I 

111TH CONGRESS 

1ST SESSION H. R. 2204 

To amend title XVIII of the Social Security Act to provide payment under 

part A of the Medicare Program on a reasonable cost basis for anesthesia 

services furnished by an anesthesiologist in certain rural hospitals in 

the same manner as payments are provided for anesthesia services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 30, 2009 

Mr. CUELLAR (for himself and Mr. AKIN) introduced the following bill; which 

was referred to the Committee on Ways and Means 

A BILL 

To amend title XVIII of the Social Security Act to provide 

payment under part A of the Medicare Program on a 

reasonable cost basis for anesthesia services furnished 

by an anesthesiologist in certain rural hospitals in the 

same manner as payments are provided for anesthesia 

services furnished by anesthesiologist assistants and certified registered nurse anesthetists in such hospitals. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Medicare Access to 

3 Rural Anesthesiology Act of 2009’’. 

4 SEC. 2. FINDINGS. 

5 Congress finds the following: 

6 (1) There is an acknowledged shortage of anes7 thesia professionals in rural hospitals. Research indi8 cates that surgeons in many rural hospitals are per9 forming and would like to perform more complex 

10 surgeries that could be made safer and more prac11 tical if anesthesia services were provided by an anes12 thesiologist. 

13 (2) As medical doctors and doctors of osteop14 athy, anesthesiologists are excluded from competing 

15 to assure the availability of anesthesia services in 

16 certain rural areas because only anesthesiologist as17 sistants and certified registered nurse anesthetists 

18 are eligible for special pass-through payments under 

19 part A of the Medicare program for anesthesia serv20 ices furnished in certain rural hospitals. 

21 (3) The Centers for Medicare & Medicaid Serv22 ices has stated that a statutory change is necessary 

23 to allow anesthesiologists to receive payment under 

24 part A of the Medicare program on a reasonable cost 

25 basis for anesthesia services provided. 


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1 SEC. 3. MEDICARE PART A PAYMENT FOR ANESTHESIOL2 OGIST SERVICES IN CERTAIN RURAL HOS3 PITALS BASED ON CRNA PASS-THROUGH 

4 RULES. 

5 (a) IN GENERAL.—Section 1814 of the Social Secu6 rity Act (42 U.S.C. 1395f) is amended by adding at the 

7 end the following new subsection: 

8 ‘‘Anesthesiologist Services Provided in Certain Rural 

9 Hospitals 

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

11 title, coverage and payment shall be provided under this 

12 part for physicians’ services that are anesthesia services 

13 furnished by a physician who is an anesthesiologist in a 

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

15 manner as payment is made under the exception provided 

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

17 Act of 1986, as amended by section 6132 of the Omnibus 

18 Budget Reconciliation Act of 1989 (42 U.S.C. 1395k 

19 note) (relating to payment on a reasonable cost, pass20 through basis), for certified registered nurse anesthetist 

21 services furnished by a certified registered nurse anes22 thetist in a hospital described in such section. 

23 ‘‘(2) No payment shall be made under any 

24 other provision of this title for physicians’ services 

25 for which payment is made under this subsection. 


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1 ‘‘(3) A rural hospital described in this para2 graph is a hospital described in section 9320(k) of 

3 the Omnibus Budget Reconciliation Act of 1986, as 

4 so amended (42 U.S.C. 1395k note), except that— 

5 ‘‘(A) any reference in such section to a 

6 ‘certified registered nurse anesthetist’ or ‘anes7 thetist’ is deemed a reference to a ‘physician 

8 who is an anesthesiologist’ or ‘anesthesiologist’, 

9 respectively; and 

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

11 ‘1987’ is deemed a reference to such date and 

12 year as the Secretary shall specify.’’. 

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

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

15 reporting periods beginning on or after the date of the 

16 enactment of this Act. 

Æ 


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