combined Outreach Grant and Network Development Grants we request robust funding in FY22.

Rural Health Research Grant Program: This grant program supports academic-based rural health research centers that study rural health issues, including work on rural hospitals, health professionals, delivery of mental health services and the functioning of managed care systems in rural areas. Rural health research centers have also conducted analysis of the impact of budgets, regulations, legislation and current law on the rural health care delivery system. We ask your support for this program to build upon the valuable work of the rural health research centers that assist federal legislators in crafting national rural health policies. We ask the Committee to provide robust funding to support critical rural health research to support policy development in FY22.

Area Health Education Center (AHEC): The AHEC Programs and Centers play an important role in addressing national health care workforce shortages, particularly those in primary care. The AHEC Program grantees support the recruitment and retention of physicians, students, faculty, and other primary care providers in rural and medically underserved areas by providing local, community-based, interdisciplinary primary care training. For FY22, we request continued support to improve workforce shortages in rural areas.

Coronavirus (COVID-19): A robust investment in the rural health safety net is critical to combating potential pandemics. Coronavirus (COVID-19) funding and preventative supplies and medications must be appropriately apportioned to ensure that the 62 million residents in rural America who are reliant on rural hospitals will have access to care. We request the Committee create an Office of Rural Health within the Centers for Disease Control and Prevention (CDC), with funding appropriated annually to establish and operate the office.

We believe maintaining fiscal responsibility is a top priority. Consistent with that priority, we hope you will recognize the role these programs play in ensuring that Americans living in rural communities can access quality, cost-effective health care. Please consider this as the Committee prepares to mark up the FY 2022 funding measure for the Department of Health and Human Services and related agencies.

Thank you for your consideration of these requests.

Ron Kind Cathy McMorris Rodgers Member of Congress Member of Congress