I 
★
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 hos-
pitals 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 cer-
tified registered nurse anesthetist services in critical ac-
cess 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. 
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 Access to Nurse 
Anesthesia Services Act of 2009’’. 
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SEC. 2. MEDICARE PASS-THROUGH PAYMENTS FOR CRNA 
SERVICES. 
(a) TREATMENT OF CRITICAL ACCESS HOSPITALS AS 
RURAL IN DETERMINING ELIGIBILITY FOR CRNA PASS- 
THROUGH PAYMENTS.—Section 9320(k) of the Omnibus 
Budget Reconciliation Act of 1986 (42 U.S.C. 1395k 
note), as amended by section 6132 of the Omnibus Budget 
Reconciliation Act of 1989, is amended by adding at the 
end the following: 
‘‘(3) Any facility that qualifies as a critical ac-
cess hospital (as defined in section 1861(mm)(1) of 
the Social Security Act) shall be treated as being lo-
cated in a rural area for purposes of paragraph (1) 
regardless of any geographic reclassification of the 
facility, including such a reclassification of the coun-
ty in which the facility is located as an urban county 
(also popularly known as a Lugar county) under sec-
tion 1886(d)(8)(B) of the Social Security Act.’’. 
(b) TREATMENT
OF
STANDBY
AND
ON-CALL 
COSTS.—Such section, as amended by subsection (a), is 
further amended by adding at the end the following: 
‘‘(4) In determining the reasonable costs in-
curred by a hospital or critical access hospital for 
the services of a certified registered nurse anes-
thetist under this subsection, the Secretary shall in-
clude standby costs and on-call costs incurred by the 
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hospital or critical access hospital, respectively, with 
respect to such nurse anesthetist.’’. 
(c) EFFECTIVE DATES.— 
(1) TREATMENT OF CAHS AS RURAL IN DETER-
MINING
CRNA
PASS-THROUGH
ELIGIBILITY.—The 
amendment made by subsection (a) shall apply to 
calendar years beginning on or after the date of the 
enactment of this Act (regardless of whether the ge-
ographic reclassification of a critical access hospital 
occurred before, on, or after such date). 
(2) INCLUSION OF STANDBY COSTS AND ON- 
CALL COSTS IN DETERMINING REASONABLE COSTS 
OF CRNA SERVICES.—The amendment made by sub-
section (b) shall apply to costs incurred in cost re-
porting periods beginning in fiscal years after fiscal 
year 2003. 
Æ 
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