II

104TH CONGRESS

1ST SESSION S. 963

To amend the medicare program under title XVIII of the Social Security

Act to improve rural health services, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 23 (legislative day, JUNE 19), 1995

Mr. BAUCUS (for himself, Mr. GRASSLEY, and Mr. ROCKEFELLER) introduced

the following bill; which was read twice and referred to the Committee

on Finance

A BILL

To amend the medicare program under title XVIII of the

Social Security Act to improve rural health services, 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.

4 This Act may be cited as the ‘‘Rural Health Improve5 ment Act of 1995’’.

6 SEC. 2. MEDICARE RURAL HOSPITAL FLEXIBILITY PRO7 GRAM.

8 (a) FINDINGS AND PURPOSE.—
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1 (1) FINDINGS.—The Congress finds the follow2 ing:

3 (A) One-quarter of the United States pop4 ulation, or about 65 million persons, reside in

5 rural areas. Rural areas have a larger propor6 tion of elderly residents. Rural populations have

7 a higher infant mortality rate, and a 40 percent

8 higher rate of death from accidents.

9 (B) Rural hospitals are forced to comply

10 with burdensome and inflexible medicare re11 quirements that do not fit the realities of the

12 rural environment.

13 (C) Rural hospitals are inadequately reim14 bursed by the medicare program.

15 (D) Inadequate medicare reimbursement

16 and burdensome and inflexible requirements

17 contribute to the high closure rate among rural

18 hospitals, resulting in reduced access to primary

19 care and emergency services for millions of

20 rural residents.

21 (E) Medical assistance facilities have been

22 operating in Montana since 1990 and rural pri23 mary care hospitals have been operating since

24 1993. Both programs help rural hospitals adapt
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1 to the changing health care needs of the local

2 community.

3 (F) The Inspector General of the Depart4 ment of Health and Human Services has found

5 that medical assistance facilities—

6 (i) provide access to health care in re7 mote rural areas; and

8 (ii) are cost efficient.

9 (G) The Inspector General of the Depart10 ment of Health and Human Services found that

11 flexible medicare requirements are key to the

12 success of medical assistance facilities.

13 (H) Twenty-one states applied to the Es14 sential Access Hospital (EACH) program au15 thorized in the Omnibus Budget Reconciliation

16 Act of 1989. Seven states, West Virginia, Cali17 fornia, Colorado, Kansas, New York, North

18 Carolina, and South Dakota were awarded

19 grants. Eleven hospitals have been designated

20 rural primary care hospitals since final Federal

21 regulations became effective in 1993.

22 (I) Medical assistance facilities and rural

23 primary care hospitals promote the development

24 of rural health care networks and result in in-
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1 creased access for rural residents to a variety of

2 health care services.

3 (2) PURPOSE.—The purpose of this section is

4 to establish the medicare rural hospital flexibility

5 program and to allow all States to develop critical

6 access hospitals.

7 (b) MEDICARE RURAL HOSPITAL FLEXIBILITY PRO8 GRAM.—Section 1820 of the Social Security Act (42

9 U.S.C. 1395i–4) is amended to read as follows:

10 ‘‘MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM

11 ‘‘SEC. 1820. (a) PURPOSE.—The purpose of this sec12 tion is to—

13 ‘‘(1) ensure access to health care services for

14 rural communities by allowing hospitals to be des15 ignated as critical access hospitals if such hospitals

16 limit the scope of available inpatient acute care serv17 ices;

18 ‘‘(2) provide more appropriate and flexible

19 staffing and licensure standards;

20 ‘‘(3) enhance the financial security of critical

21 access hospitals by requiring that medicare reim22 burse such facilities on a reasonable cost basis; and

23 ‘‘(4) promote linkages between critical access

24 hospitals designated by the State under this section

25 and broader programs supporting the development

26 of and transition to integrated provider networks.
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1 ‘‘(b) ESTABLISHMENT.—Any State that submits an

2 application in accordance with subsection (c) may estab3 lish a medicare rural hospital flexibility program described

4 in subsection (d).

5 ‘‘(c) APPLICATION.—A State may establish a medi6 care rural hospital flexibility program described in sub7 section (d) if the State submits to the Secretary at such

8 time and in such form as the Secretary may require an

9 application containing—

10 ‘‘(1) assurances that the State—

11 ‘‘(A) has developed, or is in the process of

12 developing, a State rural health care plan

13 that—

14 ‘‘(i) provides for the creation of one or

15 more rural health networks (as defined in

16 subsection (e)) in the State,

17 ‘‘(ii) promotes regionalization of rural

18 health services in the State, and

19 ‘‘(iii) improves access to hospital and

20 other health services for rural residents of

21 the State;

22 ‘‘(B) has developed the rural health care

23 plan described in subparagraph (A) in consulta24 tion with the hospital association of the State,

25 rural hospitals located in the State, and the
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1 State Office of Rural Health (or, in the case of

2 a State in the process of developing such plan,

3 that assures the Secretary that the State will

4 consult with its State hospital association, rural

5 hospitals located in the State, and the State Of6 fice of Rural Health in developing such plan);

7 ‘‘(2) assurances that the State has designated

8 (consistent with the rural health care plan described

9 in paragraph (1)(A)), or is in the process of so des10 ignating, rural nonprofit or public hospitals or facili11 ties located in the State as critical access hospitals;

12 and

13 ‘‘(3) such other information and assurances as

14 the Secretary may require.

15 ‘‘(d) MEDICARE RURAL HOSPITAL FLEXIBILITY

16 PROGRAM DESCRIBED.—

17 ‘‘(1) IN GENERAL.—A State that has submitted

18 an application in accordance with subsection (c),

19 may establish a medicare rural hospital flexibility

20 program that provides that—

21 ‘‘(A) the State shall develop at least one

22 rural health network (as defined in subsection

23 (e)) in the State; and
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1 ‘‘(B) at least one facility in the State shall

2 be designated as a critical access hospital in ac3 cordance with paragraph (2).

4 ‘‘(2) STATE DESIGNATION OF FACILITIES.—

5 ‘‘(A) IN GENERAL.—A State may des6 ignate one or more facilities as a critical access

7 hospital in accordance with subparagraph (B).

8 ‘‘(B) CRITERIA FOR DESIGNATION AS CRIT9 ICAL ACCESS HOSPITAL.—A State may des10 ignate a facility as a critical access hospital if

11 the facility—

12 ‘‘(i) is located in a county (or equiva13 lent unit of local government) in a rural

14 area (as defined in section 1886(d)(2)(D))

15 that—

16 ‘‘(I) is located more than a 35-

17 mile drive from a hospital, or another

18 facility described in this subsection, or

19 ‘‘(II) is certified by the State as

20 being a necessary provider of health

21 care services to residents in the area;

22 and

23 ‘‘(ii) makes available 24-hour emer24 gency care services that a State determines

25 are necessary for ensuring access to emer-
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1 gency care services in each area served by

2 a critical access hospital;

3 ‘‘(iii) provides not more than 15 acute

4 care inpatient beds (meeting such stand5 ards as the Secretary may establish) for

6 providing inpatient care for a period not to

7 exceed 96 hours (unless a longer period is

8 required because transfer to a hospital is

9 precluded because of inclement weather or

10 other emergency conditions), except that a

11 peer review organization or equivalent en12 tity may, on request, waive the 96-hour re13 striction on a case-by-case basis;

14 ‘‘(iv) meets such staffing requirements

15 as would apply under section 1861(e) to a

16 hospital located in a rural area, except

17 that—

18 ‘‘(I) the facility need not meet

19 hospital standards relating to the

20 number of hours during a day, or

21 days during a week, in which the fa22 cility must be open and fully staffed,

23 except insofar as the facility is re24 quired to make available emergency

25 care services as determined under
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1 clause (ii) and must have nursing

2 services available on a 24-hour basis,

3 but need not otherwise staff the facil4 ity except when an inpatient is

5 present,

6 ‘‘(II) the facility may provide any

7 services otherwise required to be pro8 vided by a full-time, on site dietician,

9 pharmacist, laboratory technician,

10 medical technologist, and radiological

11 technologist on a part-time, off site

12 basis under arrangements as defined

13 in section 1861(w)(1), and

14 ‘‘(III) the inpatient care de15 scribed in clause (iii) may be provided

16 by a physician’s assistant, nurse prac17 titioner, or clinical nurse specialist

18 subject to the oversight of a physician

19 who need not be present in the facil20 ity; and

21 ‘‘(v) meets the requirements of sub22 paragraph (I) of paragraph (2) of section

23 1861(aa).

24 ‘‘(e) RURAL HEALTH NETWORK DEFINED.—
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1 ‘‘(1) IN GENERAL.—For purposes of this sec2 tion, the term ‘rural health network’ means, with re3 spect to a State, an organization consisting of—

4 ‘‘(A) at least 1 facility that the State has

5 designated or plans to designate as a critical

6 access hospital, and

7 ‘‘(B) at least 1 hospital that furnishes

8 acute care services.

9 ‘‘(2) AGREEMENTS.—

10 ‘‘(A) IN GENERAL.—Each critical access

11 hospital that is a member of a rural health net12 work shall have an agreement with respect to

13 each item described in subparagraph (B) with

14 at least 1 hospital that is a member of the net15 work.

16 ‘‘(B) ITEMS DESCRIBED.—The items de17 scribed in this subparagraph are the following:

18 ‘‘(i) Patient referral and transfer.

19 ‘‘(ii) The development and use of com20 munications systems including (where fea21 sible)—

22 ‘‘(I) telemetry systems, and

23 ‘‘(II) systems for electronic shar24 ing of patient data.
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1 ‘‘(iii) The provision of emergency and

2 non-emergency transportation among the

3 facility and the hospital.

4 ‘‘(C) CREDENTIALING AND QUALITY AS5 SURANCE.—Each critical access hospital that is

6 a member of a rural health network shall have

7 an agreement with respect to credentialing and

8 quality assurance with at least 1—

9 ‘‘(i) hospital that is a member of the

10 network;

11 ‘‘(ii) peer review organization or

12 equivalent entity; or

13 ‘‘(iii) other appropriate and qualified

14 entity identified in the State rural health

15 care plan.

16 ‘‘(f) CERTIFICATION BY THE SECRETARY.—The Sec17 retary shall certify a facility as a critical access hospital

18 if the facility—

19 ‘‘(1) is located in a State that has established

20 a medicare rural hospital flexibility program in ac21 cordance with subsection (d);

22 ‘‘(2) is designated as a critical access hospital

23 by the State in which it is located; and

24 ‘‘(3) meets such other criteria as the Secretary

25 may require.
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1 ‘‘(g) PERMITTING MAINTENANCE OF SWING BEDS.—

2 Nothing in this section shall be construed to prohibit a

3 State from designating or the Secretary from certifying

4 a facility as a critical access hospital solely because, at

5 the time the facility applies to the State for designation

6 as a critical access hospital, there is in effect an agreement

7 between the facility and the Secretary under section 1883

8 under which the facility’s inpatient hospital facilities are

9 used for the furnishing of extended care services, except

10 that the number of beds used for the furnishing of such

11 services may not exceed the total number of licensed inpa12 tient beds at the time the facility applies to the State for

13 such designation (minus the number of inpatient beds

14 used for providing inpatient care in the facility pursuant

15 to subsection (d)(2)(A)(iii)). For purposes of the previous

16 sentence, the number of beds of the facility used for the

17 furnishing of extended care services shall not include any

18 beds of a unit of the facility that is licensed as a distinct19 part skilled nursing facility at the time the facility applies

20 to the State for designation as a critical access hospital.

21 ‘‘(h) GRANTS.—

22 ‘‘(1) MEDICARE RURAL HOSPITAL FLEXIBILITY

23 PROGRAM.—The Secretary may award grants to

24 States that have submitted applications in accord25 ance with subsection (c) for—
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1 ‘‘(A) engaging in activities relating to plan2 ning and implementing a rural health care plan;

3 ‘‘(B) engaging in activities relating to

4 planning and implementing rural health net5 works; and

6 ‘‘(C) designating facilities as critical access

7 hospitals.

8 ‘‘(2) RURAL EMERGENCY MEDICAL SERVICES.—

9 ‘‘(A) IN GENERAL.—The Secretary may

10 award grants to States that have submitted ap11 plications in accordance with subparagraph (B)

12 for the establishment or expansion of a pro13 gram for the provision of rural emergency medi14 cal services.

15 ‘‘(B) APPLICATION.—An application is in

16 accordance with this subparagraph if the State

17 submits to the Secretary at such time and in

18 such form as the Secretary may require an ap19 plication containing the assurances described in

20 subparagraphs (A)(ii), (A)(iii), and (B) of sub21 section (c)(1) and paragraph (3) of such sub22 section.

23 ‘‘(i) GRANDFATHERING OF CERTAIN FACILITIES.—

24 ‘‘(1) IN GENERAL.—Any medical assistance fa25 cility operating in Montana and any rural primary
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1 care hospital designated by the Secretary under this

2 section prior to the date of the enactment of the

3 Rural Health Improvement Act of 1995 shall be

4 deemed to have been certified by the Secretary

5 under subsection (f) as a critical access hospital if

6 such facility or hospital is otherwise eligible to be

7 designated by the State as a critical access hospital

8 under subsection (d).

9 ‘‘(2) CONTINUATION OF MEDICAL ASSISTANCE

10 FACILITY AND RURAL PRIMARY CARE HOSPITAL

11 TERMS.—Notwithstanding any other provision of

12 this title, with respect to any medical assistance fa13 cility or rural primary care hospital described in

14 paragraph (1), any reference in this title to a ‘criti15 cal access hospital’ shall be deemed to be a reference

16 to a ‘medical assistance facility’ or ‘rural primary

17 care hospital’.

18 ‘‘(j) WAIVER OF CONFLICTING PART A PROVI19 SIONS.—The Secretary is authorized to waive such provi20 sions of this part and part C as are necessary to conduct

21 the program established under this section.

22 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There

23 are authorized to be appropriated from the Federal Hos24 pital Insurance Trust Fund for making grants to all
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1 States under subsection (h), $25,000,000 in each of the

2 fiscal years 1996 through 2000.’’.

3 (c) REPORT ON ALTERNATIVE TO 96-HOUR RULE.—

4 Not later than January 1, 1996, the Administrator of the

5 Health Care Financing Administration shall submit to the

6 Congress a report on the feasibility of, and administrative

7 requirements necessary to establish an alternative for cer8 tain medical diagnoses (as determined by the Adminis9 trator) to the 96-hour limitation for inpatient care in criti10 cal access hospitals required by section 1820(d)(2)(B)(iii).

11 (d) PART A AMENDMENTS RELATING TO RURAL

12 PRIMARY CARE HOSPITALS AND CRITICAL ACCESS HOS13 PITALS.—

14 (1) DEFINITIONS.—Section 1861(mm) of the

15 Social Security Act (42 U.S.C. 1395x(mm)) is

16 amended to read as follows:

17 ‘‘CRITICAL ACCESS HOSPITAL; CRITICAL ACCESS

18 HOSPITAL SERVICES

19 ‘‘(mm)(1) The term ‘critical access hospital’ means

20 a facility certified by the Secretary as a critical access hos21 pital under section 1820(f).

22 ‘‘(2) The term ‘inpatient critical access hospital serv23 ices’ means items and services, furnished to an inpatient

24 of a critical access hospital by such facility, that would

25 be inpatient hospital services if furnished to an inpatient

26 of a hospital by a hospital.’’.
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1 (2) COVERAGE AND PAYMENT.—(A) Section

2 1812(a)(1) of such Act (42 U.S.C. 1395d(a)(1)) is

3 amended by striking ‘‘or inpatient rural primary

4 care hospital services’’ and inserting ‘‘or inpatient

5 critical access hospital services’’.

6 (B) Section 1814 of such Act (42 U.S.C.

7 1395f) is amended—

8 (i) on subsection (a)(8)—

9 (I) by striking ‘‘rural primary care

10 hospital’’ each place it appears and insert11 ing ‘‘critical access hospital’’; and

12 (II) by striking ‘‘72’’ and inserting

13 ‘‘96’’;

14 (ii) in subsection (b), by striking ‘‘other

15 than a rural primary care hospital providing in16 patient rural primary care hospital services,’’

17 and inserting ‘‘other than a critical access hos18 pital providing inpatient critical access hospital

19 services,’’; and

20 (iii) by amending subsection (l) to read as

21 follows:

22 ‘‘(l) PAYMENT FOR INPATIENT CRITICAL ACCESS

23 HOSPITAL SERVICES.—The amount of payment under

24 this part for inpatient critical access hospital services is
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1 the reasonable costs of the critical access hospital in pro2 viding such services.’’.

3 (3) TREATMENT OF CRITICAL ACCESS HOS4 PITALS AS PROVIDERS OF SERVICES.—(A) Section

5 1861(u) of such Act (42 U.S.C. 1395x(u)) is amend6 ed by striking ‘‘rural primary care hospital’’ and in7 serting ‘‘critical access hospital’’.

8 (B) The first sentence of section 1864(a) of

9 such Act (42 U.S.C. 1395aa(a)) is amended by

10 striking ‘‘a rural primary care hospital’’ and insert11 ing ‘‘a critical access hospital’’.

12 (4) CONFORMING AMENDMENTS.—(A) Section

13 1128A(b)(1) of such Act (42 U.S.C. 1320a–

14 7a(b)(1)) is amended by striking ‘‘rural primary

15 care hospital’’ each place it appears and inserting

16 ‘‘critical access hospital’’.

17 (B) Section 1128B(c) of such Act (42 U.S.C.

18 1320a–7b(c)) is amended by striking ‘‘rural primary

19 care hospital’’ and inserting ‘‘critical access hos20 pital’’.

21 (C) Section 1134 of such Act (42 U.S.C.

22 1320b–4) is amended by striking ‘‘rural primary

23 care hospitals’’ each place it appears and inserting

24 ‘‘critical access hospitals’’.
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1 (D) Section 1138(a)(1) of such Act (42 U.S.C.

2 1320b–8(a)(1)) is amended—

3 (i) in the matter preceding subparagraph

4 (A), by striking ‘‘rural primary care hospital’’

5 and inserting ‘‘critical access hospital’’; and

6 (ii) in the matter preceding clause (i) of

7 subparagraph (A), by striking ‘‘rural primary

8 care hospital’’ and inserting ‘‘critical access

9 hospital’’.

10 (E) Section 1816(c)(2)(C) of such Act (42

11 U.S.C. 1395h(c)(2)(C)) is amended by striking

12 ‘‘rural primary care hospital’’ and inserting ‘‘critical

13 access hospital’’.

14 (F) Section 1833 of such Act (42 U.S.C. 1395l)

15 is amended—

16 (i) in subsection (h)(5)(A)(iii), by striking

17 ‘‘rural primary care hospital’’ and inserting

18 ‘‘critical access hospital’’;

19 (ii) in subsection (i)(1)(A), by striking

20 ‘‘rural primary care hospital’’ and inserting

21 ‘‘critical access hospital’’;

22 (iii) in subsection (i)(3)(A), by striking

23 ‘‘rural primary care hospital services’’ and in24 serting ‘‘critical access hospital services’’;
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1 (iv) in subsection (l)(5)(A), by striking

2 ‘‘rural primary care hospital’’ each place it ap3 pears and inserting ‘‘critical access hospital’’;

4 and

5 (v) in subsection (l)(5)(B), by striking

6 ‘‘rural primary care hospital’’ each place it ap7 pears and inserting ‘‘critical access hospital’’.

8 (G) Section 1835(c) of such Act (42 U.S.C.

9 1395n(c)) is amended by striking ‘‘rural primary

10 care hospital’’ each place it appears and inserting

11 ‘‘critical access hospital’’.

12 (H) Section 1842(b)(6)(A)(ii) of such Act (42

13 U.S.C. 1395u(b)(6)(A)(ii)) is amended by striking

14 ‘‘rural primary care hospital’’ and inserting ‘‘critical

15 access hospital’’.

16 (I) Section 1861 of such Act (42 U.S.C. 1395x)

17 is amended—

18 (i) in the last sentence of subsection (e), by

19 striking ‘‘rural primary care hospital’’ and in20 serting ‘‘critical access hospital’’;

21 (ii) in subsection (v)(1)(S)(ii)(III), by

22 striking ‘‘rural primary care hospital’’ and in23 serting ‘‘critical access hospital’’;
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1 (iii) in subsection (w)(1), by striking

2 ‘‘rural primary care hospital’’ and inserting

3 ‘‘critical access hospital’’; and

4 (iv) in subsection (w)(2), by striking ‘‘rural

5 primary care hospital’’ each place it appears

6 and inserting ‘‘critical access hospital’’.

7 (J) Section 1862(a)(14) of such Act (42 U.S.C.

8 1395y(a)(14)) is amended by striking ‘‘rural pri9 mary care hospital’’ each place it appears and in10 serting ‘‘critical access hospital’’.

11 (K) Section 1866(a)(1) of such Act (42 U.S.C

12 1395cc(a)(1)) is amended—

13 (i) in subparagraph (F)(ii), by striking

14 ‘‘rural primary care hospitals’’ and inserting

15 ‘‘critical access hospitals’’;

16 (ii) in subparagraph (H), in the matter

17 preceding clause (i), by striking ‘‘rural primary

18 care hospitals’’ and ‘‘rural primary care hos19 pital services’’ and inserting ‘‘critical access

20 hospitals’’ and ‘‘critical access hospital serv21 ices’’, respectively;

22 (iii) in subparagraph (I), in the matter

23 preceding clause (i), by striking ‘‘rural primary

24 care hospital’’ and inserting ‘‘critical access

25 hospital’’; and
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1 (iv) in subparagraph (N)—

2 (I) in the matter preceding clause (i),

3 by striking ‘‘rural primary hospitals’’ and

4 inserting ‘‘critical access hospitals’’, and

5 (II) in clause (i), by striking ‘‘rural

6 primary care hospital’’ and inserting ‘‘criti7 cal access hospital’’.

8 (L) Section 1866(a)(3) of such Act (42 U.S.C

9 1395cc(a)(3)) is amended—

10 (i) by striking ‘‘rural primary care hos11 pital’’ each place it appears in subparagraphs

12 (A) and (B) and inserting ‘‘critical access hos13 pital’’; and

14 (ii) in subparagraph (C)(ii)(II), by striking

15 ‘‘rural primary care hospitals’’ each place it ap16 pears and inserting ‘‘critical access hospitals’’.

17 (M) Section 1867(e)(5) of such Act (42 U.S.C.

18 1395dd(e)(5)) is amended by striking ‘‘rural pri19 mary care hospital’’ and inserting ‘‘critical access

20 hospital’’.

21 (e) PAYMENT CONTINUED TO DESIGNATED

22 EACHS.—Section 1886(d)(5)(D) of such Act (42 U.S.C.

23 1395ww(d)(5)(D)) is amended—
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1 (1) in clause (iii)(III), by inserting ‘‘as in effect

2 on September 30, 1995’’ before the period at the

3 end; and

4 (2) in clause (v)—

5 (A) by inserting ‘‘as in effect on September

6 30, 1995’’ after ‘‘1820(i)(1)’’; and

7 (B) by striking ‘‘1820(g)’’ and inserting

8 ‘‘1820(e)’’.

9 (f) PART B AMENDMENTS RELATING TO CRITICAL

10 ACCESS HOSPITALS.—

11 (1) COVERAGE.—(A) Section 1861(mm) of the

12 Social Security Act (42 U.S.C. 1395x(mm)) as

13 amended by subsection (d)(1), is amended by adding

14 at the end the following new paragraph:

15 ‘‘(3) The term ‘outpatient critical access hospital

16 services’ means medical and other health services fur17 nished by a critical access hospital on an outpatient

18 basis.’’.

19 (B) Section 1832(a)(2)(H) of such Act (42

20 U.S.C. 1395k(a)(2)(H)) is amended by striking

21 ‘‘rural primary care hospital services’’ and inserting

22 ‘‘critical access hospital services’’.

23 (2) PAYMENT.—(A) Section 1833(a) of such

24 Act (42 U.S.C. 1395l(a)) is amended in paragraph

25 (6), by striking ‘‘outpatient rural primary care hos-
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1 pital services’’ and inserting ‘‘outpatient critical ac2 cess services’’.

3 (B) Section 1834(g) of such Act (42 U.S.C.

4 1395m(g)) is amended to read as follows:

5 ‘‘(g) PAYMENT FOR OUTPATIENT CRITICAL ACCESS

6 HOSPITAL SERVICES.—The amount of payment under

7 this part for outpatient critical access hospital services is

8 the reasonable costs of the critical access hospital in pro9 viding such services.’’.

10 (g) EFFECTIVE DATE.—The amendments made by

11 this section shall apply to services furnished on or after

12 October 1, 1995.

13 SEC. 3. OFFICE OF RURAL HEALTH POLICY.

14 (a) APPOINTMENT OF ASSISTANT SECRETARY.—

15 (1) IN GENERAL.—Section 711(a) of the Social

16 Security Act (42 U.S.C. 912(a)) is amended—

17 (A) by striking ‘‘by a Director, who shall

18 advise the Secretary’’ and inserting ‘‘by an As19 sistant Secretary for Rural Health (in this sec20 tion referred to as the ‘Assistant Secretary’),

21 who shall report directly to the Secretary’’; and

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

23 sentence: ‘‘The Office shall not be a component

24 of any other office, service, or component of the

25 Department.’’.
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1 (2) CONFORMING AMENDMENTS.—(A) Section

2 711(b) of the Social Security Act (42 U.S.C. 912(b))

3 is amended by striking ‘‘the Director’’ and inserting

4 ‘‘the Assistant Secretary’’.

5 (B) Section 338J(a) of the Public Health Serv6 ice Act (42 U.S.C. 254r(a)) is amended by striking

7 ‘‘Director of the Office of Rural Health Policy’’ and

8 inserting ‘‘Assistant Secretary for Rural Health’’.

9 (C) Section 464T(b) of the Public Health Serv10 ice Act (42 U.S.C. 285p–2(b)) is amended in the

11 matter preceding paragraph (1) by striking ‘‘Direc12 tor of the Office of Rural Health Policy’’ and insert13 ing ‘‘Assistant Secretary for Rural Health’’.

14 (D) Section 6213 of the Omnibus Budget Rec15 onciliation Act of 1989 (42 U.S.C. 1395x note) is

16 amended in subsection (e)(1) by striking ‘‘Director

17 of the Office of Rural Health Policy’’ and inserting

18 ‘‘Assistant Secretary for Rural Health’’.

19 (E) Section 403 of the Ryan White Comprehen20 sive AIDS Resources Emergency Act of 1990 (42

21 U.S.C. 300ff–11 note) is amended in the matter pre22 ceding paragraph (1) of subsection (a) by striking

23 ‘‘Director of the Office of Rural Health Policy’’ and

24 inserting ‘‘Assistant Secretary for Rural Health’’.
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1 (3) AMENDMENT TO THE EXECUTIVE SCHED2 ULE.—Section 5315 of title 5, United States Code,

3 is amended by striking ‘‘Assistant Secretaries of

4 Health and Human Services (6)’’ and inserting ‘‘As5 sistant Secretaries of Health and Human Services

6 (7)’’.

7 (b) EXPANSION OF DUTIES.—Section 711(a) of the

8 Social Security Act (42 U.S.C. 912(a)) is amended by

9 striking ‘‘and access to (and the quality of) health care

10 in rural areas’’ and inserting ‘‘access to, and quality of,

11 health care in rural areas, and reforms to the health care

12 system and the implications of such reforms for rural

13 areas’’.

14 (c) EFFECTIVE DATE.—The amendments made by

15 this section shall take effect on January 1, 1996.

16 SEC. 4. MEDICARE REIMBURSEMENT FOR TELEMEDICINE

17 SERVICES.

18 (a) SENSE OF THE CONGRESS.—It is the sense of the

19 Congress that—

20 (1) the use of telemedicine services can increase

21 access to specialized health care for rural residents;

22 and

23 (2) although telemedicine services are currently

24 being furnished to medicare beneficiaries across the

25 country, providers of telemedicine services do not re-
26

•S 963 IS

1 ceive reimbursement for such services under the

2 medicare program.

3 (b) PURPOSE.—It is the purpose of this section to

4 improve access to specialized health services for rural med5 icare beneficiaries by requiring the medicare program to

6 reimburse providers for furnishing telemedicine services.

7 (c) METHODOLOGY FOR DETERMINING PAYMENT.—

8 Not later than January 1, 1996, the Secretary of Health

9 and Human Services shall develop and submit to the Con10 gress a recommendation on a methodology for determining

11 payments under title XVIII of the Social Security Act for

12 telemedicine services (as defined by the Secretary).

Æ

HR 963 IS——2