Rural Community Hospital Assistance Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to: (1) provide for establishment of a rural community hospital (RCH) program; (2) remove certain barriers to establishment of distinct part units by RCH and Medicare critical access hospital (CAH) facilities; and (3) revise the CAH program.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2350 Introduced in House (IH)]
109th CONGRESS
1st Session
H. R. 2350
To amend title XVIII of the Social Security Act to provide for
improvements in access to services in rural hospitals and critical
access hospitals.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 12, 2005
Mr. Moran of Kansas (for himself, Mr. Hinojosa, Mr. McHugh, Mr. Berry,
Mr. Bishop of Georgia, Mr. Shimkus, Mr. Sanders, Mr. Ross, Mr. Kind,
Mr. Otter, Mr. Pickering, Mr. Paul, Mr. Osborne, Mr. McIntyre, Mr.
Oberstar, Mr. Dicks, and Mr. Renzi) 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 provide for
improvements in access to services in rural hospitals and critical
access hospitals.
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.
(a) Short Title.--This Act may be cited as the ``Rural Community
Hospital Assistance Act of 2005''.
(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 a reference to that
section or other provision of the Social Security Act.
SEC. 2. ESTABLISHMENT OF RURAL COMMUNITY HOSPITAL (RCH) PROGRAM.
(a) In General.--Section 1861 (42 U.S.C. 1395x) is amended by
adding at the end of the following new subsection:
``Rural Community Hospital; Rural Community Hospital Services
``(bbb)(1) The term `rural community hospital' means a hospital (as
defined in subsection (e)) that--
``(A) is located in a rural area (as defined in section
1886(d)(2)(D)) or treated as being so located pursuant to
section 1886(d)(8)(E);
``(B) subject to paragraph (2), has less than 51 acute care
inpatient beds, as reported in its most recent cost report;
``(C) makes available 24-hour emergency care services;
``(D) subject to paragraph (3), has a provider agreement in
effect with the Secretary and is open to the public as of
January 1, 2005; and
``(E) applies to the Secretary for such designation.
``(2) For purposes of paragraph (1)(B), beds in a psychiatric or
rehabilitation unit of the hospital which is a distinct part of the
hospital shall not be counted.
``(3) Subparagraph (1)(D) shall not be construed to prohibit any of
the following from qualifying as a rural community hospital:
``(A) A replacement facility (as defined by the Secretary
in regulations in effect on January 1, 2005) with the same
service area (as defined by the Secretary in regulations in
effect on such date).
``(B) A facility obtaining a new provider number pursuant
to a change of ownership.
``(C) A facility which has a binding written agreement with
an outside, unrelated party for the construction,
reconstruction, lease, rental, or financing of a building as of
January 1, 2005.
``(4) Nothing in this subsection shall be construed as prohibiting
a critical access hospital from qualifying as a rural community
hospital if the critical access hospital meets the conditions otherwise
applicable to hospitals under subsection (e) and section 1866.
``(5) Nothing in this subsection shall be construed as prohibiting
a rural community hospital participating in the demonstration program
under Section 410A of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2313) from
qualifying as a rural community hospital if the rural community
hospital meets the conditions otherwise applicable to hospitals under
subsection (e) and section 1866.''.
(b) Payment.--
(1) Inpatient hospital services.--Section 1814 (42 U.S.C.
1395f) is amended by adding at the end the following new
subsection:
``Payment for Inpatient Services Furnished in Rural Community Hospitals
``(m) The amount of payment under this part for inpatient hospital
services furnished in a rural community hospital, other than such
services furnished in a psychiatric or rehabilitation unit of the
hospital which is a distinct part, is, at the election of the hospital
in the application referred to in section 1861(bbb)(1)(E)--
``(1) 101 percent of the reasonable costs of providing such
services, without regard to the amount of the customary or
other charge, or
``(2) the amount of payment provided for under the
prospective payment system for inpatient hospital services
under section 1886(d).''.
(2) Outpatient services.--Section 1834 (42 U.S.C. 1395m) is
amended by adding at the end the following new subsection:
``(n) Payment for Outpatient Services Furnished in Rural Community
Hospitals.--The amount of payment under this part for outpatient
services furnished in a rural community hospital is, at the election of
the hospital in the application referred to in section
1861(bbb)(1)(E)--
``(1) 101 percent of the reasonable costs of providing such
services, without regard to the amount of the customary or
other charge and any limitation under section 1861(v)(1)(U), or
``(2) the amount of payment provided for under the
prospective payment system for covered OPD services under
section 1833(t).''.
(3) Home health services.--
(A) Exclusion from home health pps.--
(i) In general.--Section 1895 (42 U.S.C.
1395fff) is amended by adding at the end the
following:
``(f) Exclusion.--
``(1) In general.--In determining payments under this title
for home health services furnished on or after October 1, 2005,
by a qualified RCH-based home health agency (as defined in
paragraph (2))--
``(A) the agency may make a one-time election to
waive application of the prospective payment system
established under this section to such services
furnished by the agency; and
``(B) in the case of such an election, payment
shall be made on the basis of 101 percent of the
reasonable costs incurred in furnishing such services
as determined under section 1861(v), but without regard
to the amount of the customary or other charges with
respect to such services or the limitations established
under paragraph (1)(L) of such section.
``(2) Qualified rch-based home health agency defined.--For
purposes of paragraph (1), a `qualified RCH-based home health
agency' is a home health agency that is a provider-based entity
(as defined in section 404 of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000 (Appendix F,
114 Stat. 2763A-506), as enacted into law by section 1(a)(6) of
Public Law 106-554) of a rural community hospital that is
located--
``(A) in a county in which no main or branch office
of another home health agency is located; or
``(B) at least 35 miles from any main or branch
office of another home health agency.''.
(ii) Conforming changes.--
(I) Payment under part a.--Section
1814(b) (42 U.S.C. 1395f(b)) is amended
by inserting ``or with respect to
services to which section 1895(f)
applies'' after ``equipment'' in the
matter preceding paragraph (1).
(II) Payments under part b.--
Section 1833(a)(2)(A) (42 U.S.C.
1395l(a)(2)(A)) is amended by striking
``the prospective payment system
under''.
(III) Per visit limits.--Section
1861(v)(1)(L)(i) (42 U.S.C.
1395x(v)(1)(L)(i)) is amended by
inserting ``(other than by a qualified
RCH-based home health agency (as
defined in section 1895(f)(2))'' after
``with respect to services furnished by
home health agencies''.
(iii) Consolidated billing.--
(I) Recipient of payment.--Section
1842(b)(6)(F) (42 U.S.C.
1395u(b)(6)(F)) is amended by inserting
``and excluding home health services to
which section 1895(f) applies'' after
``provided for in such section''.
(II) Exception to exclusion from
coverage.--Section 1862(a) (42 U.S.C.
1395y(a)) is amended by inserting
before the period at the end of the
second sentence the following: ``and
paragraph (21) shall not apply to home
health services to which section
1895(f) applies''.
(4) Exemption from 30-percent reduction in reimbursement
for bad debt.--Section 1861(v)(1)(T) (42 U.S.C. 1395x(v)(1)(T))
is amended by inserting ``(other than for a rural community
hospital)'' after ``In determining such reasonable costs for
hospitals''.
(c) Beneficiary Cost-Sharing for Outpatient Services.--Section
1834(n) (as added by subsection (b)(2)) is amended--
(1) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively;
(2) by inserting ``(1)'' after ``(n)''; and
(3) by adding at the end the following:
``(2) The amounts of beneficiary cost-sharing for outpatient
services furnished in a rural community hospital under this part shall
be as follows:
``(A) For items and services that would have been paid
under section 1833(t) if provided by a hospital, the amount of
cost-sharing determined under paragraph (8) of such section.
``(B) For items and services that would have been paid
under section 1833(h) if furnished by a provider or supplier,
no cost-sharing shall apply.
``(C) For all other items and services, the amount of cost-
sharing that would apply to the item or service under the
methodology that would be used to determine payment for such
item or service if provided by a physician, provider, or
supplier, as the case may be.''.
(d) Conforming Amendments.--
(1) Part a payment.--Section 1814(b) (42 U.S.C. 1395f(b))
is amended in the matter preceding paragraph (1) by inserting
``other than inpatient hospital services furnished by a rural
community hospital,'' after ``critical access hospital
services,''.
(2) Part b payment.--
(A) In general.--Section 1833(a) (42 U.S.C.
1395l(a)) is amended--
(i) in paragraph (2), in the matter before
subparagraph (A), by striking ``and (I)'' and
inserting ``(I), and (K)'';
(ii) by striking ``and'' at the end of
paragraph (8);
(iii) by striking the period at the end of
paragraph (9) and inserting ``; and''; and
(iv) by adding at the end the following:
``(10) in the case of outpatient services furnished by a
rural community hospital, the amounts described in section
1834(n).''.
(B) Ambulance services.--Section 1834(l)(8) (42
U.S.C. 1395m(l)(8)) is amended--
(i) in the heading, by striking ``critical
access hospitals'' and inserting ``certain
facilities'';
(ii) in the matter preceding subparagraph
(A), by striking ``the reasonable costs'' and
inserting ``101 percent of the reasonable
costs'';
(iii) by striking ``or'' at the end of
subparagraph (A);
(iv) by redesignating subparagraph (B) as
subparagraph (C);
(v) by inserting after subparagraph (A) the
following new subparagraph:
``(B) by a rural community hospital (as defined in
section 1861(bbb)(1)), or''; and
(vi) in subparagraph (C), as so
redesignated, by inserting ``or a rural
community hospital'' after ``critical access
hospital''.
(3) Technical amendments.--
(A) Consultation with state agencies.--Section 1863
(42 U.S.C. 1395z) is amended by striking ``and
(dd)(2)'' and inserting ``(dd)(2), (mm)(1), and
(bbb)(1)''.
(B) Provider agreements.--Section 1866(a)(2)(A) (42
U.S.C. 1395cc(a)(2)(A)) is amended by inserting
``section 1834(n)(2),'' after ``section 1833(b),''.
(e) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after October 1, 2005.
SEC. 3. REMOVING BARRIERS TO ESTABLISHMENT OF DISTINCT PART UNITS BY
RCH AND CAH FACILITIES.
(a) In General.--Section 1886(d)(1)(B) (42 U.S.C. 1395(d)(1)(B)) is
amended by striking ``a distinct part of the hospital (as defined by
the Secretary)'' in the matter following clause (v) and inserting ``a
distinct part (as defined by the Secretary) of the hospital or of a
critical access hospital or a rural community hospital''.
(b) Revision of Limits on Authority for CAHs to Establish
Psychiatric and Rehabilitation Distinct Part Units.--Section
1820(c)(2)(E)(iv) (42 U.S.C. 1395i-4(c)(2)(E)(iv)) is amended--
(1) by striking ``If'' and inserting ``If the Secretary
finds that'';
(2) by striking ``with respect to a cost reporting
period''; and
(3) by striking ``during such period'' and inserting
``after such finding is made''.
(c) Effective Date.--The amendments made by this section shall
apply to determinations with respect to distinct part unit status that
are made on or after October 1, 2005.
SEC. 4. IMPROVEMENTS TO MEDICARE CRITICAL ACCESS HOSPITAL (CAH)
PROGRAM.
(a) Payments to Home Health Agencies Owned and Operated by a CAH.--
Section 1895(f) (42 U.S.C. 1395fff(f)), as added by section 2(b)(3), is
further amended by inserting ``or by a home health agency that is owned
and operated by a critical access hospital (as defined in section
1861(mm)(1))'' after ``as defined in paragraph (2))''.
(b) Payments to CAH-Owned SNFs.--
(1) In general.--Section 1888(e) (42 U.S.C. 1395yy(e)) is
amended--
(A) in paragraph (1), by striking ``and (12)'' and
inserting ``(12), and (13)''; and
(B) by adding at the end thereof the following:
``(13) Exemption of cah facilities from pps.--In
determining payments under this part for covered skilled
nursing facility services furnished on or after October 1,
2005, by a skilled nursing facility that is a distinct part
unit of a critical access hospital (as defined in section
1861(mm)(1)) or is owned and operated by a critical access
hospital--
``(A) the prospective payment system established
under this subsection shall not apply; and
``(B) payment shall be made on the basis of 101
percent of the reasonable costs incurred in furnishing
such services as determined under section 1861(v), but
without regard to the amount of the customary or other
charges with respect to such services or the
limitations established under subsection (a)''.
(2) Conforming changes.--
(A) In general.--Section 1814(b) (42 U.S.C.
1395f(b)), as amended by section 2(d)(1), is amended in
the matter preceding paragraph (1)--
(i) by inserting ``other than a skilled
nursing facility providing covered skilled
nursing facility services (as defined in
section 1888(e)(2)) or posthospital extended
care services to which section 1888(e)(13)
applies,'' after ``inpatient hospital services
furnished by a rural community hospital,''; and
(ii) by striking ``1813, 1886,'' and
inserting ``1813, 1886, 1888,''.
(B) Consolidated billing.--
(i) Recipient of payment.--Section
1842(b)(6)(E) (42 U.S.C. 1395u(b)(6)(E)) is
amended by inserting ``services to which
paragraph (7)(C) or (13) of section 1888(e)
applies and'' after ``other than''.
(ii) Exception to exclusion from
coverage.--Section 1862(a)(18) (42 U.S.C.
1395y(a)(18)) is amended by inserting ``(other
than services to which paragraph (7)(C) or (13)
of section 1888(e) applies)'' after ``section
1888(e)(2)(A)(i)''.
(c) Payments to Distinct Part Psychiatric or Rehabilitation Units
of CAHs.--
(1) In general.--Section 1886(b) (42 U.S.C. 1395(b)) is
amended--
(A) in paragraph (1), by inserting ``, other than a
distinct part psychiatric or rehabilitation unit to
which paragraph (8) applies,'' after ``subsection
(d)(1)(B)''; and
(B) by adding at the end the following:
``(8) Exemption of certain distinct part psychiatric or
rehabilitation units from cost limits.--In determining payments
under this part for inpatient hospital services furnished on or
after October 1, 2005, by a distinct part psychiatric or
rehabilitation unit (described in the matter following clause
(v) of subsection (d)(1)(B)) of a critical access hospital (as
defined in section 1861(mm)(1))--
``(A) the limits imposed under the preceding
paragraphs of this subsection shall not apply; and
``(B) payment shall be made on the basis of 101
percent of the reasonable costs incurred in furnishing
such services as determined under section 1861(v), but
without regard to the amount of the customary or other
charges with respect to such services.''.
(2) Conforming amendment.--Section 1814(l) (42 U.S.C.
1395f(l)) is amended by inserting ``furnished during fiscal
year 2005'' after ``such unit''.
(d) Elimination of Isolation Test for Cost-Based CAH Ambulance
Services.--Paragraph (8) of section 1834(l) (42 U.S.C. 1395m(l)) is
amended by striking the comma at the end of subparagraph (B) and all
that follows and inserting a period.
(e) Technical Corrections.--
(1) Section 403(b) of bbra 1999.--Section 1820(b)(2) (42
U.S.C. 1395i-4(b)(2)) is amended by striking ``nonprofit or
public hospitals'' and inserting ``hospitals''.
(2) Section 203(b) of bipa 2000.--Section 1883(a)(3) (42
U.S.C. 1395tt(a)(3)) is amended--
(A) by inserting ``section 1861(v)(1)(G) or'' after
``Notwithstanding''; and
(B) by striking ``covered skilled nursing
facility''.
(f) Effective Dates.--
(1) Elimination of requirements.--The amendments made by
subsections (a) and (c) shall apply to services furnished on or
after October 1, 2005.
(2) Technical corrections.--
(A) BBRA.--The amendment made by subsection (e)(1)
shall be effective as if included in the enactment of
section 403(b) of the Medicare, Medicaid, and SCHIP
Balanced Budget Refinement Act of 1999 (Appendix F, 113
Stat. 1501A-321), as enacted into law by section
1000(a)(6) of Public Law 106-113.
(B) BIPA.--The amendments made by subsection (e)(2)
shall be effective as if included in the enactment of
section 203(b) of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000
(Appendix F, 114 Stat. 2763A-463), as enacted into law
by section 1(a)(6) of Public Law 106-554.
<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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