II 

110TH CONGRESS 

1ST SESSION S. 1605 

To amend title XVIII of the Social Security Act to protect and preserve 

access of Medicare beneficiaries in rural areas to health care providers 

under the Medicare program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 13, 2007 

Mr. CONRAD (for himself, Mr. ROBERTS, Mr. HARKIN, Mr. SALAZAR, Mr. 

DOMENICI, Mr. BINGAMAN, Mr. SMITH, Mr. NELSON of Nebraska, Ms. 

SNOWE, Mrs. MURRAY, Mr. THUNE, Mr. DORGAN, Ms. COLLINS, Mr. 

JOHNSON, Mr. ENZI, and Mrs. LINCOLN) 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 protect 

and preserve access of Medicare beneficiaries in rural 

areas to health care providers under the Medicare program, 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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Craig Thomas Rural Hospital and Provider Equity Act 

6 of 2007’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals. 

Sec. 3. Revision of the Medicare hold harmless provision under the prospective 

payment system for hospital outpatient department (HOPD) 

services. 

Sec. 4. Improvement of definition of low-volume hospital for purposes of the 

Medicare inpatient hospital payment adjustment. 

Sec. 5. Extension of Medicare wage index reclassifications for certain hospitals. 

Sec. 6. Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas. 

Sec. 7. Critical access hospital improvements. 

Sec. 8. Capital infrastructure revolving loan program. 

Sec. 9. Extension of Medicare incentive payment program for physician scarcity 

areas. 

Sec. 10. Extension of floor on Medicare work geographic adjustment. 

Sec. 11. Improving care planning for Medicare home health services. 

Sec. 12. Rural health clinic improvements. 

Sec. 13. Community health center collaborative access expansion. 

Sec. 14. Application of the temporary Medicare payment increase for home 

health services furnished in a rural area to 2008. 

Sec. 15. Extension of increased Medicare payments for rural ground ambulance 

services. 

Sec. 16. Coverage of marriage and family therapist services and mental health 

counselor services under part B of the Medicare program. 

Sec. 17. Extension of treatment of certain physician pathology services under 

Medicare. 

Sec. 18. Medicare remote monitoring pilot projects. 

Sec. 19. Facilitating the provision of telehealth services across State lines. 

3 SEC. 2. FAIRNESS IN THE MEDICARE DISPROPORTIONATE 

4 SHARE HOSPITAL (DSH) ADJUSTMENT FOR 

5 RURAL HOSPITALS. 

6 Section 1886(d)(5)(F)(xiv)(II) of the Social Security 

7 Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended— 

8 (1) by striking ‘‘or, in the case’’ and all that 

9 follows through ‘‘subparagraph (G)(iv)’’; and 

10 (2) by inserting at the end the following new 

11 sentence: ‘‘The preceding sentence shall not apply to 


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1 any hospital with respect to discharges occurring on 

2 or after October 1, 2008.’’. 

3 SEC. 3. REVISION OF THE MEDICARE HOLD HARMLESS 

4 PROVISION UNDER THE PROSPECTIVE PAY5 MENT SYSTEM FOR HOSPITAL OUTPATIENT 

6 DEPARTMENT (HOPD) SERVICES. 

7 Section 1833(t)(7)(D)(i) of the Social Security Act 

8 (42 U.S.C. 1395l(t)(7)(D)(i)) is amended— 

9 (1) in subclause (II), by striking ‘‘85 percent’’ 

10 and inserting ‘‘100 percent’’; and 

11 (2) by adding at the end the following new sub12 clause: 

13 ‘‘(III) In the case of a sole community 

14 hospital (as defined in section 

15 1886(d)(5)(D)(iii)), for covered OPD serv16 ices furnished during 2008, for which the 

17 PPS amount is less than the pre-BBA 

18 amount, the amount of payment under this 

19 subsection shall be increased by the 

20 amount of such difference.’’. 


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1 SEC. 4. IMPROVEMENT OF DEFINITION OF LOW-VOLUME 

2 HOSPITAL FOR PURPOSES OF THE MEDICARE 

3 INPATIENT HOSPITAL PAYMENT ADJUST4 MENT. 

5 Section 1886(d)(12)(C)(i) of the Social Security Act 

6 (42 U.S.C. 1395ww(d)(12)(C)(i)) is amended by inserting 

7 ‘‘(or, beginning with fiscal year 2008, 2,000 discharges)’’ 

8 after ‘‘800 discharges’’. 

9 SEC. 5. EXTENSION OF MEDICARE WAGE INDEX RECLASSI10 FICATIONS FOR CERTAIN HOSPITALS. 

11 (a) EXTENSION OF CORRECTION OF MID-YEAR RE12 CLASSIFICATION EXPIRATION FOR CERTAIN HOS13 PITALS.— 

14 (1) IN GENERAL.—In the case of a hospital de15 scribed in paragraph (2), effective September 30, 

16 2007, the Secretary of Health and Human Services 

17 shall apply subsection (a) of section 106 of division 

18 B of the Tax Relief and Health Care Act of 2006 

19 (42 U.S.C. 1395ww note) by substituting ‘‘Sep20 tember 30, 2008’’ for ‘‘September 30, 2007’’. 

21 (2) HOSPITAL DESCRIBED.—A hospital de22 scribed in this paragraph is a hospital— 

23 (A) that is described in subsection (a) of 

24 such section 106; and 

25 (B)(i) that is located in a State with less 

26 than 10 people per square mile; or 


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1 (ii)(I) that is located in a rural area; and 

2 (II) for which the Secretary of Health and 

3 Human Services has determined the extension 

4 under this subsection to be appropriate. 

5 (b) ADDITIONAL EXTENSION.—The Secretary of 

6 Health and Human Services shall extend the special ex7 ception reclassification of a sole community hospital lo8 cated in a State with less than 10 people per square mile 

9 (made under the authority of section 1886(d)(5)(I)(i) of 

10 the Social Security Act (42 U.S.C. 1395ww(d)(5)(I)(i)) 

11 and contained in the final rule promulgated by the Sec12 retary in the Federal Register on August 11, 2004 (69 

13 Fed. Reg. 49107)) for 1 year through September 30, 

14 2008. 

15 (c) NOT BUDGET NEUTRAL.—The provisions of this 

16 section shall not be effected in a budget-neutral manner. 

17 SEC. 6. EXTENSION OF MEDICARE REASONABLE COSTS 

18 PAYMENTS FOR CERTAIN CLINICAL DIAG19 NOSTIC LABORATORY TESTS FURNISHED TO 

20 HOSPITAL PATIENTS IN CERTAIN RURAL 

21 AREAS. 

22 Section 416(b) of the Medicare Prescription Drug, 

23 Improvement, and Modernization Act of 2003 (42 U.S.C. 

24 1395l–4(b)), as amended by section 105 of division B of 

25 the Tax Relief and Health Care Act of 2006 (42 U.S.C. 


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1 1395l note), is amended by striking ‘‘3-year’’ and insert2 ing ‘‘5-year’’. 

3 SEC. 7. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 

4 (a) CLARIFICATION OF PAYMENT FOR CLINICAL

5 LABORATORY TESTS FURNISHED BY CRITICAL ACCESS

6 HOSPITALS.— 

7 (1) IN GENERAL.—Section 1834(g)(4) of the 

8 Social Security Act (42 U.S.C. 1395m(g)(4)) is 

9 amended— 

10 (A) in the heading, by striking ‘‘NO BENE11 FICIARY COST-SHARING FOR’’ and inserting 

12 ‘‘TREATMENT OF’’; and 

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

14 sentence: ‘‘For purposes of the preceding sen15 tence and section 1861(mm)(3), clinical diag16 nostic laboratory services furnished by a critical 

17 access hospital shall be treated as being fur18 nished as part of outpatient critical access serv19 ices without regard to whether— 

20 ‘‘(A) the individual with respect to whom 

21 such services are furnished is physically present 

22 in the critical access hospital at the time the 

23 specimen is collected; 

24 ‘‘(B) such individual is registered as an 

25 outpatient on the records of, and receives such 


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1 services directly from, the critical access hos2 pital; or 

3 ‘‘(C) payment is (or, but for this sub4 section, would be) available for such services 

5 under the fee schedule established under section 

6 1833(h).’’. 

7 (2) EFFECTIVE DATE.—The amendments made 

8 by paragraph (1) shall apply to cost reporting peri9 ods beginning on or after the date of enactment of 

10 this Act. 

11 (b) ELIMINATION OF ISOLATION TEST FOR COST12 BASED AMBULANCE REIMBURSEMENT.— 

13 (1) IN GENERAL.—Section 1834(l)(8) of the 

14 Social Security Act (42 U.S.C. 1395m(l)(8)) is 

15 amended— 

16 (A) in subparagraph (B)— 

17 (i) by striking ‘‘owned and’’; and 

18 (ii) by inserting ‘‘(including when 

19 such services are provided by the entity 

20 under an arrangement with the hospital)’’ 

21 after ‘‘hospital’’; and 

22 (B) by striking the comma at the end of 

23 subparagraph (B) and all that follows and in24 serting a period. 


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1 (2) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply to services furnished 

3 on or after January 1, 2008. 

4 SEC. 8. CAPITAL INFRASTRUCTURE REVOLVING LOAN PRO5 GRAM. 

6 (a) IN GENERAL.—Part A of title XVI of the Public 

7 Health Service Act (42 U.S.C. 300q et seq.) is amended 

8 by adding at the end the following new section: 

9 ‘‘CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM

10 ‘‘SEC. 1603. (a) AUTHORITY TO MAKE AND GUAR11 ANTEE LOANS.— 

12 ‘‘(1) AUTHORITY TO MAKE LOANS.—The Sec13 retary may make loans from the fund established 

14 under section 1602(d) to any rural entity for 

15 projects for capital improvements, including— 

16 ‘‘(A) the acquisition of land necessary for 

17 the capital improvements; 

18 ‘‘(B) the renovation or modernization of 

19 any building; 

20 ‘‘(C) the acquisition or repair of fixed or 

21 major movable equipment; and 

22 ‘‘(D) such other project expenses as the 

23 Secretary determines appropriate. 

24 ‘‘(2) AUTHORITY TO GUARANTEE LOANS.— 

25 ‘‘(A) IN GENERAL.—The Secretary may 

26 guarantee the payment of principal and interest 


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1 for loans made to rural entities for projects for 

2 any capital improvement described in paragraph 

3 (1) to any non-Federal lender. 

4 ‘‘(B) INTEREST SUBSIDIES.—In the case 

5 of a guarantee of any loan made to a rural enti6 ty under subparagraph (A), the Secretary may 

7 pay to the holder of such loan, for and on be8 half of the project for which the loan was made, 

9 amounts sufficient to reduce (by not more than 

10 3 percent) the net effective interest rate other11 wise payable on such loan. 

12 ‘‘(b) AMOUNT OF LOAN.—The principal amount of 

13 a loan directly made or guaranteed under subsection (a) 

14 for a project for capital improvement may not exceed 

15 $5,000,000. 

16 ‘‘(c) FUNDING LIMITATIONS.— 

17 ‘‘(1) GOVERNMENT CREDIT SUBSIDY EXPO18 SURE.—The total of the Government credit subsidy 

19 exposure under the Credit Reform Act of 1990 scor20 ing protocol with respect to the loans outstanding at 

21 any time with respect to which guarantees have been 

22 issued, or which have been directly made, under sub23 section (a) may not exceed $50,000,000 per year. 

24 ‘‘(2) TOTAL AMOUNTS.—Subject to paragraph 

25 (1), the total of the principal amount of all loans diVerDate Aug 31 2005 22:08 Jun 14, 2007 Jkt 059200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1605.IS S1605

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1 rectly made or guaranteed under subsection (a) may 

2 not exceed $250,000,000 per year. 

3 ‘‘(d) CAPITAL ASSESSMENT AND PLANNING

4 GRANTS.— 

5 ‘‘(1) NONREPAYABLE GRANTS.—Subject to 

6 paragraph (2), the Secretary may make a grant to 

7 a rural entity, in an amount not to exceed $50,000, 

8 for purposes of capital assessment and business 

9 planning. 

10 ‘‘(2) LIMITATION.—The cumulative total of 

11 grants awarded under this subsection may not ex12 ceed $2,500,000 per year. 

13 ‘‘(e) TERMINATION OF AUTHORITY.—The Secretary 

14 may not directly make or guarantee any loan under sub15 section (a) or make a grant under subsection (d) after 

16 September 30, 2011.’’. 

17 (b) RURAL ENTITY DEFINED.—Section 1624 of the 

18 Public Health Service Act (42 U.S.C. 300s–3) is amended 

19 by adding at the end the following new paragraph: 

20 ‘‘(15)(A) The term ‘rural entity’ includes— 

21 ‘‘(i) a rural health clinic, as defined in sec22 tion 1861(aa)(2) of the Social Security Act; 

23 ‘‘(ii) any medical facility with at least 1 

24 bed, but with less than 50 beds, that is located 

25 in— 


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1 ‘‘(I) a county that is not part of a 

2 metropolitan statistical area; or 

3 ‘‘(II) a rural census tract of a metro4 politan statistical area (as determined 

5 under the most recent modification of the 

6 Goldsmith Modification, originally pub7 lished in the Federal Register on February 

8 27, 1992 (57 Fed. Reg. 6725)); 

9 ‘‘(iii) a hospital that is classified as a 

10 rural, regional, or national referral center under 

11 section 1886(d)(5)(C) of the Social Security 

12 Act; and 

13 ‘‘(iv) a hospital that is a sole community 

14 hospital (as defined in section 

15 1886(d)(5)(D)(iii) of the Social Security Act). 

16 ‘‘(B) For purposes of subparagraph (A), the 

17 fact that a clinic, facility, or hospital has been geo18 graphically reclassified under the Medicare program 

19 under title XVIII of the Social Security Act shall not 

20 preclude a hospital from being considered a rural en21 tity under clause (i) or (ii) of subparagraph (A).’’. 

22 (c) CONFORMING AMENDMENTS.—Section 1602 of 

23 the Public Health Service Act (42 U.S.C. 300q–2) is 

24 amended— 


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1 (1) in subsection (b)(2)(D), by inserting ‘‘or 

2 1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’; and 

3 (2) in subsection (d)— 

4 (A) in paragraph (1)(C), by striking ‘‘sec5 tion 1601(a)(2)(B)’’ and inserting ‘‘sections 

6 1601(a)(2)(B) and 1603(a)(2)(B)’’; and 

7 (B) in paragraph (2)(A), by inserting ‘‘or 

8 1603(a)(2)(B)’’ after ‘‘1601(a)(2)(B)’’. 

9 SEC. 9. EXTENSION OF MEDICARE INCENTIVE PAYMENT 

10 PROGRAM FOR PHYSICIAN SCARCITY AREAS. 

11 Section 1833(u)(1) of the Social Security Act (42 

12 U.S.C. 1395l(u)(1)) is amended by striking ‘‘before Janu13 ary 1, 2008’’ and inserting ‘‘before January 1, 2010’’. 

14 SEC. 10. EXTENSION OF FLOOR ON MEDICARE WORK GEO15 GRAPHIC ADJUSTMENT. 

16 Section 1848(e)(1)(E) of the Social Security Act (42 

17 U.S.C. 1395w–4(e)(1)(E)), as amended by section 102 of 

18 division B of the Tax Relief and Health Care Act of 2006, 

19 is amended by striking ‘‘before January 1, 2008’’ and in20 serting ‘‘before January 1, 2010’’. 

21 SEC. 11. IMPROVING CARE PLANNING FOR MEDICARE 

22 HOME HEALTH SERVICES. 

23 (a) IN GENERAL.—Section 1814(a)(2) of the Social 

24 Security Act (42 U.S.C. 1395f(a)(2)), in the matter pre25 ceding subparagraph (A), is amended— 


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1 (1) by inserting ‘‘(as those terms are defined in 

2 section 1861(aa)(5))’’ after ‘‘clinical nurse spe3 cialist’’; and 

4 (2) by inserting ‘‘, or in the case of services de5 scribed in subparagraph (C), a physician, or a nurse 

6 practitioner or clinical nurse specialist who is work7 ing in collaboration with a physician in accordance 

8 with State law, or a certified nurse-midwife (as de9 fined in section 1861(gg)) as authorized by State 

10 law, or a physician assistant (as defined in section 

11 1861(aa)(5)) under the supervision of a physician’’ 

12 after ‘‘collaboration with a physician’’. 

13 (b) CONFORMING AMENDMENTS.—(1) Section 

14 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) 

15 is amended— 

16 (A) in paragraph (2)(C), by inserting ‘‘, a nurse 

17 practitioner, a clinical nurse specialist, a certified 

18 nurse-midwife, or a physician assistant (as the case 

19 may be)’’ after ‘‘physician’’ each place it appears; 

20 (B) in the second sentence, by striking ‘‘or clin21 ical nurse specialist’’ and inserting ‘‘clinical nurse 

22 specialist, certified nurse-midwife, or physician as23 sistant’’; 

24 (C) in the third sentence— 


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1 (i) by striking ‘‘physician certification’’ 

2 and inserting ‘‘certification’’; 

3 (ii) by inserting ‘‘(or on January 1, 2008, 

4 in the case of regulations to implement the 

5 amendments made by section 2 of the Home 

6 Health Care Planning Improvement Act of 

7 2007)’’ after ‘‘1981’’; and 

8 (iii) by striking ‘‘a physician who’’ and in9 serting ‘‘a physician, nurse practitioner, clinical 

10 nurse specialist, certified nurse-midwife, or phy11 sician assistant who’’; and 

12 (D) in the fourth sentence, by inserting ‘‘, 

13 nurse practitioner, clinical nurse specialist, certified 

14 nurse-midwife, or physician assistant’’ after ‘‘physi15 cian’’. 

16 (2) Section 1835(a) of the Social Security Act (42 

17 U.S.C. 1395n(a)) is amended— 

18 (A) in paragraph (2)— 

19 (i) in the matter preceding subparagraph 

20 (A), by inserting ‘‘or, in the case of services de21 scribed in subparagraph (A), a physician, or a 

22 nurse practitioner or clinical nurse specialist (as 

23 those terms are defined in 1861(aa)(5)) who is 

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1 midwife (as defined in section 1861(gg)) as au2 thorized by State law, or a physician assistant 

3 (as defined in section 1861(aa)(5)) under the 

4 supervision of a physician’’ after ‘‘a physician’’; 

5 and 

6 (ii) in each of clauses (ii) and (iii) of sub7 paragraph (A) by inserting ‘‘, a nurse practi8 tioner, a clinical nurse specialist, a certified 

9 nurse-midwife, or a physician assistant (as the 

10 case may be)’’ after ‘‘physician’’; 

11 (B) in the third sentence, by inserting ‘‘, nurse 

12 practitioner, clinical nurse specialist, certified nurse13 midwife, or physician assistant (as the case may 

14 be)’’ after physician; 

15 (C) in the fourth sentence— 

16 (i) by striking ‘‘physician certification’’ 

17 and inserting ‘‘certification’’; 

18 (ii) by inserting ‘‘(or on January 1, 2008, 

19 in the case of regulations to implement the 

20 amendments made by section 2 of the Home 

21 Health Care Planning Improvement Act of 

22 2007)’’ after ‘‘1981’’; and 

23 (iii) by striking ‘‘a physician who’’ and in24 serting ‘‘a physician, nurse practitioner, clinical 


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1 nurse specialist, certified nurse-midwife, or phy2 sician assistant who’’; and 

3 (D) in the fifth sentence, by inserting ‘‘, nurse 

4 practitioner, clinical nurse specialist, certified nurse5 midwife, or physician assistant’’ after ‘‘physician’’. 

6 (3) Section 1861 of the Social Security Act (42 

7 U.S.C. 1395x) is amended— 

8 (A) in subsection (m)— 

9 (i) in the matter preceding paragraph 

10 (1)— 

11 (I) by inserting ‘‘a nurse practitioner 

12 or a clinical nurse specialist (as those 

13 terms are defined in subsection (aa)(5)), a 

14 certified nurse-midwife (as defined in sec15 tion 1861(gg)), or a physician assistant (as 

16 defined in subsection (aa)(5))’’ after ‘‘phy17 sician’’ the first place it appears; and 

18 (II) by inserting ‘‘a nurse practi19 tioner, a clinical nurse specialist, a cer20 tified nurse-midwife, or a physician assist21 ant’’ after ‘‘physician’’ the second place it 

22 appears; and 

23 (ii) in paragraph (3), by inserting ‘‘a nurse 

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1 tified nurse-midwife, or a physician assistant’’ 

2 after ‘‘physician’’; and 

3 (B) in subsection (o)(2)— 

4 (i) by inserting ‘‘, nurse practitioners or 

5 clinical nurse specialists (as those terms are de6 fined in subsection (aa)(5)), certified nurse-mid7 wives (as defined in section 1861(gg)), or physi8 cian assistants (as defined in subsection 

9 (aa)(5))’’ after ‘‘physicians’’; and 

10 (ii) by inserting ‘‘, nurse practitioner, clin11 ical nurse specialist, certified nurse-midwife, 

12 physician assistant,’’ after ‘‘physician’’. 

13 (4) Section 1895 of the Social Security Act (42 

14 U.S.C. 1395fff) is amended— 

15 (A) in subsection (c)(1), by inserting ‘‘, the 

16 nurse practitioner or clinical nurse specialist (as 

17 those terms are defined in section 1861(aa)(5)), the 

18 certified nurse-midwife (as defined in section 

19 1861(gg)), or the physician assistant (as defined in 

20 section 1861(aa)(5)),’’ after ‘‘physician’’; and 

21 (B) in subsection (e)— 

22 (i) in paragraph (1)(A), by inserting ‘‘, a 

23 nurse practitioner or clinical nurse specialist (as 

24 those terms are defined in section 1861(aa)(5)), 

25 a certified nurse-midwife (as defined in section 


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1 1861(gg)), or a physician assistant (as defined 

2 in section 1861(aa)(5))’’ after ‘‘physician’’; and 

3 (ii) in paragraph (2)— 

4 (I) in the heading, by striking ‘‘PHY5 SICIAN CERTIFICATION’’ and inserting 

6 ‘‘RULE OF CONSTRUCTION REGARDING RE7 QUIREMENT FOR CERTIFICATION’’; and 

8 (II) by striking ‘‘physician’’. 

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

10 this section shall apply to items and services furnished on 

11 or after January 1, 2008. 

12 SEC. 12. RURAL HEALTH CLINIC IMPROVEMENTS. 

13 Section 1833(f) of the Social Security Act (42 U.S.C. 

14 1395l(f)) is amended— 

15 (1) in paragraph (1), by striking ‘‘, and’’ at the 

16 end and inserting a semicolon; 

17 (2) in paragraph (2)— 

18 (A) by inserting ‘‘(before 2008)’’ after ‘‘in 

19 a subsequent year’’; and 

20 (B) by striking the period at the end and 

21 inserting a semicolon; and 

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

23 paragraphs: 

24 ‘‘(3) in 2008, at $92 per visit; and 


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1 ‘‘(4) in a subsequent year, at the limit estab2 lished under this subsection for the previous year in3 creased by the percentage increase in the MEI (as 

4 so defined) applicable to primary care services (as so 

5 defined) furnished as of the first day of that year.’’. 

6 SEC. 13. COMMUNITY HEALTH CENTER COLLABORATIVE 

7 ACCESS EXPANSION. 

8 Section 330 of the Public Health Service Act (42 

9 U.S.C. 254b) is amended by adding at the end the fol10 lowing: 

11 ‘‘(s) MISCELLANEOUS PROVISIONS.— 

12 ‘‘(1) RULE OF CONSTRUCTION WITH RESPECT

13 TO RURAL HEALTH CLINICS.— 

14 ‘‘(A) IN GENERAL.—Nothing in this sec15 tion shall be construed to prevent a community 

16 health center from contracting with a federally 

17 certified rural health clinic (as defined by sec18 tion 1861(aa)(2) of the Social Security Act) for 

19 the delivery of primary health care services that 

20 are available at the rural health clinic to indi21 viduals who would otherwise be eligible for free 

22 or reduced cost care if that individual were able 

23 to obtain that care at the community health 

24 center. Such services may be limited in scope to 


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1 those primary health care services available in 

2 that rural health clinic. 

3 ‘‘(B) ASSURANCES.—In order for a rural 

4 health clinic to receive funds under this section 

5 through a contract with a community health 

6 center under paragraph (1), such rural health 

7 clinic shall establish policies to ensure— 

8 ‘‘(i) nondiscrimination based upon the 

9 ability of a patient to pay; and 

10 ‘‘(ii) the establishment of a sliding fee 

11 scale for low-income patients.’’. 

12 SEC. 14. APPLICATION OF THE TEMPORARY MEDICARE 

13 PAYMENT INCREASE FOR HOME HEALTH 

14 SERVICES FURNISHED IN A RURAL AREA TO 

15 2008. 

16 Section 421 of the Medicare Prescription Drug, Im17 provement, and Modernization Act of 2003 (42 U.S.C. 

18 1395fff note), as amended by section 5201(b) of the Def19 icit Reduction Act of 2005 (42 U.S.C. 1395fff note), is 

20 amended— 

21 (1) in the section heading, by striking ‘‘ONE22 YEAR’’ and inserting ‘‘TEMPORARY’’; and 

23 (2) in subsection (a), by inserting ‘‘and episodes 

24 and visits ending on or after January 1, 2008, and 

25 before January 1, 2009,’’ after ‘‘January 1, 2007,’’. 


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1 SEC. 15. EXTENSION OF INCREASED MEDICARE PAYMENTS 

2 FOR RURAL GROUND AMBULANCE SERVICES. 

3 Section 1834(l)(13) of the Social Security Act (42 

4 U.S.C. 1395m(l)(13)) is amended— 

5 (1) in subparagraph (A), in the heading, by 

6 striking ‘‘IN GENERAL’’ and inserting ‘‘FOR THE

7 SECOND HALF OF 2004 AND FOR 2005 AND 2006’’; 

8 (2) by redesignating subparagraph (B) as sub9 paragraph (C); 

10 (3) by inserting the following after subpara11 graph (A): 

12 ‘‘(B) FOR 2008 AND 2009 FOR RURAL

13 AREAS.—After computing the rates with respect 

14 to ground ambulance services under the other 

15 applicable provisions of this subsection, in the 

16 case of such services furnished on or after Jan17 uary 1, 2008, and before January 1, 2010, for 

18 which the transportation originates in a rural 

19 area described in paragraph (9) or in a rural 

20 census tract described in such paragraph, the 

21 fee schedule established under this section shall 

22 provide that the rate for the service otherwise 

23 established, after application of any increase 

24 under paragraphs (11) and (12), shall be in25 creased by 5 percent.’’; and 


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1 (4) in subparagraph (C), as redesignated by 

2 paragraph (2)— 

3 (A) in the heading, by striking ‘‘APPLICA4 TION OF INCREASED PAYMENTS AFTER 2006’’ 

5 and inserting ‘‘NO EFFECT ON SUBSEQUENT

6 PERIODS’’; and 

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

8 sentence: ‘‘The increased payments under sub9 paragraph (B) shall not be taken into account 

10 in calculating payments for services furnished 

11 after the period specified in such subpara12 graph.’’. 

13 SEC. 16. COVERAGE OF MARRIAGE AND FAMILY THERAPIST 

14 SERVICES AND MENTAL HEALTH COUNSELOR 

15 SERVICES UNDER PART B OF THE MEDICARE 

16 PROGRAM. 

17 (a) COVERAGE OF SERVICES.— 

18 (1) IN GENERAL.—Section 1861(s)(2) of the 

19 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

20 amended— 

21 (A) in subparagraph (Z), by striking 

22 ‘‘and’’ after the semicolon at the end; 

23 (B) in subparagraph (AA), by inserting 

24 ‘‘and’’ after the semicolon at the end; and 


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1 (C) by adding at the end the following new 

2 subparagraph: 

3 ‘‘(BB) marriage and family therapist services 

4 (as defined in subsection (ccc)(1)) and mental health 

5 counselor services (as defined in subsection 

6 (ccc)(3));’’. 

7 (2) DEFINITIONS.—Section 1861 of the Social 

8 Security Act (42 U.S.C. 1395x) is amended by add9 ing at the end the following new subsection: 

10 ‘‘Marriage and Family Therapist Services; Marriage and 

11 Family Therapist; Mental Health Counselor Serv12 ices; Mental Health Counselor 

13 ‘‘(ccc)(1) The term ‘marriage and family therapist 

14 services’ means services performed by a marriage and 

15 family therapist (as defined in paragraph (2)) for the diag16 nosis and treatment of mental illnesses, which the mar17 riage and family therapist is legally authorized to perform 

18 under State law (or the State regulatory mechanism pro19 vided by State law) of the State in which such services 

20 are performed, as would otherwise be covered if furnished 

21 by a physician or as an incident to a physician’s profes22 sional service, but only if no facility or other provider 

23 charges or is paid any amounts with respect to the fur24 nishing of such services. 


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1 ‘‘(2) The term ‘marriage and family therapist’ means 

2 an individual who— 

3 ‘‘(A) possesses a master’s or doctoral degree 

4 which qualifies for licensure or certification as a 

5 marriage and family therapist pursuant to State 

6 law; 

7 ‘‘(B) after obtaining such degree has performed 

8 at least 2 years of clinical supervised experience in 

9 marriage and family therapy; and 

10 ‘‘(C) in the case of an individual performing 

11 services in a State that provides for licensure or cer12 tification of marriage and family therapists, is li13 censed or certified as a marriage and family thera14 pist in such State. 

15 ‘‘(3) The term ‘mental health counselor services’ 

16 means services performed by a mental health counselor (as 

17 defined in paragraph (4)) for the diagnosis and treatment 

18 of mental illnesses which the mental health counselor is 

19 legally authorized to perform under State law (or the 

20 State regulatory mechanism provided by the State law) of 

21 the State in which such services are performed, as would 

22 otherwise be covered if furnished by a physician or as inci23 dent to a physician’s professional service, but only if no 

24 facility or other provider charges or is paid any amounts 

25 with respect to the furnishing of such services. 


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1 ‘‘(4) The term ‘mental health counselor’ means an 

2 individual who— 

3 ‘‘(A) possesses a master’s or doctor’s degree in 

4 mental health counseling or a related field; 

5 ‘‘(B) after obtaining such a degree has per6 formed at least 2 years of supervised mental health 

7 counselor practice; and 

8 ‘‘(C) in the case of an individual performing 

9 services in a State that provides for licensure or cer10 tification of mental health counselors or professional 

11 counselors, is licensed or certified as a mental health 

12 counselor or professional counselor in such State.’’. 

13 (3) PROVISION FOR PAYMENT UNDER PART

14 b.—Section 1832(a)(2)(B) of the Social Security Act 

15 (42 U.S.C. 1395k(a)(2)(B)) is amended by adding 

16 at the end the following new clause: 

17 ‘‘(v) marriage and family therapist 

18 services (as defined in section 

19 1861(ccc)(1)) and mental health counselor 

20 services (as defined in section 

21 1861(ccc)(3));’’. 

22 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

23 of the Social Security Act (42 U.S.C. 1395l(a)(1)) 

24 is amended— 


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1 (A) by striking ‘‘and (V)’’ and inserting 

2 ‘‘(V)’’; and 

3 (B) by inserting before the semicolon at 

4 the end the following: ‘‘, and (W) with respect 

5 to marriage and family therapist services and 

6 mental health counselor services under section 

7 1861(s)(2)(BB), the amounts paid shall be 80 

8 percent of the lesser of the actual charge for 

9 the services or 75 percent of the amount deter10 mined for payment of a psychologist under sub11 paragraph (L)’’. 

12 (5) EXCLUSION OF MARRIAGE AND FAMILY

13 THERAPIST SERVICES AND MENTAL HEALTH COUN14 SELOR SERVICES FROM SKILLED NURSING FACILITY

15 PROSPECTIVE PAYMENT SYSTEM.—Section 

16 1888(e)(2)(A)(ii) of the Social Security Act (42 

17 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 

18 ‘‘marriage and family therapist services (as defined 

19 in section 1861(ccc)(1)), mental health counselor 

20 services (as defined in section 1861(ccc)(3)),’’ after 

21 ‘‘qualified psychologist services,’’. 

22 (6) INCLUSION OF MARRIAGE AND FAMILY

23 THERAPISTS AND MENTAL HEALTH COUNSELORS AS

24 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec25 tion 1842(b)(18)(C) of the Social Security Act (42 


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1 U.S.C. 1395u(b)(18)(C)) is amended by adding at 

2 the end the following new clauses: 

3 ‘‘(vii) A marriage and family therapist (as de4 fined in section 1861(ccc)(2)). 

5 ‘‘(viii) A mental health counselor (as defined in 

6 section 1861(ccc)(4)).’’. 

7 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV8 ICES PROVIDED IN CERTAIN SETTINGS.— 

9 (1) RURAL HEALTH CLINICS AND FEDERALLY

10 QUALIFIED HEALTH CENTERS.—Section 

11 1861(aa)(1)(B) of the Social Security Act (42 

12 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

13 by a clinical social worker (as defined in subsection 

14 (hh)(1))’’ and inserting ‘‘, by a clinical social worker 

15 (as defined in subsection (hh)(1)), by a marriage 

16 and family therapist (as defined in subsection 

17 (ccc)(2)), or by a mental health counselor (as de18 fined in subsection (ccc)(4))’’. 

19 (2) HOSPICE PROGRAMS.—Section 

20 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 

21 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in22 serting ‘‘or one marriage and family therapist (as 

23 defined in subsection (ccc)(2))’’ after ‘‘social work24 er’’. 


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1 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

2 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST3 HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So4 cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 

5 by inserting ‘‘marriage and family therapist (as defined 

6 in subsection (ccc)(2)),’’ after ‘‘social worker,’’. 

7 (d) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply with respect to services furnished 

9 on or after January 1, 2008. 

10 SEC. 17. EXTENSION OF TREATMENT OF CERTAIN PHYSI11 CIAN PATHOLOGY SERVICES UNDER MEDI12 CARE. 

13 Section 542(c) of the Medicare, Medicaid, and 

14 SCHIP Benefits Improvement and Protection Act of 2000 

15 (as enacted into law by section 1(a)(6) of Public Law 106– 

16 554), as amended by section 732 of the Medicare Prescrip17 tion Drug, Improvement, and Modernization Act of 2003 

18 (42 U.S.C. 1395w–4 note) and section 104 of division B 

19 of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 

20 1395w–4 note), is amended by striking ‘‘and 2007’’ and 

21 inserting ‘‘2007, 2008, and 2009’’. 

22 SEC. 18. MEDICARE REMOTE MONITORING PILOT 

23 PROJECTS. 

24 (a) PILOT PROJECTS.— 


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1 (1) IN GENERAL.—Not later than 9 months 

2 after the date of enactment of this Act, the Sec3 retary of Health and Human Services (in this sec4 tion referred to as the ‘‘Secretary’’) shall conduct 

5 pilot projects under title XVIII of the Social Secu6 rity Act for the purpose of providing incentives to 

7 home health agencies to utilize home monitoring and 

8 communications technologies that— 

9 (A) enhance health outcomes for Medicare 

10 beneficiaries; and 

11 (B) reduce expenditures under such title. 

12 (2) SITE REQUIREMENTS.— 

13 (A) URBAN AND RURAL.—The Secretary 

14 shall conduct the pilot projects under this sec15 tion in both urban and rural areas. 

16 (B) SITE IN A SMALL STATE.—The Sec17 retary shall conduct at least 3 of the pilot 

18 projects in a State with a population of less 

19 than 1,000,000. 

20 (3) DEFINITION OF HOME HEALTH AGENCY.— 

21 In this section, the term ‘‘home health agency’’ has 

22 the meaning given that term in section 1861(o) of 

23 the Social Security Act (42 U.S.C. 1395x(o)). 

24 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE

25 OF PROJECTS.—The Secretary shall specify the criteria 


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1 for identifying those Medicare beneficiaries who shall be 

2 considered within the scope of the pilot projects under this 

3 section for purposes of the application of subsection (c) 

4 and for the assessment of the effectiveness of the home 

5 health agency in achieving the objectives of this section. 

6 Such criteria may provide for the inclusion in the projects 

7 of Medicare beneficiaries who begin receiving home health 

8 services under title XVIII of the Social Security Act after 

9 the date of the implementation of the projects. 

10 (c) INCENTIVES.— 

11 (1) PERFORMANCE TARGETS.—The Secretary 

12 shall establish for each home health agency partici13 pating in a pilot project under this section a per14 formance target using one of the following meth15 odologies, as determined appropriate by the Sec16 retary: 

17 (A) ADJUSTED HISTORICAL PERFORMANCE

18 TARGET.—The Secretary shall establish for the 

19 agency— 

20 (i) a base expenditure amount equal 

21 to the average total payments made to the 

22 agency under parts A and B of title XVIII 

23 of the Social Security Act for Medicare 

24 beneficiaries determined to be within the 


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1 scope of the pilot project in a base period 

2 determined by the Secretary; and 

3 (ii) an annual per capita expenditure 

4 target for such beneficiaries, reflecting the 

5 base expenditure amount adjusted for risk 

6 and adjusted growth rates. 

7 (B) COMPARATIVE PERFORMANCE TAR8 GET.—The Secretary shall establish for the 

9 agency a comparative performance target equal 

10 to the average total payments under such parts 

11 A and B during the pilot project for comparable 

12 individuals in the same geographic area that 

13 are not determined to be within the scope of the 

14 pilot project. 

15 (2) INCENTIVE.—Subject to paragraph (3), the 

16 Secretary shall pay to each participating home care 

17 agency an incentive payment for each year under the 

18 pilot project equal to a portion of the Medicare sav19 ings realized for such year relative to the perform20 ance target under paragraph (1). 

21 (3) LIMITATION ON EXPENDITURES.—The Sec22 retary shall limit incentive payments under this sec23 tion in order to ensure that the aggregate expendi24 tures under title XVIII of the Social Security Act 

25 (including incentive payments under this subsection) 


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1 do not exceed the amount that the Secretary esti2 mates would have been expended if the pilot projects 

3 under this section had not been implemented. 

4 (d) WAIVER AUTHORITY.—The Secretary may waive 

5 such provisions of titles XI and XVIII of the Social Secu6 rity Act as the Secretary determines to be appropriate for 

7 the conduct of the pilot projects under this section. 

8 (e) REPORT TO CONGRESS.—Not later than 5 years 

9 after the date that the first pilot project under this section 

10 is implemented, the Secretary shall submit to Congress a 

11 report on the pilot projects. Such report shall contain a 

12 detailed description of issues related to the expansion of 

13 the projects under subsection (f) and recommendations for 

14 such legislation and administrative actions as the Sec15 retary considers appropriate. 

16 (f) EXPANSION.—If the Secretary determines that 

17 any of the pilot projects under this section enhance health 

18 outcomes for Medicare beneficiaries and reduce expendi19 tures under title XVIII of the Social Security Act, the Sec20 retary may initiate comparable projects in additional 

21 areas. 

22 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON

23 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen24 tive payment under this section— 


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1 (1) shall be in addition to the payments that a 

2 home health agency would otherwise receive under 

3 title XVIII of the Social Security Act for the provi4 sion of home health services; and 

5 (2) shall have no effect on the amount of such 

6 payments. 

7 SEC. 19. FACILITATING THE PROVISION OF TELEHEALTH 

8 SERVICES ACROSS STATE LINES. 

9 (a) IN GENERAL.—For purposes of expediting the 

10 provision of telehealth services, for which payment is made 

11 under the Medicare program, across State lines, the Sec12 retary of Health and Human Services shall, in consulta13 tion with representatives of States, physicians, health care 

14 practitioners, and patient advocates, encourage and facili15 tate the adoption of provisions allowing for multistate 

16 practitioner practice across State lines. 

17 (b) DEFINITIONS.—In subsection (a): 

18 (1) TELEHEALTH SERVICE.—The term ‘‘tele19 health service’’ has the meaning given that term in 

20 subparagraph (F) of section 1834(m)(4) of the So21 cial Security Act (42 U.S.C. 1395m(m)(4)). 

22 (2) PHYSICIAN, PRACTITIONER.—The terms 

23 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

24 given those terms in subparagraphs (D) and (E), re25 spectively, of such section. 


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1 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

2 program’’ means the program of health insurance 

3 administered by the Secretary of Health and Human 

4 Services under title XVIII of the Social Security Act 

5 (42 U.S.C. 1395 et seq.). 

Æ 


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