Predicting the survival of rural hospitals is no easy task. A 1989 study of rural hospitals in Northwestern states, for example, listed eight "high risk" hospitals in Minnesota. High risk was defined as hospitals with net overall losses in three of the last four years. Although none of the hospitals listed in the study closed, 15 other rural Minnesota hospitals did close since 1989.

In addition to being social institutions, rural hospitals play important roles in attracting retirees and industry to small communities. In rural Minnesota, 55% percent of the communities with hospitals rank health care as their first or second leading industry and 81% of these communities rank health care in their top five industries. Although rural hospitals are termed "small" in statewide size comparisons, when viewed from their community's perspective they are enormous resources. (Source: Rural Hospital Study Work Group 1997; to order a free copy of their report, phone (612) 282-3838).

• Rural Primary Care Hospitals: Experience Offers Suggestions for Medicare's Expanded Program. HEHS-98-60. 15 pp. plus 5 appendices (11 pp.) February 23, 1998. Reviews the rural primary care hospital (RPCH) program, assessing compliance with the requirements that RPCHs have an average length of stay of 72 hours or less and that physicians certify that inpatients are expected to be discharged within 72 hours.

• BALANCED BUDGET ACT OF 1997: TITLE IV--MEDICARE, MEDICAID, AND CHILDREN'S HEALTH PROVISIONS
  • Subtitle C--Rural Initiatives
    • Sec. 4201. Medicare rural hospital flexibility program.
    • Sec. 4202. Prohibiting denial of request by rural referral centers for reclassification on basis of comparability of wages.
    • Sec. 4203. Hospital geographic reclassification permitted for purposes of disproportionate share payment adjustments.
    • Sec. 4204. Medicare-dependent, small rural hospital payment extension.
    • Sec. 4205. Rural health clinic services.
    • Sec. 4206. Medicare reimbursement for telehealth services.
    • Sec. 4207. Informatics, telemedicine, and education demonstration project.
• 42 USC Sec. 1396i, Certification and approval of rural health clinics
• 42 USC Sec. 1320b-4. Nonprofit hospital or rural primary care hospital philanthropy

• 42 CFR PART 5, DESIGNATION OF HEALTH MANPOWER SHORTAGE AREAS
  • Sec. 5.1 Purpose
  • Sec. 5.2 Definitions
  • Sec. 5.3 Procedures for designation
  • Sec. 5.4 Notification and publication of designations
• 42 CFR PART 405, SUBPART X - RURAL HEALTH CLINIC SERVICES
  • Sec. 405.2401 Scope and definitions
  • Sec. 405.2402 Basic requirements
  • Sec. 405.2403 Content and terms of the agreement
  • Sec. 405.2404 Terminations of agreements
  • Sec. 405.2410 Beneficiary entitlement and liability
  • Sec. 405.2411 Scope of benefits
  • Sec. 405.2412 Physicians' services
  • Sec. 405.2413 Services and supplies incident to a physician's
  • Sec. 405.2414 Nurse practitioner and physician assistant services
  • Sec. 405.2415 Services and supplies incident to nurse practitionerand physician assistant services
  • Sec. 405.2416 Visiting nurse services
  • Sec. 405.2417 Visiting nurse services: Determination of shortage
  • Sec. 405.2418 Applicability of general payment exclusions
  • Sec. 405.2425 Payment for rural health clinic services
  • Sec. 405.2426 All-inclusive rate
  • Sec. 405.2427 Annual reconciliation
  • Sec. 405.2428 Allowable costs
  • Sec. 405.2429 Reports and maintenance of records
  • Sec. 405.2430 Beneficiary appeals
• Sec. 410.165 Payment for rural health clinic services
• 42 CFR PART 491, SUBPART A: RURAL HEALTH CLINICS
  • Sec. 491.1 Purpose and scope
  • Sec. 491.2 Definitions
  • Sec. 491.3 Certification procedures
  • Sec. 491.4 Compliance with Federal, State and local laws
  • Sec. 491.5 Location of clinic
  • Sec. 491.6 Physical plant and environment
  • Sec. 491.7 Organizational structure
  • Sec. 491.8 Staffing and staff responsibilities
  • Sec. 491.9 Provision of services
  • Sec. 491.10 Patient health records
  • Sec. 491.11 Program evaluation

• Rural Health Bills (105th Congress)
• Congressional Record 1997: Rural Health
• Search "Rural Health"
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• Rural Primary Care Hospitals: Experience Offers Suggestions for Medicare's Expanded Program. HEHS-98-60. 15 pp. plus 5 appendices (11 pp.) February 23, 1998.
• Health Professions Education: Role of Title VII/VIII Programs in Improving Access to Care Is Unclear (Letter Report, 07/08/94, GAO/HEHS-94-164). During the past decade, the supply of nearly all health professionals has increased faster than has the population. For most health professions, however, data are unavailable to show whether this increased supply has translated into more access to care in rural and underserved areas.
• Rural Health Clinics: Rising Program Expenditures Not Focused on Improving Care in Isolated Areas (Letter Report, 11/22/96, GAO/HEHS-97-24). Pursuant to a congressional request, GAO reviewed the Rural Health Clinic (RHC) Program.
• Antitrust and Rural Health Formation of regional integrated service networks-or is it the development of monopolies and the sanctioning of monopolistic practices?
• APA: Rural Health in America The purpose of this document is to express the commitment of the American Psychological Association, its Task Force on Rural Health, and its Office of Rural Health to fair and equitable access to health and mental health services for all Americans.
• Centre for Rural Social Research - Rural Society Rural Society is a quarterly journal of rural social issues. It is a fully refereed academic journal, but designed to be accessible to a broad readership.
• Consumer Choice and the Rural Hospital This two-year, cross-sectional study, conducted from July, 1993 through June, 1995, will investigate the association of hospital-specific consumer perceptions, preferences and behaviors of residents of small, rural communities served by single hospitals.
• HHS: Survey Shows Promise and Challenge of Rural Telemedicine
• NADO: TELECOMMUNICATIONS AND ITS IMPACT ON RURAL AMERICA Telecommunications has significant potential to contribute to economic development in rural America.
• Rural Information Center Health Service (RICHS) Publications
• RICHS: Rural Health Newsletters This bulletin lists national and state newsletters that address rural health issues.
• Rural Health Care: listserv@MUSOM01.mu.wvnet.edu Rural Health Care Discussion List. Send the following message to: subscribe RuralNet-L Your Name
• RWHC Monthly Executive Director Reports Full text online versions of these reports.
• RWHC: A Pause On The Road To Rural Hospital Equity This year has seen a number of important congressional, administrative and judicial events related to rural hospitals' quest for payment equity under Medicare's Prospective Payment System (PPS).
• RWHC: Medicare's Disproportionate & Inequitable Impact On Rural Health The small portion of Medicare expenditures for rural communities makes it difficult for them to gain the attention needed to solve long-standing rural equity issues.

Bureau of Health Professions Grants Files ~ Center on Aging and Health in Rural America ~ Federally Funded Rural Health Research Centers ~ HHS: GrantsNet ~ Indian Health Service ~ Minnesota Center for Rural Health ~ National Association for Rural Mental Health ~ Office of Rural Health Policy ~ Pennsylvania Office of Rural Health Home Page ~ Project for Rural Health Communication and Information Technology ~ Rural Centers Bibliography Listing ~ RURAL CLINIC ADMINISTRATION AND OPERATION ~ Rural Health Gopher ~ Rural Health Information ~ Rural Health Services Outreach ~ Rural Information Center Health Service ~ Rural Wisconsin Health Cooperative ~ RuralNet ~ RuralPSYCH ~ The Australian Rural Health Research Institute ~ THE MICHIGAN CENTER FOR RURAL HEALTH HOME PAGE ~ University of Iowa: Institute for Rural & Environmental Health ~ WAMI Rural Health Research Center ~ Wisconsin Office of Rural Health