I
107TH CONGRESS
2D SESSION
H. R. 4515
To amend title XVIII of the Social Security Act to provide for improvements
in access to services in rural hospitals and critical access hospitals.
IN THE HOUSE OF REPRESENTATIVES
APRIL 18, 2002
Mr. MORAN of Kansas (for himself, Mr. TURNER, Mr. THUNE, Mr. PICK-
ERING, Mr. WALDEN, Mr. MCINTYRE, Mr. BERRY, Mr. SANDLIN, Mr.
LUCAS of Kentucky, Mr. PHELPS, Mr. CARSON of Oklahoma, Mr. PAUL,
Mr. BEREUTER, Mr. SHOWS, Mr. SHIMKUS, Mr. KIND, Mr. OTTER, Mr.
WATKINS of Oklahoma, Mr. YOUNG of Alaska, Mr. BARRETT of Wis-
consin, Mr. BOUCHER, and Mr. LATHAM) introduced the following bill;
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently 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 provide
for improvements in access to services in rural hospitals
and critical access hospitals.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECU-
RITY ACT.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Rural Community Hospital Assistance Act of 2002’’.
(b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex-
cept as otherwise specifically provided, whenever in this
Act an amendment is expressed in terms of an amendment
to, or repeal of, a section or other provision, the reference
shall be considered a reference to that section or other
provision of the Social Security Act.
SEC. 2. ESTABLISHMENT OF RURAL COMMUNITY HOSPITAL
(RCH) PROGRAM.
(a) IN GENERAL.—Section 1861 (42 U.S.C. 1395x)
is amended by adding at the end of the following new sub-
section:
‘‘Rural Community Hospital; Rural Community Hospital
Services
‘‘(ww)(1) The term ‘rural community hospital’ means
a hospital (as defined in subsection (e)) that—
‘‘(A) is located in a rural area (as defined in
section 1886(d)(2)(D)) or treated as being so lo-
cated pursuant to section 1886(d)(8)(E);
‘‘(B) subject to subparagraph (B), has less than
51 acute care inpatient beds, as reported in its most
recent cost report;
‘‘(C) makes available 24-hour emergency care
services;
‘‘(D) subject to subparagraph (C), has a pro-
vider agreement in effect with the Secretary and is
open to the public as of January 1, 2002; and
‘‘(E) applies to the Secretary for such designa-
tion.
‘‘(2) For purposes of paragraph (1)(B), beds in a
psychiatric or rehabilitation unit of the hospital which is
a distinct part of the hospital shall not be counted.
‘‘(3) Subparagraph (1)(C) shall not be construed to
prohibit any of the following from qualifying as a rural
community hospital:
‘‘(A) A replacement facility (as defined by the
Secretary in regulations in effect on January 1,
2002) with the same service area (as defined by the
Secretary in regulations in effect on such date).
‘‘(B) A facility obtaining a new provider num-
ber pursuant to a change of ownership.
‘‘(C) A facility which has a binding written
agreement with an outside, unrelated party for the
construction, reconstruction, lease, rental, or financ-
ing of a building as of January 1, 2002.
‘‘(4) Nothing in this subsection shall be construed as
prohibiting a critical access hospital from qualifying as a
rural community hospital if the critical access hospital
meets the conditions otherwise applicable to hospitals
under subsection (e) and section 1866.’’.
(b) PAYMENT.—
(1) INPATIENT
SERVICES.—Section 1814 (42
U.S.C. 1395f) is amended by adding at the end the
following new subsection:
‘‘Payment for Inpatient Services Furnished in Rural
Community Hospitals
‘‘(m) The amount of payment under this part for in-
patient hospital services furnished in a rural community
hospital, other than such services furnished in a psy-
chiatric or rehabilitation unit of the hospital which is a
distinct part, is, at the election of the hospital in the appli-
cation referred to in section 1861(ww)(1)(D)—
‘‘(1) the reasonable costs of providing such
services, without regard to the amount of the cus-
tomary or other charge, or
‘‘(2) the amount of payment provided for under
the prospective payment system for inpatient hos-
pital services under section 1886(d).’’.
(2) OUTPATIENT SERVICES.—Section 1834 (42
U.S.C. 1395m) is amended by adding at the end the
following new subsection:
‘‘(n) PAYMENT FOR OUTPATIENT SERVICES FUR-
NISHED
IN
RURAL
COMMUNITY
HOSPITALS.—The
amount of payment under this part for outpatient services
furnished in a rural community hospital is, at the election
of the hospital in the application referred to in section
1861(ww)(1)(D)—
‘‘(1) the reasonable costs of providing such
services, without regard to the amount of the cus-
tomary or other charge and any limitation under
section 1861(v)(1)(U), or
‘‘(2) the amount of payment provided for under
the prospective payment system for covered OPD
services under section 1833(t).’’.
(3) HOME HEALTH SERVICES.—
(A) EXCLUSION
FROM
HOME
HEALTH
PPS.—
(i) IN GENERAL.—Section 1895 (42
U.S.C. 1395fff) is amended by adding at
the end the following:
‘‘(f) EXCLUSION.—
‘‘(1) IN GENERAL.—In determining payments
under this title for home health services furnished on
or after October 1, 2002, by a qualified RCH-based
home health agency (as defined in paragraph (2))—
‘‘(A) the agency may make a one-time elec-
tion to waive application of the prospective pay-
ment system established under this section to
such services furnished by the agency shall not
apply; and
‘‘(B) in the case of such an election, pay-
ment shall be made on the basis of the reason-
able costs incurred in furnishing such services
as determined under section 1861(v), but with-
out regard to the amount of the customary or
other charges with respect to such services or
the limitations established under paragraph
(1)(L) of such section.
‘‘(2) QUALIFIED
RCH-BASED
HOME
HEALTH
AGENCY DEFINED.—For purposes of paragraph (1),
a ‘qualified RCH-based home health agency’ is a
home health agency that is a provider-based entity
(as defined in section 404 of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection
Act of 2000 (Public Law 106–554; Appendix F, 114
Stat. 2763A–506) of a rural community hospital
that is located—
‘‘(A) in a county in which no main or
branch office of another home health agency is
located; or
‘‘(B) at least 35 miles from any main or
branch office of another home health agency.’’.
(ii) CONFORMING CHANGES.—