I 

108TH CONGRESS 

1ST SESSION H.R. 1675

To amend title XVIII of the Social Security Act to protect and preserve 

access of Medicare beneficiaries to health care provided by hospitals 

in rural areas, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 8, 2003

Mr. MORAN of Kansas (for himself, Mr. POMEROY, Mr. WALDEN of Oregon, 

Mr. STENHOLM, Mr. PETERSON of Pennsylvania, Mr. BERRY, Mr. KIND, 

Mr. MCHUGH, Mr. SANDLIN, Mr. EVANS, Mr. DAVIS of Alabama, and 

Mr. CASE) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy 

and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL

To amend title XVIII of the Social Security Act to protect 

and preserve access of Medicare beneficiaries to health 

care provided by hospitals in rural areas, and for other 

purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
2

•HR 1675 IH 

1 SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECU2 RITY ACT; REFERENCES TO BIPA; TABLE OF 

3 CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Health Care Access and Rural Equity Act of 2003’’. 

6 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex7 cept as otherwise specifically provided, whenever in this 

8 Act an amendment is expressed in terms of an amendment 

9 to or repeal of a section or other provision, the reference 

10 shall be considered to be made to that section or other 

11 provision of the Social Security Act. 

12 (c) REFERENCES TO BIPA.—In this Act, the term 

13 ‘‘BIPA’’ means the Medicare, Medicaid, and SCHIP Ben14 efits Improvement and Protection Act of 2000, as enacted 

15 into law by section 1(a)(6) of Public Law 106–554 (114 

16 Stat. 2763). 

17 (d) TABLE OF CONTENTS.—The table of contents of 

18 this Act is as follows:

Sec. 1. Short title; table of contents. 

TITLE I—MEDICARE RURAL HEALTH CARE IMPROVEMENTS 

Sec. 101. Equalizing urban and rural standardized payment amounts under the 

Medicare inpatient hospital prospective payment system. 

Sec. 102. Fairness in the medicare disproportionate share hospital (DSH) adjustment for rural hospitals. 

Sec. 103. Adjustment to the medicare inpatient hospital PPS wage index to revise the labor-related share of such index. 

Sec. 104. One-year extension of hold harmless provisions for small rural hospitals under medicare prospective payment system for hospital 

outpatient department services. 

Sec. 105. One-year hold harmless treatment of certain sole community hospitals 

to limit decline in payment under the OPD PPS. 

Sec. 106. Critical access hospital (CAH) improvements. 
3

•HR 1675 IH 

Sec. 107. Permanent treatment of certain physician pathology services under 

medicare. 

TITLE II—OTHER RURAL HOSPITAL REFORMS 

Sec. 201. Capital infrastructure revolving loan program. 

Sec. 202. Five-year extension of the authorization for appropriations for certain 

medicare rural grants.

1 TITLE I—MEDICARE RURAL 

2 HEALTH CARE IMPROVEMENTS 

3 SEC. 101. EQUALIZING URBAN AND RURAL STANDARDIZED 

4 PAYMENT AMOUNTS UNDER THE MEDICARE 

5 INPATIENT HOSPITAL PROSPECTIVE PAY6 MENT SYSTEM. 

7 (a) IN GENERAL.—Section 1886(d)(3)(A)(iv) (42 

8 U.S.C. 1395ww(d)(3)(A)(iv)) is amended—

9 (1) by striking ‘‘(iv) For discharges’’ and in10 serting ‘‘(iv)(I) Subject to subclause (II), for dis11 charges’’; and 

12 (2) by adding at the end the following new sub13 clause: 

14 ‘‘(II) For discharges occurring in a fiscal year 

15 beginning with fiscal year 2004, the Secretary shall 

16 compute a standardized amount for hospitals located 

17 in any area within the United States and within 

18 each region equal to the standardized amount com19 puted for the previous fiscal year under this sub20 paragraph for hospitals located in a large urban area 

21 (or, beginning with fiscal year 2005, for hospitals lo22 cated in any area) increased by the applicable per-
4

•HR 1675 IH 

1 centage increase under subsection (b)(3)(B)(i) for 

2 the fiscal year involved.’’. 

3 (b) CONFORMING AMENDMENTS.—

4 (1) COMPUTING DRG-SPECIFIC RATES.—Section 

5 1886(d)(3)(D) (42 U.S.C. 1395ww(d)(3)(D)) is 

6 amended—

7 (A) in the heading, by striking ‘‘IN DIF8 FERENT AREAS’’; 

9 (B) in the matter preceding clause (i), by 

10 striking ‘‘, each of’’; 

11 (C) in clause (i)—

12 (i) in the matter preceding subclause 

13 (I), by inserting ‘‘for fiscal years before fis14 cal year 2004,’’ before ‘‘for hospitals’’; and 

15 (ii) in subclause (II), by striking 

16 ‘‘and’’ after the semicolon at the end; 

17 (D) in clause (ii)—

18 (i) in the matter preceding subclause 

19 (I), by inserting ‘‘for fiscal years before fis20 cal year 2004,’’ before ‘‘for hospitals’’; and 

21 (ii) in subclause (II), by striking the 

22 period at the end and inserting ‘‘; and’’; 

23 and 

24 (E) by adding at the end the following new 

25 clause: 
5

•HR 1675 IH 

1 ‘‘(iii) for a fiscal year beginning after fiscal 

2 year 2003, for hospitals located in all areas, to 

3 the product of—

4 ‘‘(I) the applicable standardized 

5 amount (computed under subparagraph 

6 (A)), reduced under subparagraph (B), 

7 and adjusted or reduced under subpara8 graph (C) for the fiscal year; and 

9 ‘‘(II) the weighting factor (determined 

10 under paragraph (4)(B)) for that diag11 nosis-related group.’’. 

12 (2) TECHNICAL CONFORMING SUNSET.—Section 

13 1886(d)(3) (42 U.S.C. 1395ww(d)(3)) is amended—

14 (A) in the matter preceding subparagraph 

15 (A), by inserting ‘‘, for fiscal years before fiscal 

16 year 1997,’’ before ‘‘a regional adjusted DRG 

17 prospective payment rate’’; and 

18 (B) in subparagraph (D), in the matter 

19 preceding clause (i), by inserting ‘‘, for fiscal 

20 years before fiscal year 1997,’’ before ‘‘a re21 gional DRG prospective payment rate for each 

22 region,’’.
6

•HR 1675 IH 

1 SEC. 102. FAIRNESS IN THE MEDICARE DISPROPOR2 TIONATE SHARE HOSPITAL (DSH) ADJUST3 MENT FOR RURAL HOSPITALS. 

4 (a) EQUALIZING DSH PAYMENT AMOUNTS.—

5 (1) IN GENERAL.—Section 1886(d)(5)(F)(vii) 

6 (42 U.S.C. 1395ww(d)(5)(F)(vii)) is amended by in7 serting ‘‘, and, after October 1, 2003, for any other 

8 hospital described in clause (iv),’’ after ‘‘clause 

9 (iv)(I)’’ in the matter preceding subclause (I). 

10 (2) CONFORMING AMENDMENTS.—Section 

11 1886(d)(5)(F) (42 U.S.C. 1395ww(d)(5)(F)) is 

12 amended—

13 (A) in clause (iv)—

14 (i) in subclause (II)—

15 (I) by inserting ‘‘and before Oc16 tober 1, 2003,’’ after ‘‘April 1, 

17 2001,’’; and 

18 (II) by inserting ‘‘or, for dis19 charges occurring on or after October 

20 1, 2003, is equal to the percent deter21 mined in accordance with the applica22 ble formula described in clause (vii)’’ 

23 after ‘‘clause (xiii)’’; 

24 (ii) in subclause (III)—
7

•HR 1675 IH 

1 (I) by inserting ‘‘and before Oc2 tober 1, 2003,’’ after ‘‘April 1, 

3 2001,’’; and 

4 (II) by inserting ‘‘or, for dis5 charges occurring on or after October 

6 1, 2003, is equal to the percent deter7 mined in accordance with the applica8 ble formula described in clause (vii)’’ 

9 after ‘‘clause (xii)’’; 

10 (iii) in subclause (IV)— 

11 (I) by inserting ‘‘and before Oc12 tober 1, 2003,’’ after ‘‘April 1, 

13 2001,’’; and 

14 (II) by inserting ‘‘or, for dis15 charges occurring on or after October 

16 1, 2003, is equal to the percent deter17 mined in accordance with the applica18 ble formula described in clause (vii)’’ 

19 after ‘‘clause (x) or (xi)’’; 

20 (iv) in subclause (V)—

21 (I) by inserting ‘‘and before Oc22 tober 1, 2003,’’ after ‘‘April 1, 

23 2001,’’; and 

24 (II) by inserting ‘‘or, for dis25 charges occurring on or after October 
8

•HR 1675 IH 

1 1, 2003, is equal to the percent deter2 mined in accordance with the applica3 ble formula described in clause (vii)’’ 

4 after ‘‘clause (xi)’’; and 

5 (v) in subclause (VI)— 

6 (I) by inserting ‘‘and before Oc7 tober 1, 2003,’’ after ‘‘April 1, 

8 2001,’’; and 

9 (II) by inserting ‘‘or, for dis10 charges occurring on or after October 

11 1, 2003, is equal to the percent deter12 mined in accordance with the applica13 ble formula described in clause (vii)’’ 

14 after ‘‘clause (x)’’; 

15 (B) in clause (viii), by striking ‘‘The for16 mula’’ and inserting ‘‘For discharges occurring 

17 before October 1, 2003, the formula’’; and 

18 (C) in each of clauses (x), (xi), (xii), and 

19 (xiii), by striking ‘‘For purposes’’ and inserting 

20 ‘‘With respect to discharges occurring before 

21 October 1, 2003, for purposes’’. 

22 (b) EFFECTIVE DATE.—The amendments made by 

23 this section shall apply with respect to discharges occur24 ring on or after October 1, 2003. 
9

•HR 1675 IH 

1 SEC. 103. ADJUSTMENT TO THE MEDICARE INPATIENT HOS2 PITAL PPS WAGE INDEX TO REVISE THE 

3 LABOR-RELATED SHARE OF SUCH INDEX. 

4 (a) IN GENERAL.—Section 1886(d)(3)(E) (42 U.S.C. 

5 1395ww(d)(3)(E)) is amended—

6 (1) by striking ‘‘WAGE LEVELS.—The Sec7 retary’’ and inserting ‘‘WAGE LEVELS.—

8 ‘‘(i) IN GENERAL.—Except as provided in 

9 clause (ii), the Secretary’’; and 

10 (2) by adding at the end the following new 

11 clause: 

12 ‘‘(ii) ALTERNATIVE PROPORTION TO BE

13 ADJUSTED BEGINNING IN FISCAL YEAR 2004.—

14 ‘‘(I) IN GENERAL.—Except as pro15 vided in subclause (II), for discharges oc16 curring on or after October 1, 2003, the 

17 Secretary shall substitute ‘62 percent’ for 

18 the proportion described in the first sen19 tence of clause (i). 

20 ‘‘(II) HOLD HARMLESS FOR CERTAIN

21 HOSPITALS.—If the application of sub22 clause (I) would result in lower payments 

23 to a hospital than would otherwise be 

24 made, then this subparagraph shall be ap25 plied as if this clause had not been en26 acted.’’. 
10

•HR 1675 IH 

1 (b) WAIVING BUDGET NEUTRALITY.—Section 

2 1886(d)(3)(E) (42 U.S.C. 1395ww(d)(3)(E)), as amended 

3 by subsection (a), is amended by adding at the end of 

4 clause (i) the following new sentence: ‘‘The Secretary shall 

5 apply the previous sentence for any period as if the 

6 amendments made by section 103(a) of the Health Care 

7 Access and Rural Equity Act of 2003 had not been en8 acted.’’. 

9 SEC. 104. ONE-YEAR EXTENSION OF HOLD HARMLESS PRO10 VISIONS FOR SMALL RURAL HOSPITALS 

11 UNDER MEDICARE PROSPECTIVE PAYMENT 

12 SYSTEM FOR HOSPITAL OUTPATIENT DE13 PARTMENT SERVICES. 

14 Section 1833(t)(7)(D)(i) (42 U.S.C. 

15 1395l(t)(7)(D)(i)) is amended by striking ‘‘2004’’ and in16 serting ‘‘2005’’. 

17 SEC. 105. ONE-YEAR HOLD HARMLESS TREATMENT OF CER18 TAIN SOLE COMMUNITY HOSPITALS TO LIMIT 

19 DECLINE IN PAYMENT UNDER THE OPD PPS. 

20 (a) HOLD HARMLESS PROVISION.—Section 

21 1833(t)(7)(D)(i) (42 U.S.C. 1395l(t)(7)(D)(i)), as amend22 ed by section 104, is further amended—

23 (1) in the heading, by striking ‘‘SMALL’’ and in24 serting ‘‘CERTAIN’’; and
11

•HR 1675 IH 

1 (2) by inserting ‘‘or a sole community hospital 

2 (as defined in section 1886(d)(5)(D)(iii)) located in 

3 a rural area’’ after ‘‘100 beds’’. 

4 (b) EFFECTIVE DATE.—The amendment made by 

5 subsection (a)(2) shall apply with respect to payment for 

6 OPD services furnished on and after January 1, 2004. 

7 SEC. 106. CRITICAL ACCESS HOSPITAL (CAH) IMPROVE8 MENTS. 

9 (a) ELIMINATION OF THE ISOLATION TEST FOR

10 COST-BASED CAH AMBULANCE SERVICES.—

11 (1) IN GENERAL.—Section 1834(l)(8) (42 

12 U.S.C. 1395m(l)), as added by section 205(a) of 

13 BIPA (114 Stat. 2763A–482), is amended by strik14 ing the comma at the end of subparagraph (B) and 

15 all that follows and inserting a period. 

16 (2) TECHNICAL CORRECTION.—Section 1834(l) 

17 (42 U.S.C. 1395m(l)) is amended by redesignating 

18 paragraph (8), as added by section 221(a) of BIPA 

19 (114 Stat. 2763A–486), as paragraph (9). 

20 (b) COVERAGE OF COSTS FOR CERTAIN EMERGENCY

21 ROOM ON-CALL PROVIDERS.—

22 (1) IN GENERAL.—Section 1834(g)(5) (42 

23 U.S.C. 1395m(g)(5)) is amended—

24 (A) in the heading—
12

•HR 1675 IH 

1 (i) by inserting ‘‘CERTAIN’’ before 

2 ‘‘EMERGENCY’’; and 

3 (ii) by striking ‘‘PHYSICIANS’’ and in4 serting ‘‘PROVIDERS’’; 

5 (B) by striking ‘‘emergency room physi6 cians who are on-call (as defined by the Sec7 retary)’’ and inserting ‘‘physicians, physician 

8 assistants, nurse practitioners, and clinical 

9 nurse specialists who are on-call (as defined by 

10 the Secretary) to provide emergency services’’; 

11 and 

12 (C) by striking ‘‘physicians’ services’’ and 

13 inserting ‘‘services covered under this title’’. 

14 (2) EFFECTIVE DATE.—The amendment made 

15 by paragraph (1) shall apply with respect to costs 

16 incurred for services provided on or after January 1, 

17 2004. 

18 (c) AUTHORIZATION OF PERIODIC INTERIM PAY19 MENT (PIP).—

20 (1) IN GENERAL.—Section 1815(e)(2) (42 

21 U.S.C. 1395g(e)(2)) is amended—

22 (A) in subparagraph (C), by striking 

23 ‘‘and’’ after the semicolon at the end; 

24 (B) in subparagraph (D), by adding ‘‘and’’ 

25 after the semicolon at the end; and 
13

•HR 1675 IH 

1 (C) by inserting after subparagraph (D) 

2 the following new subparagraph: 

3 ‘‘(E) inpatient critical access hospital services,’’. 

4 (2) EFFECTIVE DATE.—The amendments made 

5 by paragraph (1) shall apply with respect to pay6 ments for inpatient critical access hospital services 

7 furnished on or after January 1, 2004. 

8 (d) EXCLUSION OF NEW CAHS FROM PPS HOS9 PITAL WAGE INDEX CALCULATION.—Section 

10 1886(d)(3)(E) (42 U.S.C. 1395ww(d)(3)(E)), as amended 

11 by section 103(a), is further amended by inserting after 

12 the first sentence of clause (i) the following new sentence: 

13 ‘‘In calculating the hospital wage levels under the pre14 ceding sentence applicable with respect to cost reporting 

15 periods beginning on or after January 1, 2004, the Sec16 retary shall exclude the wage levels of any hospital that 

17 became a critical access hospital prior to the cost reporting 

18 period for which such hospital wage levels are calculated.’’. 

19 SEC. 107. PERMANENT TREATMENT OF CERTAIN PHYSI20 CIAN PATHOLOGY SERVICES UNDER MEDI21 CARE. 

22 (a) IN GENERAL.—Section 1848(i) (42 U.S.C. 

23 1395w–4(i)) is amended by adding at the end the fol24 lowing new paragraph: 
14

•HR 1675 IH 

1 ‘‘(4) TREATMENT OF CERTAIN PHYSICIAN PA2 THOLOGY SERVICES.—

3 ‘‘(A) IN GENERAL.—With respect to serv4 ices furnished on or after January 1, 2001, if 

5 an independent laboratory furnishes the tech6 nical component of a physician pathology serv7 ice to a fee-for-service medicare beneficiary who 

8 is an inpatient or outpatient of a covered hos9 pital, the Secretary shall treat such component 

10 as a service for which payment shall be made 

11 to the laboratory under this section and not as 

12 an inpatient hospital service for which payment 

13 is made to the hospital under section 1886(d) 

14 or as a hospital outpatient service for which 

15 payment is made to the hospital under section 

16 1833(t). 

17 ‘‘(B) DEFINITIONS.—In this paragraph: 

18 ‘‘(i) COVERED HOSPITAL.—

19 ‘‘(I) IN GENERAL.—The term 

20 ‘covered hospital’ means, with respect 

21 to an inpatient or outpatient, a hos22 pital that had an arrangement with 

23 an independent laboratory that was in 

24 effect as of July 22, 1999, under 

25 which a laboratory furnished the tech-
15

•HR 1675 IH 

1 nical component of physician pathol2 ogy services to fee-for-service medi3 care beneficiaries who were hospital 

4 inpatients or outpatients, respectively, 

5 and submitted claims for payment for 

6 such component to a carrier with a 

7 contract under section 1842 and not 

8 to the hospital. 

9 ‘‘(II) CHANGE IN OWNERSHIP

10 DOES NOT AFFECT DETERMINA11 TION.—A change in ownership with 

12 respect to a hospital on or after the 

13 date referred to in subclause (I) shall 

14 not affect the determination of wheth15 er such hospital is a covered hospital 

16 for purposes of such subclause. 

17 ‘‘(ii) FEE-FOR-SERVICE MEDICARE

18 BENEFICIARY.—The term ‘fee-for-service 

19 medicare beneficiary’ means an individual 

20 who is entitled to (or enrolled for) benefits 

21 under part A, or enrolled under this part, 

22 or both, but who is not enrolled in any of 

23 the following: 

24 ‘‘(I) A Medicare+Choice plan 

25 under part C.
16

•HR 1675 IH 

1 ‘‘(II) A plan offered by an eligi2 ble organization under section 1876. 

3 ‘‘(III) A program of all-inclusive 

4 care for the elderly (PACE) under 

5 section 1894. 

6 ‘‘(IV) A social health mainte7 nance organization (SHMO) dem8 onstration project established under 

9 section 4018(b) of the Omnibus 

10 Budget Reconciliation Act of 1987 

11 (Public Law 100–203).’’. 

12 (b) CONFORMING AMENDMENT.—Section 542 of 

13 BIPA (114 Stat. 2763A–550) is repealed. 

14 (c) EFFECTIVE DATE.—The amendments made by 

15 this section shall take effect as if included in the enact16 ment of the Medicare, Medicaid, and SCHIP Benefits Im17 provement and Protection Act of 2000 (114 Stat. 2763A–

18 463 et seq.), as enacted into law by section 1(a)(6) of Pub19 lic Law 106–554. 
17

•HR 1675 IH 

1 TITLE II—OTHER RURAL 

2 HOSPITAL REFORMS 

3 SEC. 201. CAPITAL INFRASTRUCTURE REVOLVING LOAN 

4 PROGRAM. 

5 (a) IN GENERAL.—Part A of title XVI of the Public 

6 Health Service Act (42 U.S.C. 300q et seq.) is amended 

7 by adding at the end the following new section: 

8 ‘‘CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM

9 ‘‘SEC. 1603. (a) AUTHORITY TO MAKE AND GUAR10 ANTEE LOANS.—

11 ‘‘(1) AUTHORITY TO MAKE LOANS.—The Sec12 retary may make loans from the fund established 

13 under section 1602(d) to any rural entity for 

14 projects for capital improvements, including—

15 ‘‘(A) the acquisition of land necessary for 

16 the capital improvements; 

17 ‘‘(B) the renovation or modernization of 

18 any building; 

19 ‘‘(C) the acquisition or repair of fixed or 

20 major movable equipment; and 

21 ‘‘(D) such other project expenses as the 

22 Secretary determines appropriate. 

23 ‘‘(2) AUTHORITY TO GUARANTEE LOANS.—

24 ‘‘(A) IN GENERAL.—The Secretary may 

25 guarantee the payment of principal and interest 
18

•HR 1675 IH 

1 for loans made to rural entities for projects for 

2 any capital improvement described in paragraph 

3 (1) to any non-Federal lender. 

4 ‘‘(B) INTEREST SUBSIDIES.—In the case 

5 of a guarantee of any loan made to a rural enti6 ty under subparagraph (A), the Secretary may 

7 pay to the holder of such loan, for and on be8 half of the project for which the loan was made, 

9 amounts sufficient to reduce (by not more than 

10 3 percent) the net effective interest rate other11 wise payable on such loan. 

12 ‘‘(b) AMOUNT OF LOAN.—The principal amount of 

13 a loan directly made or guaranteed under subsection (a) 

14 for a project for capital improvement may not exceed 

15 $5,000,000. 

16 ‘‘(c) FUNDING LIMITATIONS.—

17 ‘‘(1) GOVERNMENT CREDIT SUBSIDY EXPO18 SURE.—The total of the Government credit subsidy 

19 exposure under the Credit Reform Act of 1990 scor20 ing protocol with respect to the loans outstanding at 

21 any time with respect to which guarantees have been 

22 issued, or which have been directly made, under sub23 section (a) may not exceed $50,000,000 per year. 

24 ‘‘(2) TOTAL AMOUNTS.—Subject to paragraph 

25 (1), the total of the principal amount of all loans di-
19

•HR 1675 IH 

1 rectly made or guaranteed under subsection (a) may 

2 not exceed $250,000,000 per year. 

3 ‘‘(d) CAPITAL ASSESSMENT AND PLANNING

4 GRANTS.—

5 ‘‘(1) NONREPAYABLE GRANTS.—Subject to 

6 paragraph (2), the Secretary may make a grant to 

7 a rural entity, in an amount not to exceed $50,000, 

8 for purposes of capital assessment and business 

9 planning. 

10 ‘‘(2) LIMITATION.—The cumulative total of 

11 grants awarded under this subsection may not ex12 ceed $2,500,000 per year. 

13 ‘‘(e) TERMINATION OF AUTHORITY.—The Secretary 

14 may not directly make or guarantee any loan under sub15 section (a) or make a grant under subsection (d) after 

16 September 30, 2008.’’. 

17 (b) RURAL ENTITY DEFINED.—Section 1624 of the 

18 Public Health Service Act (42 U.S.C. 300s–3) is amended 

19 by adding at the end the following new paragraph: 

20 ‘‘(14)(A) The term ‘rural entity’ includes—

21 ‘‘(i) a rural health clinic, as defined in sec22 tion 1861(aa)(2) of the Social Security Act; 

23 ‘‘(ii) any medical facility with at least 1 

24 bed, but with less than 50 beds, that is located 

25 in—
20

•HR 1675 IH 

1 ‘‘(I) a county that is not part of a 

2 metropolitan statistical area; or 

3 ‘‘(II) a rural census tract of a metro4 politan statistical area (as determined 

5 under the most recent modification of the 

6 Goldsmith Modification, originally pub7 lished in the Federal Register on February 

8 27, 1992 (57 Fed. Reg. 6725)); 

9 ‘‘(iii) a hospital that is classified as a 

10 rural, regional, or national referral center under 

11 section 1886(d)(5)(C) of the Social Security 

12 Act; and 

13 ‘‘(iv) a hospital that is a sole community 

14 hospital (as defined in section 

15 1886(d)(5)(D)(iii) of the Social Security Act). 

16 ‘‘(B) For purposes of subparagraph (A), the 

17 fact that a clinic, facility, or hospital has been geo18 graphically reclassified under the medicare program 

19 under title XVIII of the Social Security Act shall not 

20 preclude a hospital from being considered a rural en21 tity under clause (i) or (ii) of subparagraph (A).’’. 

22 (c) CONFORMING AMENDMENTS.—Section 1602 of 

23 the Public Health Service Act (42 U.S.C. 300q–2) is 

24 amended—
21

•HR 1675 IH 

1 (1) in subsection (b)(2)(D), by inserting ‘‘or 

2 1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’; and 

3 (2) in subsection (d)—

4 (A) in paragraph (1)(C), by striking ‘‘sec5 tion 1601(a)(2)(B)’’ and inserting ‘‘sections 

6 1601(a)(2)(B) and 1603(a)(2)(B)’’; and 

7 (B) in paragraph (2)(A), by inserting ‘‘or 

8 1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’. 

9 SEC. 202. FIVE-YEAR EXTENSION OF THE AUTHORIZATION 

10 FOR APPROPRIATIONS FOR CERTAIN MEDI11 CARE RURAL GRANTS. 

12 Section 1820(j) (42 U.S.C. 1395i–4(j)) is amended 

13 by striking ‘‘subsection (g)’’ and all that follows and in14 serting ‘‘subsection (g)—

15 ‘‘(1) $25,000,000 in each of the fiscal years 

16 1998 through 2003; and 

17 ‘‘(2) $40,000,000 in each of the fiscal years 

18 2004 through 2008.’’.

Æ