II 

108TH CONGRESS 

2D SESSION S. 2284 

To expand the medicare rural community hospital demonstration program 

to include outpatient services. 

IN THE SENATE OF THE UNITED STATES 

APRIL 6, 2004 

Mr. NELSON of Nebraska (for himself and Mr. BROWNBACK) introduced the 

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

A BILL 

To expand the medicare rural community hospital 

demonstration program to include outpatient services. 

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 ‘‘Medicare Rural Com5 munity Hospital Demonstration Project Expansion Act of 

6 2004’’. 

7 SEC. 2. EXPANSION OF THE MEDICARE COMMUNITY HOS8 PITAL DEMONSTRATION PROGRAM. 

9 (a) EXPANSION.— 
2 

•S 2284 IS 

1 (1) IN GENERAL.—Section 410A(a)(1) of the 

2 Medicare Prescription Drug, Improvement, and 

3 Modernization Act of 2003 (Public Law 108–173) is 

4 amended by inserting ‘‘covered outpatient hospital 

5 services (as defined in subsection (f)(3))’’ after 

6 ‘‘subsection (f)(2))’’. 

7 (2) PAYMENT.—Section 410A(b) of the Medi8 care Prescription Drug, Improvement, and Mod9 ernization Act of 2003 (Public Law 108–173) is 

10 amended— 

11 (A) in paragraph (1), in the heading, by 

12 striking ‘‘IN GENERAL’’ and inserting ‘‘COV13 ERED INPATIENT HOSPITAL SERVICES’’; and 

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

15 paragraph: 

16 ‘‘(3) COVERED OUTPATIENT HOSPITAL SERV17 ICES.—The amount of payment under the dem18 onstration program for covered outpatient hospital 

19 services furnished in a rural community hospital is, 

20 at the election of the hospital in the application re21 ferred to in subsection (a)(3)— 

22 ‘‘(A) the reasonable costs of providing such 

23 services, without regard to the amount of the 

24 customary or other charge and any limitation 
3 

•S 2284 IS 

1 under section 1861(v)(1)(U) of the Social Secu2 rity Act (42 U.S.C. 1395x(v)(1)(U)); or 

3 ‘‘(B) the amount of payment that would 

4 otherwise be provided for such services under 

5 the prospective payment system for hospital 

6 outpatient department services under section 

7 1833(t) of such Act (42 U.S.C. 1395l(t)). 

8 ‘‘(4) BENEFICIARY COST-SHARING FOR COV9 ERED OUTPATIENT HOSPITAL SERVICES.—The 

10 amount of beneficiary cost-sharing for covered out11 patient hospital services furnished in a rural commu12 nity hospital under the demonstration program shall 

13 be the amount determined under section 1833(t) of 

14 the Social Security Act (42 U.S.C. 1395l(t)), with15 out regard to any payment under paragraph (3)(A) 

16 of this subsection.’’. 

17 (3) FUNDING.—Section 410A(c)(1) of the 

18 Medicare Prescription Drug, Improvement, and 

19 Modernization Act of 2003 (Public Law 108–173) is 

20 amended by inserting ‘‘and the Federal Supple21 mentary Insurance Trust Fund established under 

22 section 1841 of such Act (42 U.S.C. 1395t), in such 

23 proportion as the Secretary determines to be appro24 priate,’’ after ‘‘(42 U.S.C. 1395i)’’. 
4 

•S 2284 IS 

1 (4) DEFINITION.—Section 410A(f) of the Medi2 care Prescription Drug, Improvement, and Mod3 ernization Act of 2003 (Public Law 108–173) is 

4 amended by adding at the end the following new 

5 paragraph: 

6 ‘‘(3) COVERED OUTPATIENT HOSPITAL SERV7 ICES.—The term ‘‘covered outpatient hospital serv8 ices’’ has the meaning given the term ‘‘covered OPD 

9 services’’ in section 1833(t)(1)(B) of the Social Se10 curity Act (42 U.S.C. 1395l(t)(1)(B)).’’. 

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

12 this section shall take effect as if included in the enact13 ment of section 410A of the Medicare Prescription Drug, 

14 Improvement, and Modernization Act of 2003 (Public Law 

15 108–173). 

Æ