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111TH CONGRESS 

1ST SESSION H. R. 3151 

To permit pass-through payment for reasonable costs of certified registered 

nurse anesthetist services in critical access hospitals notwithstanding 

the reclassification of such hospitals as urban hospitals, including hospitals located in ‘‘Lugar counties’’, and for on-call and standby costs 

for such services. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 9, 2009 

Mr. HARE (for himself and Mr. JOHNSON of Illinois) introduced the following 

bill; which was referred to the Committee on Ways and Means 

A BILL 

To permit pass-through payment for reasonable costs of certified registered nurse anesthetist services in critical access hospitals notwithstanding the reclassification of such 

hospitals as urban hospitals, including hospitals located 

in ‘‘Lugar counties’’, and for on-call and standby costs 

for such 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 ‘‘Rural Access to Nurse 

5 Anesthesia Services Act of 2009’’. 


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HR 3151 IH1S 

1 SEC. 2. MEDICARE PASS-THROUGH PAYMENTS FOR CRNA 

2 SERVICES. 

3 (a) TREATMENT OF CRITICAL ACCESS HOSPITALS AS

4 RURAL IN DETERMINING ELIGIBILITY FOR CRNA PASS5 THROUGH PAYMENTS.—Section 9320(k) of the Omnibus 

6 Budget Reconciliation Act of 1986 (42 U.S.C. 1395k 

7 note), as amended by section 6132 of the Omnibus Budget 

8 Reconciliation Act of 1989, is amended by adding at the 

9 end the following: 

10 ‘‘(3) Any facility that qualifies as a critical ac11 cess hospital (as defined in section 1861(mm)(1) of 

12 the Social Security Act) shall be treated as being lo13 cated in a rural area for purposes of paragraph (1) 

14 regardless of any geographic reclassification of the 

15 facility, including such a reclassification of the coun16 ty in which the facility is located as an urban county 

17 (also popularly known as a Lugar county) under sec18 tion 1886(d)(8)(B) of the Social Security Act.’’. 

19 (b) TREATMENT OF STANDBY AND ON-CALL

20 COSTS.—Such section, as amended by subsection (a), is 

21 further amended by adding at the end the following: 

22 ‘‘(4) In determining the reasonable costs in23 curred by a hospital or critical access hospital for 

24 the services of a certified registered nurse anes25 thetist under this subsection, the Secretary shall in26 clude standby costs and on-call costs incurred by the 


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HR 3151 IH1S 

1 hospital or critical access hospital, respectively, with 

2 respect to such nurse anesthetist.’’. 

3 (c) EFFECTIVE DATES.— 

4 (1) TREATMENT OF CAHS AS RURAL IN DETER5 MINING CRNA PASS-THROUGH ELIGIBILITY.—The 

6 amendment made by subsection (a) shall apply to 

7 calendar years beginning on or after the date of the 

8 enactment of this Act (regardless of whether the ge9 ographic reclassification of a critical access hospital 

10 occurred before, on, or after such date). 

11 (2) INCLUSION OF STANDBY COSTS AND ON12 CALL COSTS IN DETERMINING REASONABLE COSTS

13 OF CRNA SERVICES.—The amendment made by sub14 section (b) shall apply to costs incurred in cost re15 porting periods beginning in fiscal years after fiscal 

16 year 2003. 

Æ 


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