Island Primary Care–Orcas successfully ‘grandfathered’ as Rural Health Clinic

||| FROM TOM EVERSOLE, INTERIM SUPERINTENDENT for ORCAS ISLAND HEALTH CARE DISTRICT |||

When Congress passed the Consolidated Appropriations Act of 2021, it included an unexpected reduction of payment rates for Provider-Based Rural Health Clinics (RHCs) that would have jeopardized access to care for Orcas Island residents and visitors. The act had a “grandfathering” provision to exempt RHCs that were already established or in process to be established. Originally, our clinic on Orcas was not included in that exemption.

The anticipated loss of health care reimbursement from the Centers for Medicare and Medicaid Services (CMS) would have delivered a serious blow to the District’s and Island Hospital’s (now Island Health’s) joint efforts to build up health care services on the island. The impact was estimated at several millions of dollars revenue lost over the next five years.

Beginning September 2021, a team of leaders from Island Health (IH) and OIHCD along with experts from WIPFLi, the Johnson Group, and Health Facilities Planning and Development worked together to achieve a remedy. Options included new, corrective legislation in Congress and administrative rule changes in federal agencies that manage reimbursements.

The Island Health and District’s workgroup team actively pursued both angles in search of a solution. In order to qualify for grandfathering, Island Primary Care – Orcas clinic staff, led by Aaimee Johnson, successfully completed an un-announced, on-site inspection by CMS with flying colors.

On January 25, 2022, OIHCD Commissioners received word that the Island Primary Care – Orcas clinic had successfully been grandfathered in and will be allowed to retain and/or recover the maximum reimbursements allowed. The District is extremely grateful to Island Health, the consultants involved, and especially to Congressmembers Murray, Cantwell, and Larsen, Region X (ten) staff of CMS, and everyone who made this successful solution possible on behalf of our island community. Thank you!

For more information about Orcas Island Health Care District see: Orcas Island Health Care District – OIHCD (orcashealth.org)

For more information about the Island Primary Care – Orcas clinic, see: islandhealth.org/department/island-primary-care-orcas/