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HEHS-96-12R 1 (1995-10-02)

handle is hein.gao/gaobaclba0001 and id is 1 raw text is: United States -IXj J General Accounting Office Washington, D.C. 20548 Health, Education and Human Services Division B-259614 October 2, 1995 The Honorable Max Baucus United States Senate Dear Senator Baucus: One of the issues before the Congress as it considers modifications to the Medicare program is controlling costs while maintaining access to basic hospital and physician services. One model intended to preserve access to basic services in rural areas is medical assistance facilities (MAF), which are limited-service hospitals located only in Montana. Following the closure of numerous rural hospitals in Montana, the state legislature created the MAF provider category in 1987. In 1990, the Congress authorized Medicare to pay for MAF services provided to Medicare beneficiaries on the basis of reasonable cost. In 1993, the Congress extended this authorization until July 1, 1997. The MAF program was meant to preserve access to basic emergency care, outpatient services, and limited inpatient care in areas where full-service hospitals had closed or were at risk of closure. MAFs must be located in frontier counties' or be more than 35 miles from another hospital. MAFs were not intended to provide surgical services (although they are not prohibited from doing so), and inpatient stays are limited to 96 hours. Montana established special licensure rules to allow mid-level practitioners (physician assistants and nurse practitioners) to provide care at MAFs under the supervision of a physician, who is not required to be collocated with the MAF. Currently, seven MAFs exist in Montana, primarily in the eastern portion of the state. Each MAF shares space, personnel, and utilities with a nursing home. The MAFs each have an emergency room, outpatient clinic, and a 2- to 10-bed inpatient unit. 'Under the Montana law, a frontier county is one with a population density of fewer than six persons per square mile. GAO/HEHS-96-12R Montana's Medical Assistance Facilities

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