I 
108TH CONGRESS 
1ST SESSION 
H. R. 830
To amend title XVIII of the Social Security Act to protect and preserve 
access of Medicare beneficiaries to health care in rural areas. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 13, 2003
Mr. MCINNIS (for himself, Mr. HOUGHTON, Mr. CAMP, Mr. ENGLISH, Mr. 
LEWIS of Kentucky, Mr. HEFLEY, Mr. TANCREDO, Mr. BEAUPREZ, Mrs. 
MUSGRAVE, Mr. CLYBURN, Mr. HAYES, Mr. PETERSON of Minnesota, 
Mr. DAVIS of Illinois, Mr. GREEN of Wisconsin, Mr. MURTHA, Mr. GOR-
DON, Mr. CASE, Mr. MCNULTY, and Mr. JANKLOW) introduced the fol-
lowing 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 consider-
ation 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 to health 
care in rural areas.
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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare Rural Health Care Preservation Act of 2003’’.
(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 to be made to that section or other 
provision of the Social Security Act. 
(c) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; amendments to Social Security Act; table of contents. 
Sec. 2. Five-year continuation of medicare managed care cost contracts. 
Sec. 3. Temporary protection for sole community hospitals under outpatient 
prospective payment schedule. 
Sec. 4. Improvements to the critical access hospital program. 
Sec. 5. Extension of temporary increase for home health services furnished in 
a rural area. 
Sec. 6. Increase in payments for hospice care furnished in frontier areas. 
Sec. 7. Treatment of eligibility for hospice care.
SEC. 2. FIVE-YEAR CONTINUATION OF MEDICARE MAN-
AGED CARE COST CONTRACTS. 
Section 1876(h)(5)(C) (42 U.S.C. 1395mm(h)(5)(C)) 
is amended by striking ‘‘2004’’ and inserting ‘‘2009’’.
SEC. 3. TEMPORARY PROTECTION FOR SOLE COMMUNITY 
HOSPITALS UNDER OUTPATIENT PROSPEC-
TIVE PAYMENT SCHEDULE. 
Section 1833(t)(7)(D) (42 U.S.C. 1395l(t)(7)(D)) is 
amended by adding at the end the following new clause: 
‘‘(iii) TEMPORARY
TREATMENT
FOR 
SOLE
COMMUNITY
HOSPITALS.—In the 
case of a hospital described in section 
1886(d)(5)(C)(iii) that furnishes covered
OPD services for which the PPS amount is 
less than the pre-BBA amount—
‘‘(I) in the case of such services 
furnished during 2004 or 2005, the 
amount of payment under this sub-
section shall be increased by the 
amount of such difference; 
‘‘(II) in the case of such services 
furnished during 2006 or 2007, the 
amount of payment under this sub-
section shall be increased by 95 per-
cent of the amount of such difference; 
and 
‘‘(III) in the case of such services 
furnished during 2008 or 2009, the 
amount of payment under this sub-
section shall be increased by 90 per-
cent of the amount of such dif-
ference.’’. 
SEC. 4. IMPROVEMENTS TO CRITICAL ACCESS HOSPITAL 
PROGRAM. 
(a) REINSTATEMENT OF PERIODIC INTERIM PAY-
MENT
(PIP).—Section 
1815(e)(2) 
(42 
U.S.C. 
1395g(e)(2)) is amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (C); 
(2) by adding ‘‘and’’ at the end of subpara-
graph (D); and 
(3) by inserting after subparagraph (D) the fol-
lowing new subparagraph: 
‘‘(E) inpatient critical access hospital services;’’. 
(b) CONDITION FOR APPLICATION OF SPECIAL PHY-
SICIAN PAYMENT ADJUSTMENT.—Section 1834(g)(2) (42 
U.S.C. 1395m(g)(2)) is amended by adding after and 
below subparagraph (B) the following: 
‘‘The Secretary may not require, as a condition for 
applying subparagraph (B) with respect to a critical 
access hospital, that each physician providing profes-
sional services in the hospital must assign billing 
rights with respect to such services, except that such 
subparagraph shall not apply to those physicians 
who have not assigned such billing rights.’’. 
(c) FLEXIBILITY
IN BED LIMITATION
FOR HOS-
PITALS.—Section 1820 (42 U.S.C. 1395i–4) is amended—
(1) in subsection (c)(2)(B)(iii), by inserting 
‘‘subject to paragraph (3)’’ after ‘‘(iii) provides’’; 
(2) by adding at the end of subsection (c) the 
following new paragraph:
‘‘(3) INCREASE IN MAXIMUM NUMBER OF BEDS 
FOR HOSPITALS WITH STRONG SEASONAL CENSUS 
FLUCTUATIONS.—
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (C), in the case of a hospital that dem-
onstrates that it meets the standards estab-
lished under subparagraph (B) and has not 
made the election described in subsection 
(f)(2)(A), the bed limitations otherwise applica-
ble under paragraph (2)(B)(iii) and subsection 
(f) shall be increased by 5 beds. 
‘‘(B) STANDARDS.—The Secretary shall 
specify standards for determining whether a 
critical access hospital has sufficiently strong 
seasonal variations in patient admissions to jus-
tify the increase in bed limitation provided 
under subparagraph (A).’’; and 
(3) in subsection (f)—
(A) by inserting ‘‘(1)’’ after ‘‘(f)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(2)(A) A hospital may elect to treat the reference 
in paragraph (1) to ‘15 beds’ as a reference to ‘25 beds’, 
but only if no more than 10 beds in the hospital are at 
any time used for non-acute care services. A hospital that
makes such an election is not eligible for the increase pro-
vided under subsection (c)(3)(A). 
‘‘(B) The limitations in numbers of beds under the 
first sentence of paragraph (1) are subject to adjustment 
under subsection (c)(3).’’. 
(d) 5-YEAR EXTENSION
OF
THE AUTHORIZATION 
FOR APPROPRIATIONS FOR GRANT PROGRAM.—Section 
1820(j) (42 U.S.C. 1395i–4(j)) is amended by striking 
‘‘through 2002’’ and inserting ‘‘through 2007’’.
(e) PROHIBITION OF RETROACTIVE RECOUPMENT.—
The Secretary shall not recoup (or otherwise seek to re-
cover) overpayments made for outpatient critical access 
hospital services under part B of title XVIII of the Social 
Security Act, for services furnished in cost reporting peri-
ods that began before October 1, 2002, insofar as such 
overpayments are attributable to payment being based on 
80 percent of reasonable costs (instead of 100 percent of 
reasonable costs minus 20 percent of charges). 
(f) EFFECTIVE DATES.—
(1) REINSTATEMENT
OF
PIP.—The amend-
ments made by subsection (a) shall apply to pay-
ments made on or after January 1, 2004. 
(2) PHYSICIAN PAYMENT ADJUSTMENT CONDI-
TION.—The amendment made by subsection (b) 
shall be effective as if included in the enactment of
section 403(d) of the Medicare, Medicaid, and 
SCHIP Balanced Budget Refinement Act of 1999 
(113 Stat. 1501A–371). 
SEC. 5. EXTENSION OF TEMPORARY INCREASE FOR HOME 
HEALTH SERVICES FURNISHED IN A RURAL 
AREA. 
(a) IN GENERAL.—Section 508(a) of the Medicare, 
Medicaid, and SCHIP Benefits Improvement and Protec-
tion Act of 2000 (114 Stat. 2763A–533), as enacted into 
law by section 1(a)(6) of Public Law 106–554, is amend-
ed—
(1) by striking ‘‘24-MONTH INCREASE BEGIN-
NING APRIL 1, 2001’’ and inserting ‘‘IN GENERAL’’; 
and 
(2) by striking ‘‘April 1, 2003’’ and inserting 
‘‘January 1, 2006’’. 
(b) CONFORMING AMENDMENT.—Section 547(c)(2) 
of such Act (114 Stat. 2763A–553) is amended by striking 
‘‘the period beginning on April 1, 2001, and ending on 
September 30, 2002,’’ and inserting ‘‘a period under such 
section’’. 
SEC. 6. INCREASE IN PAYMENTS FOR HOSPICE CARE FUR-
NISHED IN FRONTIER AREAS. 
(a) 10 PERCENT INCREASE IN PAYMENT FOR HOS-
PICE CARE FURNISHED IN A FRONTIER AREA.—Section
1814(i)(1) (42 U.S.C. 1395f(i)(1)) is amended by adding 
at the end the following new subparagraph: 
‘‘(D) With respect to hospice care furnished in a fron-
tier area on or after January 1, 2004, and before January 
1, 2009, the payment rates otherwise established for such 
care shall be increased by 10 percent. For purposes of this 
subparagraph, the term ‘frontier area’ means a county in 
which the population density is less than 7 persons per 
square mile.’’. 
(b) REPORT ON COSTS.—Not later than January 1, 
2008, the Comptroller General of the United States shall 
submit to Congress a report on the costs of furnishing 
hospice care in frontier areas. Such report shall include 
recommendations regarding the appropriateness of extend-
ing, and modifying, the payment increase provided under 
the amendment made by subsection (a). 
SEC. 7. TREATMENT OF ELIGIBILITY FOR HOSPICE CARE.
(a) DEEMED ELIGIBILITY BASED
ON DEATH
IN 
FACT.—
(1) IN GENERAL.—Section 1814(i) of the Social 
Security Act is amended by adding at the end the 
following new paragraph: 
‘‘(4) For purposes of section 1814(a)(7)(A), the Sec-
retary and a fiscal intermediary shall not take any action 
to deny payment for hospice care for an individual on the
basis that the individual is not terminally ill if the indi-
vidual dies within 6 months of the date the individual is 
initially admitted into the hospice program for the receipt 
of hospice care.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by paragraph (1) shall take effect on January 1, 
2004. 
(b) CMS REPORT.—
(1) IN
GENERAL.—The Administrator of the 
Centers for Medicare & Medicaid Services shall 
evaluate the standards used by fiscal intermediaries 
in denying physician certifications under section 
1814(a)(7) of the Social Security Act (42 U.S.C. 
1395f(a)(7)) that an individual is terminally ill (and 
thereby making such individuals ineligible to elect 
the hospice care alternative) and the impact of such 
decisions on length of stay. Such evaluation shall re-
view the impact of the amendments made by section 
322(a) of the Medicare, Medicaid, and SCHIP Bene-
fits Improvement and Protection Act of 2000 (114 
Stat. 2763A–501), as enacted into law by section 
1(a)(6) of Public Law 106–554 and the results of 
the study conducted under section 322(b) of such 
Act of 2000.
(2) REPORT.—Not later than 6 months after 
the date of the enactment of this Act, the Adminis-
trator shall submit to Congress a report on the eval-
uation under paragraph (1).
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