I 

108TH CONGRESS 

1ST SESSION H. R. 830

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

access of Medicare beneficiaries to health care in rural areas. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 13, 2003

Mr. MCINNIS (for himself, Mr. HOUGHTON, Mr. CAMP, Mr. ENGLISH, Mr. 

LEWIS of Kentucky, Mr. HEFLEY, Mr. TANCREDO, Mr. BEAUPREZ, Mrs. 

MUSGRAVE, Mr. CLYBURN, Mr. HAYES, Mr. PETERSON of Minnesota, 

Mr. DAVIS of Illinois, Mr. GREEN of Wisconsin, Mr. MURTHA, Mr. GORDON, Mr. CASE, Mr. MCNULTY, and Mr. JANKLOW) introduced the following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committee on Energy and Commerce, for a period 

to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

A BILL

To amend title XVIII of the Social Security Act to protect 

and preserve access of Medicare beneficiaries to health 

care in rural areas.

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; AMENDMENTS TO SOCIAL SECU4 RITY ACT; TABLE OF CONTENTS. 

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

6 ‘‘Medicare Rural Health Care Preservation Act of 2003’’. 
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1 (b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex2 cept as otherwise specifically provided, whenever in this 

3 Act an amendment is expressed in terms of an amendment 

4 to or repeal of a section or other provision, the reference 

5 shall be considered to be made to that section or other 

6 provision of the Social Security Act. 

7 (c) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows:

Sec. 1. Short title; amendments to Social Security Act; table of contents. 

Sec. 2. Five-year continuation of medicare managed care cost contracts. 

Sec. 3. Temporary protection for sole community hospitals under outpatient 

prospective payment schedule. 

Sec. 4. Improvements to the critical access hospital program. 

Sec. 5. Extension of temporary increase for home health services furnished in 

a rural area. 

Sec. 6. Increase in payments for hospice care furnished in frontier areas. 

Sec. 7. Treatment of eligibility for hospice care.

9 SEC. 2. FIVE-YEAR CONTINUATION OF MEDICARE MAN10 AGED CARE COST CONTRACTS. 

11 Section 1876(h)(5)(C) (42 U.S.C. 1395mm(h)(5)(C)) 

12 is amended by striking ‘‘2004’’ and inserting ‘‘2009’’.

13 SEC. 3. TEMPORARY PROTECTION FOR SOLE COMMUNITY 

14 HOSPITALS UNDER OUTPATIENT PROSPEC15 TIVE PAYMENT SCHEDULE. 

16 Section 1833(t)(7)(D) (42 U.S.C. 1395l(t)(7)(D)) is 

17 amended by adding at the end the following new clause: 

18 ‘‘(iii) TEMPORARY TREATMENT FOR

19 SOLE COMMUNITY HOSPITALS.—In the 

20 case of a hospital described in section 

21 1886(d)(5)(C)(iii) that furnishes covered 
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1 OPD services for which the PPS amount is 

2 less than the pre-BBA amount—

3 ‘‘(I) in the case of such services 

4 furnished during 2004 or 2005, the 

5 amount of payment under this sub6 section shall be increased by the 

7 amount of such difference; 

8 ‘‘(II) in the case of such services 

9 furnished during 2006 or 2007, the 

10 amount of payment under this sub11 section shall be increased by 95 per12 cent of the amount of such difference; 

13 and 

14 ‘‘(III) in the case of such services 

15 furnished during 2008 or 2009, the 

16 amount of payment under this sub17 section shall be increased by 90 per18 cent of the amount of such dif19 ference.’’. 

20 SEC. 4. IMPROVEMENTS TO CRITICAL ACCESS HOSPITAL 

21 PROGRAM. 

22 (a) REINSTATEMENT OF PERIODIC INTERIM PAY23 MENT (PIP).—Section 1815(e)(2) (42 U.S.C. 

24 1395g(e)(2)) is amended—
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1 (1) by striking ‘‘and’’ at the end of subpara2 graph (C); 

3 (2) by adding ‘‘and’’ at the end of subpara4 graph (D); and 

5 (3) by inserting after subparagraph (D) the fol6 lowing new subparagraph: 

7 ‘‘(E) inpatient critical access hospital services;’’. 

8 (b) CONDITION FOR APPLICATION OF SPECIAL PHY9 SICIAN PAYMENT ADJUSTMENT.—Section 1834(g)(2) (42 

10 U.S.C. 1395m(g)(2)) is amended by adding after and 

11 below subparagraph (B) the following: 

12 ‘‘The Secretary may not require, as a condition for 

13 applying subparagraph (B) with respect to a critical 

14 access hospital, that each physician providing profes15 sional services in the hospital must assign billing 

16 rights with respect to such services, except that such 

17 subparagraph shall not apply to those physicians 

18 who have not assigned such billing rights.’’. 

19 (c) FLEXIBILITY IN BED LIMITATION FOR HOS20 PITALS.—Section 1820 (42 U.S.C. 1395i–4) is amended—

21 (1) in subsection (c)(2)(B)(iii), by inserting 

22 ‘‘subject to paragraph (3)’’ after ‘‘(iii) provides’’; 

23 (2) by adding at the end of subsection (c) the 

24 following new paragraph:
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1 ‘‘(3) INCREASE IN MAXIMUM NUMBER OF BEDS

2 FOR HOSPITALS WITH STRONG SEASONAL CENSUS

3 FLUCTUATIONS.—

4 ‘‘(A) IN GENERAL.—Subject to subpara5 graph (C), in the case of a hospital that dem6 onstrates that it meets the standards estab7 lished under subparagraph (B) and has not 

8 made the election described in subsection 

9 (f)(2)(A), the bed limitations otherwise applica10 ble under paragraph (2)(B)(iii) and subsection 

11 (f) shall be increased by 5 beds. 

12 ‘‘(B) STANDARDS.—The Secretary shall 

13 specify standards for determining whether a 

14 critical access hospital has sufficiently strong 

15 seasonal variations in patient admissions to jus16 tify the increase in bed limitation provided 

17 under subparagraph (A).’’; and 

18 (3) in subsection (f)—

19 (A) by inserting ‘‘(1)’’ after ‘‘(f)’’; and 

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

21 paragraph: 

22 ‘‘(2)(A) A hospital may elect to treat the reference 

23 in paragraph (1) to ‘15 beds’ as a reference to ‘25 beds’, 

24 but only if no more than 10 beds in the hospital are at 

25 any time used for non-acute care services. A hospital that 
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1 makes such an election is not eligible for the increase pro2 vided under subsection (c)(3)(A). 

3 ‘‘(B) The limitations in numbers of beds under the 

4 first sentence of paragraph (1) are subject to adjustment 

5 under subsection (c)(3).’’. 

6 (d) 5-YEAR EXTENSION OF THE AUTHORIZATION

7 FOR APPROPRIATIONS FOR GRANT PROGRAM.—Section 

8 1820(j) (42 U.S.C. 1395i–4(j)) is amended by striking 

9 ‘‘through 2002’’ and inserting ‘‘through 2007’’.

10 (e) PROHIBITION OF RETROACTIVE RECOUPMENT.—

11 The Secretary shall not recoup (or otherwise seek to re12 cover) overpayments made for outpatient critical access 

13 hospital services under part B of title XVIII of the Social 

14 Security Act, for services furnished in cost reporting peri15 ods that began before October 1, 2002, insofar as such 

16 overpayments are attributable to payment being based on 

17 80 percent of reasonable costs (instead of 100 percent of 

18 reasonable costs minus 20 percent of charges). 

19 (f) EFFECTIVE DATES.—

20 (1) REINSTATEMENT OF PIP.—The amend21 ments made by subsection (a) shall apply to pay22 ments made on or after January 1, 2004. 

23 (2) PHYSICIAN PAYMENT ADJUSTMENT CONDI24 TION.—The amendment made by subsection (b) 

25 shall be effective as if included in the enactment of 
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1 section 403(d) of the Medicare, Medicaid, and 

2 SCHIP Balanced Budget Refinement Act of 1999 

3 (113 Stat. 1501A–371). 

4 SEC. 5. EXTENSION OF TEMPORARY INCREASE FOR HOME 

5 HEALTH SERVICES FURNISHED IN A RURAL 

6 AREA. 

7 (a) IN GENERAL.—Section 508(a) of the Medicare, 

8 Medicaid, and SCHIP Benefits Improvement and Protec9 tion Act of 2000 (114 Stat. 2763A–533), as enacted into 

10 law by section 1(a)(6) of Public Law 106–554, is amend11 ed—

12 (1) by striking ‘‘24-MONTH INCREASE BEGIN13 NING APRIL 1, 2001’’ and inserting ‘‘IN GENERAL’’; 

14 and 

15 (2) by striking ‘‘April 1, 2003’’ and inserting 

16 ‘‘January 1, 2006’’. 

17 (b) CONFORMING AMENDMENT.—Section 547(c)(2) 

18 of such Act (114 Stat. 2763A–553) is amended by striking 

19 ‘‘the period beginning on April 1, 2001, and ending on 

20 September 30, 2002,’’ and inserting ‘‘a period under such 

21 section’’. 

22 SEC. 6. INCREASE IN PAYMENTS FOR HOSPICE CARE FUR23 NISHED IN FRONTIER AREAS. 

24 (a) 10 PERCENT INCREASE IN PAYMENT FOR HOS25 PICE CARE FURNISHED IN A FRONTIER AREA.—Section 
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1 1814(i)(1) (42 U.S.C. 1395f(i)(1)) is amended by adding 

2 at the end the following new subparagraph: 

3 ‘‘(D) With respect to hospice care furnished in a fron4 tier area on or after January 1, 2004, and before January 

5 1, 2009, the payment rates otherwise established for such 

6 care shall be increased by 10 percent. For purposes of this 

7 subparagraph, the term ‘frontier area’ means a county in 

8 which the population density is less than 7 persons per 

9 square mile.’’. 

10 (b) REPORT ON COSTS.—Not later than January 1, 

11 2008, the Comptroller General of the United States shall 

12 submit to Congress a report on the costs of furnishing 

13 hospice care in frontier areas. Such report shall include 

14 recommendations regarding the appropriateness of extend15 ing, and modifying, the payment increase provided under 

16 the amendment made by subsection (a). 

17 SEC. 7. TREATMENT OF ELIGIBILITY FOR HOSPICE CARE.

18 (a) DEEMED ELIGIBILITY BASED ON DEATH IN

19 FACT.—

20 (1) IN GENERAL.—Section 1814(i) of the Social 

21 Security Act is amended by adding at the end the 

22 following new paragraph: 

23 ‘‘(4) For purposes of section 1814(a)(7)(A), the Sec24 retary and a fiscal intermediary shall not take any action 

25 to deny payment for hospice care for an individual on the 
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1 basis that the individual is not terminally ill if the indi2 vidual dies within 6 months of the date the individual is 

3 initially admitted into the hospice program for the receipt 

4 of hospice care.’’. 

5 (2) EFFECTIVE DATE.—The amendment made 

6 by paragraph (1) shall take effect on January 1, 

7 2004. 

8 (b) CMS REPORT.—

9 (1) IN GENERAL.—The Administrator of the 

10 Centers for Medicare & Medicaid Services shall 

11 evaluate the standards used by fiscal intermediaries 

12 in denying physician certifications under section 

13 1814(a)(7) of the Social Security Act (42 U.S.C. 

14 1395f(a)(7)) that an individual is terminally ill (and 

15 thereby making such individuals ineligible to elect 

16 the hospice care alternative) and the impact of such 

17 decisions on length of stay. Such evaluation shall re18 view the impact of the amendments made by section 

19 322(a) of the Medicare, Medicaid, and SCHIP Bene20 fits Improvement and Protection Act of 2000 (114 

21 Stat. 2763A–501), as enacted into law by section 

22 1(a)(6) of Public Law 106–554 and the results of 

23 the study conducted under section 322(b) of such 

24 Act of 2000. 
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1 (2) REPORT.—Not later than 6 months after 

2 the date of the enactment of this Act, the Adminis3 trator shall submit to Congress a report on the eval4 uation under paragraph (1).

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