Graves Introduces Bill to Protect Low-Volume, Medicare-Dependent Rural Hospitals

September 22, 2022

WASHINGTON, DC – Congressman Sam Graves, (MO-06) introduced H.R. 8565, the Rural Hospital Extensions for Low-volume Programs (HELP) Act, to permanently extend two critical programs our rural hospitals rely on—the low-volume Medicare adjustment for small rural prospective payment system hospitals and the Medicare-Dependent Hospital Program.

“Our rural hospitals are a lifeline for our communities,” Graves said. “Not only do we depend on them to cure the sick, heal the injured, and care for our families, many times they’re one of the largest employers in the area. When a rural hospital closes, it doesn’t just force rural Americans to travel further for the care they need, it can spell the death of a small town. That’s why it’s critically important we do everything we can to protect the programs our rural hospitals depend on and keep them serving small town America.”

The low-volume Medicare adjustment helps to level the playing field for rural hospitals whose operating costs often exceed their revenues, while the Medicare-Dependent Hospital program which ensures the eligible rural hospitals are reimbursed for the full cost of caring for older Americans. 634 hospitals nationwide utilize the low-volume hospital adjustment and 174 hospitals are eligible for the Medicare-Dependent Hospital Program. Both programs have been critical for keeping the doors open at rural hospitals across the country and protecting access to vital care in our rural communities.

“Our estimates suggest it would cost us approximately $850K annually in a time when we, and rural hospitals across the state, are struggling to break-even (and, in some cases, stay open). The MLV reduction would have a significant impact likely forcing us to consider a reduction in services and/or staff and negatively impacting our ability to provide critical care to the communities we are entrusted to serve,” said Nate Blackford, President of Mosaic Maryville

Joseph F. Abrutz, Jr., Cameron Regional Medical Center Administrator said, "Cameron Regional Medical Center is currently experiencing an inflation factor well over 20 percent. This is due to the ongoing shortage of labor, supply chain issues, and increasing energy, food, and general operating costs. It is imperative that Cameron Regional retain the Medicare Low Volume adjustment in order to continue providing necessary health care services to the residents of northwest Missouri." -

“Most rural hospitals serve a disproportionately large number of Medicare beneficiaries,” said Jon D. Doolittle, Missouri Hospital Association President and CEO. “Programs that help hospitals reduce the losses of low Medicare reimbursements create stability, allowing rural and low-volume hospitals to remain viable community-supporting institutions.

“Extension of these programs is essential to the health of the hospitals the programs support, as well as the health of the patients and communities these hospitals serve. The Rural HELP Act would continue enhanced Medicare Low Volume Adjustment and extend the Medicare Dependent Hospital program. Extending these essential payments to qualifying Missouri hospitals would save them from annual Medicare reductions of approximately $15.9 million. MHA appreciates Rep. Graves leadership in support of rural hospitals and health care.”

Congressman Graves also introduced the Save America’s Rural Hospitals Act earlier this year, which protects these programs, eliminates Medicare sequestration for rural hospitals, and extends increased Medicare payments for rural ground ambulance services.