I 
113TH CONGRESS 
2D SESSION 
H. R. 4781 
To amend title XVIII of the Social Security Act to provide payment under 
part A of the Medicare Program on a reasonable cost basis for anesthesia 
services furnished by an anesthesiologist in certain rural hospitals in 
the same manner as payments are provided for anesthesia services fur-
nished by anesthesiologist assistants and certified registered nurse anes-
thetists in such hospitals. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 30, 2014 
Ms. JENKINS (for herself and Mr. CLEAVER) introduced the following bill; 
which was referred to the Committee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to provide 
payment under part A of the Medicare Program on a 
reasonable cost basis for anesthesia services furnished 
by an anesthesiologist in certain rural hospitals in the 
same manner as payments are provided for anesthesia 
services furnished by anesthesiologist assistants and cer-
tified registered nurse anesthetists in such hospitals. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Access to 
Rural Anesthesiology Act of 2014’’. 
SEC. 2. MEDICARE PART A PAYMENT FOR ANESTHESIOL-
OGIST SERVICES IN CERTAIN RURAL HOS-
PITALS BASED ON CRNA PASS-THROUGH 
RULES. 
(a) IN GENERAL.—Section 1814 of the Social Secu-
rity Act (42 U.S.C. 1395f) is amended by adding at the 
end the following new subsection: 
‘‘Anesthesiologist Services Provided in Certain Rural 
Hospitals 
‘‘(m)(1) Notwithstanding any other provision of this 
title, coverage and payment shall be provided under this 
part for physicians’ services that are anesthesia services 
furnished by a physician who is an anesthesiologist in a 
rural hospital described in paragraph (3) in the same 
manner as payment is made under the exception provided 
in section 9320(k) of the Omnibus Budget Reconciliation 
Act of 1986, as amended by section 6132 of the Omnibus 
Budget Reconciliation Act of 1989 (42 U.S.C. 1395k 
note) (relating to payment on a reasonable cost, pass- 
through basis), for certified registered nurse anesthetist 
services furnished by a certified registered nurse anes-
thetist in a hospital described in such section. 
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‘‘(2) No payment shall be made under any other pro-
vision of this title for physicians’ services for which pay-
ment is made under this subsection. 
‘‘(3) A rural hospital described in this paragraph is 
a hospital described in section 9320(k) of the Omnibus 
Budget Reconciliation Act of 1986, as so amended (42 
U.S.C. 1395k note), except that— 
‘‘(A) any reference in such section to a ‘cer-
tified registered nurse anesthetist’ or ‘anesthetist’ is 
deemed a reference to a ‘physician who is an anes-
thesiologist’ or ‘anesthesiologist’, respectively; and 
‘‘(B) any reference to ‘January 1, 1988’ or 
‘1987’ is deemed a reference to such date and year 
as the Secretary shall specify.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to services furnished during cost 
reporting periods beginning on or after the date of the 
enactment of this Act. 
Æ 
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