I 
109TH CONGRESS 
2D SESSION 
H. R. 6030 
To amend title XVIII of the Social Security Act to protect and preserve 
access of Medicare beneficiaries in rural areas to health care providers 
under the Medicare Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 6, 2006 
Mr. WALDEN of Oregon (for himself, Mr. POMEROY, Mrs. EMERSON, Mr. 
MCINTYRE, Mr. MARSHALL, Mr. PAUL, Mr. MCNULTY, Mr. GOODE, Mr. 
GRAVES, Ms. HERSETH, Mr. PETERSON of Minnesota, Mr. DAVIS of Ten-
nessee, Mrs. JO ANN DAVIS of Virginia, Mr. MCHUGH, Mr. JONES of 
North Carolina, Mr. ROSS, Mr. TANNER, Mr. PETERSON of Pennsylvania, 
Mr. BERRY, Mr. NUSSLE, Mr. MATHESON, Mr. BOYD, Mr. MORAN of 
Kansas, Mr. KIND, Mr. SWEENEY, Mr. DEFAZIO, Mr. LEACH, Mr. 
ETHERIDGE, Mr. SHERWOOD, Mr. BOUCHER, Mr. BISHOP of Georgia, 
Mr. OBERSTAR, Mr. SALAZAR, Mr. ROGERS of Alabama, Mr. NEY, Mr. 
STUPAK, Mr. THOMPSON of California, Mr. HINOJOSA, Mr. BASS, Mr. 
LUCAS, Mr. HASTINGS of Washington, Mr. OTTER, Mr. EDWARDS, Mrs. 
CUBIN, Mr. LATHAM, Mr. KENNEDY of Minnesota, Mr. RAHALL, Mr. 
HINCHEY, Mrs. CAPITO, Mr. MICHAUD, Mr. STRICKLAND, Mr. SIMPSON, 
Mr. HOEKSTRA, Mr. ALLEN, Mr. UDALL of New Mexico, Mr. PICKERING, 
Mr. KILDEE, Mr. MELANCON, and Mr. RENZI) introduced the following 
bill; which was referred to the Committee on Energy and Commerce, and 
in addition to the Committee on Ways and Means, 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 protect 
and preserve access of Medicare beneficiaries in rural 
areas to health care providers under the Medicare Pro-
gram, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Health Care Access and Rural Equity (H–CARE) Act 
of 2006’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—MEDICARE HOSPITAL SERVICES 
Sec. 101. Fairness in the Medicare disproportionate share hospital (DSH) ad-
justment for rural hospitals. 
Sec. 102. Treatment of Medicare hospital reclassifications. 
Sec. 103. Critical access hospital improvements. 
Sec. 104. Rebasing for sole community hospitals. 
Sec. 105. Establishment of rural community hospital (RCH) program. 
Sec. 106. Extension of medicare rural hospital hold harmless provision under 
the prospective payment system for hospital outpatient depart-
ment (HOPD) services. 
TITLE II—MEDICARE PRACTITIONER SERVICES 
Sec. 201. Coverage of marriage and family therapist services and mental health 
counselor services under part B of the Medicare program. 
Sec. 202. Permanent treatment of certain physician pathology services under 
Medicare. 
Sec. 203. Extension of medicare incentive payment program for physician scar-
city areas. 
Sec. 204. Extension of medicare increase payments for ground ambulance serv-
ices in rural areas. 
Sec. 205. Extension of floor on medicare work geographic adjustment. 
TITLE III—OTHER MEDICARE PROVISIONS 
Sec. 301. Ensuring proportional representation of interests of rural areas on 
MedPAC. 
Sec. 302. Rural health clinic improvements. 
Sec. 303. Use of medical conditions for coding ambulance services. 
Sec. 304. Improvement in payments to retain emergency and other capacity for 
ambulances in rural areas. 
Sec. 305. Medicare remote monitoring pilot projects. 
Sec. 306. Minimum payment rate by Medicare Advantage organizations for 
critical access hospital services and rural health clinic services. 
Sec. 307. Prompt payment by Medicare prescription drug plans and MA–PD 
plans under part D. 
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Sec. 308. Extension of medicare reasonable costs payments for certain clinical 
diagnostic laboratory tests furnished to hospital patients in cer-
tain rural areas. 
Sec. 309. Extension of temporary Medicare payment increase for home health 
services furnished in a rural area. 
TITLE IV—OTHER PROVISIONS 
Sec. 401. Health information technology grants for rural health care providers. 
Sec. 402. Capital infrastructure revolving loan program. 
Sec. 403. Rural health quality advisory commission and demonstration projects. 
Sec. 404. Rural health care services. 
Sec. 405. Community health center collaborative access expansion. 
Sec. 406. Facilitating the provision of telehealth services across State lines. 
TITLE I—MEDICARE HOSPITAL 
SERVICES 
SEC. 
101. 
FAIRNESS 
IN 
THE 
MEDICARE 
DISPROPOR-
TIONATE SHARE HOSPITAL (DSH) ADJUST-
MENT FOR RURAL HOSPITALS. 
Section 1886(d)(5)(F)(xiv)(II) of the Social Security 
Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended— 
(1) by striking ‘‘or, in the case’’ and all that 
follows through ‘‘subparagraph (G)(iv)’’; and 
(2) by inserting at the end the following new 
sentence: ‘‘The preceding sentence shall not apply to 
any hospital with respect to discharges occurring on 
or after October 1, 2006.’’. 
SEC. 102. TREATMENT OF MEDICARE HOSPITAL RECLASSI-
FICATIONS. 
(a) EXTENDING
CERTAIN
MEDICARE
HOSPITAL 
WAGE INDEX RECLASSIFICATIONS THROUGH FISCAL 
YEAR 2010.— 
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