To amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries to health care in rural areas.

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Rural 
Access Preservation Act of 2002''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. 2 year hold-harmless for sole community hospitals under 
                            outpatient prospective payment schedule.
Sec. 3. 20 percent increase in medicare payment for home health care 
                            furnished in a frontier area.
Sec. 4. Adjustment in critical access hospital bed limit.
Sec. 5. 15 percent increase in medicare payment for hospice care 
                            furnished in a frontier area.
Sec. 6. Treatment of eligibility for hospice care.

SEC. 2. 2 YEAR HOLD-HARMLESS FOR SOLE COMMUNITY HOSPITALS UNDER 
              OUTPATIENT PROSPECTIVE PAYMENT SCHEDULE.

    Section 1833(t)(7)(D) of the Social Security Act (42 U.S.C. 
1395l(t)(7)(D)) is amended by adding at the end the following new 
clause:
                            ``(iii) Temporary treatment for sole 
                        community hospitals.--In the case of a hospital 
                        described in section 1886(d)(5)(C)(iii), for 
                        covered OPD services furnished during 2003 or 
                        2004 for which the PPS amount is less than the 
                        pre-BBA amount, the amount of payment under 
                        this subsection shall be increased by the 
                        amount of such difference.''.

SEC. 3. 20 PERCENT INCREASE IN MEDICARE PAYMENT FOR HOME HEALTH CARE 
              FURNISHED IN A FRONTIER AREA.

    Section 1895(b)(4)(A) of the Social Security Act (42 U.S.C. 
1395fff(b)(4)(A)) is amended by adding at the end the following new 
clause:
                            ``(iii) Differential for frontier areas.--
                        In the case of home health services furnished 
                        in a frontier area on or after January 1, 2003, 
                        and before January 1, 2007, the payment amount 
                        otherwise established for services furnished, 
                        shall be increased by 20 percent. For purposes 
                        of this clause, the term `frontier area' means 
                        a county in which the population density is 
                        less than 7 persons per square mile.''.

SEC. 4. ADJUSTMENT IN CRITICAL ACCESS HOSPITAL BED LIMIT.

    (a) In General.--Section 1820(c)(2) of the Social Security Act (42 
U.S.C. 1395i-4(c)(2)) is amended--
            (1) in subsection (c)(2)--
                    (A) in subparagraph (A), by striking 
                ``subparagraphs (B), (C), and (D)'' and inserting ``the 
                succeeding provisions of this paragraph'';
                    (B) in subparagraph (B)(iii), by inserting 
                ``subject to subparagraph (E),'' after ``(iii)''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(E) Higher number of beds permitted so long as 
                annual average of not more than 12 beds.--The 15-bed 
                limitation specified in subparagraph (B)(iii) and 
                subsection (f) shall not apply to a hospital that 
                provides assurances satisfactory to the Secretary that 
                it will maintain (on an annual basis) an average daily 
                inpatient census of acute care patients of not more 
                than 12.''; and
            (2) in subsection (f), by inserting ``except as permitted 
        under subsection (c)(2)(E)'' after ``15 beds''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on January 1, 2003.

SEC. 5. 15 PERCENT INCREASE IN MEDICARE PAYMENT FOR HOSPICE CARE 
              FURNISHED IN A FRONTIER AREA.

    Section 1814(i)(1) of the Social Security Act (42 U.S.C. 
1395f(i)(1)) is amended by adding at the end the following new 
subparagraph:
    ``(D) With respect to routine home care and other services included 
in hospice care furnished in a frontier area on or after January 1, 
2003, and before January 1, 2007, the payment rates otherwise 
established for such care and services shall be increased by 15 
percent. For purposes of this clause, the term `frontier area' means a 
county in which the population density is less than 7 persons per 
square mile.''.

SEC. 6. TREATMENT OF ELIGIBILITY FOR HOSPICE CARE.

    (a) Deemed Eligibility Based on Death in Fact.--
            (1) In general.--Section 1814(i) of the Social Security Act 
        is amended by adding at the end the following new paragraph:
    ``(4) For purposes of section 1814(a)(7)(A), the Secretary and a 
fiscal intermediary shall not take any action to deny payment for 
hospice care for an individual on the basis that the individual is not 
terminally ill if the individual dies within 6 months of the date the 
individual is initially admitted into the hospice program for the 
receipt of hospice care.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall take effect on January 1, 2003.
    (b) CMS Report.--
            (1) In general.--The Administrator of the Centers for 
        Medicare & Medicaid Services shall evaluate the standards used 
        by fiscal intermediaries in denying physician certifications 
        under section 1814(a)(7) of the Social Security Act that an 
        individual is terminally ill (and thereby making such 
        individuals ineligible to elect the hospice care alternative) 
        and the impact of such decisions on length of stay. Such 
        evaluation shall review the impact of the amendments made by 
        section 322(a) of the Medicare, Medicaid, and SCHIP Benefits 
        Improvement and Protection Act of 2000 (114 Stat. 2763A-501), 
        as enacted into law by section 1(a)(6) of Public Law 106-554 
        and the results of the study conducted under section 322(b) of 
        such Act of 2000.
            (2) Report.--Not later than 6 months after the date of the 
        enactment of this Act, such Administrator shall submit to 
        Congress a report on such evaluation.

Summary: Medicare Rural Access Preservation Act of 2002 - Amends title XVIII (Medicare) of the Social Security Act (SSA), with respect to covered outpatient department (OPD) services furnished in sole community hospitals during 2003 or 2004, to require that the payment due be increased by the difference between the two amounts whenever the prospective payment system (PPS) amount is less than the pre-BBA amount . Increases by 20 percent the Medicare payment for home health care furnished in a frontier area during 2003 through 2006. Permits hospitals to increase temporarily above 15 the number of acute care inpatient beds, provided the hospital will maintain an annual average daily inpatient census of not more than 12 beds. Increases by 15 percent the Medicare payment for hospice care furnished in a frontier area during 2003 through 2006. Prohibits the Secretary of Human Services and a fiscal intermediary from taking action to deny payment for hospice care for an individual on the basis that the individual is not terminally ill if the individual dies within six months of the date admitted into the hospice program. Directs the Administrator of the Centers for Medicare and Medicaid Services to evaluate the standards used by fiscal intermediaries in denying a physician certification that an individual is terminally ill.