I

103D CONGRESS

1ST SESSION H. R. 3078

To amend title XVIII of the Social Security Act to permit certain rural

hospitals under the medicare program to serve as rural emergency access

care facilities under the program.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 14, 1993

Mr. THOMAS of Wyoming (for himself, Mr. GUNDERSON, Mr. ROBERTS, Mr.

STENHOLM, Mrs. MINK, Mr. STRICKLAND, Mr. ENGLISH of Oklahoma,

Mr. GRANDY, and Mr. BEREUTER) introduced the following bill; which

was referred jointly to the Committees on Ways and Means and Energy

and Commerce

A BILL

To amend title XVIII of the Social Security Act to permit

certain rural hospitals under the medicare program to

serve as rural emergency access care facilities under the

program.

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.

4 This Act may be cited as the ‘‘Rural Emergency Care

5 Access Hospital Act of 1993’’.

6 SEC. 2. FINDINGS.

7 Congress finds the following:
2

•HR 3078 IH

1 (1) Each citizen of the United States will need

2 emergency medical care an average of 2 times in a

3 lifetime.

4 (2) Comprehensive emergency medical service

5 systems are essential to the health care delivery sys6 tem.

7 (3) Individuals residing in rural areas face an

8 additional challenge because they tend to have more

9 serious injuries.

10 (4) Emergency medical care is more difficult to

11 deliver in rural areas.

12 (5) Individuals involved in accidents in rural

13 areas are 3 times more likely to sustain serious or

14 untreatable injuries than individuals involved in acci15 dents in urban areas.

16 (6) Small rural hospitals continue to face finan17 cial difficulties and are often forced to close.

18 (7) Residents of rural areas must be provided

19 some assurance that their critical emergency care

20 needs will be met.

21 SEC. 3. RURAL EMERGENCY ACCESS CARE HOSPITALS DE22 SCRIBED.

23 Section 1861 of the Social Security Act (42 U.S.C.

24 1395x) is amended by adding at the end the following new

25 subsection:
3

•HR 3078 IH

1 ‘‘Rural Emergency Access Care Hospital; Rural

2 Emergency Access Care Hospital Services

3 ‘‘(oo)(1) The term ‘rural emergency access care hos4 pital’ means, for a fiscal year, a facility with respect to

5 which the Secretary finds the following:

6 ‘‘(A) The facility is located in a rural area (as

7 defined in section 1886(d)(2)(D)).

8 ‘‘(B) The facility was a hospital under this title

9 at any time during the 5-year period that ends on

10 the date of the enactment of this subsection.

11 ‘‘(C) The facility is in danger of closing due to

12 low inpatient utilization rates and negative operating

13 losses, and the closure of the facility would limit the

14 access of individuals residing in the facility’s service

15 area to emergency services.

16 ‘‘(D) The facility has entered into (or plans to

17 enter into) an agreement with a hospital with a par18 ticipation agreement in effect under section 1866(a),

19 and under such agreement the hospital shall accept

20 patients transferred to the hospital from the facility

21 and receive data from and transmit data to the facil22 ity.

23 ‘‘(E) There is a practitioner who is qualified to

24 provide advanced cardiac life support services (as de-
4

•HR 3078 IH

1 termined by the State in which the facility is lo2 cated) on-site at the facility on a 24-hour basis.

3 ‘‘(F) A physician is available on-call to provide

4 emergency medical services on a 24-hour basis.

5 ‘‘(G) The facility meets such staffing require6 ments as would apply under section 1861(e) to a

7 hospital located in a rural area, except that—

8 ‘‘(i) the facility need not meet hospital

9 standards relating to the number of hours dur10 ing a day, or days during a week, in which the

11 facility must be open, except insofar as the fa12 cility is required to provide emergency care on

13 a 24-hour basis under subparagraphs (E) and

14 (F); and

15 ‘‘(ii) the facility may provide any services

16 otherwise required to be provided by a full-time,

17 on-site dietician, pharmacist, laboratory techni18 cian, medical technologist, or radiological tech19 nologist on a part-time, off-site basis.

20 ‘‘(H) The facility meets the requirements appli21 cable to clinics and facilities under subparagraphs

22 (C) through (J) of paragraph (2) of section

23 1861(aa) and of clauses (ii) and (iv) of the second

24 sentence of such paragraph (or, in the case of the

25 requirements of subparagraph (E), (F), or (J) of
5

•HR 3078 IH

1 such paragraph, would meet the requirements if any

2 reference in such subparagraph to a ‘nurse practi3 tioner’ or to ‘nurse practitioners’ was deemed to be

4 a reference to a ‘nurse practitioner or nurse’ or to

5 ‘nurse practitioners or nurses’), except that in deter6 mining whether a facility meets the requirements of

7 this subparagraph, subparagraphs (E) and (F) of

8 that paragraph shall be applied as if any reference

9 to a ‘physician’ is a reference to a physician as de10 fined in section 1861(r)(1).

11 ‘‘(2) The term ‘rural emergency access care hospital

12 services’ means medical and other health services fur13 nished by a rural emergency access care hospital.’’.

14 SEC. 4. COVERAGE OF AND PAYMENT FOR SERVICES.

15 (a) COVERAGE UNDER PART B.—Section 1832(a)(2)

16 of the Social Security Act (42 U.S.C. 1395k(a)(2)) is

17 amended—

18 (1) by striking ‘‘and’’ at the end of subpara19 graph (I);

20 (2) by striking the period at the end of sub21 paragraph (J) and inserting ‘‘; and’’; and

22 (3) by adding at the end the following new sub23 paragraph:

24 ‘‘(K) rural emergency access care hospital

25 services (as defined in section 1861(oo)(2)).’’.
6

•HR 3078 IH

1 (b) PAYMENT BASED ON PAYMENT FOR OUTPATIENT

2 RURAL PRIMARY CARE HOSPITAL SERVICES.—

3 (1) IN GENERAL.—Section 1833(a)(6) of the

4 Social Security Act (42 U.S.C. 1395l(a)(6)) is

5 amended by striking ‘‘services,’’ and inserting ‘‘serv6 ices and rural emergency access care hospital serv7 ices,’’.

8 (2) PAYMENT METHODOLOGY DESCRIBED.—

9 Section 1834(g) of such Act (42 U.S.C. 1395m(g))

10 is amended—

11 (A) in the heading, by striking ‘‘SERV12 ICES’’ and inserting ‘‘SERVICES AND RURAL

13 EMERGENCY ACCESS CARE HOSPITAL SERV14 ICES’’; and

15 (B) in paragraph (1), by striking ‘‘during

16 a year before 1993’’ and inserting ‘‘during a

17 year before the prospective payment system de18 scribed in paragraph (2) is in effect’’;

19 (C) in paragraph (1), by adding at the end

20 the following:

21 ‘‘The amount of payment shall be determined under

22 either method without regard to the amount of the

23 customary or other charge.’’;
7

•HR 3078 IH

1 (D) in paragraph (2), by striking ‘‘Janu2 ary 1, 1993,’’ and inserting ‘‘January 1,

3 1996,’’; and

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

5 paragraph:

6 ‘‘(3) APPLICATION OF METHODS TO PAYMENT

7 FOR RURAL EMERGENCY ACCESS CARE HOSPITAL

8 SERVICES.—The amount of payment for rural emer9 gency access care hospital services provided during

10 a year shall be determined using the applicable

11 method provided under this subsection for determin12 ing payment for outpatient rural primary care hos13 pital services during the year.’’.

14 SEC. 5. EFFECTIVE DATE.

15 The amendments made by sections 3 and 4 shall

16 apply to fiscal years beginning on or after October 1,

17 1993.

Æ