‘Rural Safeguard’ Funding Needs Extension, Advocates Say

A 3% cost bump provided by Medicare that helps pay for the added expense of providing home health care services to those in rural areas should be extended, according to The Partnership for Quality Home Healthcare.

The 3% Medicare payment, known as the “rural safeguard,” has been an add-on payment to home health providers operating in rural communities since Congress approved it 2000. The safeguard is currently set to expire on December 31, 2017, if Congress does not extend it.

The additional 3% payment is necessary to cover the additional transportation and staffing costs to deliver home care services in remote locations, advocates say.


“The disadvantages of the vulnerable rural patient population and the challenges they face when compared to their urban counterparts demonstrate the critical importance of ensuring the availability of home health in underserved, rural communities across America,” Keith Myers, chairman of the Partnership for Quality Home Healthcare and CEO of home health provider LHC Group (Nasdaq: LHCG), said in a statement. “Without access to home health, patients will end up receiving more emergent care in more expensive care settings, diving up costs and risking patient health.”

Rural Disadvantages 

Overall, providing home health services to rural beneficiaries is more costly—about 36% higher than in non-rural communities, according to a recent study by Ability. Per episode, total travel costs on average cost $229 for a rural beneficiary compared to $168 for a non-rural counterpart.


Mediare beneficiaries living in rural areas are less likely to have access to and utilize home health care services. In 2014, rural beneficiaries were 15% less likely to receive these services than urban counterparts, according to an analysis by The Moran Company. By comparison, this rural group received fewer episodes of care per 100 beneficiaries in 2014. These patients live more than twice as far from their doctor and nearly twice as far from the nearest hospital compared to beneficiaries in an urban setting, according to The Moran Company.

These are also some of the most vulnerable patients, with 37% of all rural home health beneficiaries having seven or more chronic conditions, the analysis found. Rural beneficiaries are 17% more likely to be 200% below of the Federal Poverty Line (FPL). 

While the additional 3% cost bump likely doesn’t already cover all the expenses of serving patients in rural settings, eliminating the rural safeguard would increase pressures on providers operating in these communities and put rural beneficiaries in jeopardy, advocates urge.

“We commend the Congress for ensuring this protection for rural patients since 2000 and urge the new 115th Congress to prioritize the extension of the three percent rural safeguard to protect home health services for these patients,” Myers said.

Written by Amy Baxter

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