National Rural Health Care Act of 1989

National Rural Health Care Act of 1989 - Title I: Medicare Provisions - Directs the Prospective Payment Assessment Commission to conduct studies and report to the Congress by January 1, 1991, on: (1) the relationship between costs for rural inpatient hospital services and Medicare (title XVIII of the Social Security Act) payments for such services; and (2) the Medicare program's role in paying for rural inpatient hospital services provided as a charity to persons who are not covered under the Medicare program.

Provides funding for the development of medical care access facilities. Defines a "medical care access facility" as a facility which: (1) provides ambulatory, primary, emergency, urgent, and surgical care; (2) provides inpatient care for from one-to-ten inpatient beds for stays not exceeding 48 hours; and (3) is located in a medically underserved area or a county with a population of less than 20,000, or serves a frontier service area. Provides Medicare coverage of facility services. Authorizes such facilities to provide dietician, pharmacist, laboratory technician, medical technologist, and radiological services on a part-time, off-site basis, and remain open for less time than Medicare hospitals.

Establishes physician, physician assistant, and nurse practitioner productivity standards to be used in determining Medicare payments for rural health clinic services. Requires rural health clinics to participate in the Medicaid program (title XIX of the Social Security Act) if their State provides Medicaid coverage for clinic services. Directs the Secretary of Health and Human Services to establish a Medicare rural health clinic demonstration program: (1) testing new payment methods; (2) covering early detection procedures, health education, and health risk reduction services; (3) not requiring clinics to have more than 40 percent of clinic time covered by physician assistants and nurse practitioners; and (4) reducing physician, physician assistant, and nurse practitioner productivity standards for low population density areas.

Requires the Secretary to instruct Medicare carriers to make payment rates for professional medical services furnished in rural areas under part B (Supplementary Medical Insurance) of the Medicare program reflect the particular costs of furnishing services in rural areas.

Authorizes rural skilled nursing facilities to be paid on a prospective basis for all routine services costs of Medicare extended care services provided in a cost reporting period.

Authorizes rural home health agencies to be paid on the basis of a prospectively established fee schedule for Medicare home health services provided in a cost reporting period.

Requires the Administrator of the Health Care Financing Administration (HCFA) to establish additional research and demonstration projects into how the Medicare and Medicaid programs could better cover care for rural beneficiaries.

Provides direct Medicare reimbursement for nurse practitioner and clinical nurse specialist services, whether or not the practitioner or specialist is under the supervision of, or associated with, another health care provider, if such services would otherwise be covered if furnished by a physician or as an incident to a physician's service. Provides payments for nurse practitioner, clinical nurse specialist, and certified nurse midwife services under part B (Supplementary Medical Insurance) of the Medicare program on the basis of a fee schedule to be established by the Secretary. Requires the Administrator of the HCFA to establish a toll-free, telephone hotline for nursing payment inquiries under the Medicare program and, to the extent feasible, under the Medicaid program. Amends part B (Peer Review) of title XI of the Act to require peer review of nursing services. Directs the Secretary to: (1) contract for studies evaluating nursing costs, and gathering and disseminating data on obstacles nurses face in receiving direct reimbursement for their services; and (2) report the results of such studies to the Congress in January of 1992, 1993, and 1994.

Title II: Medicaid Provisions - Amends the Medicaid program to extend coverage to all individuals whose income does not exceed the Federal poverty level and whose resources do not exceed twice the resource eligibility limit for Medicaid benefits.

Requires that State Medicaid payments for rural medical practices reflect the particular costs of furnishing services in rural areas. Directs the Secretary, jointly with the States, to develop an appropriate system to reduce the payment differential between urban and rural professional health personnel.

Permits rural nursing facilities to elect to receive Medicaid payments on the basis of a daily rate schedule to be established by the Secretary. Permits rural home health agencies to elect to receive payments on the basis of a per visit rate to be established by the Secretary.

Provides Medicaid coverage of medical care access facility services. Requires such facilities to participate in the program.

Requires direct Medicaid reimbursement for certified nurse midwife, certified registered nurse anesthetist, nurse practitioner, and clinical nurse specialist services, whether or not such nurse is under the supervision of, or associated with, another health care provider, if such services would otherwise be covered if furnished by a physician or as an incident to a physician's services. Requires that such payments be equal to payments for such services under the Medicare program and not vary on the basis of the type of nurse involved.

Title III: Private Health Insurance Provisions - Amends the Internal Revenue Code to provide a tax deduction for the entire health insurance costs of the self-employed. Makes such deduction permanent.

Directs the Secretary to develop and submit to the Congress a proposal for creating a self-financing insurance pool for individuals, small businesses, and farms which have difficulty finding affordable private insurance.

Title IV: Health Care System Development Provisions - Amends title VII (Administration) of the Act to place the Office of Rural Health Care in the Office of the Secretary of Health and Human Services.

Amends the Public Health Service Act to authorize the Secretary to make grants to States which have submitted fiscal year plans for comprehensive State rural health access planning to assist States in such planning. Authorizes appropriations for such grant program through FY 1992.

Requires each State to submit a comprehensive rural emergency medical services plan to the Secretary for each fiscal year, beginning with FY 1990. Authorizes appropriations through FY 1992 for payments to States, which vary among States on the basis of the proportion of the nation's rural population which reside in each State, to cover the costs of planning, implementing, and monitoring the operation of trauma care systems in rural areas.

Authorizes the Secretary to make grants to public and nonprofit entities for planning, constructing, equipping, supplying, and operating a rural health clinic and training the personnel at such clinic. Authorizes the Secretary to make grants to solo and small group medical practices which provide primary health services to medically underserved rural populations to assist such practices in purchasing equipment and supplies and training personnel. Sets forth grant conditions, including the requirement that such clinics and practices accept as patients Medicare and Medicaid recipients residing in their service area, and provide 24-hour-a-day emergency medical services. Authorizes appropriations through FY 1992.

Authorizes appropriations through FY 1991 for grants to migrant health centers and community health centers.

Sets aside five percent of amounts appropriated to the National Center for Health Services Research and Health Care Technology Assessment for research on improving rural health care delivery systems. Directs the Secretary to conduct a study on improvements which can be made in the collection and analysis of data used in designating rural areas as medically underserved areas.

Title V: Health Care Personnel Development Provisions - Amends the Public Health Service Act to authorize appropriations through FY 1992 under the National Health Service Corps Scholarship Program and Loan Repayment Program.

Requires the Secretary to establish a program of scholarships and loan repayments to assure an adequate supply of trained health care personnel at medical facilities which serve medically underserved populations. Requires that no less than 40 percent of the persons receiving such assistance be targeted for placement with medically underserved rural populations. Authorizes appropriations for such program through FY 1992.

Requires that persons receiving Federal financial assistance under the Public Health Service Act to operate health care personnel training programs: (1) take into account the special health care conditions of rural areas; and (2) improve efforts to recruit, as students, individuals who are likely to practice in medically underserved rural areas.

Authorizes the Secretary to make grants to public or private nonprofit health or educational entities for training programs to increase the number of health care personnel and multi-competent health care technicians serving medically underserved rural populations. Authorizes appropriations for such grant programs through FY 1992.

Requires the Secretary, in entering into contracts with schools of medicine and osteopathy for area health education centers, to give priority to health education projects targeted toward health professions having an inadequate number of practitioners, either by specialty or geographic location. Makes administrative changes affecting area health education centers. Authorizes appropriations for such centers through FY 1992.

Authorizes the Secretary to make grants to and enter into contracts with public and nonprofit private entities to cover the costs of providing continuing education for nurses in rural areas through the use of satellite transmissions.

Title VI: Mental Health Care Provisions - Amends the Public Health Service Act to require that a State's application for an Alcohol, Drug Abuse, and Mental Health Services Block Grant include an examination of the mental health care needs of rural residents and specify the effort that has and will be made to satisfy such needs.

Directs the Secretary to conduct research on improving rural mental health delivery systems. Authorizes appropriations for such research through FY 1992.