TORCH Advocacy for Rural Hospitals
The TORCH mission statement is “to be the voice and principal advocate for rural and community hospitals in Texas and to provide leadership in addressing the special needs and issues of these hospitals.”
TORCH carries out that mission statement through it advocacy in two primary action areas:
1. Promote, support, and advocate for state and federal legislation, rules, regulations, and funding that assists Texas rural hospitals with operational issues and financing, and helps them carry out their mission to serve their communities.
2. Oppose laws, rules, regulations and funding cuts that create operational and financing problems for Texas rural hospitals.
The TORCH advocacy effort is very much member driven at a grassroots level. Member hospitals set the advocacy agenda through their input and prioritize efforts on a consensus basis. Member hospitals also lead the advocacy efforts with the support of professional staff by outreach and communications to their elected officials.
The TORCH mission statement is “to be the voice and principal advocate for rural and community hospitals in Texas and to provide leadership in addressing the special needs and issues of these hospitals.”
TORCH carries out that mission statement through it advocacy in two primary action areas:
1. Promote, support, and advocate for state and federal legislation, rules, regulations, and funding that assists Texas rural hospitals with operational issues and financing, and helps them carry out their mission to serve their communities.
2. Oppose laws, rules, regulations and funding cuts that create operational and financing problems for Texas rural hospitals.
The TORCH advocacy effort is very much member driven at a grassroots level. Member hospitals set the advocacy agenda through their input and prioritize efforts on a consensus basis. Member hospitals also lead the advocacy efforts with the support of professional staff by outreach and communications to their elected officials.
- TORCH regularly reviews proposed state and federal legislation that will impact rural hospitals.
- TORCH regularly visits Texas legislative offices and testifies in state legislative hearings on bills and other state issues that impact rural hospitals.
- TORCH regularly visits Texas delegation congressional offices in Washington, advises the offices on the impact of federal issues on rural hospitals, and provides written testimony on occasion to congressional committees.
- TORCH participates in ongoing communications and coordination with other Texas hospital associations and the National Rural Health Association.
- TORCH maintains regular communications with state agencies and addresses specific issues with those agencies that have financial or regulatory impact on rural hospitals (HHSC, DSHS, Pharmacy Board, etc.)
- TORCH regularly reviews proposed state and federal rules that will impact rural hospitals, and submits official comments as needed.
- TORCH regularly updates member hospitals about state and federal issues impacting them.
- TORCH alerts member hospital when it is advisable to contact their state and federal representatives and assists with messaging.
- TORCH works with local, state, and national news media to promote stories that further the efforts of rural hospitals and address their challenges.
Some of the major advocacy and legislative accomplishments by TORCH include:
- Successfully changed the state law to allow physicians to be direct employees of rural hospitals, however the bill was vetoed by the Governor because of some unrelated issues in the same bill.
- Successfully coordinated a state law change to allow the direct hiring of physicians by several specific rural hospital districts. Those bills did become law.
- Successfully changed the state law (again) to allow physicians to be direct employees of rural hospitals. The bill was not vetoed by the Governor and became law.
- A successful effort by TORCH to add to state law a provision to permanently allow nurses in a rural hospital to retrieve patient drugs if a pharmacist or technician is not available.
- Orchestrated a change in state law to remove a requirement that hospitals allowing use of their rehab facilities as a public gym, are not required to register with the state and post a bond.
- Revised state law to allow hospitals to borrow money from local banks on a short-term basis to allow rural hospitals to rapid address volatile and changing revenue issues.
- Secured a three-year delay in a requirement for rural hospitals to report discharge data to the state as rural hospitals had previously been exempted and the rush to data reporting would have posed an immediate financial burden.
- Bill halted that could have required rural hospitals to hold mental patients for days if no bed is available in an inpatient mental health facility.
- Alternative rural hospital pool of funds created in the 1115 waiver which provided more dollars to rural hospitals.
- A face-to-face meeting between TORCH and the CMS Administer about recovery audit contractors gains the attention of CMS of problems associated with the program which ultimately helps contribute to positive revisions in the RAC program.
- TORCH efforts lead to the filing of a bill in Congress to require CMS to pay critical access hospitals for wait time charges of Certified Registered Nurse Anesthetists. The bill does not pass but calls attention to the increasing disallowance of those charges.
- Provisions added to new Texas law requiring that hospitals with labor and delivery services have a state designation which allows for hospitals without a designation to still be paid for an emergency Medicaid delivery.
- Successfully secured changes in a proposed hospital penalty bill in the Texas Legislature to elevate daily penalties for hospital violations to $25,000 where rural hospital penalties would be limited to a cap of $10,000 and the hospital’s financial status would have to be taken into account in assessing the penalty (this bill has yet to be passed although filed in 2013, 2015 and 2017 sessions).
- TORCH gains changes in proposed state neonatal rules to reduce cost of compliance for rural hospitals providing obstetrical services.
- State budget rider added to increase rural hospital outpatient Medicaid payments by over $30 million a year.
- TORCH was a major contributor to the effort that blocked health plan from eroding the state’s health provider prompt pay law.
- Instrumental in securing a two-year extension for hospitals to comply with new Texas maternal and neonatal rules.
- Participated in successful multi-association efforts to stop Texas legislative bill to remove the authority of government hospitals to ban guns.
- Publicly raised issue about massive underpayment to rural hospitals by Medicaid managed care system and launched efforts to have payments corrected. The issue remains unresolved but TORCH has promoted education of the issue with rural hospitals and provided guidance to negotiate better Medicaid managed care contracts. TORCH continues to encourage the Texas Legislature to require Medicaid payments to rural hospitals cover the cost of treating Medicaid beneficiaries which the Legislature has directed since 1993 but it not being done under the managed care system in Texas.
- Protected the rural hospital pharmacy supervision system which was proposed by the State Board of Pharmacy for the state Legislative session to be abolished, which would have imposed substantial cost on many rural hospitals.
- Protected the $30 million-dollar Medicaid outpatient enhanced payments for rural hospitals passed in 2015 by the Texas Legislature in the face of Medicaid reductions discussed in the 2017 session.
- Lead an effort to remove rural hospitals from Medicaid managed care and restore them to a fee-for-service system. The bill did not pass but the effort continues with a focus next Texas legislative session to modify how rural hospitals are addressed in the managed care system.
- Pushed for revised state budget language clarifying payments at cost in Medicaid for rural hospitals, however no changes were approved in the budget process.
- Successfully encouraged the Legislature to study the rural hospital closures and the Medicaid underpayment during the off-session year in 2018.
- Successfully persuaded the state Pharmacy Board rule to reverse its decision to require prescriptions issued in a rural hospital be reviewed by a pharmacist in advance at all times a tech fills the prescription.
- Contributed to national efforts to have Medicare Dependent Hospital and Low Volume Adjustment hospital designations revived and extended for five years.