It's amazing how legislation out of Washington, D.C. works - or doesn't work. Federal rules and regulations are full of strange acronyms, pages of verbiage designed to move final providers in a certain direction. Too many times, that direction, instead of being clearly defined, makes program administrators move in the opposite direction from the original intent.

Such is the case with the Indigent Care Trust Fund (ICTF) and how the billions of dollars are distributed to pay for health care services for the poor. The ICTF money is essential to hospitals and can mean the difference between having access or not.

In order to receive ICTF money, a hospital needs to be designated a "Disproportionate Share Hospital" (DSH), but in order to receive a DSH designation, hospitals have to provide obstetrics. That's the lawmakers' attempt to insure rural and poor women have access to those critical services.

On the surface those OB requirements, particularly for rural hospitals, seem quite liberal. In order to comply with the regulations they need two physicians, not necessarily OB/GYNs, with staff privileges available to perform non-emergency obstetric procedures.

But those in charge of payments and certifying the hospitals, the Centers for Medicare and Medicaid Services and the state Department of Community Health, saw the regulations differently from the original intent. They required rural hospitals to have specifically trained obstetricians and gynecologists. And, the hospitals had to perform a certain number of OB procedures to receive DSH designation.

No designation, no ICTF money. Without ICTF money, hospitals in rural areas have a tough time operating. The legislation, designed to guarantee medical access - in practice - was forcing hospitals to shut their doors to everyone.

The state Department of Community Health had the power, all along, to ignore the skewed federal interpretation for the 18 rural hospitals in the Georgia but without the federal OK they weren't going to budge.

How do you cut through the reams of bureaucratic red tape to solve this problem and keep hospitals open instead of shut? You call your congressman. If he or she is responsive, you'll get answers.

First, the congressman needs to be interested - and in a position - to affect change.

Second, he or she has to have the gray matter to figure out what the lawmakers actually meant when the regulations were written.

Third, he or she has to understand the law, and finally, he or she has to have the stick-to-itiveness to follow up and keep the scissors cutting through the thick tape. Bureaucracies do not give up their notions easily. But that's exactly what Congressman Jim Marshall, D-Georgia (3rd District) made them do.

Because of his work, five of the rural hospitals in his district, Tattnall, Candler, Peach, Flint River and Perry will be able to provide services as the legislation intended.

"I've been working on this project since I became hospital administrator in 1996," said Nancy Peed, hospital administrator at Peach Regional Medical Center in Fort Valley. "It's because of him, (Marshall) that we hope to be able to open up some things we regard as part of our mission."

Marshall's mission wasn't easy. After numerous letters and phone calls, the issue ended up on the desk of the top administrator of the CMS, Mark B. McClellan. Marshall's two points were simple. He had made them several times, with several people: That rural hospitals did not have to have OB/GYN specialists, nor did they have perform a particular number of procedures to qualify as a DSH. McClellan agreed, and a simple one-page letter to Marshall, dated April 1, 2004, will now, once the state gets the message, make money available to help keep rural hospitals viable.

How important is that? It literally can mean the difference between life and death. If you ever wanted to know what a congressman is supposed to do, this is a perfect example.

Charles E. Richardson's columns appear Tuesday and Sunday. He can be reached at crichardson@macontel.com or 744-4342