Amends the Public Health Service Act to give the Secretary the authority to make and guarantee loans from the loan fund to any rural entity for projects for capital improvements.
Amends SSA title XVIII to provide for a five-year extension of the authorization for appropriations for certain Medicare rural grants.
[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1675 Introduced in House (IH)]
108th CONGRESS
1st Session
H.R. 1675
To amend title XVIII of the Social Security Act to protect and preserve
access of Medicare beneficiaries to health care provided by hospitals
in rural areas, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 8, 2003
Mr. Moran of Kansas (for himself, Mr. Pomeroy, Mr. Walden of Oregon,
Mr. Stenholm, Mr. Peterson of Pennsylvania, Mr. Berry, Mr. Kind, Mr.
McHugh, Mr. Sandlin, Mr. Evans, Mr. Davis of Alabama, and Mr. Case)
introduced the following 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 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 to health care provided by hospitals
in rural areas, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECURITY ACT; REFERENCES
TO BIPA; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Health Care Access
and Rural Equity Act of 2003''.
(b) Amendments to Social Security Act.--Except 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) References to BIPA.--In this Act, the term ``BIPA'' means the
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act
of 2000, as enacted into law by section 1(a)(6) of Public Law 106-554
(114 Stat. 2763).
(d) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--MEDICARE RURAL HEALTH CARE IMPROVEMENTS
Sec. 101. Equalizing urban and rural standardized payment amounts under
the Medicare inpatient hospital prospective
payment system.
Sec. 102. Fairness in the medicare disproportionate share hospital
(DSH) adjustment for rural hospitals.
Sec. 103. Adjustment to the medicare inpatient hospital PPS wage index
to revise the labor-related share of such
index.
Sec. 104. One-year extension of hold harmless provisions for small
rural hospitals under medicare prospective
payment system for hospital outpatient
department services.
Sec. 105. One-year hold harmless treatment of certain sole community
hospitals to limit decline in payment under
the OPD PPS.
Sec. 106. Critical access hospital (CAH) improvements.
Sec. 107. Permanent treatment of certain physician pathology services
under medicare.
TITLE II--OTHER RURAL HOSPITAL REFORMS
Sec. 201. Capital infrastructure revolving loan program.
Sec. 202. Five-year extension of the authorization for appropriations
for certain medicare rural grants.
TITLE I--MEDICARE RURAL HEALTH CARE IMPROVEMENTS
SEC. 101. EQUALIZING URBAN AND RURAL STANDARDIZED PAYMENT AMOUNTS UNDER
THE MEDICARE INPATIENT HOSPITAL PROSPECTIVE PAYMENT
SYSTEM.
(a) In General.--Section 1886(d)(3)(A)(iv) (42 U.S.C.
1395ww(d)(3)(A)(iv)) is amended--
(1) by striking ``(iv) For discharges'' and inserting
``(iv)(I) Subject to subclause (II), for discharges''; and
(2) by adding at the end the following new subclause:
``(II) For discharges occurring in a fiscal year beginning
with fiscal year 2004, the Secretary shall compute a
standardized amount for hospitals located in any area within
the United States and within each region equal to the
standardized amount computed for the previous fiscal year under
this subparagraph for hospitals located in a large urban area
(or, beginning with fiscal year 2005, for hospitals located in
any area) increased by the applicable percentage increase under
subsection (b)(3)(B)(i) for the fiscal year involved.''.
(b) Conforming Amendments.--
(1) Computing drg-specific rates.--Section 1886(d)(3)(D)
(42 U.S.C. 1395ww(d)(3)(D)) is amended--
(A) in the heading, by striking ``in different
areas'';
(B) in the matter preceding clause (i), by striking
``, each of'';
(C) in clause (i)--
(i) in the matter preceding subclause (I),
by inserting ``for fiscal years before fiscal
year 2004,'' before ``for hospitals''; and
(ii) in subclause (II), by striking ``and''
after the semicolon at the end;
(D) in clause (ii)--
(i) in the matter preceding subclause (I),
by inserting ``for fiscal years before fiscal
year 2004,'' before ``for hospitals''; and
(ii) in subclause (II), by striking the
period at the end and inserting ``; and''; and
(E) by adding at the end the following new clause:
``(iii) for a fiscal year beginning after fiscal
year 2003, for hospitals located in all areas, to the
product of--
``(I) the applicable standardized amount
(computed under subparagraph (A)), reduced
under subparagraph (B), and adjusted or reduced
under subparagraph (C) for the fiscal year; and
``(II) the weighting factor (determined
under paragraph (4)(B)) for that diagnosis-
related group.''.
(2) Technical conforming sunset.--Section 1886(d)(3) (42
U.S.C. 1395ww(d)(3)) is amended--
(A) in the matter preceding subparagraph (A), by
inserting ``, for fiscal years before fiscal year
1997,'' before ``a regional adjusted DRG prospective
payment rate''; and
(B) in subparagraph (D), in the matter preceding
clause (i), by inserting ``, for fiscal years before
fiscal year 1997,'' before ``a regional DRG prospective
payment rate for each region,''.
SEC. 102. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE HOSPITAL
(DSH) ADJUSTMENT FOR RURAL HOSPITALS.
(a) Equalizing DSH Payment Amounts.--
(1) In general.--Section 1886(d)(5)(F)(vii) (42 U.S.C.
1395ww(d)(5)(F)(vii)) is amended by inserting ``, and, after
October 1, 2003, for any other hospital described in clause
(iv),'' after ``clause (iv)(I)'' in the matter preceding
subclause (I).
(2) Conforming amendments.--Section 1886(d)(5)(F) (42
U.S.C. 1395ww(d)(5)(F)) is amended--
(A) in clause (iv)--
(i) in subclause (II)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (xiii)'';
(ii) in subclause (III)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (xii)'';
(iii) in subclause (IV)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (x) or
(xi)'';
(iv) in subclause (V)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (xi)'';
and
(v) in subclause (VI)--
(I) by inserting ``and before
October 1, 2003,'' after ``April 1,
2001,''; and
(II) by inserting ``or, for
discharges occurring on or after
October 1, 2003, is equal to the
percent determined in accordance with
the applicable formula described in
clause (vii)'' after ``clause (x)'';
(B) in clause (viii), by striking ``The formula''
and inserting ``For discharges occurring before October
1, 2003, the formula''; and
(C) in each of clauses (x), (xi), (xii), and
(xiii), by striking ``For purposes'' and inserting
``With respect to discharges occurring before October
1, 2003, for purposes''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to discharges occurring on or after October 1, 2003.
SEC. 103. ADJUSTMENT TO THE MEDICARE INPATIENT HOSPITAL PPS WAGE INDEX
TO REVISE THE LABOR-RELATED SHARE OF SUCH INDEX.
(a) In General.--Section 1886(d)(3)(E) (42 U.S.C. 1395ww(d)(3)(E))
is amended--
(1) by striking ``wage levels.--The Secretary'' and
inserting ``wage levels.--
``(i) In general.--Except as provided in clause
(ii), the Secretary''; and
(2) by adding at the end the following new clause:
``(ii) Alternative proportion to be adjusted
beginning in fiscal year 2004.--
``(I) In general.--Except as provided in
subclause (II), for discharges occurring on or
after October 1, 2003, the Secretary shall
substitute `62 percent' for the proportion
described in the first sentence of clause (i).
``(II) Hold harmless for certain
hospitals.--If the application of subclause (I)
would result in lower payments to a hospital
than would otherwise be made, then this
subparagraph shall be applied as if this clause
had not been enacted.''.
(b) Waiving Budget Neutrality.--Section 1886(d)(3)(E) (42 U.S.C.
1395ww(d)(3)(E)), as amended by subsection (a), is amended by adding at
the end of clause (i) the following new sentence: ``The Secretary shall
apply the previous sentence for any period as if the amendments made by
section 103(a) of the Health Care Access and Rural Equity Act of 2003
had not been enacted.''.
SEC. 104. ONE-YEAR EXTENSION OF HOLD HARMLESS PROVISIONS FOR SMALL
RURAL HOSPITALS UNDER MEDICARE PROSPECTIVE PAYMENT SYSTEM
FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES.
Section 1833(t)(7)(D)(i) (42 U.S.C. 1395l(t)(7)(D)(i)) is amended
by striking ``2004'' and inserting ``2005''.
SEC. 105. ONE-YEAR HOLD HARMLESS TREATMENT OF CERTAIN SOLE COMMUNITY
HOSPITALS TO LIMIT DECLINE IN PAYMENT UNDER THE OPD PPS.
(a) Hold Harmless Provision.--Section 1833(t)(7)(D)(i) (42 U.S.C.
1395l(t)(7)(D)(i)), as amended by section 104, is further amended--
(1) in the heading, by striking ``small'' and inserting
``certain''; and
(2) by inserting ``or a sole community hospital (as defined
in section 1886(d)(5)(D)(iii)) located in a rural area'' after
``100 beds''.
(b) Effective Date.--The amendment made by subsection (a)(2) shall
apply with respect to payment for OPD services furnished on and after
January 1, 2004.
SEC. 106. CRITICAL ACCESS HOSPITAL (CAH) IMPROVEMENTS.
(a) Elimination of the Isolation Test for Cost-Based CAH Ambulance
Services.--
(1) In general.--Section 1834(l)(8) (42 U.S.C. 1395m(l)),
as added by section 205(a) of BIPA (114 Stat. 2763A-482), is
amended by striking the comma at the end of subparagraph (B)
and all that follows and inserting a period.
(2) Technical correction.--Section 1834(l) (42 U.S.C.
1395m(l)) is amended by redesignating paragraph (8), as added
by section 221(a) of BIPA (114 Stat. 2763A-486), as paragraph
(9).
(b) Coverage of Costs for Certain Emergency Room On-Call
Providers.--
(1) In general.--Section 1834(g)(5) (42 U.S.C. 1395m(g)(5))
is amended--
(A) in the heading--
(i) by inserting ``certain'' before
``emergency''; and
(ii) by striking ``physicians'' and
inserting ``providers'';
(B) by striking ``emergency room physicians who are
on-call (as defined by the Secretary)'' and inserting
``physicians, physician assistants, nurse
practitioners, and clinical nurse specialists who are
on-call (as defined by the Secretary) to provide
emergency services''; and
(C) by striking ``physicians' services'' and
inserting ``services covered under this title''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply with respect to costs incurred for services
provided on or after January 1, 2004.
(c) Authorization of Periodic Interim Payment (PIP).--
(1) In general.--Section 1815(e)(2) (42 U.S.C. 1395g(e)(2))
is amended--
(A) in subparagraph (C), by striking ``and'' after
the semicolon at the end;
(B) in subparagraph (D), by adding ``and'' after
the semicolon at the end; and
(C) by inserting after subparagraph (D) the
following new subparagraph:
``(E) inpatient critical access hospital services,''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply with respect to payments for inpatient critical
access hospital services furnished on or after January 1, 2004.
(d) Exclusion of New CAHs From PPS Hospital Wage Index
Calculation.--Section 1886(d)(3)(E) (42 U.S.C. 1395ww(d)(3)(E)), as
amended by section 103(a), is further amended by inserting after the
first sentence of clause (i) the following new sentence: ``In
calculating the hospital wage levels under the preceding sentence
applicable with respect to cost reporting periods beginning on or after
January 1, 2004, the Secretary shall exclude the wage levels of any
hospital that became a critical access hospital prior to the cost
reporting period for which such hospital wage levels are calculated.''.
SEC. 107. PERMANENT TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES
UNDER MEDICARE.
(a) In General.--Section 1848(i) (42 U.S.C. 1395w-4(i)) is amended
by adding at the end the following new paragraph:
``(4) Treatment of certain physician pathology services.--
``(A) In general.--With respect to services
furnished on or after January 1, 2001, if an
independent laboratory furnishes the technical
component of a physician pathology service to a fee-
for-service medicare beneficiary who is an inpatient or
outpatient of a covered hospital, the Secretary shall
treat such component as a service for which payment
shall be made to the laboratory under this section and
not as an inpatient hospital service for which payment
is made to the hospital under section 1886(d) or as a
hospital outpatient service for which payment is made
to the hospital under section 1833(t).
``(B) Definitions.--In this paragraph:
``(i) Covered hospital.--
``(I) In general.--The term
`covered hospital' means, with respect
to an inpatient or outpatient, a
hospital that had an arrangement with
an independent laboratory that was in
effect as of July 22, 1999, under which
a laboratory furnished the technical
component of physician pathology
services to fee-for-service medicare
beneficiaries who were hospital
inpatients or outpatients,
respectively, and submitted claims for
payment for such component to a carrier
with a contract under section 1842 and
not to the hospital.
``(II) Change in ownership does not
affect determination.--A change in
ownership with respect to a hospital on
or after the date referred to in
subclause (I) shall not affect the
determination of whether such hospital
is a covered hospital for purposes of
such subclause.
``(ii) Fee-for-service medicare
beneficiary.--The term `fee-for-service
medicare beneficiary' means an individual who
is entitled to (or enrolled for) benefits under
part A, or enrolled under this part, or both,
but who is not enrolled in any of the
following:
``(I) A Medicare+Choice plan under
part C.
``(II) A plan offered by an
eligible organization under section
1876.
``(III) A program of all-inclusive
care for the elderly (PACE) under
section 1894.
``(IV) A social health maintenance
organization (SHMO) demonstration
project established under section
4018(b) of the Omnibus Budget
Reconciliation Act of 1987 (Public Law
100-203).''.
(b) Conforming Amendment.--Section 542 of BIPA (114 Stat. 2763A-
550) is repealed.
(c) Effective Date.--The amendments made by this section shall take
effect as if included in the enactment of the Medicare, Medicaid, and
SCHIP Benefits Improvement and Protection Act of 2000 (114 Stat. 2763A-
463 et seq.), as enacted into law by section 1(a)(6) of Public Law 106-
554.
TITLE II--OTHER RURAL HOSPITAL REFORMS
SEC. 201. CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM.
(a) In General.--Part A of title XVI of the Public Health Service
Act (42 U.S.C. 300q et seq.) is amended by adding at the end the
following new section:
``capital infrastructure revolving loan program
``Sec. 1603. (a) Authority To Make and Guarantee Loans.--
``(1) Authority to make loans.--The Secretary may make
loans from the fund established under section 1602(d) to any
rural entity for projects for capital improvements, including--
``(A) the acquisition of land necessary for the
capital improvements;
``(B) the renovation or modernization of any
building;
``(C) the acquisition or repair of fixed or major
movable equipment; and
``(D) such other project expenses as the Secretary
determines appropriate.
``(2) Authority to guarantee loans.--
``(A) In general.--The Secretary may guarantee the
payment of principal and interest for loans made to
rural entities for projects for any capital improvement
described in paragraph (1) to any non-Federal lender.
``(B) Interest subsidies.--In the case of a
guarantee of any loan made to a rural entity under
subparagraph (A), the Secretary may pay to the holder
of such loan, for and on behalf of the project for
which the loan was made, amounts sufficient to reduce
(by not more than 3 percent) the net effective interest
rate otherwise payable on such loan.
``(b) Amount of Loan.--The principal amount of a loan directly made
or guaranteed under subsection (a) for a project for capital
improvement may not exceed $5,000,000.
``(c) Funding Limitations.--
``(1) Government credit subsidy exposure.--The total of the
Government credit subsidy exposure under the Credit Reform Act
of 1990 scoring protocol with respect to the loans outstanding
at any time with respect to which guarantees have been issued,
or which have been directly made, under subsection (a) may not
exceed $50,000,000 per year.
``(2) Total amounts.--Subject to paragraph (1), the total
of the principal amount of all loans directly made or
guaranteed under subsection (a) may not exceed $250,000,000 per
year.
``(d) Capital Assessment and Planning Grants.--
``(1) Nonrepayable grants.--Subject to paragraph (2), the
Secretary may make a grant to a rural entity, in an amount not
to exceed $50,000, for purposes of capital assessment and
business planning.
``(2) Limitation.--The cumulative total of grants awarded
under this subsection may not exceed $2,500,000 per year.
``(e) Termination of Authority.--The Secretary may not directly
make or guarantee any loan under subsection (a) or make a grant under
subsection (d) after September 30, 2008.''.
(b) Rural Entity Defined.--Section 1624 of the Public Health
Service Act (42 U.S.C. 300s-3) is amended by adding at the end the
following new paragraph:
``(14)(A) The term `rural entity' includes--
``(i) a rural health clinic, as defined in section
1861(aa)(2) of the Social Security Act;
``(ii) any medical facility with at least 1 bed,
but with less than 50 beds, that is located in--
``(I) a county that is not part of a
metropolitan statistical area; or
``(II) a rural census tract of a
metropolitan statistical area (as determined
under the most recent modification of the
Goldsmith Modification, originally published in
the Federal Register on February 27, 1992 (57
Fed. Reg. 6725));
``(iii) a hospital that is classified as a rural,
regional, or national referral center under section
1886(d)(5)(C) of the Social Security Act; and
``(iv) a hospital that is a sole community hospital
(as defined in section 1886(d)(5)(D)(iii) of the Social
Security Act).
``(B) For purposes of subparagraph (A), the fact that a
clinic, facility, or hospital has been geographically
reclassified under the medicare program under title XVIII of
the Social Security Act shall not preclude a hospital from
being considered a rural entity under clause (i) or (ii) of
subparagraph (A).''.
(c) Conforming Amendments.--Section 1602 of the Public Health
Service Act (42 U.S.C. 300q-2) is amended--
(1) in subsection (b)(2)(D), by inserting ``or
1603(a)(2)(B)'' after ``1601(a)(2)(B)''; and
(2) in subsection (d)--
(A) in paragraph (1)(C), by striking ``section
1601(a)(2)(B)'' and inserting ``sections 1601(a)(2)(B)
and 1603(a)(2)(B)''; and
(B) in paragraph (2)(A), by inserting ``or
1603(a)(2)(B)'' after ``1601(a)(2)(B)''.
SEC. 202. FIVE-YEAR EXTENSION OF THE AUTHORIZATION FOR APPROPRIATIONS
FOR CERTAIN MEDICARE RURAL GRANTS.
Section 1820(j) (42 U.S.C. 1395i-4(j)) is amended by striking
``subsection (g)'' and all that follows and inserting ``subsection
(g)--
``(1) $25,000,000 in each of the fiscal years 1998 through
2003; and
``(2) $40,000,000 in each of the fiscal years 2004 through
2008.''.
<all>
Introduced in House
Introduced in House
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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health, for a period to be subsequently determined by the Chairman.
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