I
103D CONGRESS
1ST SESSION
H. R. 3078
To amend title XVIII of the Social Security Act to permit certain rural
hospitals under the medicare program to serve as rural emergency access
care facilities under the program.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 14, 1993
Mr. THOMAS of Wyoming (for himself, Mr. GUNDERSON, Mr. ROBERTS, Mr.
STENHOLM, Mrs. MINK, Mr. STRICKLAND, Mr. ENGLISH of Oklahoma,
Mr. GRANDY, and Mr. BEREUTER) introduced the following bill; which
was referred jointly to the Committees on Ways and Means and Energy
and Commerce
A BILL
To amend title XVIII of the Social Security Act to permit
certain rural hospitals under the medicare program to
serve as rural emergency access care facilities under the
program.
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 Emergency Care
Access Hospital Act of 1993’’.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Each citizen of the United States will need
emergency medical care an average of 2 times in a
lifetime.
(2) Comprehensive emergency medical service
systems are essential to the health care delivery sys-
tem.
(3) Individuals residing in rural areas face an
additional challenge because they tend to have more
serious injuries.
(4) Emergency medical care is more difficult to
deliver in rural areas.
(5) Individuals involved in accidents in rural
areas are 3 times more likely to sustain serious or
untreatable injuries than individuals involved in acci-
dents in urban areas.
(6) Small rural hospitals continue to face finan-
cial difficulties and are often forced to close.
(7) Residents of rural areas must be provided
some assurance that their critical emergency care
needs will be met.
SEC. 3. RURAL EMERGENCY ACCESS CARE HOSPITALS DE-
SCRIBED.
Section 1861 of the Social Security 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 negative operating
losses, and the closure of the facility would limit the
access of individuals residing in the facility’s service
area to emergency services.
‘‘(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 dietician, 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’ was 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 medical and other health services fur-
nished by a rural emergency access care hospital.’’.
SEC. 4. COVERAGE OF AND PAYMENT FOR SERVICES.
(a) COVERAGE UNDER PART B.—Section 1832(a)(2)
of the Social Security Act (42 U.S.C. 1395k(a)(2)) is
amended—
(1) by striking ‘‘and’’ at the end of subpara-
graph (I);
(2) by striking the period at the end of sub-
paragraph (J) and inserting ‘‘; and’’; and
(3) by adding at the end the following new sub-
paragraph:
‘‘(K) rural emergency access care hospital
services (as defined in section 1861(oo)(2)).’’.
(b) PAYMENT BASED ON PAYMENT FOR OUTPATIENT
RURAL PRIMARY CARE HOSPITAL SERVICES.—
(1) IN GENERAL.—Section 1833(a)(6) of the
Social Security Act (42 U.S.C. 1395l(a)(6)) is
amended by striking ‘‘services,’’ and inserting ‘‘serv-
ices and rural emergency access care hospital serv-
ices,’’.
(2) PAYMENT
METHODOLOGY
DESCRIBED.—
Section 1834(g) of such Act (42 U.S.C. 1395m(g))
is amended—
(A) in the heading, by striking ‘‘SERV-
ICES’’ and inserting ‘‘SERVICES
AND RURAL
EMERGENCY ACCESS CARE HOSPITAL SERV-
ICES’’; and
(B) in paragraph (1), by striking ‘‘during
a year before 1993’’ and inserting ‘‘during a
year before the prospective payment system de-
scribed in paragraph (2) is in effect’’;
(C) in paragraph (1), by adding at the end
the following:
‘‘The amount of payment shall be determined under
either method without regard to the amount of the
customary or other charge.’’;
(D) in paragraph (2), by striking ‘‘Janu-
ary 1, 1993,’’ and inserting ‘‘January 1,
1996,’’; and
(E) by adding at the end the following new
paragraph:
‘‘(3) APPLICATION OF METHODS TO PAYMENT
FOR
RURAL
EMERGENCY
ACCESS
CARE
HOSPITAL
SERVICES.—The amount of payment for rural emer-
gency access care hospital services provided during
a year shall be determined using the applicable
method provided under this subsection for determin-
ing payment for outpatient rural primary care hos-
pital services during the year.’’.
SEC. 5. EFFECTIVE DATE.
The amendments made by sections 3 and 4 shall
apply to fiscal years beginning on or after October 1,
1993.
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