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103D CONGRESS

1ST SESSION H. R. 1768

To amend title XVIII of the Social Security Act to make miscellaneous

and technical changes to the medicare program.

IN THE HOUSE OF REPRESENTATIVES

APRIL 21, 1993

Mr. SLATTERY (for himself, Mr. SYNAR, Mr. THOMAS of Wyoming, Mr. ROBERTS, and Mr. BEREUTER) introduced the following bill; which was referred jointly to the Committees on Ways and Means and Energy and

Commerce

A BILL

To amend title XVIII of the Social Security Act to make

miscellaneous and technical changes to the medicare program.

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 ‘‘Essential Access Com5 munity Hospital (EACH) Amendments of 1993’’.
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1 SEC. 2. ESSENTIAL ACCESS COMMUNITY HOSPITAL (EACH)

2 AMENDMENTS.

3 (a) INCREASING NUMBER OF PARTICIPATING

4 STATES.—Section 1820(a)(1) (42 U.S.C. 1395i–4(a)(1))

5 is amended by striking ‘‘7’’ and inserting ‘‘9’’.

6 (b) TREATMENT OF INPATIENT HOSPITAL SERVICES

7 PROVIDED IN RURAL PRIMARY CARE HOSPITALS.—

8 (1) IN GENERAL.—Section 1820(f)(1)(F) (42

9 U.S.C. 1395i–4(f)(1)(F)) is amended to read as fol10 lows:

11 ‘‘(F) subject to paragraph (4), provides not

12 more than 6 inpatient beds (meeting such con13 ditions as the Secretary may establish) for pro14 viding inpatient care to patients requiring sta15 bilization before discharge or transfer to a hos16 pital, except that the facility may not provide

17 any inpatient hospital services—

18 ‘‘(i) to any patient whose attending

19 physician does not certify that the patient

20 may reasonably be expected to be dis21 charged or transferred to a hospital within

22 72 hours of admission to the facility; or

23 ‘‘(ii) consisting of surgery or any

24 other service requiring the use of general

25 anesthesia (other than surgical procedures

26 specified by the Secretary under section
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1 1833(i)(1)(A)), unless the attending physi2 cian certifies that the risk associated with

3 transferring the patient to a hospital for

4 such services outweighs the benefits of

5 transferring the patient to a hospital for

6 such services.’’.

7 (2) LIMITATION ON AVERAGE LENGTH OF

8 STAY.—Section 1820(f) (42 U.S.C. 1395i–4(f)) is

9 amended by adding at the end the following new

10 paragraph:

11 ‘‘(4) LIMITATION ON AVERAGE LENGTH OF IN12 PATIENT STAYS.—The Secretary may terminate a

13 designation of a rural primary care hospital under

14 paragraph (1) if the Secretary finds that the average

15 length of stay for inpatients at the facility during

16 the previous year in which the designation was in ef17 fect exceeded 72 hours. In determining the compli18 ance of a facility with the requirement of the pre19 vious sentence, there shall not be taken into account

20 periods of duty of inpatients in excess of 72 hours

21 to the extent such periods exceed 72 hours because

22 transfer to a hospital is precluded because of inclem23 ent weather or other emergency conditions.’’.

24 (3) CONFORMING AMENDMENT.—Section

25 1814(a)(8) (42 U.S.C. 1395f(a)(8)) is amended by
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1 striking ‘‘such services’’ and all that follows and in2 serting ‘‘the individual may reasonably be expected

3 to be discharged or transferred to a hospital within

4 72 hours after admission to the rural primary care

5 hospital.’’.

6 (4) GAO REPORTS.—Not later than 2 years

7 after the date of the enactment of this Act, the

8 Comptroller General shall submit reports to Con9 gress on—

10 (A) the application of the requirements

11 under section 1820(f) of the Social Security Act

12 (as amended by this subsection) that rural pri13 mary care hospitals provide inpatient care only

14 to those individuals whose attending physicians

15 certify may reasonably be expected to be dis16 charged within 72 hours after admission and

17 maintain an average length of inpatient stay

18 during a year that does not exceed 72 hours;

19 and

20 (B) the extent to which such requirements

21 have resulted in such hospitals providing inpa22 tient care beyond their capabilities or have lim23 ited the ability of such hospitals to provide

24 needed services.

25 (c) DESIGNATION OF HOSPITALS.—
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1 (1) PERMITTING DESIGNATION OF HOSPITALS

2 LOCATED IN URBAN AREAS.—

3 (A) IN GENERAL.—Section 1820 (42

4 U.S.C. 1395i–4) is amended—

5 (i) by striking paragraph (1) of sub6 section (e) and redesignating paragraphs

7 (2) through (6) as paragraphs (1) through

8 (5); and

9 (ii) in subsection (e)(1)(A) (as redes10 ignated by subparagraph (A))—

11 (I) by striking ‘‘is located’’ and

12 inserting ‘‘except in the case of a hos13 pital located in an urban area, is lo14 cated’’,

15 (II) by striking ‘‘, (ii)’’ and in16 serting ‘‘or (ii)’’,

17 (III) by striking ‘‘or (iii)’’ and all

18 that follows through ‘‘section,’’, and

19 (IV) in subsection (i)(1)(B), by

20 striking ‘‘paragraph (3)’’ and insert21 ing ‘‘paragraph (2)’’.

22 (B) NO CHANGE IN MEDICARE PROSPEC23 TIVE PAYMENT.—Section 1886(d)(5)(D) (42

24 U.S.C. 1395ww(d)(5)(D)) is amended—
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1 (i) in clause (iii)(III), by inserting ‘‘lo2 cated in a rural area and’’ after ‘‘that is’’,

3 and

4 (ii) in clause (v), by inserting ‘‘located

5 in a rural area and’’ after ‘‘in the case of

6 a hospital’’.

7 (2) PERMITTING HOSPITALS LOCATED IN AD8 JOINING STATES TO PARTICIPATE IN STATE PRO9 GRAM.—

10 (A) IN GENERAL.—Section 1820 (42

11 U.S.C. 1395i–4) is amended—

12 (i) by redesignating subsection (k) as

13 subsection (l); and

14 (ii) by inserting after subsection (j)

15 the following new subsection:

16 ‘‘(k) ELIGIBILITY OF HOSPITALS NOT LOCATED IN

17 PARTICIPATING STATES.—Notwithstanding any other

18 provision of this section—

19 ‘‘(1) for purposes of including a hospital or fa20 cility as a member institution of a rural health net21 work, a State may designate a hospital or facility

22 that is not located in the State as an essential access

23 community hospital or a rural primary care hospital

24 if the hospital or facility is located in an adjoining
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1 State and is otherwise eligible for designation as

2 such a hospital;

3 ‘‘(2) the Secretary may designate a hospital or

4 facility that is not located in a State receiving a

5 grant under subsection (a)(1) as an essential access

6 community hospital or a rural primary care hospital

7 if the hospital or facility is a member institution of

8 a rural health network of a State receiving a grant

9 under such subsection; and

10 ‘‘(3) a hospital or facility designated pursuant

11 to this subsection shall be eligible to receive a grant

12 under subsection (a)(2).’’.

13 (B) CONFORMING AMENDMENTS.—(i) Sec14 tion 1820(c)(1) (42 U.S.C. 1395i–4(c)(1)) is

15 amended by striking ‘‘paragraph (3)’’ and in16 serting ‘‘paragraph (3) or subsection (k)’’.

17 (ii) Paragraphs (1)(A) and (2)(A) of sec18 tion 1820(i) (42 U.S.C. 1395i–4(i)) are each

19 amended—

20 (I) in clause (i), by striking ‘‘(a)(1)’’

21 and inserting ‘‘(a)(1) (except as provided

22 in subsection (k))’’, and

23 (II) in clause (ii), by striking ‘‘sub24 paragraph (B)’’ and inserting ‘‘subpara25 graph (B) or subsection (k)’’.
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1 (d) SKILLED NURSING SERVICES IN RURAL PRIMARY

2 CARE HOSPITALS.—Section 1820(f)(3) (42 U.S.C. 1395i–

3 4(f)(3)) is amended by striking ‘‘because the facility’’ and

4 all that follows and inserting the following: ‘‘because, at

5 the time the facility applies to the State for designation

6 as a rural primary care hospital, there is in effect an

7 agreement between the facility and the Secretary under

8 section 1883 under which the facility’s inpatient hospital

9 facilities are used for the furnishing of extended care serv10 ices, except that the number of beds used for the furnish11 ing of such services may not exceed the total number of

12 licensed inpatient beds at the time the facility applies to

13 the State for such designation (minus the number of inpa14 tient beds used for providing inpatient care pursuant to

15 paragraph (1)(F)). For purposes of the previous sentence,

16 the number of beds of the facility used for the furnishing

17 of extended care services shall not include any beds of a

18 unit of the facility that is licensed as a distinct-part skilled

19 nursing facility at the time the facility applies to the State

20 for designation as a rural primary care hospital.’’.

21 (e) PAYMENT FOR OUTPATIENT RURAL PRIMARY

22 CARE HOSPITAL SERVICES.—Section 1834(g)(1) (42

23 U.S.C. 1395m(g)(1)) is amended by adding at the end the

24 following: ‘‘The amount of payment shall be determined
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1 under either method without regard to the amount of the

2 customary or other charge.’’.

3 (f) CLARIFICATION OF PHYSICIAN STAFFING RE4 QUIREMENT FOR RURAL PRIMARY CARE HOSPITALS.—

5 Section 1820(f)(1)(H) (42 U.S.C. 1395i–4(f)(1)(H)) is

6 amended by striking the period and inserting the follow7 ing: ‘‘, except that in determining whether a facility meets

8 the requirements of this subparagraph, subparagraphs (E)

9 and (F) of that paragraph shall be applied as if any ref10 erence to a ‘physician’ is a reference to a physician as de11 fined in section 1861(r)(1).’’.

12 (g) TECHNICAL AMENDMENTS RELATING TO PART

13 A DEDUCTIBLE, COINSURANCE, AND SPELL OF ILL14 NESS.—(1) Section 1812(a)(1) (42 U.S.C. 1395d(a)(1))

15 is amended—

16 (A) by striking ‘‘inpatient hospital services’’ the

17 first place it appears and inserting ‘‘inpatient hos18 pital services or inpatient rural primary care hos19 pital services’’;

20 (B) by striking ‘‘inpatient hospital services’’ the

21 second place it appears and inserting ‘‘such serv22 ices’’; and

23 (C) by striking ‘‘and inpatient rural primary

24 care hospital services’’.
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1 (2) Sections 1813(a) and 1813(b)(3)(A) (42 U.S.C.

2 1395e(a), 1395e(b)(3)(A)) are each amended by striking

3 ‘‘inpatient hospital services’’ each place it appears and in4 serting ‘‘inpatient hospital services or inpatient rural pri5 mary care hospital services’’.

6 (3) Section 1813(b)(3)(B) (42 U.S.C.

7 1395e(b)(3)(B)) is amended by striking ‘‘inpatient hos8 pital services’’ and inserting ‘‘inpatient hospital services,

9 inpatient rural primary care hospital services’’.

10 (4) Section 1861(a) (42 U.S.C. 1395x(a)) is amend11 ed—

12 (A) in paragraph (1), by striking ‘‘inpatient

13 hospital services’’ and inserting ‘‘inpatient hospital

14 services, inpatient rural primary care hospital serv15 ices’’; and

16 (B) in paragraph (2), by striking ‘‘hospital’’

17 and inserting ‘‘hospital or rural primary care hos18 pital’’.

19 (h) AUTHORIZATION OF APPROPRIATIONS.—Section

20 1820(k) (42 U.S.C. 1395i–4(k)) is amended by striking

21 ‘‘1990, 1991, and 1992’’ and inserting ‘‘1990 through

22 1995’’.

23 (i) EFFECTIVE DATE.—The amendments made by

24 this section shall take effect on the date of the enactment

25 of this Act.
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