I 
109TH CONGRESS 
2D SESSION 
H. R. 5118 
To amend title XVIII of the Social Security Act and the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 to extend certain 
Medicare payment methodologies provided for rural health care providers. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 6, 2006 
Mr. WALDEN of Oregon (for himself, Mr. POMEROY, Mr. ALEXANDER, Mr. 
ALLEN, Mr. BERRY, Mr. BISHOP of Georgia, Mr. BOUCHER, Mr. BOYD, 
Mrs. CAPITO, Mr. CASE, Mr. COSTELLO, Mrs. JO ANN DAVIS of Virginia, 
Mr. DAVIS of Tennessee, Mr. DEFAZIO, Mrs. EMERSON, Mr. EVANS, Mr. 
GRAVES, Mr. HASTINGS of Washington, Ms. HERSETH, Mr. HINCHEY, 
Mr. HINOJOSA, Ms. HOOLEY, Mr. KIND, Ms. JACKSON-LEE of Texas, 
Mr. MARSHALL, Mr. MATHESON, Mr. MCHUGH, Mr. MCINTYRE, Miss 
MCMORRIS, Mr. MORAN of Kansas, Mr. OBERSTAR, Mr. ORTIZ, Mr. 
PAUL, Mr. PETERSON of Minnesota, Mr. PETERSON of Pennsylvania, Mr. 
RENZI, Mr. ROSS, Mr. SANDERS, Mr. SHUSTER, Mr. SIMPSON, Mr. 
SKELTON, Mr. STUPAK, Mr. SWEENEY, Mr. TANNER, Mr. TAYLOR of 
Mississippi, Mr. UDALL of New Mexico, Mr. WHITFIELD, Mr. WICKER, 
and Mr. YOUNG of Alaska) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined 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 and the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 to extend certain Medicare pay-
ment methodologies provided for rural health care pro-
viders. 
VerDate Aug 31 2005 
17:48 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H5118.IH
H5118
dsatterwhite on PROD1PC76 with BILLS
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 
‘‘Medicare Rural Health Provider Payment Extension Act 
of 2006’’. 
(b) TABLE OF CONTENTS.— 
Sec. 1. Short title and table of contents. 
Sec. 2. Extension of medicare rural hospital hold harmless provision under the 
prospective payment system for hospital outpatient department 
(HOPD) services. 
Sec. 3. Extension of medicare incentive payment program for physician scarcity 
areas. 
Sec. 4. Extension of medicare increase payments for ground ambulance services 
in rural areas. 
Sec. 5. Extension of floor on medicare work geographic adjustment. 
Sec. 6. Extension of medicare reasonable costs payments for certain clinical di-
agnostic laboratory tests furnished to hospital patients in cer-
tain rural areas. 
Sec. 7. Extension of temporary medicare payment increase for home health 
services furnished in a rural area. 
SEC. 2. EXTENSION OF MEDICARE RURAL HOSPITAL HOLD 
HARMLESS PROVISION UNDER THE PRO-
SPECTIVE PAYMENT SYSTEM FOR HOSPITAL 
OUTPATIENT 
DEPARTMENT 
(HOPD) 
SERV-
ICES. 
(a) IN GENERAL.—Section 1833(t)(7)(D)(i) of the 
Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)), as 
amended by section 5105 of the Deficit Reduction Act of 
2005, is amended— 
(1) in subclause (I)— 
(A) by striking ‘‘(I)’’; and 
VerDate Aug 31 2005 
17:48 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5118.IH
H5118
dsatterwhite on PROD1PC76 with BILLS
(B) by striking ‘‘2006’’ and inserting 
‘‘2010’’; and 
(2) by striking subclause (II). 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to covered OPD services fur-
nished on or after January 1, 2006. 
SEC. 3. EXTENSION OF MEDICARE INCENTIVE PAYMENT 
PROGRAM FOR PHYSICIAN SCARCITY AREAS. 
Section 1833(u)(1) of the Social Security Act (42 
U.S.C. 1395l(u)(1)) is amended by striking ‘‘2008’’ and 
inserting ‘‘ 2011’’. 
SEC. 4. EXTENSION OF MEDICARE INCREASE PAYMENTS 
FOR 
GROUND 
AMBULANCE 
SERVICES 
IN 
RURAL AREAS. 
Section 1834(l)(13) of the Social Security Act (42 
U.S.C. 1395m(l)(13)) is amended— 
(1) in subparagraph (A)— 
(A) in the matter before clause (i), by 
striking ‘‘furnished on or after July 1, 2004, 
and before January 1, 2007,’’; 
(B) in clause (i), by inserting ‘‘for services 
furnished on or after July 1, 2004, and before 
January 1, 2011,’’ after ‘‘in such paragraph,’’; 
and 
VerDate Aug 31 2005 
17:48 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5118.IH
H5118
dsatterwhite on PROD1PC76 with BILLS
(C) in clause (ii), by inserting ‘‘for services 
furnished on or after July 1, 2004, and before 
January 1, 2007,’’ after ‘‘in clause (i),’’; and 
(2) in subparagraph (B)— 
(A) in the heading, by striking ‘‘AFTER 
2006’’ and inserting ‘‘FOR SUBSEQUENT PERI-
ODS’’; 
(B) by inserting ‘‘clauses (i) and (ii) of’’ 
before ‘‘subparagraph (A)’’; and 
(C) by striking ‘‘in such subparagraph’’ 
and inserting ‘‘in the respective clause’’. 
SEC. 5. EXTENSION OF FLOOR ON MEDICARE WORK GEO-
GRAPHIC ADJUSTMENT. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘2007’’ 
and inserting ‘‘2011’’. 
SEC. 6. EXTENSION OF MEDICARE REASONABLE COSTS 
PAYMENTS FOR CERTAIN CLINICAL DIAG-
NOSTIC LABORATORY TESTS FURNISHED TO 
HOSPITAL PATIENTS IN CERTAIN RURAL 
AREAS. 
Section 416(b) of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2282; 42 U.S.C. 1395l–4(b)) is 
amended by striking ‘‘2-year’’ and inserting ‘‘7-year’’. 
VerDate Aug 31 2005 
17:48 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5118.IH
H5118
dsatterwhite on PROD1PC76 with BILLS
SEC. 7. EXTENSION OF TEMPORARY MEDICARE PAYMENT 
INCREASE FOR HOME HEALTH SERVICES 
FURNISHED IN A RURAL AREA. 
(a) IN GENERAL.—Section 421 of the Medicare Pre-
scription Drug, Improvement, and Modernization Act of 
2003 (Public Law 108–173; 117 Stat. 2283; 42 U.S.C. 
1395fff note), as amended by section 5201(b) of the Def-
icit Reduction Act of 2005, is amended— 
(1) in the heading, by striking ‘‘ONE-YEAR’’ 
and inserting ‘‘TEMPORARY’’; and 
(2) in subsection (a) by striking ‘‘before April 
1, 2005, and episodes and visits beginning on or 
after January 1, 2006, and before January 1, 2007’’ 
and inserting ‘‘before December 31, 2011’’. 
(b) APPLICATION TO CERTAIN HOME HEALTH SERV-
ICES FURNISHED PRIOR TO DATE OF ENACTMENT.—For 
episodes and visits for home health services furnished on 
or after April 1, 2005, and before the date of the enact-
ment of this Act, the Secretary of Health and Human 
Services shall provide for a lump sum payment, not later 
than 60 days after such enactment, of amounts due under 
the amendment made by subsection (a)(2). 
(c) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to episodes and visits on or after 
April 1, 2005. 
Æ 
VerDate Aug 31 2005 
17:48 Apr 13, 2006
Jkt 049196
PO 00000
Frm 00005
Fmt 6652
Sfmt 6301
E:\BILLS\H5118.IH
H5118
dsatterwhite on PROD1PC76 with BILLS