II

106TH CONGRESS

1ST SESSION S. 1757

To amend title XVIII of the Social Security Act to improve access to rural

health care providers.

IN THE SENATE OF THE UNITED STATES

OCTOBER 20, 1999

Mr. COCHRAN 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 improve

access to rural health care providers.

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 Hospital Relief

5 Act of 1999’’.

6 SEC. 2. ELIMINATING UNINTENDED REDUCTION IN CON7 VERSION FACTOR FOR MEDICARE OPD PPS.

8 (a) CALCULATION OF BASE AMOUNTS.—Section

9 1833(t)(3)(A)(ii) of the Social Security Act (42 U.S.C.

10 1395l(t)(3)(A)(ii)) is amended—
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1 (1) by striking ‘‘copayments estimated to be

2 paid under this subsection’’ and inserting ‘‘coinsur3 ance that would be paid under this part’’;and

4 (2) by striking ‘‘1999,’’ and inserting ‘‘1999 if

5 this subsection did not apply and’’.

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

7 subsection (a) shall take effect as if included in the provi8 sion of the Balanced Budget Act of 1997 to which the

9 amendment relates at the time such provision became law.

10 SEC. 3. LIMITING REDUCTIONS IN FEDERAL PAYMENTS

11 UNDER OPD PPS.

12 (a) IN GENERAL.—Section 4523 of the Balanced

13 Budget Act of 1997 is amended by adding at the end the

14 following:

15 ‘‘(e) TEMPORARY LIMIT ON REDUCTIONS IN FED16 ERAL PAYMENTS.—

17 ‘‘(1) IN GENERAL.—Notwithstanding section

18 1833(t) of the Social Security Act (42 U.S.C.

19 1395l(t)), as added by subsection (a), the amount

20 that is paid from the Federal Supplementary Med21 ical Insurance Trust Fund for covered OPD Services

22 furnished by a hospital in a rural area during a cal23 endar year (or portion thereof) specified in para24 graph (2)(A) may not be less than the applicable

25 percentage of the case mix adjusted average amount
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1 that would have been payable to such hospital for

2 such services (including cost-sharing) if the prospec3 tive payment system established under such section

4 did not apply. Such average amount may be deter5 mined on a prospective basis using the Secretary’s

6 best estimate of the reasonable costs incurred in fur7 nishing covered OPD services or on a retrospective

8 basis using cost reports submitted by such a hos9 pital.

10 ‘‘(2) DEFINITIONS.—For purposes of paragraph

11 (1)—

12 ‘‘(A) subject to paragraph (3), the term

13 ‘applicable percentage’ means—

14 ‘‘(i) with respect to covered OPD

15 services furnished during the first full cal16 endar year (and any portion of the imme17 diately preceding calendar year) for which

18 the prospective payment system established

19 under section 1833(t) of such Act is in

20 effect—

21 ‘‘(I) 100 percent for hospitals in

22 rural areas with less than 50 beds;

23 and

24 ‘‘(II) 95 percent for hospitals not

25 described in subclause (I);
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1 ‘‘(ii) with respect to the second full

2 calendar year for which such system is in

3 effect—

4 ‘‘(I) 98 percent for hospitals in

5 rural areas with less than 50 beds;

6 and

7 ‘‘(II) 90 percent for hospitals not

8 described in subclause (I);

9 ‘‘(iii) with respect to the third full cal10 endar year for which such system is in

11 effect—

12 ‘‘(I) 95 percent for hospitals in

13 rural areas with less than 50 beds;

14 and

15 ‘‘(II) 85 percent for hospitals not

16 described in subclause (I); and

17 ‘‘(B) the term ‘covered OPD services’ has

18 the meaning given that term in section

19 1833(t)(1)(B) of such Act.

20 ‘‘(3) APPLICATION TO CERTAIN HOSPITALS.—In

21 the case of hospitals described in section 1833(t)(8)

22 of such Act, the ‘applicable percentage’ for a cal23 endar year (or portion thereof) shall be the same ap24 plicable percentage that applies to covered OPD

25 services furnished by hospitals that are not described
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1 in such section during such calendar year (or portion

2 thereof).

3 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in

4 this subsection shall be construed as affecting the

5 amount of cost-sharing paid by individuals enrolled

6 under part B of title XVIII of the Social Security

7 Act for covered OPD services.’’.

8 (b) CONFORMING AMENDMENT.—Section

9 1833(t)(1)(A) of the Social Security Act (42 U.S.C.

10 1395l(t)(1)(A)) is amended by inserting ‘‘except as pro11 vided in section 4523(e) of the Balanced Budget Act of

12 1997,’’ after ‘‘1999,’’.

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

14 this section shall become effective as if included in the en15 actment of the Balanced Budget Act of 1997.

16 SEC. 4. EXCLUDING CERTAIN AMBULANCE SERVICES FROM

17 SNF PPS.

18 (a) IN GENERAL.—Section 1888(e)(2)(A)(ii) of the

19 Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is

20 amended by inserting ‘‘ambulance and transport services

21 furnished to patients requiring outpatient dialysis serv22 ices,’’ after ‘‘section 1861(s)(2),’’.

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

24 subsection (a) shall apply to services furnished on or after

25 January 1, 2000.
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1 SEC. 5. STANDARDS FOR, AND TREATMENT OF, CRITICAL

2 ACCESS HOSPITALS.

3 (a) IN GENERAL.—

4 (1) LIMITATIONS ON BEDS AND LOS.—Section

5 1820(c)(2)(B)(iii) of the Social Security Act (42

6 U.S.C. 1395i–4(c)(2)(B)(iii)) is amended by striking

7 ‘‘to exceed 96 hours’’ and inserting ‘‘to exceed, on

8 average, 96 hours per patient’’.

9 (2) PAYMENT.—

10 (A) PART A.—Section 1814(l) of the Social

11 Security Act (42 U.S.C. 1395f(l) is amended by

12 adding at the end the following: ‘‘In the case of

13 a critical access hospital that is located in a

14 health professional shortage area, the amount

15 otherwise payable under the preceding sentence

16 shall be increased by 5 percentage points.’’.

17 (B) PART B.—Section 1834(g) of the So18 cial Security Act (42 U.S.C. 1395m(g)) is

19 amended by adding at the end the following:

20 ‘‘In the case of a critical access hospital that is

21 located in a health professional shortage area,

22 the amount otherwise payable under the pre23 ceding sentence shall be increased by 5 percent24 age points.’’.

25 (3) PERMITTING MAINTENANCE OF DISTINCT

26 PART GERIATRIC PSYCHIATRIC UNIT.—Section
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1 1820(f) of the Social Security Act (42 U.S.C.

2 1395i–4(f)) is amended—

3 (A) by inserting ‘‘AND CERTAIN DISTINCT

4 PART UNITS’’ after ‘‘SWING BEDS’’;

5 (B) by inserting ‘‘(1)’’ after ‘‘BEDS.—’’,

6 and

7 (C) by adding at the end the following:

8 ‘‘(2) Nothing in this section shall be construed to pro9 hibit a State from designating or the Secretary from certi10 fying a facility as a critical access hospital solely because

11 the facility maintains a distinct part psychiatric unit for

12 geriatric patients.’’.

13 (b) CRITERIA FOR DESIGNATION.—Section

14 1820(c)(2)(B)(i) of the Social Security Act (42 U.S.C.

15 1395i–4(c)(2)(B)(i)) is amended by striking ‘‘is a’’ and

16 all that follows through ‘‘hospital and’’.

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

18 this section shall apply to services furnished on or after

19 October 1, 1999.

20 SEC. 6. EXCLUSION OF SWING-BED DAYS FROM SNF PPS.

21 (a) EXCLUSION FROM SNF PPS.—Section

22 1888(e)(7) of the Social Security Act (42 U.S.C.

23 1395yy(e)(7)) is amended to read as follows:

24 ‘‘(7) EXCLUSION.—The prospective payment

25 system established under this subsection shall not
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1 apply to services provided by a hospital under an

2 agreement described in section 1883.’’.

3 (b) EFFECTIVE DATE.—The amendments made by

4 this section shall apply to services furnished on or after

5 October 1, 1999.

6 SEC. 7. RESTORATION OF MEDICARE PAYMENTS FOR BAD

7 DEBT.

8 (a) IN GENERAL.—Section 1861(v)(1)(T)(iii) of the

9 Social Security Act (42 U.S.C. 1395x(v)(1)(T)(iii)) is

10 amended by striking ‘‘45’’ and inserting ‘‘10’’.

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

12 subsection (a) shall take effect as if included in the provi13 sion of the Balanced Budget Act of 1997 to which the

14 amendment relates at the time such provision became law.

15 SEC. 8. TEMPORARY EXEMPTION OF RURAL HEALTH CLIN16 ICS FROM PRODUCTIVITY STANDARDS.

17 (a) IN GENERAL.—Section 1833(f) of the Social Se18 curity Act (42 U.S.C. 1395l(f)) is amended—

19 (1) by redesignating paragraphs (1) and (2) as

20 subparagraphs (A) and (B), respectively;

21 (2) by inserting ‘‘(1)’’ after ‘‘(f)’’; and

22 (3) by adding at the end the following:

23 ‘‘(2) The Secretary may not apply productivity guide24 lines in determining the reasonable costs of rural health
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1 clinics for services furnished in calendar year 1998, 1999,

2 2000, or 2001.’’.

3 SEC. 9. INFLATION UPDATES FOR RURAL PROVIDERS.

4 (a) HOSPITALS.—

5 (1) PPS.—Subclauses (XV) and (XVI) of sec6 tion 1886(b)(3)(B)(i) of the Social Security Act (42

7 U.S.C. 1395ww(b)(3)(B)(i)) are each amended by

8 striking ‘‘all areas’’ and inserting ‘‘urban areas, and

9 the market basket percentage increase for hospitals

10 in rural areas’’.

11 (2) PPS-EXEMPT.—Section 1886(b)(3)

12 (B)(ii)(VII) of the Social Security Act (42 U.S.C.

13 1395ww(b)(3)(B)(ii)(VlI)) is amended to read as fol14 lows:

15 ‘‘(VII) for fiscal years 1999 through 2002, is

16 the market basket percentage increase for hospitals

17 in rural areas, and the applicable update factor spec18 ified under clause (vi) for the fiscal year for hos19 pitals in urban areas; and’’.

20 (b) SKILLED NURSING FACILITIES.—Subclauses (I)

21 and (II) of section 1888(e)(4)(E)(ii) of the Social Security

22 Act (42 U.S.C. 1395yy(e)(4)(E)(ii)) are each amended by

23 inserting ‘‘for skilled nursing facilities in urban areas, and

24 by the skilled nursing facility market basket percentage
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1 change for such year for skilled nursing facilities in rural

2 areas’’ after ‘‘point’’.

3 SEC. 10. EMERGENCY REQUIREMENT.

4 The entire amount necessary to carry out this Act

5 and the amendments made by this Act shall be available

6 only to the extent that an official budget request for the

7 entire amount, that includes designation of the entire

8 amount of the request as an emergency requirement as

9 defined in the Balanced Budget and Emergency Deficit

10 Control Act of 1985, as amended, is transmitted by the

11 President to the Congress: Provided, That the entire

12 amount is designated by the Congress as an emergency

13 requirement pursuant to section 251(b)(2)(A) of such Act.

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