I 

112TH CONGRESS 

2D SESSION H. R. 3859 

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

access of Medicare beneficiaries in rural areas to health care providers 

under the Medicare program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 1, 2012 

Mrs. MCMORRIS RODGERS (for herself, Mr. THOMPSON of California, and Mr. 

KIND) introduced the following bill; which was referred to the Committee 

on Energy and Commerce, and in addition to the Committee on Ways 

and Means, 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 in rural 

areas to health care providers under the Medicare program, 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, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Rural Hospital and Provider Equity Act of 2012’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Sense of the Congress. 

Sec. 3. Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals. 

Sec. 4. Extension and expansion of the Medicare hold harmless provision under 

the prospective payment system for hospital outpatient department (HOPD) services for certain hospitals. 

Sec. 5. Temporary improvements to the Medicare inpatient hospital payment 

adjustment for low-volume hospitals. 

Sec. 6. Extension of Medicare wage index reclassifications for certain hospitals. 

Sec. 7. Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas. 

Sec. 8. Elimination of isolation test for cost-based ambulance reimbursement 

for critical access hospitals. 

Sec. 9. Extension of Medicare incentive payment program for physician scarcity 

areas. 

Sec. 10. Extension of floor on Medicare work geographic adjustment. 

Sec. 11. Improving care planning for Medicare home health services. 

Sec. 12. Rural health clinic improvements. 

Sec. 13. Temporary Medicare payment increase for home health services furnished in a rural area. 

Sec. 14. Extension of increased Medicare payments for rural ground ambulance 

services. 

Sec. 15. Extension of payment for technical component of certain physician pathology services. 

Sec. 16. Facilitating the provision of telehealth services across State lines. 

Sec. 17. Medicare Part A payment for anesthesiologist services in certain rural 

hospitals based on CRNA pass-through rules. 

Sec. 18. Temporary floor on the practice expense geographic index for services 

furnished in rural areas outside of frontier States under the 

Medicare physician fee schedule. 

Sec. 19. Revisions to standard for designation of sole community hospitals. 

Sec. 20. State offices of rural health. 

Sec. 21. Ensuring proportional representation of interests of rural areas on 

MEDPAC. 

3 SEC. 2. SENSE OF THE CONGRESS. 

4 It is the sense of the Congress that— 

5 (1) residents of rural and frontier communities 

6 should have access to affordable, quality health care; 

7 (2) rural and frontier communities face unique 

8 challenges in health care delivery and financing; 


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1 (3) Federal health policy must reflect the 

2 unique needs of residents of rural and frontier com3 munities and such communities in an equitable and 

4 sustainable manner; and 

5 (4) stakeholders should work collectively to 

6 identify innovative policies that address the avail7 ability, delivery, and affordability of health care 

8 services in rural and frontier communities. 

9 SEC. 3. FAIRNESS IN THE MEDICARE DISPROPORTIONATE 

10 SHARE HOSPITAL (DSH) ADJUSTMENT FOR 

11 RURAL HOSPITALS. 

12 Section 1886(d)(5)(F)(xiv)(II) of the Social Security 

13 Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended by 

14 adding at the end the following new sentence: ‘‘The pre15 ceding sentence shall not apply to any hospital with re16 spect to discharges occurring on or after October 1, 2011, 

17 and before October 1, 2012.’’. 

18 SEC. 4. EXTENSION AND EXPANSION OF THE MEDICARE 

19 HOLD HARMLESS PROVISION UNDER THE 

20 PROSPECTIVE PAYMENT SYSTEM FOR HOS21 PITAL OUTPATIENT DEPARTMENT (HOPD) 

22 SERVICES FOR CERTAIN HOSPITALS. 

23 Section 1833(t)(7)(D)(i) of the Social Security Act 

24 (42 U.S.C. 1395l(t)(7)(D)(i)) is amended— 

25 (1) in subclause (II)— 


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1 (A) in the first sentence, by striking 

2 ‘‘March 1, 2012’’ and inserting ‘‘January 1, 

3 2013’’; and 

4 (B) in the second sentence— 

5 (i) by striking ‘‘and 85’’ and inserting 

6 ‘‘85’’; and 

7 (ii) by inserting the following before 

8 the period at the end: ‘‘, and 100 percent 

9 with respect to such services furnished in 

10 the last 10 months of 2012’’; and 

11 (2) in subclause (III)— 

12 (A) in the first sentence— 

13 (i) by striking ‘‘2009, and before 

14 March 1, 2012, for which’’ and inserting 

15 ‘‘2009, and before January 1, 2013, for 

16 which’’; and 

17 (ii) by striking ‘‘85 percent’’ and in18 serting ‘‘the applicable percentage (as de19 termined under the second sentence of sub20 clause (II) for the year)’’; and 

21 (B) in the second sentence, by striking 

22 ‘‘2010, and before March 1, 2012, the pre23 ceding’’ and inserting ‘‘2010, and before Janu24 ary 1, 2013, the preceding’’. 


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1 SEC. 5. TEMPORARY IMPROVEMENTS TO THE MEDICARE 

2 INPATIENT HOSPITAL PAYMENT ADJUST3 MENT FOR LOW-VOLUME HOSPITALS. 

4 Section 1886(d)(12) of the Social Security Act (42 

5 U.S.C. 1395ww(d)(12)) is amended— 

6 (1) in subparagraph (C)(i), by inserting ‘‘and 

7 2,000 discharges, respectively,’’ after ‘‘1,600 dis8 charges’’; and 

9 (2) in subparagraph (D)— 

10 (A) by striking ‘‘1,600’’ and inserting ‘‘the 

11 applicable number of’’; and 

12 (B) by adding at the end the following new 

13 sentence: ‘‘For purposes of the preceding sen14 tence, the term ‘applicable number of dis15 charges’ means 1,600 discharges with respect to 

16 discharges occurring in fiscal year 2011 and 

17 2,000 discharges with respect to discharges oc18 curring in fiscal year 2012’’. 

19 SEC. 6. EXTENSION OF MEDICARE WAGE INDEX RECLASSI20 FICATIONS FOR CERTAIN HOSPITALS. 

21 (a) EXTENSION OF CORRECTION OF MID-YEAR RE22 CLASSIFICATION EXPIRATION FOR CERTAIN HOS23 PITALS.— 

24 (1) IN GENERAL.—In the case of a hospital de25 scribed in paragraph (2), the Secretary of Health 

26 and Human Services shall apply subsection (a) of 


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1 section 106 of division B of the Tax Relief and 

2 Health Care Act of 2006 (42 U.S.C. 1395ww note), 

3 as amended by section 117 of the Medicare, Med4 icaid, and SCHIP Extension Act of 2007 (Public 

5 Law 110–173), section 124 of the Medicare Im6 provements for Patients and Providers Act of 2008 

7 (Public Law 110–275), sections 3137(a) and 10317 

8 of the Patient Protection and Affordable Care Act 

9 (Public Law 111–148), and section 102 of the Medi10 care and Medicaid Extenders Act of 2010 (Public 

11 Law 111–309), by substituting ‘‘September 30, 

12 2012’’ for ‘‘November 30, 2011’’. 

13 (2) HOSPITAL DESCRIBED.—A hospital de14 scribed in this paragraph is— 

15 (A) a hospital— 

16 (i) that is described in subsection (a) 

17 of such section 106; and 

18 (ii)(I) that is located in a rural area; 

19 and 

20 (II) for which the Secretary of Health 

21 and Human Services has determined the 

22 extension under this subsection to be ap23 propriate; or 

24 (B) a sole community hospital located in a 

25 State with less than 10 people per square mile 


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1 that was provided with a special exception re2 classification extension under section 117(a)(2) 

3 of the Medicare, Medicaid, and SCHIP Exten4 sion Act of 2007 (Public Law 110–173). 

5 (b) NOT BUDGET NEUTRAL.—The provisions of this 

6 section shall not be effected in a budget-neutral manner. 

7 SEC. 7. EXTENSION OF MEDICARE REASONABLE COSTS 

8 PAYMENTS FOR CERTAIN CLINICAL DIAG9 NOSTIC LABORATORY TESTS FURNISHED TO 

10 HOSPITAL PATIENTS IN CERTAIN RURAL 

11 AREAS. 

12 Section 416(b) of the Medicare Prescription Drug, 

13 Improvement, and Modernization Act of 2003 (42 U.S.C. 

14 1395l–4), as amended by section 105 of division B of the 

15 Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395l 

16 note), section 107 of the Medicare, Medicaid, and SCHIP 

17 Extension Act of 2007 (42 U.S.C. 1395l note), section 

18 3122 of the Patient Protection and Affordable Care Act 

19 (Public Law 111–148), and section 109 of the Medicare 

20 and Medicaid Extenders Act of 2010 (Public Law 111– 

21 309), is amended by striking ‘‘the 2-year period beginning 

22 on July 1, 2010’’ and inserting ‘‘the 30-month period be23 ginning on July 1, 2010’’. 


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1 SEC. 8. ELIMINATION OF ISOLATION TEST FOR COST-BASED 

2 AMBULANCE REIMBURSEMENT FOR CRIT3 ICAL ACCESS HOSPITALS. 

4 (a) IN GENERAL.—Section 1834(l)(8) of the Social 

5 Security Act (42 U.S.C. 1395m(l)(8)) is amended— 

6 (1) in subparagraph (B)— 

7 (A) by striking ‘‘owned and’’; and 

8 (B) by inserting ‘‘(including when such 

9 services are provided by the entity under an ar10 rangement with the hospital)’’ after ‘‘hospital’’; 

11 and 

12 (2) by striking the comma at the end of sub13 paragraph (B) and all that follows and inserting a 

14 period. 

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

16 this section shall apply to services furnished on or after 

17 January 1, 2012. 

18 SEC. 9. EXTENSION OF MEDICARE INCENTIVE PAYMENT 

19 PROGRAM FOR PHYSICIAN SCARCITY AREAS. 

20 Section 1833(u)(1) of the Social Security Act (42 

21 U.S.C. 1395l(u)(1)) is amended by inserting ‘‘, and such 

22 services furnished on or after January 1, 2012, and before 

23 January 1, 2013’’ after ‘‘2008’’. 


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1 SEC. 10. EXTENSION OF FLOOR ON MEDICARE WORK GEO2 GRAPHIC ADJUSTMENT. 

3 Section 1848(e)(1)(E) of the Social Security Act (42 

4 U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘before 

5 March 1, 2012’’ and inserting ‘‘before January 1, 2013’’. 

6 SEC. 11. IMPROVING CARE PLANNING FOR MEDICARE 

7 HOME HEALTH SERVICES. 

8 (a) PART A PROVISIONS.—Section 1814(a) of the So9 cial Security Act (42 U.S.C. 1395f(a)) is amended— 

10 (1) in paragraph (2)— 

11 (A) in the matter preceding subparagraph 

12 (A), by inserting ‘‘, a nurse practitioner or clin13 ical nurse specialist who is working in collabo14 ration with a physician in accordance with 

15 State law, a certified nurse-midwife (as defined 

16 in section 1861(gg)) as authorized by State law, 

17 or a physician assistant (as defined in section 

18 1861(aa)(5)) under the supervision of a physi19 cian’’ after ‘‘1866(j)’’; and 

20 (B) in subparagraph (C)— 

21 (i) by inserting ‘‘, a nurse practi22 tioner, a clinical nurse specialist, a cer23 tified nurse-midwife, or a physician assist24 ant (as the case may be)’’ after ‘‘physi25 cian’’ the first 2 times it appears; and 


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1 (ii) by striking ‘‘, and, in the case of 

2 a certification made by a physician’’ and 

3 all that follows through ‘‘face-to-face en4 counter’’ and inserting ‘‘, and, in the case 

5 of a certification made by a physician after 

6 January 1, 2010, or by a nurse practi7 tioner, clinical nurse specialist, certified 

8 nurse-midwife, or physician assistant (as 

9 the case may be) after January 1, 2012, 

10 prior to making such certification the phy11 sician, nurse practitioner, clinical nurse 

12 specialist, certified nurse-midwife, or physi13 cian assistant must document that the 

14 physician, nurse practitioner, clinical nurse 

15 specialist, certified nurse-midwife, or physi16 cian assistant has had a face-to-face en17 counter’’; 

18 (2) in the second sentence, by inserting ‘‘cer19 tified nurse-midwife,’’ after ‘‘clinical nurse spe20 cialist,’’; 

21 (3) in the third sentence— 

22 (A) by striking ‘‘physician certification’’ 

23 and inserting ‘‘certification’’; 

24 (B) by inserting ‘‘(or on January 1, 2012, 

25 in the case of regulations to implement the 


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1 amendments made by section 11 of the Rural 

2 Hospital and Provider Equity Act of 2012)’’ 

3 after ‘‘1981’’; and 

4 (C) by striking ‘‘a physician who’’ and in5 serting ‘‘a physician, nurse practitioner, clinical 

6 nurse specialist, certified nurse-midwife, or phy7 sician assistant who’’; and 

8 (4) in the fourth sentence, by inserting ‘‘, nurse 

9 practitioner, clinical nurse specialist, certified nurse10 midwife, or physician assistant’’ after ‘‘physician’’. 

11 (b) PART B PROVISIONS.—Section 1835(a) of the So12 cial Security Act (42 U.S.C. 1395n(a)) is amended— 

13 (1) in paragraph (2)— 

14 (A) in the matter preceding subparagraph 

15 (A), by inserting ‘‘, a nurse practitioner or clin16 ical nurse specialist (as those terms are defined 

17 in section 1861(aa)(5)) who is working in col18 laboration with a physician in accordance with 

19 State law, a certified nurse-midwife (as defined 

20 in section 1861(gg)) as authorized by State law, 

21 or a physician assistant (as defined in section 

22 1861(aa)(5)) under the supervision of a physi23 cian’’ after ‘‘1866(j)’’; and 

24 (B) in subparagraph (A)— 


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1 (i) in each of clauses (ii) and (iii) of 

2 subparagraph (A) by inserting ‘‘, a nurse 

3 practitioner, a clinical nurse specialist, a 

4 certified nurse-midwife, or a physician as5 sistant (as the case may be)’’ after ‘‘physi6 cian’’; and 

7 (ii) in clause (iv), by striking ‘‘after 

8 January 1, 2010’’ and all that follows 

9 through ‘‘face-to-face encounter’’ and in10 serting ‘‘made by a physician after Janu11 ary 1, 2010, or by a nurse practitioner, 

12 clinical nurse specialist, certified nurse13 midwife, or physician assistant (as the case 

14 may be) after January 1, 2012, prior to 

15 making such certification the physician, 

16 nurse practitioner, clinical nurse specialist, 

17 certified nurse-midwife, or physician assist18 ant must document that the physician, 

19 nurse practitioner, clinical nurse specialist, 

20 certified nurse-midwife, or physician assist21 ant has had a face-to-face encounter’’; 

22 (2) in the third sentence, by inserting ‘‘, nurse 

23 practitioner, clinical nurse specialist, certified nurse24 midwife, or physician assistant (as the case may 

25 be)’’ after ‘‘physician’’; 


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1 (3) in the fourth sentence— 

2 (A) by striking ‘‘physician certification’’ 

3 and inserting ‘‘certification’’; 

4 (B) by inserting ‘‘(or on January 1, 2012, 

5 in the case of regulations to implement the 

6 amendments made by section 11 of the Rural 

7 Hospital and Provider Equity Act of 2012)’’ 

8 after ‘‘1981’’; and 

9 (C) by striking ‘‘a physician who’’ and in10 serting ‘‘a physician, nurse practitioner, clinical 

11 nurse specialist, certified nurse-midwife, or phy12 sician assistant who’’; and 

13 (4) in the fifth sentence, by inserting ‘‘, nurse 

14 practitioner, clinical nurse specialist, certified nurse15 midwife, or physician assistant’’ after ‘‘physician’’. 

16 (c) DEFINITION PROVISIONS.— 

17 (1) HOME HEALTH SERVICES.—Section 

18 1861(m) of the Social Security Act (42 U.S.C. 

19 1395x(m)) is amended— 

20 (A) in the matter preceding paragraph 

21 (1)— 

22 (i) by inserting ‘‘, a nurse practitioner 

23 or a clinical nurse specialist (as those 

24 terms are defined in subsection (aa)(5)), a 

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1 tion 1861(gg)), or a physician assistant (as 

2 defined in subsection (aa)(5))’’ after ‘‘phy3 sician’’ the first place it appears; and 

4 (ii) by inserting ‘‘, a nurse practi5 tioner, a clinical nurse specialist, a cer6 tified nurse-midwife, or a physician assist7 ant’’ after ‘‘physician’’ the second place it 

8 appears; and 

9 (B) in paragraph (3), by inserting ‘‘, a 

10 nurse practitioner, a clinical nurse specialist, a 

11 certified nurse-midwife, or a physician assist12 ant’’ after ‘‘physician’’. 

13 (2) HOME HEALTH AGENCY.—Section 

14 1861(o)(2) of the Social Security Act (42 U.S.C. 

15 1395x(o)(2)) is amended— 

16 (A) by inserting ‘‘, nurse practitioners or 

17 clinical nurse specialists (as those terms are de18 fined in subsection (aa)(5)), certified nurse-mid19 wives (as defined in section 1861(gg)), or physi20 cian assistants (as defined in subsection 

21 (aa)(5))’’ after ‘‘physicians’’; and 

22 (B) by inserting ‘‘, nurse practitioner, clin23 ical nurse specialist, certified nurse-midwife, 

24 physician assistant,’’ after ‘‘physician’’. 


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1 (d) HOME HEALTH PROSPECTIVE PAYMENT SYSTEM

2 PROVISIONS.—Section 1895 of the Social Security Act (42 

3 U.S.C. 1395fff) is amended— 

4 (1) in subsection (c)(1), by inserting ‘‘, the 

5 nurse practitioner or clinical nurse specialist (as 

6 those terms are defined in section 1861(aa)(5)), the 

7 certified nurse-midwife (as defined in section 

8 1861(gg)), or the physician assistant (as defined in 

9 section 1861(aa)(5)),’’ after ‘‘physician’’; and 

10 (2) in subsection (e)— 

11 (A) in paragraph (1)(A), by inserting ‘‘, a 

12 nurse practitioner or clinical nurse specialist (as 

13 those terms are defined in section 1861(aa)(5)), 

14 a certified nurse-midwife (as defined in section 

15 1861(gg)), or a physician assistant (as defined 

16 in section 1861(aa)(5))’’ after ‘‘physician’’; and 

17 (B) in paragraph (2)— 

18 (i) in the heading, by striking ‘‘PHY19 SICIAN CERTIFICATION’’ and inserting 

20 ‘‘RULE OF CONSTRUCTION REGARDING RE21 QUIREMENT FOR CERTIFICATION’’; and 

22 (ii) by striking ‘‘physician’’. 

23 (e) EFFECTIVE DATE.—The amendments made by 

24 this section shall apply to items and services furnished on 

25 or after January 1, 2012. 


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1 SEC. 12. RURAL HEALTH CLINIC IMPROVEMENTS. 

2 Section 1833(f) of the Social Security Act (42 U.S.C. 

3 1395l(f)) is amended— 

4 (1) in paragraph (1), by striking ‘‘, and’’ at the 

5 end and inserting a semicolon; 

6 (2) in paragraph (2)— 

7 (A) by inserting ‘‘(before 2012)’’ after ‘‘in 

8 a subsequent year’’; and 

9 (B) by striking the period at the end and 

10 inserting a semicolon; and 

11 (3) by adding at the end the following new 

12 paragraphs: 

13 ‘‘(3) in 2012, at $101 per visit; and 

14 ‘‘(4) in a subsequent year, at the limit estab15 lished under this subsection for the previous year in16 creased by the percentage increase in the MEI (as 

17 so defined) applicable to primary care services (as so 

18 defined) furnished as of the first day of that year.’’. 

19 SEC. 13. TEMPORARY MEDICARE PAYMENT INCREASE FOR 

20 HOME HEALTH SERVICES FURNISHED IN A 

21 RURAL AREA. 

22 Section 421(a) of the Medicare Prescription Drug, 

23 Improvement, and Modernization Act of 2003 (Public Law 

24 108–173; 117 Stat. 2283), as amended by section 5201(b) 

25 of the Deficit Reduction Act of 2005 (Public Law 109– 

26 171; 120 Stat. 46) and section 3131(c) of the Patient ProVerDate Mar 15 2010 03:14 Feb 02, 2012 Jkt 019200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H3859.IH H3859

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1 tection and Affordable Care Act (Public Law 111–148; 

2 124 Stat. 428), is amended by striking ‘‘2016, 3 percent’’ 

3 and inserting ‘‘2011, and episodes and visits ending on 

4 or after January 1, 2013, and before January 1, 2016, 

5 3 percent’’. 

6 SEC. 14. EXTENSION OF INCREASED MEDICARE PAYMENTS 

7 FOR RURAL GROUND AMBULANCE SERVICES. 

8 (a) IN GENERAL.—Section 1834(l)(13)(A) of the So9 cial Security Act (42 U.S.C. 1395m(l)(13)(A)) is amend10 ed— 

11 (1) in the matter preceding clause (i)— 

12 (A) by striking ‘‘2007, and for’’ and in13 serting ‘‘2007, for’’; and 

14 (B) by inserting ‘‘, and for such services 

15 described in clause (i) furnished on or after 

16 March 1, 2012, and before January 1, 2013’’ 

17 after ‘‘2012’’; and 

18 (2) in clause (i), by inserting ‘‘, or 5 percent if 

19 such service is furnished on or after March 1, 2012, 

20 and before January 1, 2013’’ after ‘‘2012’’. 

21 (b) SUPER RURAL AMBULANCE.—Section 

22 1834(l)(12)(A) of the Social Security Act (42 U.S.C. 

23 1395m(l)(12)(A)) is amended by striking ‘‘March 1, 

24 2012’’ and inserting ‘‘January 1, 2013’’. 


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1 SEC. 15. EXTENSION OF PAYMENT FOR TECHNICAL COMPO2 NENT OF CERTAIN PHYSICIAN PATHOLOGY 

3 SERVICES. 

4 Section 542(c) of the Medicare, Medicaid, and 

5 SCHIP Benefits Improvement and Protection Act of 2000 

6 (as enacted into law by section 1(a)(6) of Public Law 106– 

7 554), as amended by section 732 of the Medicare Prescrip8 tion Drug, Improvement, and Modernization Act of 2003 

9 (42 U.S.C. 1395w–4 note), section 104 of division B of 

10 the Tax Relief and Health Care Act of 2006 (42 U.S.C. 

11 1395w–4 note), section 104 of the Medicare, Medicaid, 

12 and SCHIP Extension Act of 2007 (Public Law 110– 

13 173), section 136 of the Medicare Improvements for Pa14 tients and Providers Act of 2008 (Public Law 110–275), 

15 section 3104 of the Patient Protection and Affordable 

16 Care Act (Public Law 111–148), section 105 of the Medi17 care and Medicaid Extenders Act of 2010 (Public Law 

18 111–309), and section 305 of the Temporary Payroll Tax 

19 Cut Continuation Act of 2011 (Public Law 112–78) is 

20 amended by striking ‘‘the first two months of’’. 

21 SEC. 16. FACILITATING THE PROVISION OF TELEHEALTH 

22 SERVICES ACROSS STATE LINES. 

23 (a) IN GENERAL.—For purposes of expediting the 

24 provision of telehealth services, for which payment is made 

25 under the Medicare program, across State lines, the Sec26 retary of Health and Human Services shall, in consultaVerDate Mar 15 2010 03:14 Feb 02, 2012 Jkt 019200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H3859.IH H3859

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1 tion with representatives of States, physicians, health care 

2 practitioners, and patient advocates, encourage and facili3 tate the adoption of provisions allowing for multistate 

4 practitioner practice across State lines. 

5 (b) DEFINITIONS.—In subsection (a): 

6 (1) TELEHEALTH SERVICE.—The term ‘‘tele7 health service’’ has the meaning given that term in 

8 subparagraph (F) of section 1834(m)(4) of the So9 cial Security Act (42 U.S.C. 1395m(m)(4)). 

10 (2) PHYSICIAN, PRACTITIONER.—The terms 

11 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

12 given those terms in subparagraphs (D) and (E), re13 spectively, of such section. 

14 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

15 program’’ means the program of health insurance 

16 administered by the Secretary of Health and Human 

17 Services under title XVIII of the Social Security Act 

18 (42 U.S.C. 1395 et seq.). 

19 SEC. 17. MEDICARE PART A PAYMENT FOR ANESTHESIOL20 OGIST SERVICES IN CERTAIN RURAL HOS21 PITALS BASED ON CRNA PASS-THROUGH 

22 RULES. 

23 (a) IN GENERAL.—Section 1814 of the Social Secu24 rity Act (42 U.S.C. 1395f) is amended by adding at the 

25 end the following new subsection: 


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1 ‘‘Anesthesiologist Services Provided in Certain Rural 

2 Hospitals 

3 ‘‘(m)(1) Notwithstanding any other provision of this 

4 title, coverage and payment shall be provided under this 

5 part for physicians’ services that are anesthesia services 

6 furnished by a physician who is an anesthesiologist in a 

7 rural hospital described in paragraph (3) in the same 

8 manner as payment is made under the exception provided 

9 in section 9320(k) of the Omnibus Budget Reconciliation 

10 Act of 1986, as added by section 608(c)(2) of the Family 

11 Support Act of 1988 and amended by section 6132 of the 

12 Omnibus Budget Reconciliation Act of 1989, (relating to 

13 payment on a reasonable cost, pass-through basis) for cer14 tified registered nurse anesthetist services furnished by a 

15 certified registered nurse anesthetist in a hospital de16 scribed in such section 9320(k). 

17 ‘‘(2) No payment shall be made under any other pro18 vision of this title for physicians’ services for which pay19 ment is made under this subsection. 

20 ‘‘(3) A rural hospital described in this paragraph is 

21 a hospital described in section 9320(k) of the Omnibus 

22 Budget Reconciliation Act of 1986, as so added and 

23 amended, except that— 

24 ‘‘(A) any reference in such section to a ‘cer25 tified registered nurse anesthetist’ or an ‘anesthetist’ 


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1 is deemed a reference to a ‘physician who is an anes2 thesiologist’ or an ‘anesthesiologist’, respectively; 

3 and 

4 ‘‘(B) any reference to ‘January 1, 1988’ or 

5 ‘1987’ is deemed a reference to such date and year 

6 as the Secretary shall specify.’’. 

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

8 subsection (a) shall apply to services furnished during cost 

9 reporting periods beginning on or after the date of the 

10 enactment of this Act. 

11 SEC. 18. TEMPORARY FLOOR ON THE PRACTICE EXPENSE 

12 GEOGRAPHIC INDEX FOR SERVICES FUR13 NISHED IN RURAL AREAS OUTSIDE OF FRON14 TIER STATES UNDER THE MEDICARE PHYSI15 CIAN FEE SCHEDULE. 

16 Section 1848(e)(1) of the Social Security Act (42 

17 U.S.C. 1395w–4(e)(1)) is amended— 

18 (1) in subparagraph (A), by striking ‘‘and (I)’’ 

19 and inserting ‘‘(I), and (J)’’; and 

20 (2) by adding at the end the following new sub21 paragraph: 

22 ‘‘(J) FLOOR AT 1.0 ON PRACTICE EXPENSE

23 GEOGRAPHIC INDEX FOR SERVICES FURNISHED

24 IN RURAL AREAS OUTSIDE OF FRONTIER

25 STATES.—For purposes of payment for services 


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1 furnished in a rural area (other than a rural 

2 area located in a State to which subparagraph 

3 (I) applies) on or after January 1, 2012, and 

4 before January 1, 2013, after calculating the 

5 practice expense index under subparagraph 

6 (A)(i), the Secretary shall increase any such 

7 index to 1.0 if such index would otherwise be 

8 less than 1.0. The preceding sentence shall not 

9 be applied in a budget neutral manner.’’. 

10 SEC. 19. REVISIONS TO STANDARD FOR DESIGNATION OF 

11 SOLE COMMUNITY HOSPITALS. 

12 Section 1886(d)(5)(D)(iv) of the Social Security Act 

13 (42 U.S.C. 1395ww(d)(5)(D)(iv)) is amended by adding 

14 at the end the following new sentence: ‘‘Under such stand15 ard, the time required for an individual to travel to the 

16 nearest alternative source of care shall be measured over 

17 improved roads maintained by a local, State, or Federal 

18 Government entity for use by the general public which is 

19 the most expeditious and accessible route as designated 

20 by law enforcement for emergency vehicle travel.’’. 

21 SEC. 20. STATE OFFICES OF RURAL HEALTH. 

22 Section 338J(j)(1) of the Public Health Service Act 

23 (42 U.S.C. 254r(j)(1)) is amended by inserting ‘‘and 2012 

24 through 2013’’ before the period. 


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1 SEC. 21. ENSURING PROPORTIONAL REPRESENTATION OF 

2 INTERESTS OF RURAL AREAS ON MEDPAC. 

3 (a) IN GENERAL.—Section 1805(c)(2) of the Social 

4 Security Act (42 U.S.C. 1395b–6(c)(2)) is amended— 

5 (1) in subparagraph (A), by inserting ‘‘(con6 sistent with the requirements of subparagraph (E))’’ 

7 after ‘‘rural representatives’’; and 

8 (2) by adding at the end the following new sub9 paragraph: 

10 ‘‘(E) PROPORTIONAL REPRESENTATION OF

11 INTERESTS OF RURAL AREAS.—In order to pro12 vide a balance between urban and rural rep13 resentatives under subparagraph (A), the pro14 portion of members who represent the interests 

15 of health care providers and Medicare bene16 ficiaries located in rural areas shall be no less 

17 than the proportion of the total number of 

18 Medicare beneficiaries who reside in rural 

19 areas.’’. 

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

21 subsection (a) shall apply to appointments made to the 

22 Medicare Payment Advisory Commission after the date of 

23 the enactment of this Act. 

Æ 


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