(B) The entity is undertaking to develop
and implement a community rural health net-
work in one or more underserved rural areas
(as defined in section 204) with the active par-
ticipation of at least 3 health care providers or
facilities in the area.
(C) The entity has consulted with the local
governments of the area to be served by the
network and with individuals who reside in the
area.
(2) COORDINATION WITH PROVIDERS OUTSIDE
OF AREA PERMITTED.—Nothing in this section shall
be construed as preventing an entity that coordi-
nates the delivery of services in an underserved rural
area with an entity outside the area from qualifying
for financial assistance under this section, or as pre-
venting an entity consisting of a consortia of mem-
bers located in adjoining States from qualifying for
such assistance.
(3) PERMITTING
ENTITIES
NOT
RECEIVING
FUNDING FOR DEVELOPMENT OF PLAN TO RECEIVE
FUNDING FOR IMPLEMENTATION.—An entity that is
eligible to receive financial assistance under this sec-
tion may receive assistance to carry out activities de-
scribed in subsection (c)(1)(B) notwithstanding that
the entity does not receive assistance to carry out
activities described in subsection (c)(1)(A).
(c) USE OF FUNDS.—
(1) IN
GENERAL.—Financial assistance made
available to eligible entities under this section may
be used only—
(A) for the development of a community
health network and the submission of the plan
for the network to the Secretary; and
(B) after the Secretary approves the plan
for the network, for activities to implement the
network, including (but not limited to)—
(i) establishing information systems,
including telecommunications,
(ii) recruiting health care providers,
(iii) providing services to enable indi-
viduals to have access to health care serv-
ices, including transportation and language
interpretation services (including interpre-
tation services for the hearing-impaired),
and
(iv) establishing and operating a com-
munity health advisor program described
in paragraph (2).
(2) COMMUNITY HEALTH ADVISOR PROGRAM.—
(A) PROGRAM DESCRIBED.—In paragraph
(1), a ‘‘community health advisor program’’ is
a program under which community health advi-
sors carry out the following activities:
(i) Collaborating efforts with health
care providers and related entities to facili-
tate the provision of health services and
health-related social services.
(ii) Providing public education on
health promotion and disease prevention
and efforts to facilitate the use of available
health services and health-related social
services.
(iii) Providing health-related counsel-
ing.
(iv) Making referrals for available
health services and health-related social
services.
(v) Improving the ability of individ-
uals to use health services and health-relat-
ed social services under Federal, State,
and local programs through assisting indi-
viduals in establishing eligibility under the
programs.
(vi) Providing outreach services to in-
form the community of the availability of
the services provided under the program.
(B) COMMUNITY
HEALTH
ADVISOR
DE-
FINED.—In subparagraph (A), the term ‘‘com-
munity health advisor’’ means, with respect to
a community health advisor program, an indi-
vidual—
(i) who has demonstrated the capacity
to carry out one or more of the activities
carried out under the program; and
(ii) who, for not less than one year,
has been a resident of the community in
which the program is to be operated.
(3) LIMITATIONS ON ACTIVITIES FUNDED.—Fi-
nancial assistance made available under this section
may not be used for any of the following:
(A) For construction or renovation of a
telecommunications system.
(B) For construction or remodeling of
health care facilities.
(4) LIMITATION ON AMOUNT AVAILABLE FOR
DEVELOPMENT OF NETWORK.—The amount of fi-
nancial assistance available to an entity for activities
described in paragraph (1)(A) may not exceed
$50,000 and may not be made available for a period
of time exceeding 1 year.
(d) APPLICATION.—
(1) IN GENERAL.—No financial assistance shall
be provided under this section to an entity unless
the entity has submitted to the Secretary, in a time
and manner specified by the Secretary, and had ap-
proved by the Secretary an application.
(2) INFORMATION
TO
BE
INCLUDED.—Each
such application shall include—
(A) a description of the community rural
health network, including service area and ca-
pacity, and
(B) a description of how the proposed net-
work will utilize existing health care facilities in
a manner that avoids unnecessary duplication.
(e) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—There are authorized to be
appropriated $50,000,000 for each of fiscal years
1997 through 2001 to carry out this section.
Amounts appropriated under this section shall be
available until expended.
(2) ANNUAL LIMIT ON ASSISTANCE TO GRANT-
EE.—The amount of financial assistance provided to
an entity under this section during a year may not
exceed $250,000.
SEC. 204. DEFINITIONS.
(a) COMMUNITY RURAL HEALTH NETWORK.—For
purposes of this title, the term ‘‘community rural health
network’’ means a formal cooperative arrangement be-
tween participating hospitals, rural health clinics, physi-
cians, and other health care providers which—
(1) is located in an underserved rural area;
(2) furnishes health care services to individuals
residing in the area; and
(3) is governed by a board of directors selected
by participating health care providers and residents
of the area.
(b) OTHER DEFINITIONS.—For purposes of this title:
(1) The term ‘‘rural area’’ has the meaning
given such term in section 1886(d)(2)(D) of the So-
cial Security Act.
(2) The term ‘‘Secretary’’ means the Secretary
of Health and Human Services.
(3) The term ‘‘State’’ means each of the several
States, the District of Columbia, Puerto Rico, the
Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa.
TITLE 
III—MEDICARE 
RURAL
PRIMARY 
CARE 
HOSPITALS
AND RURAL EMERGENCY AC-
CESS CARE HOSPITALS
Subtitle A—Rural Primary Care
Hospital Program
SEC. 301. DESIGNATION OF RURAL PRIMARY CARE HOS-
PITALS.
Section 1820 of the Social Security Act (42 U.S.C.
1395i–4) is amended to read as follows:
‘‘MEDICARE RURAL PRIMARY CARE HOSPITAL PROGRAM
‘‘SEC. 1820. (a) STATE DESIGNATION OF FACILI-
TIES.—
‘‘(1) IN GENERAL.—A State may designate one
or more facilities as a rural primary care hospital in
accordance with paragraph (2).
‘‘(2) CRITERIA
FOR
DESIGNATION
AS
RURAL
PRIMARY CARE HOSPITAL.—A State may designate a
facility as a rural primary care hospital if the facil-
ity—
‘‘(A) is located in a county (or equivalent
unit of local government) in a rural area (as de-
fined in section 1886(d)(2)(D)) that—
‘‘(i) is located more than a 20-mile
drive from a hospital, or another facility
described in this subsection, or
‘‘(ii) is certified by the State as being
a necessary provider of health care services
to residents in the area because of local ge-
ography or service patterns;
‘‘(B) makes available 24-hour emergency
care services;
‘‘(C) provides not more than 15 acute care
inpatient beds (meeting such standards as the
Secretary may establish) for providing inpatient
care for a period not to exceed 96 hours (unless
a longer period is required because transfer to
a hospital is precluded because of inclement
weather or other emergency conditions), except
that a peer review organization or equivalent
entity may, on request, waive the 96-hour re-
striction on a case-by-case basis;
‘‘(D) meets such staffing requirements as
would apply under section 1861(e) to a hospital
located in a rural area, except that—
‘‘(i) the facility need not meet hospital
standards relating to the number of hours
during a day, or days during a week, in
which the facility must be open and fully
staffed, except insofar as the facility is re-
quired to make available emergency care
services as determined under subparagraph
(B) and must have nursing services avail-
able on a 24-hour basis, but need not oth-
erwise staff the facility except when an in-
patient is present,
‘‘(ii) the facility may provide any serv-
ices otherwise required to be provided by a
full-time, on-site dietitian, pharmacist, lab-
oratory technician, medical technologist,
and radiological technologist on a part-
time, off-site basis under arrangements as
defined in section 1861(w)(1), and
‘‘(iii) the inpatient care described in
subparagraph (C) may be provided by a
physician’s assistant, nurse practitioner, or
clinical nurse specialist subject to the over-
sight of a physician who need not be
present in the facility;
‘‘(E) meets the requirements of subpara-
graph (I) of paragraph (2) of section 1861(aa);
and
‘‘(F) has executed and in effect an agree-
ment described in subsection (b)(1).
‘‘(b) AGREEMENTS.—
‘‘(1) IN GENERAL.—Each rural primary care
hospital shall have an agreement with respect to
each item described in paragraph (2) with at least
1 hospital (as defined in section 1861(e)).
‘‘(2) ITEMS DESCRIBED.—The items described
in this paragraph are the following:
‘‘(A) Patient referral and transfer.
‘‘(B) The development and use of commu-
nications systems including (where feasible)—
‘‘(i) telemetry systems, and
‘‘(ii) systems for electronic sharing of
patient data.
‘‘(C) The provision of emergency and non-
emergency transportation among the facility
and the hospital.
‘‘(3) CREDENTIALING
AND
QUALITY
ASSUR-
ANCE.—Each rural primary care hospital shall have
an agreement with respect to credentialing and qual-
ity assurance with at least 1—
‘‘(A) hospital,
‘‘(B) peer review organization or equivalent
entity, or
‘‘(C) other appropriate and qualified entity
identified by the State.
‘‘(c) CERTIFICATION BY THE SECRETARY.—The Sec-
retary shall certify a facility as a rural primary care hos-
pital if the facility—
‘‘(1) is designated as a rural primary care hos-
pital by the State in which it is located; and
‘‘(2) meets such other criteria as the Secretary
may require.
‘‘(d) PERMITTING MAINTENANCE OF SWING BEDS.—
Nothing in this section shall be construed to prohibit a
State from designating or the Secretary from certifying
a facility as a rural primary care hospital solely because,
at the time the facility applies to the State for designation
as a rural primary care hospital, there is in effect an
agreement between the facility and the Secretary under
section 1883 under which the facility’s inpatient hospital
facilities are used for the furnishing of extended care serv-
ices, except that the number of beds used for the furnish-
ing of such services may not exceed 25 beds (minus the
number of inpatient beds used for providing inpatient care
in the facility pursuant to subsection (a)). For purposes
of the previous sentence, the number of beds of the facility
used for the furnishing of extended care services shall not
include any beds of a unit of the facility that is licensed
as a distinct-part skilled nursing facility at the time the
facility applies to the State for designation as a rural pri-
mary care hospital.
‘‘(e) WAIVER
OF CONFLICTING PART A PROVI-
SIONS.—The Secretary is authorized to waive such provi-
sions of this part and part C as are necessary to conduct
the program established under this section.’’.
SEC. 302. PAYMENT ON A REASONABLE COST BASIS.
(a) MEDICARE PART A.—Section 1814(l) of the So-
cial Security Act (42 U.S.C. 1395f(l)) is amended to read
as follows:
‘‘(l) PAYMENT
FOR INPATIENT RURAL PRIMARY
CARE HOSPITAL SERVICES.—The amount of payment
under this part for inpatient rural primary care hospital
services is the reasonable costs of the rural primary care
hospital in providing such services.’’.
(b) MEDICARE PART B.—Section 1834(g) of such
Act (42 U.S.C. 1395m(g)) is amended to read as follows:
‘‘(g) PAYMENT FOR OUTPATIENT RURAL PRIMARY
CARE HOSPITAL SERVICES.—The amount of payment
under this part for outpatient rural primary care hospital
services is the reasonable costs of the rural primary care
hospital in providing such services.’’.
SEC. 303. LENGTHENING MAXIMUM PERIOD OF PERMITTED
INPATIENT STAY.
Section 1814(a)(8) of the Social Security Act (42
U.S.C. 1395f(a)(8)) is amended by striking ‘‘72 hours’’
and inserting ‘‘96 hours’’.
SEC. 304. PAYMENT CONTINUED TO DESIGNATED ESSEN-
TIAL ACCESS COMMUNITY HOSPITALS.
Section 1886(d)(5)(D) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(D)) is amended—
(1) in clause (iii)(III), by inserting ‘‘as in effect
on September 30, 1996’’ before the period at the
end; and
(2) in clause (v), by inserting ‘‘as in effect on
September 30, 1996’’ after ‘‘1820(i)(1)’’ and after
‘‘1820(g)’’.
SEC. 305. EFFECTIVE DATE.
The amendments made by this subtitle shall apply to
services furnished on or after October 1, 1996.
Subtitle B—Rural Emergency
Access Care Hospitals
SEC. 311. ESTABLISHMENT OF HOSPITALS.
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended by adding at the
end the following new subsection:
‘‘Rural Emergency Access Care Hospital; Rural
Emergency Access Care Hospital Services
‘‘(oo)(1) The term ‘rural emergency access care hos-
pital’ means, for a fiscal year, a facility with respect to
which the Secretary finds the following:
‘‘(A) The facility is located in a rural area (as
defined in section 1886(d)(2)(D)).
‘‘(B) The facility was a hospital under this title
at any time during the 5-year period that ends on
the date of the enactment of this subsection.
‘‘(C) The facility is in danger of closing due to
low inpatient utilization rates and operating losses,
and the closure of the facility would limit the access
to emergency services of individuals residing in the
facility’s service area.
‘‘(D) The facility has entered into (or plans to
enter into) an agreement with a hospital with a par-
ticipation agreement in effect under section 1866(a),
and under such agreement the hospital shall accept
patients transferred to the hospital from the facility
and receive data from and transmit data to the facil-
ity.
‘‘(E) There is a practitioner who is qualified to
provide advanced cardiac life support services (as de-
termined by the State in which the facility is lo-
cated) on-site at the facility on a 24-hour basis.
‘‘(F) A physician is available on-call to provide
emergency medical services on a 24-hour basis.
‘‘(G) The facility meets such staffing require-
ments as would apply under section 1861(e) to a
hospital located in a rural area, except that—
‘‘(i) the facility need not meet hospital
standards relating to the number of hours dur-
ing a day, or days during a week, in which the
facility must be open, except insofar as the fa-
cility is required to provide emergency care on
a 24-hour basis under subparagraphs (E) and
(F); and
‘‘(ii) the facility may provide any services
otherwise required to be provided by a full-time,
on-site dietitian, pharmacist, laboratory techni-
cian, medical technologist, or radiological tech-
nologist on a part-time, off-site basis.
‘‘(H) The facility meets the requirements appli-
cable to clinics and facilities under subparagraphs
(C) through (J) of paragraph (2) of section
1861(aa) and of clauses (ii) and (iv) of the second
sentence of such paragraph (or, in the case of the
requirements of subparagraph (E), (F), or (J) of
such paragraph, would meet the requirements if any
reference in such subparagraph to a ‘nurse practi-
tioner’ or to ‘nurse practitioners’ were deemed to be
a reference to a ‘nurse practitioner or nurse’ or to
‘nurse practitioners or nurses’); except that in deter-
mining whether a facility meets the requirements of
this subparagraph, subparagraphs (E) and (F) of
that paragraph shall be applied as if any reference
to a ‘physician’ is a reference to a physician as de-
fined in section 1861(r)(1).
‘‘(2) The term ‘rural emergency access care hospital
services’ means the following services provided by a rural
emergency access care hospital and furnished to an indi-
vidual over a continuous period not to exceed 24 hours
(except that such services may be furnished over a longer
period in the case of an individual who is unable to leave
the hospital because of inclement weather):
‘‘(A) An appropriate medical screening exam-
ination (as described in section 1867(a)).
‘‘(B) Necessary stabilizing examination and
treatment services for an emergency medical condi-
tion and labor (as described in section 1867(b)).’’.
(b) REQUIRING RURAL EMERGENCY ACCESS CARE
HOSPITALS TO MEET HOSPITAL ANTI-DUMPING RE-
QUIREMENTS.—Section 1867(e)(5) of the Social Security
Act (42 U.S.C. 1395dd(e)(5)) is amended by striking
‘‘1861(mm)(1))’’ and inserting ‘‘1861(mm)(1)) and a
rural emergency access care hospital (as defined in section
1861(oo)(1))’’.
(c) COVERAGE AND PAYMENT FOR SERVICES.—
(1) COVERAGE.—Section 1832(a)(2) of the So-
cial Security Act (42 U.S.C. 1395k(a)(2)) is amend-
ed—
(A) by striking ‘‘and’’ at the end of sub-
paragraph (I);
(B) by striking the period at the end of
subparagraph (J) and inserting ‘‘; and’’; and
(C) by adding at the end the following new
subparagraph:
‘‘(K) rural emergency access care hospital
services (as defined in section 1861(oo)(2)).’’.
(2) PAYMENT BASED ON PAYMENT FOR OUT-
PATIENT CRITICAL ACCESS HOSPITAL SERVICES.—
(A) IN GENERAL.—Section 1833(a)(6) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395l(a)(6)), as amended by section 331(2)(A),
is amended by striking ‘‘services,’’ and inserting
‘‘services and rural emergency access care hos-
pital services,’’.
(B) 
PAYMENT
METHODOLOGY
DE-
SCRIBED.—Section 1834(g) of the Social Secu-
rity Act (42 U.S.C. 1395m(g)), as amended by
section 331(2)(B), is amended—
(i) in the heading, by striking ‘‘SERV-
ICES’’ and inserting ‘‘SERVICES
AND
RURAL EMERGENCY ACCESS CARE HOS-
PITAL SERVICES’’; and
(ii) by adding at the end the following
new sentence: ‘‘The amount of payment for
rural emergency access care hospital serv-
ices provided during a year shall be deter-
mined using the applicable method pro-
vided under this subsection for determining
payment for outpatient rural primary care
hospital services during the year.’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to fiscal years beginning on or
after October 1, 1996.
TITLE 
IV—INCENTIVES 
FOR
HEALTH PROFESSIONALS TO
PRACTICE IN RURAL AREAS
Subtitle A—National Health
Service Corps
SEC. 401. NATIONAL HEALTH SERVICE CORPS SCHOLAR-
SHIP AND LOAN REPAYMENTS EXCLUDED
FROM GROSS INCOME.
(a) IN GENERAL.—Part III of subchapter B of chap-
ter 1 of the Internal Revenue Code of 1986 (relating to
items specifically excluded from gross income) is amended
by redesignating section 137 as section 138 and by insert-
ing after section 136 the following new section:
‘‘SEC. 137. NATIONAL HEALTH SERVICE CORPS SCHOLAR-
SHIP AND LOAN PAYMENTS.
‘‘(a) GENERAL RULE.—Gross income shall not in-
clude any qualified scholarship payment or any qualified
loan repayment.
‘‘(b) QUALIFIED PAYMENTS.—For purposes of this
section, the term ‘qualified scholarship payment’ means
any payment made on behalf of the taxpayer by the Na-
tional Health Service Corps Scholarship Program under
section 338A(g) of the Public Health Service Act, and the
term ‘qualified loan repayment’ means any payment made
on behalf of the taxpayer by the National Health Service
Corps Loan Repayment Program under section 338B(g)
of such Act.’’.
(b) CONFORMING AMENDMENT.—Paragraph (3) of
section 338B(g) of the Public Health Service Act is
amended by striking ‘‘Federal, State, or local’’ and insert-
ing ‘‘State or local’’.
(c) CLERICAL AMENDMENT.—The table of sections
for part III of subchapter B of chapter 1 of the Internal
Revenue Code of 1986 is amended by striking the item
relating to section 137 and inserting the following:
‘‘Sec. 137. National Health Service Corps scholarship and loan
payments.
‘‘Sec. 138. Cross references to other Acts.’’.
(d) EFFECTIVE DATE.—The amendments made by
this section shall apply to payments made under sections
338A(g) and 338B(g) of the Public Health Service Act
after the date of the enactment of this Act.
SEC. 402. STUDY REGARDING ALLOCATION OF CORPS MEM-
BERS AMONG SHORTAGE AREAS.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall conduct a study for the purpose of
determining, with respect to the assignment of members
of the National Health Service Corps under subpart II of
part D of title III of the Public Health Service Act—
(1) whether the statutory and administrative
criteria for the assignment of Corps members should
be modified in order to ensure that the members are
equitably allocated among health professional short-
age areas; and
(2) if so, the recommendations of the Secretary
for modifications in the criteria.
(b) REPORT.—Not later than May 1, 1997, the Sec-
retary shall complete the study required in subsection (a)
and submit to the Congress a report describing the find-
ings made in the study.
SEC. 403. PRIORITY IN ASSIGNMENT OF CORPS MEMBERS;
COMMUNITY RURAL HEALTH NETWORKS.
Section 333A(a)(1)(B) of the Public Health Service
Act (42 U.S.C. 254f–1(a)(1)(B)) is amended—
(1) in clause (iii), by striking ‘‘and’’ after the
semicolon at the end;
(2) in clause (iv), by adding ‘‘and’’ after the
semicolon at the end; and
(3) by adding at the end the following clause:
‘‘(v) is a participant in a community
rural health network, as defined in section
204 of the Rural Health Improvement Act
of 1996.’’.
Subtitle B—Primary Care Services
Furnished in Shortage Areas
SEC. 411. ADDITIONAL PAYMENTS UNDER MEDICARE FOR
PRIMARY CARE SERVICES FURNISHED IN
RURAL SHORTAGE AREAS.
(a) INCREASE
IN AMOUNT
OF ADDITIONAL PAY-
MENT.—Section 1833(m) of the Social Security Act (42
U.S.C. 1395l(m)) is amended by striking ‘‘10 percent’’
and inserting ‘‘20 percent’’.
(b) RESTRICTION TO PRIMARY CARE SERVICES.—
Section 1833(m) of the Social Security Act (42 U.S.C.
1395l(m)) is amended—
(1) by striking ‘‘physicians’ services’’ and in-
serting ‘‘primary care services (as defined in section
1842(i)(4) and including services described in such
section that are furnished by a physician assistant,
nurse practitioner, or nurse midwife and that would
be physicians’ services if furnished by a physician)’’,
(2) by striking ‘‘in an area’’ and inserting ‘‘in
a rural area’’, and
(3) by inserting ‘‘or physician assistant, nurse
practitioner, or nurse midwife furnishing the serv-
ice’’ after ‘‘physician’’.
(c) EXTENSION OF PAYMENT FOR FORMER SHORT-
AGE AREAS.—
(1) IN GENERAL.—Section 1833(m) of the So-
cial Security Act (42 U.S.C. 1395l(m)) is amended
by striking ‘‘area,’’ and inserting ‘‘area (or, in the
case of an area for which the designation as a health
professional shortage area under such section is
withdrawn, in the case of such services furnished to
such an individual during the 3-year period begin-
ning on the effective date of the withdrawal of such
designation),’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to services furnished in
an area for which the designation as a health profes-
sional shortage area under section 332(a)(1)(A) of
the Public Health Service Act is withdrawn on or
after October 1, 1996.
(d) REQUIRING CARRIERS TO REPORT ON SERVICES
PROVIDED.—Section 1842(b)(3) of the Social Security
Act (42 U.S.C. 1395u(b)(3)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (I); and
(2) by inserting after subparagraph (I) the fol-
lowing new subparagraph:
‘‘(J) will provide information to the Secretary
not later than 30 days after the end of the contract
year on the types of providers to whom the carrier
made additional payments during the year for cer-
tain services pursuant to section 1833(m), together
with a description of the services furnished by such
providers during the year; and’’.
(e) EFFECTIVE DATE.—The amendments made by
subsections (a), (b), and (d) shall apply to services fur-
nished on or after October 1, 1996.
(f) SUBMISSION OF REPORT ON STUDY.—The Sec-
retary of Health and Human Services shall transmit to
Congress, by not later than May 1, 1997, a report on the
study being conducted on the criteria for designation of
health professional shortage areas under subpart II of
part D of title III of the Public Health Service Act and
for designation of medically underserved areas under sec-
tion 330(b) of such Act.
TITLE V—CLASSIFICATION OF
RURAL REFERRAL CENTERS
SEC. 501. CLASSIFICATION OF CENTERS.
(a) PROHIBITING DENIAL OF REQUEST FOR RECLAS-
SIFICATION ON BASIS OF COMPARABILITY OF WAGES.—
(1) IN GENERAL.—Section 1886(d)(10)(D) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395ww(d)(10)(D)) is amended—
(A) by redesignating clause (iii) as clause
(iv); and
(B) by inserting after clause (ii) the follow-
ing new clause:
‘‘(iii) Under the guidelines published by the Secretary
under clause (i), in the case of a hospital which is classi-
fied by the Secretary as a rural referral center under para-
graph (5)(C), the Board may not reject the application
of the hospital under this paragraph on the basis of any
comparison between the average hourly wage of the hos-
pital and the average hourly wage of hospitals in the area
in which it is located.’’.
(2) EFFECTIVE
DATE.—Notwithstanding sec-
tion 1886(d)(10)(C)(ii) of the Social Security Act, a
hospital may submit an application to the Medicare
Geographic Classification Review Board during the
30-day period beginning on the date of the enact-
ment of this Act requesting a change in its classi-
fication for purposes of determining the area wage
index applicable to the hospital under section
1886(d)(3)(D) of such Act for fiscal year 1997, if
the hospital would be eligible for such a change in
its classification under the standards described in
section 1886(d)(10)(D) (as amended by paragraph
(1)) but for its failure to meet the deadline for appli-
cations under section 1886(d)(10)(C)(ii).
(b) CONTINUING TREATMENT OF PREVIOUSLY DES-
IGNATED CENTERS.—Any hospital classified as a rural re-
ferral center by the Secretary of Health and Human Serv-
ices under section 1886(d)(5)(C) of the Social Security
Act for fiscal year 1991 shall be classified as such a rural
referral center for fiscal year 1997 and each subsequent
fiscal year.
TITLE 
VI—PROMOTION 
OF
HEALTH CENTERS IN RURAL
REGIONS
SEC. 601. EXPANSION OF HEALTH CENTERS IN RURAL RE-
GIONS.
Section 330 of the Public Health Service Act (42
U.S.C. 254c) is amended by adding at the end the follow-
ing new subsection:
‘‘(l) In making grants in rural areas for new or ex-
panded services for each fiscal year under this section, the
Secretary shall give priority to projects that would be lo-
cated in a State, or county or region of a State, that is
not already serviced by an existing community health cen-
ter.’’.
SEC. 602. COLLABORATION OF HEALTH CENTERS WITH
COMMUNITY HOSPITALS.
Section 330 of the Public Health Service Act (42
U.S.C. 254c), as amended by section 601, is further
amended by adding at the end the following new sub-
section:
‘‘(m)(1) In making grants under this section for new
or expanded services in rural areas for each fiscal year,
the Secretary shall give special consideration to projects
which have entered into a collaborative agreement with a
community hospital that meets the following requirements:
‘‘(A) The community health center is located in,
or adjacent to, the community hospital.
‘‘(B) To the extent practicable, excess facilities
and equipment in or owned by the community hos-
pital are available for use by the community health
center.
‘‘(C) The community health center and the hos-
pital avoid unnecessary duplication of facilities and
equipment, except that the center may install appro-
priate support equipment for routine primary health
services.
‘‘(D) The community health center provides pri-
mary health services.
‘‘(E) To the extent practicable, the community
health center provides referrals to providers of sup-
plemental health services.
‘‘(F) The physicians of the community health
center have admitting privileges at the community
hospital.
‘‘(G) To ensure quality, efficiency, and cost-ef-
fectiveness, the community health center and the
community hospital will work in collaboration to di-
rect patients to the appropriate location for care.
‘‘(2) For purposes of this subsection, the term ‘com-
munity hospital’ means a public general hospital that—
‘‘(A) is owned and operated by a State, county,
or unit of local government or is a private nonprofit
community hospital,
‘‘(B) has less than 75 beds, and
‘‘(C) primarily serves a rural area designated
under subsection (b)(3) as a medically underserved
area.
‘‘(3) For purposes of this subsection, the term ‘rural
area’ has the meaning given such term in section
1886(d)(2)(D) of the Social Security Act.’’.
TITLE VII—MEDICARE PAYMENT
METHODOLOGIES
SEC. 701. TELEMEDICINE SERVICES.
The Secretary of Health and Human Services shall
establish a methodology for making payments under part
B of the medicare program for telemedicine services fur-
nished on an emergency basis to individuals residing in
a rural area (as defined in section 1886(d)(2)(D)).
TITLE VIII—ANTITRUST
SEC. 801. SENSE OF CONGRESS RELATING TO APPLICATION
OF GUIDELINES.
It is the sense of Congress that—
(1) the Federal Trade Commission, in conjunc-
tion with the Justice Department, give special con-
sideration to antitrust guidelines affecting physician
and hospital networks located in rural areas during
its ongoing review of such guidelines; and
(2) the completion of the Commission’s review
be expedited to provide relief and clarification to
physicians and hospitals working to develop alter-
native means of providing accessible, affordable, and
quality health care services to all Americans, espe-
cially those living and working in rural areas.
TITLE IX—FINANCING
SEC. 901. EXTENSION AND EXPANSION OF EXISTING MEDI-
CARE SECONDARY PAYER REQUIREMENTS.
(a) DATA MATCH.—
(1) Section 1862(b)(5)(C) of the Social Security
Act (42 U.S.C. 1395y(b)(5)(C)) is amended by strik-
ing clause (iii).
(2) Section 6103(l)(12) of the Internal Revenue
Code of 1986 is amended by striking subparagraph
(F).
(b) APPLICATION
TO DISABLED INDIVIDUALS
IN
LARGE GROUP HEALTH PLANS.—
(1) IN
GENERAL.—Section 1862(b)(1)(B) of
the Social Security Act (42 U.S.C. 1395y(b)(1)(B))
is amended—
(A) in clause (i), by striking ‘‘clause (iv)’’
and inserting ‘‘clause (iii)’’,
(B) by striking clause (iii), and
(C) by redesignating clause (iv) as clause
(iii).
(2) CONFORMING
AMENDMENTS.—Paragraphs
(1) through (3) of section 1837(i) of such Act (42
U.S.C. 1395p(i)) and the second sentence of section
1839(b) (42 U.S.C. 1395r(b)) are each amended by
striking ‘‘1862(b)(1)(B)(iv)’’ each place it appears
and inserting ‘‘1862(b)(1)(B)(iii)’’.
(c) INDIVIDUALS WITH END STAGE RENAL DIS-
EASE.—Section 1862(b)(1)(C) of such Act (42 U.S.C.
1395y(b)(1)(C)) is amended—
(1) in the last sentence by striking ‘‘October 1,
1998’’ and inserting ‘‘the date of the enactment of
the Rural Health Improvement Act of 1996’’; and
(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on
or after the date of the enactment of the Rural
Health Improvement Act of 1996, (with respect to
periods beginning on or after the date that is 18
months prior to such date), clauses (i) and (ii) shall
be applied by substituting ‘30-month’ for ‘12-month’
each place it appears.’’.
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