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Throughout the late 1980s, several U.S. Congressional Committees held hearings on the sustainability of the rural health care delivery system. On June 4, 1987 the U.S. House of Representatives Select Committee on Aging held a hearing entitled “The American Rural Health Care System: What Should It Be and How We Sustain It” – this created a new level of attention to rural health care issues. 

In 1987, the Under Secretary for the Department of Health and Human Services (HHS) asked the Health Resources and Services Administration (HRSA) to investigate the pressing health concerns of health in rural America. The resulting report entitled, “Rural Hospitals/Health Services – Executive Summary,” made recommendations as to how to strengthen and expand access to health care services for non-metro areas.  

Following this report, former HHS Secretary Otis Bowen administratively established both the Federal Office of Rural Health Policy (formerly Office of Rural Health Policy) and the National Advisory Committee on Rural Health & Human Services (formerly National Rural Health Advisory Committee) within HRSA. Subsequently, the Omnibus Budget Reconciliation Act of 1987 (PL. 100-203) gives formal statutory recognition to the office and ensures that it serves in a policy advisory and coordination role. 

The statute specifically directs the Federal Office of Rural Health Policy (FORHP) to conduct regulatory impact analyses and advise the HHS Secretary on the effects of current policies and proposed statutory, regulatory, administrative, and budgetary changes in programs established under Titles XVIII and XIX of the Social Security Act (Medicare and Medicaid). In addition to this authority, the office is responsible for evaluating the financial viability of small rural hospitals, the ability of rural areas to attract and retain physicians and other health professionals, and general access to health care in rural areas. 

Since its establishment, FORHP has supported innovative efforts to address the unique environmental and institutional circumstances that contribute to the financial instability of rural hospitals, issues surrounding workforce recruitment and retention, and barriers to achieving health equity in rural areas. 

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