Bill Overview
Title: To direct the Secretary of Health and Human Services to revise regulations to remove the requirement under the Medicare program that an off-campus facility or organization shall be located within a 35-mile radius of a hospital or critical access hospital, and for other purposes.
Description: This bill requires the Centers for Medicare & Medicaid Services to repeal regulations that require off-campus facilities to be located within 35 miles of the main hospital or critical access hospital in order to receive provider-based status under Medicare (i.e., to be considered as hospital outpatient departments for purposes of Medicare payment).
Sponsors: Rep. Green, Mark E. [R-TN-7]
Target Audience
Population: Individuals in rural areas dependent on Medicare services
Estimated Size: 57000000
- The bill aims to remove the 35-mile radius requirement for off-campus facilities to receive Medicare benefits, which would impact rural communities.
- The policy change primarily affects populations residing in rural areas who are within the proximity but outside the 35-mile radius of hospitals and critical access hospitals.
- Rural areas often have limited access to healthcare facilities, thus expanding the qualifying radius could significantly increase their healthcare access options.
Reasoning
- The policy would primarily benefit rural communities that are outside the current 35-mile radius for receiving Medicare benefits, helping increase their access to hospital services.
- The cost limit implies prioritizing areas with significant population clusters just beyond the 35-mile radius to maximize impact while staying within budget.
- People in rural areas with significant older populations reliant on Medicare would potentially see the most benefits.
- Some people in rural areas may not see changes if they are already within the 35-mile range or if infrastructure changes are slow.
Simulated Interviews
Retired (Wyoming)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- I think the policy would be a great help for those of us living far from major hospitals.
- Access to emergencies would be better without traveling long distances.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Farmer (Kansas)
Age: 45 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- This policy could lessen my travel time to get decent hospital services, especially in emergencies.
- It will relieve some healthcare access burdens.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 9 | 4 |
| Year 20 | 9 | 4 |
Teacher (Alaska)
Age: 30 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- I am not directly affected as I don't use Medicare, but it might help my parents.
- It's good for the community overall.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 7 | 6 |
Retired (Montana)
Age: 68 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 9/20
Statement of Opinion:
- With clinics closer, my life quality would improve significantly.
- This means more frequent check-ups with less travel hassle.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 4 |
| Year 20 | 9 | 3 |
Small business owner (North Dakota)
Age: 55 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 7/20
Statement of Opinion:
- Having closer emergency facilities will be reassuring given my spouse's condition.
- I would support removing unnecessary restrictions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 4 |
Retired (Nebraska)
Age: 61 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 10/20
Statement of Opinion:
- Opening new access points would facilitate elderly care.
- Policy would reduce stress of long-distance travel for healthcare.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Mechanic (Maine)
Age: 38 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- While not immediately concerning for me, this policy would support rural development.
- Good for long-term community wellbeing.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Retired (South Dakota)
Age: 70 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 20.0 years
Commonness: 6/20
Statement of Opinion:
- The policy could potentially be life-saving for someone like me.
- Closer ER access would ease my anxiety and improve my health outcomes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 2 |
Freelancer (Texas)
Age: 34 | Gender: other
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 4/20
Statement of Opinion:
- This won't change my current situation, but beneficial for those in emergency cases.
- I support changes that help others even if not applicable to me personally.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 6 | 6 |
Construction worker (Georgia)
Age: 47 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 8/20
Statement of Opinion:
- This could reduce my waiting time for vital healthcare services without relying on public transport.
- I would feel much better knowing emergency services are more accessible.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 9 | 4 |
| Year 10 | 9 | 3 |
| Year 20 | 9 | 3 |
Cost Estimates
Year 1: $35000000 (Low: $25000000, High: $45000000)
Year 2: $38000000 (Low: $27000000, High: $49000000)
Year 3: $40000000 (Low: $29000000, High: $51000000)
Year 5: $45000000 (Low: $31000000, High: $57000000)
Year 10: $50000000 (Low: $35000000, High: $65000000)
Year 100: $120000000 (Low: $90000000, High: $150000000)
Key Considerations
- The policy could improve healthcare access in rural areas, potentially improving health outcomes and reducing long-term costs.
- Rural healthcare providers will need guidance and support to attain provider-based status under the new rule.
- The cost and savings estimates vary depending on the uptake rate by facilities and the actual geographic distribution of facilities relative to the 35-mile radius.