II 

111TH CONGRESS 

1ST SESSION S. 1585 

To permit pass-through payment for reasonable costs of certified registered 

nurse anesthetist services in critical access hospitals notwithstanding 

the reclassification of such hospitals as urban hospitals, including hospitals located in ‘‘Lugar counties’’, and for on-call and standby costs 

for such services. 

IN THE SENATE OF THE UNITED STATES 

AUGUST 5, 2009 

Mr. DURBIN introduced the following bill; which was read twice and referred 

to the Committee on Finance 

A BILL 

To permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such 

hospitals as urban hospitals, including hospitals located 

in ‘‘Lugar counties’’, and for on-call and standby costs 

for such services. 

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

3 SECTION 1. MEDICARE PASS-THROUGH PAYMENTS FOR 

4 CRNA SERVICES. 

5 (a) TREATMENT OF CRITICAL ACCESS HOSPITALS AS

6 RURAL IN DETERMINING ELIGIBILITY FOR CRNA PASSVerDate Nov 24 2008 02:42 Aug 06, 2009 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1585.IS S1585

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•S 1585 IS

1 THROUGH PAYMENTS.—Section 9320(k) of the Omnibus 

2 Budget Reconciliation Act of 1986 (42 U.S.C. 1395k 

3 note), as added by section 608(c)(2) of the Family Sup4 port Act of 1988 and amended by section 6132 of the Om5 nibus Budget Reconciliation Act of 1989, is amended by 

6 adding at the end the following: 

7 ‘‘(3) Any facility that qualifies as a critical ac8 cess hospital (as defined in section 1861(mm)(1) of 

9 the Social Security Act) shall be treated as being lo10 cated in a rural area for purposes of paragraph (1) 

11 regardless of any geographic reclassification of the 

12 facility, including such a reclassification of the coun13 ty in which the facility is located as an urban county 

14 (also popularly known as a Lugar county) under sec15 tion 1886(d)(8)(B) of the Social Security Act (42 

16 U.S.C. 1395ww(d)(8)(B)).’’. 

17 (b) TREATMENT OF STANDBY AND ON-CALL

18 COSTS.—Such section 9320(k), as amended by subsection 

19 (a), is further amended by adding at the end the following: 

20 ‘‘(4) In determining the reasonable costs in21 curred by a hospital or critical access hospital for 

22 the services of a certified registered nurse anes23 thetist under this subsection, the Secretary shall in24 clude standby costs and on-call costs incurred by the 


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•S 1585 IS

1 hospital or critical access hospital, respectively, with 

2 respect to such nurse anesthetist.’’. 

3 (c) EFFECTIVE DATES.— 

4 (1) TREATMENT OF CAHS AS RURAL IN DETER5 MINING CRNA PASS-THROUGH ELIGIBILITY.—The 

6 amendment made by subsection (a) shall apply to 

7 calendar years beginning on or after the date of the 

8 enactment of this Act (regardless of whether the ge9 ographic reclassification of a critical access hospital 

10 occurred before, on, or after such date). 

11 (2) INCLUSION OF STANDBY COSTS AND ON12 CALL COSTS IN DETERMINING REASONABLE COSTS

13 OF CRNA SERVICES.—The amendment made by sub14 section (b) shall apply to costs incurred in cost re15 porting periods beginning in fiscal years after fiscal 

16 year 2003. 

Æ 


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