```

[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2600 Introduced in Senate (IS)]

106th CONGRESS
  2d Session
                                S. 2600

To amend title XVIII of the Social Security Act to make enhancements to 
    the critical access hospital program under the medicare program.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                              May 22, 2000

   Ms. Snowe 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 make enhancements to 
    the critical access hospital program under the medicare program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Critical Access Hospital Enhancement 
Act of 2000''.

 SEC. 2. ENHANCEMENTS TO CRITICAL ACCESS HOSPITAL (CAH) PROGRAM.

    (a) Exemption From Bad Debt Reductions.--Section 1861(v)(1)(T) of 
the Social Security Act (42 U.S.C. 1395x(v)(1)(T)) is amended--
            (1) by redesignating clauses (i), (ii), and (iii) as 
        subclauses (I), (II), and (III), respectively;
            (2) by inserting ``(i)'' after ``(T)''; and
            (3) by adding at the end the following new clause:
    ``(ii) The reductions required by clause (i) shall not apply to 
critical access hospitals for cost reporting periods beginning on or 
after October 1, 1998.''.
    (b) Exemption From Payment Reductions and Fee Schedule for 
Ambulance Services.--
            (1) Exemption from fee schedule.--
                    (A) In general.--Section 1834(l) of the Social 
                Security Act (42 U.S.C. 1395m(l)) is amended by adding 
                at the end the following new paragraph:
            ``(8) Inapplicability of fee schedule to certain 
        services.--In the case of ambulance services (described in 
        section 1861(s)(7)) that are provided in a locality by a 
        critical access hospital that is the only provider of ambulance 
        services in the locality, or by an entity that is owned and 
        operated by such a critical access hospital--
                    ``(A) the fee schedule established under this 
                subsection shall not apply; and
                    ``(B) payment under this part shall be paid on the 
                basis of the reasonable costs incurred in providing 
                such services.''.
                    (B) Conforming amendment.--Section 1833(a)(1)(R) of 
                the Social Security Act (42 U.S.C. 1395l(a)(1)(R)) is 
                amended by inserting ``(other than the ambulance 
                services described in section 1834(l)(8))'' after 
                ``ambulance service''.
                    (C) Effective date.--The amendments made by this 
                paragraph shall take effect as if included in the 
                enactment of the Balanced Budget Act of 1997 (Public 
                Law 105-33; 111 Stat. 251).
            (2) Exemption from reasonable cost reductions.--Section 
        1861(v)(1)(U) of the Social Security Act (42 U.S.C. 
        1395x(v)(1)(U)) is amended by inserting after the first 
        sentence the following new sentence: ``The reductions required 
        by the preceding sentence shall not apply in the case of 
        ambulance services that are provided in a locality on or after 
        October 1, 1998, by a critical access hospital that is the only 
        provider of ambulance services in the locality, or by an entity 
        that is owned and operated by such a critical access 
        hospital.''.
    (c) Exemption From Home Health Payment Limits and PPS.--
            (1) Exemption from cost limits.--Section 1861(v)(1)(L) of 
        the Social Security Act (42 U.S.C. 1395x(v)(1)(L)) (as amended 
        by section 303 of the Medicare, Medicaid, and SCHIP Balanced 
        Budget Refinement Act of 1999 (113 Stat. 1501A-360), as enacted 
        into law by section 1000(a)(6) of Public Law 106-113) is 
        amended by adding at the end the following new clause:
    ``(xi) The preceding provisions of this subparagraph shall not 
apply to home health services that are furnished on or after October 1, 
1998, by a home health agency that is--
            ``(I) the only home health agency serving a locality; and
            ``(II) owned and operated by a critical access hospital.''.
            (2) Exemption from pps.--
                    (A) In general.--Section 1895 of the Social 
                Security Act (42 U.S.C. 1395fff) is amended by adding 
                at the end the following new subsection:
    ``(e) Exception.--The prospective payment system established under 
this section shall not apply in determining payments for home health 
services furnished by a home health agency that is--
            ``(1) the only home health agency serving a locality; and
            ``(2) owned and operated by a critical access hospital.''.
                    (B) Conforming amendment.--Section 1833(a)(2)(A) of 
                the Social Security Act (42 U.S.C. 1395l(a)(2)(A)) is 
                amended by inserting ``home health services described 
                in section 1895(e) and'' after ``other than''.
                    (C) Effective date.--The amendments made by this 
                paragraph shall take effect as if included in the 
                enactment of the Balanced Budget Act of 1997 (Public 
                Law 105-33; 111 Stat. 251).
    (d) Payment for Swing Bed Services.--
            (1) Exemption from pps for skilled nursing facility 
        services.--Section 1888(e)(7) of the Social Security Act (42 
        U.S.C. 1395yy(e)(7)) is amended--
                    (A) in the heading, by striking ``Transition for'' 
                and inserting ``Treatment of'';
                    (B) in subparagraph (A), by striking ``In 
                general.--The'' and inserting ``Transition.--Except as 
                provided in subparagraph (C), the'';
                    (C) in subparagraph (B), by striking ``1883'' and 
                all that follows through ``date)'' and inserting ``1883 
                (other than critical access hospitals)''; and
                    (D) by adding at the end the following:
                    ``(C) Treatment of swing-bed services furnished by 
                critical access hospitals.--The prospective payment 
                system established under this subsection shall not 
                apply to services furnished by a critical access 
                hospital pursuant to an agreement described in section 
                1883.''.
            (2) Payment basis for swing bed services furnished by 
        critical access hospitals.--Section 1883(a) of the Social 
        Security Act (42 U.S.C 1395tt(a)) is amended--
                    (A) in paragraph (2)(A), by inserting ``(other than 
                a critical access hospital)'' after ``any hospital''; 
                and
                    (B) by adding at the end the following new 
                paragraph:
            ``(3) Notwithstanding any other provision of this title, a 
        critical access hospital shall be paid for services furnished 
        under an agreement entered into under this section on the basis 
        of the reasonable costs of such services (as determined under 
        section 1861(v)).''.
            (3) Effective dates.--
                    (A) The amendments made by paragraph (1) shall take 
                effect as if included in the enactment of the Balanced 
                Budget Act of 1997 (Public Law 105-33; 111 Stat. 251).
                    (B) The amendments made by paragraph (2) shall 
                apply to cost reporting periods beginning on or after 
                October 1, 1998.
    (e) Payment Basis for Outpatient Laboratory Tests.--
            (1) Payment on cost basis without beneficiary cost-
        sharing.--
                    (A) In general.--Section 1833(a)(6) of the Social 
                Security Act (42 U.S.C. 1395l(a)(6)) is amended by 
                inserting ``(including clinical diagnostic laboratory 
                services furnished by a critical access hospital)'' 
                after ``outpatient critical access hospital services''.
                    (B) No beneficiary cost-sharing.--
                            (i) In general.--Section 1834(g) of the 
                        Social Security Act (42 U.S.C. 1395m(g)) is 
                        amended by inserting ``(except that in the case 
                        of clinical diagnostic laboratory services 
                        furnished by a critical access hospital the 
                        amount of payment shall be equal to 100 percent 
                        of the reasonable costs of the critical access 
                        hospital in providing such services)'' before 
                        the period at the end.
                            (ii) BBRA amendment.--Section 1834(g) of 
                        the Social Security Act (42 U.S.C. 1395m(g)) 
                        (as amended by section 403(d) of the Medicare, 
                        Medicaid, and SCHIP Balanced Budget Refinement 
                        Act of 1999 (113 Stat. 1501A-371), as enacted 
                        into law by section 1000(a)(6) of Public Law 
                        106-113) is amended--
                                    (I) in paragraph (1), by inserting 
                                ``(except that in the case of clinical 
                                diagnostic laboratory services 
                                furnished by a critical access hospital 
                                the amount of payment shall be equal to 
                                100 percent of the reasonable costs of 
                                the critical access hospital in 
                                providing such services)'' after ``such 
                                services,''; and
                                    (II) in paragraph (2)(A), by 
                                inserting ``(except that in the case of 
                                clinical diagnostic laboratory services 
                                furnished by a critical access hospital 
                                the amount of payment shall be equal to 
                                100 percent of the reasonable costs of 
                                the critical access hospital in 
                                providing such services)'' before the 
                                period at the end.
            (2) Conforming amendments.--Paragraphs (1)(D)(i) and 
        (2)(D)(i) of section 1833(a) of the Social Security Act (42 
        U.S.C. 1395l(a)(1)(D)(i); 1395l(a)(2)(D)(i)) (as amended by 
        section 403(e) of the Medicare, Medicaid, and SCHIP Balanced 
        Budget Refinement Act of 1999 (113 Stat. 1501A-371), as enacted 
        into law by section 1000(a)(6) of Public Law 106-113) are 
        amended by striking ``or which are furnished on an outpatient 
        basis by a critical access hospital'' each place it appears.
            (3) Effective dates.--
                    (A) In general.--Except as provided in subparagraph 
                (B), the amendments made by this subsection shall apply 
                to services furnished on or after November 29, 1999.
                    (B) BBRA amendment.--The amendment made by 
                paragraph (1)(B)(ii) shall take effect as if included 
                in the enactment of section 403(d) of the Medicare, 
                Medicaid, and SCHIP Balanced Budget Refinement Act of 
                1999 (113 Stat. 1501A-371), as enacted into law by 
                section 1000(a)(6) of Public Law 106-113.
    (f) Alternative to 15-Bed Limit.--Section 1820 of the Social 
Security Act (42 U.S.C. 1395i-4) is amended--
            (1) in subsection (c)--
                    (A) in paragraph (2)(B)(iii), by striking 
                ``provides'' and inserting ``subject to paragraph (3), 
                provides''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(3) Flexibility on bed limits for certain facilities.--
        Notwithstanding clause (iii) and subsection (f), a State may 
        designate (and the Secretary may certify) a facility with more 
        than 15 (or in the case of a facility under an agreement 
        described in subsection (f), 25) acute care inpatient beds as a 
        critical access hospital if--
                    ``(A) the service area of the facility experiences 
                substantial seasonal fluctuations in population;
                    ``(B) the number of beds used by the facility for 
                acute care inpatient services, determined on an average 
                annual basis, does not exceed 15; and
                    ``(C) in the case of a facility under an agreement 
                described in subsection (f), the total number of beds 
                used by the facility for either acute care or extended 
                care services, determined on an average annual basis, 
                does not exceed 25.''; and
            (2) in subsection (f), by inserting ``(or, in the case of a 
        facility with a service area that experiences substantial 
        seasonal fluctuations in population, so long as the facility 
        meets the requirements of subparagraphs (B) and (C) of 
        subsection (c)(3)'' after ``15 beds''.
                                 <all>
```