II

104TH CONGRESS

1ST SESSION S. 210

To amend title XVIII of the Social Security Act to provide for coverage

under part B of the medicare program of emergency care and related

services furnished by rural emergency access care hospitals.

IN THE SENATE OF THE UNITED STATES

JANUARY 12 (legislative day, JANUARY 10), 1995

Mr. THOMAS (for himself, Mr. LOTT, Mr. SIMPSON, Mr. STEVENS, Mr.

INOUYE, and Mr. BURNS) introduced the following bill; which was read

twice and referred to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to provide

for coverage under part B of the medicare program

of emergency care and related services furnished by rural

emergency access care hospitals.

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 Ac5 cess Care Hospital Act of 1995’’.
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1 SEC. 2. RURAL EMERGENCY ACCESS CARE HOSPITALS DE2 SCRIBED.

3 (a) IN GENERAL.—Section 1861 of the Social Secu4 rity Act (42 U.S.C. 1395x) is amended by adding at the

5 end the following new subsection:

6 ‘‘Rural Emergency Access Care Hospital; Rural

7 Emergency Access Care Hospital Services

8 ‘‘(oo)(1) The term ‘rural emergency access care hos9 pital’ means, for a fiscal year, a facility with respect to

10 which the Secretary finds the following:

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

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

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

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

15 the date of the enactment of this subsection.

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

17 low inpatient utilization rates and negative operating

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

19 access of individuals residing in the facility’s service

20 area to emergency services.

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

22 enter into) an agreement with a hospital with a par23 ticipation agreement in effect under section 1866(a),

24 and under such agreement the hospital shall accept

25 patients transferred to the hospital from the facility
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1 and receive data from and transmit data to the facil2 ity.

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

4 provide advanced cardiac life support services (as de5 termined by the State in which the facility is lo6 cated) on-site at the facility on a 24-hour basis.

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

8 emergency medical services on a 24-hour basis.

9 ‘‘(G) The facility meets such staffing require10 ments as would apply under section 1861(e) to a

11 hospital located in a rural area, except that—

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

13 standards relating to the number of hours dur14 ing a day, or days during a week, in which the

15 facility must be open, except insofar as the fa16 cility is required to provide emergency care on

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

18 (F); and

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

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

21 on-site dietician, pharmacist, laboratory techni22 cian, medical technologist, or radiological tech23 nologist on a part time, off-site basis.

24 ‘‘(H) The facility meets the requirements appli25 cable to clinics and facilities under subparagraphs
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1 (C) through (J) of paragraph (2) of section

2 1861(aa) and of clauses (ii) and (iv) of the second

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

4 requirements of subparagraph (E), (F), or (J) of

5 such paragraph, would meet the requirements if any

6 reference in such subparagraph to a ‘nurse practi7 tioner’ or to ‘nurse practitioners’ was deemed to be

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

9 ‘nurse practitioners or nurses’); except that in deter10 mining whether a facility meets the requirements of

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

12 that paragraph shall be applied as if any reference

13 to a ‘physician’ is a reference to a physician as de14 fined in section 1861(r)(1).

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

16 services’ means the following services provided by a rural

17 emergency access care hospital:

18 ‘‘(A) An appropriate medical screening exam19 ination (as described in section 1867(a)).

20 ‘‘(B) Necessary stabilizing examination and

21 treatment services for an emergency medical condi22 tion and labor (as described in section 1867(b)).’’.

23 (b) REQUIRING RURAL EMERGENCY ACCESS CARE

24 HOSPITALS TO MEET HOSPITAL ANTI-DUMPING RE25 QUIREMENTS.—Section 1867(e)(5) of such Act (42 U.S.C.
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1 1395dd(e)(5)) is amended by striking ‘‘1861(mm)(1))’’

2 and inserting ‘‘1861(mm)(1)) and a rural emergency ac3 cess care hospital (as defined in section 1861(oo)(1))’’.

4 SEC. 3. COVERAGE OF AND PAYMENT FOR SERVICES.

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

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

7 amended—

8 (1) by striking ‘‘and’’ at the end of subpara9 graph (I);

10 (2) by striking the period at the end of sub11 paragraph (J) and inserting ‘‘; and’’; and

12 (3) by adding at the end the following new sub13 paragraph:

14 ‘‘(K) rural emergency access care hospital

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

16 (b) PAYMENT BASED ON PAYMENT FOR OUTPATIENT

17 RURAL PRIMARY CARE HOSPITAL SERVICES.—

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

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

20 amended by striking ‘‘services,’’ and inserting ‘‘serv21 ices and rural emergency access care hospital serv22 ices,’’.

23 (2) PAYMENT METHODOLOGY DESCRIBED.—

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

25 is amended—
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1 (A) in the heading, by striking ‘‘SERV2 ICES’’ and inserting ‘‘SERVICES AND RURAL

3 EMERGENCY ACCESS CARE HOSPITAL SERV4 ICES’’; and

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

6 paragraph:

7 ‘‘(3) APPLICATION OF METHODS TO PAYMENT

8 FOR RURAL EMERGENCY ACCESS CARE HOSPITAL

9 SERVICES.—The amount of payment for rural emer10 gency access care hospital services provided during

11 a year shall be determined using the applicable

12 method provided under this subsection for determin13 ing payment for outpatient rural primary care hos14 pital services during the year.’’.

15 SEC. 4. EFFECTIVE DATE.

16 The amendments made by this Act shall apply to fis17 cal years beginning on or after October 1, 1995.

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