I 
108TH CONGRESS 
1ST SESSION 
H. R. 754
To amend title XVIII of the Social Security Act to remove the 20 percent 
inpatient limitation under the Medicare Program on the proportion of 
hospice care that certain rural hospice programs may provide. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 12, 2003
Mr. WICKER introduced the following bill; which was referred to the Com-
mittee on Ways and Means, and in addition to the Committee on Energy 
and Commerce, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to remove 
the 20 percent inpatient limitation under the Medicare 
Program on the proportion of hospice care that certain 
rural hospice programs may provide.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Communities 
Hospice Care Access Improvement Act of 2003’’.
SEC. 2. EXCEPTION TO MEDICARE 20 PERCENT INPATIENT 
CARE LIMITATION FOR CERTAIN RURAL HOS-
PICE PROGRAMS. 
(a) IN GENERAL.—Section 1861(dd) of the Social Se-
curity Act (42 U.S.C. 1395x(dd)) is amended—
(1) in paragraph (2)(A)(iii), by inserting ‘‘sub-
ject to paragraph (6),’’ after ‘‘(iii)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(6) The requirement of paragraph (2)(A)(iii) (relat-
ing to a limitation on proportion of hospice care provided 
in an inpatient setting) shall not apply in the case of a 
hospice program that meets the following requirements: 
‘‘(A) The hospice program is a non-profit orga-
nization, provides a residence for inidividuals who do 
not have a primary caregiver available at home, is 
located in a rural area (as defined in section 
1886(d)(2)(D)), is not certified for purposes of this 
title to provide other than hospice care, and is not 
affiliated with any organization that provides a type 
of care other than hospice care. 
‘‘(B) The residence has not more than 20 beds. 
‘‘(C) The residence offers all other categories of 
hospice care, including continuous home care, respite 
care, and general patient care, for individuals who 
qualify to receive such care.’’.
(b) MAINTAINING PAYMENT RATES FOR ROUTINE 
CARE.—Section 1814(a) of such Act (42 U.S.C. 1395f(a)) 
is amended—
(1) by redesignating paragraph (3) as para-
graph (4); and 
(2) by inserting after paragraph (2) the fol-
lowing new paragraph: 
‘‘(3)(A) With respect to a care provided under a hos-
pice program described in section 1861(dd)(6) that meets 
the requirements of that section, payment for routine care 
and other services included in hospice care furnished 
under such program shall be made at the rate applicable 
under this subsection for routine home care and other 
services included in hospice care. 
‘‘(B) For purposes of determining payment amounts 
under subparagraph (A) with respect to routine and 
conitnuous care, the residence described in section 
1861(dd)(6) is deemed to be the home of the individual 
receiving hospice care.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to hospice care provided on or after 
the date of the enactment of this Act.
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