I
107TH CONGRESS
1ST SESSION
H. R. 2157
To address health care disparities in rural areas by amending title XVIII
of the Social Security Act, the Public Health Service Act, and the
Internal Revenue Code of 1986, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 13, 2001
Mr. MORAN of Kansas (for himself, Mr. MCINTYRE, Mr. BEREUTER, Mr.
STENHOLM, Mr. BRADY of Texas, Mr. TANNER, Mr. NUSSLE, Mr. HILL-
IARD, Mr. POMEROY, Mr. STUPAK, Mrs. THURMAN, Mr. BASS, Mr.
NETHERCUTT, Mr. WICKER, Mrs. EMERSON, Mr. KIND, Mr. PETERSON
of Pennsylvania, Mr. SANDLIN, Mr. THUNE, Mr. SWEENEY, Mr. CARSON
of Oklahoma, Mr. OBERSTAR, Mr. RAHALL, Mr. SKELTON, Mr. WATKINS
of Oklahoma, Mr. GORDON, Mr. CRAMER, Mr. EHLERS, Mr. HOLDEN,
Mr. LEWIS of Kentucky, Mr. MCHUGH, Mr. FOLEY, Mr. HILLEARY, Mr.
JONES of North Carolina, Mr. BOSWELL, Mr. GOODE, Ms. HOOLEY of
Oregon, Mr. PICKERING, Mr. SHIMKUS, Mr. BAIRD, Mr. HAYES, Mr.
PHELPS, Mr. TERRY, Mr. KENNEDY of Minnesota, Mr. PUTNAM, and Mr.
ROSS) 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 juris-
diction of the committee concerned
A BILL
To address health care disparities in rural areas by amending
title XVIII of the Social Security Act, the Public Health
Service Act, and the Internal Revenue Code of 1986,
and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; REFERENCES TO BIPA; TABLE
OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Rural Health Care Improvement Act of 2001’’.
(b) REFERENCES TO BIPA.—In this Act, the term
‘‘BIPA’’ means the Medicare, Medicaid, and SCHIP Ben-
efits Improvement and Protection Act of 2000 (114 Stat.
2763A–463 et seq.), as enacted into law by section 1(a)(6)
of Public Law 106–554.
(c) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
TITLE I—RURAL MEDICARE REFORMS
Subtitle A—Rural Hospital Improvements
Sec. 101. Fairness in the disproportionate share hospital (DSH) adjustment for
rural hospitals.
Sec. 102. Establishing a single standardized amount under inpatient hospital
prospective payment system.
Sec. 103. Hospital geographic reclassification for labor costs for all items and
services reimbursed under prospective payment systems.
Sec. 104. Treatment of certain physician pathology services.
Subtitle B—Rural Home Health Improvements
Sec. 111. Elimination of 15 percent reduction in payment rates under the pro-
spective payment system for home health services.
Sec. 112. Permanent increase for home health services furnished in a rural
area.
Subtitle C—Rural Health Clinic Improvements
Sec. 121. Improvement in rural health clinic reimbursement.
Sec. 122. Exclusion of certain rural health clinic services and Federally quali-
fied health center services from the prospective payment system
for covered skilled nursing facility services.
TITLE II—RURAL GRANT AND LOAN PROGRAMS FOR
INFRASTRUCTURE, TECHNOLOGY, AND TELEHEALTH
Sec. 201. Capital infrastructure revolving loan program.
Sec. 202. High technology acquisition grant and loan program.
Sec. 203. Establishment of telehealth resource centers.
TITLE III—NATIONAL HEALTH SERVICE CORPS TAX RELIEF
Sec. 301. Exclusion of certain amounts received under the National Health
Service Corps Loan Repayment Program.
TITLE I—RURAL MEDICARE
REFORMS
Subtitle A—Rural Hospital
Improvements
SEC. 101. FAIRNESS IN THE DISPROPORTIONATE SHARE
HOSPITAL (DSH) ADJUSTMENT FOR RURAL
HOSPITALS.
(a) EQUALIZING DSH PAYMENT AMOUNTS.—
(1) IN
GENERAL.—Section 1886(d)(5)(F)(vii)
of 
the 
Social 
Security 
Act 
(42 
U.S.C.
1395ww(d)(5)(F)(vii)) is amended by inserting ‘‘,
and, after October 1, 2001, for any other hospital
described in clause (iv),’’ after ‘‘clause (iv)(I)’’.
(2) 
CONFORMING
AMENDMENTS.—Section
1886(d)(5)(F) 
of 
such 
Act 
(42 
U.S.C.
1395ww(d)(5)(F)), as amended by section 211 of
BIPA (114 Stat. 2763A–483), is amended—
(A) in clause (iv)—
(i) in subclause (II), by inserting ‘‘or,
for discharges occurring on or after Octo-
ber 1, 2001, is equal to the percent deter-
mined in accordance with the applicable
formula described in clause (vii)’’ after
‘‘clause (xiii)’’;
(ii) in subclause (III), by inserting
‘‘or, for discharges occurring on or after
October 1, 2001, is equal to the percent
determined in accordance with the applica-
ble formula described in clause (vii)’’ after
‘‘clause (xii)’’;
(iii) in subclause (IV), by inserting
‘‘or, for discharges occurring on or after
October 1, 2001, is equal to the percent
determined in accordance with the applica-
ble formula described in clause (vii)’’ after
‘‘clause (x) or (xi)’’;
(iv) in subclause (V), by inserting ‘‘or,
for discharges occurring on or after Octo-
ber 1, 2001, is equal to the percent deter-
mined in accordance with the applicable
formula described in clause (vii)’’ after
‘‘clause (xi)’’ ; and
(v) in subclause (VI), by inserting
‘‘or, for discharges occurring on or after
October 1, 2001, is equal to the percent
determined in accordance with the applica-
ble formula described in clause (vii)’’ after
‘‘clause (x)’’;
(B) in clause (viii), by striking ‘‘The for-
mula’’ and inserting ‘‘For discharges occurring
before October 1, 2001, the formula’’; and
(C) in each of clauses (x), (xi), (xii), and
(xiii), by striking ‘‘For purposes’’ and inserting
‘‘With respect to discharges occurring before
October 1, 2001, for purposes’’.
(b) EFFECTIVE DATE.—The amendments made by
this section shall apply with respect to discharges occur-
ring on or after October 1, 2001.
SEC. 
102. 
ESTABLISHING 
A 
SINGLE 
STANDARDIZED
AMOUNT UNDER INPATIENT HOSPITAL PRO-
SPECTIVE PAYMENT SYSTEM.
(a) IN GENERAL.—Section 1886(d)(3)(A) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(3)(A)) is
amended—
(1) in clause (iv), by inserting ‘‘and ending on
or before September 30, 2001,’’ after ‘‘October 1,
1995,’’; and
(2) by redesignating clauses (v) and (vi) as
clauses (vii) and (viii), respectively, and inserting
after clause (iv) the following new clauses:
‘‘(v) For discharges occurring in the fiscal year
beginning on October 1, 2001, the average standard-
ized amount for hospitals located in areas other than
a large urban area shall be equal to the average
standardized amount for hospitals located in a large
urban area.
‘‘(vi) For discharges occurring in a fiscal year
beginning on or after October 1, 2002, the Secretary
shall compute an average standardized amount for
hospitals located in all areas within the United
States equal to the average standardized amount
computed under clause (v) or this clause for the pre-
vious fiscal year increased by the applicable percent-
age increase under subsection (b)(3)(B)(i) for the
fiscal year involved.’’.
(b) CONFORMING AMENDMENTS.—
(1) 
UPDATE
FACTOR.—Section
1886(b)(3)(B)(i)(XVII) of the Social Security Act
(42 U.S.C. 1395ww(b)(3)(B)(i)(XVII)) is amended
by striking ‘‘for hospitals in all areas,’’ and inserting
‘‘for hospitals located in a large urban area,’’.
(2) COMPUTING DRG-SPECIFIC RATES.—
(A) IN GENERAL.—Section 1886(d)(3)(D)
of such Act (42 U.S.C. 1395ww(d)(3)(D)) is
amended—
(i) in the heading by striking ‘‘IN DIF-
FERENT AREAS’’;
(ii) in the matter preceding clause
(i)—
(I) by inserting ‘‘for fiscal years
before fiscal year 1997’’ before ‘‘a re-
gional DRG prospective payment rate
for each region,’’; and
(II) by striking ‘‘each of which
is’’;
(iii) in clause (i)—
(I) by inserting ‘‘for fiscal years
before fiscal year 2002,’’ after ‘‘(i)’’;
and
(II) by striking ‘‘and’’ at the end;
(iv) in clause (ii)—
(I) by inserting ‘‘for fiscal years
before fiscal year 2002,’’ after ‘‘(ii)’’;
and
(II) by striking the period at the
end and inserting ‘‘; and’’; and
(v) by adding at the end the following
new clause: