Craig Thomas Rural Hospital and Provider Equity Act of 2014 - Expresses the sense of the Senate that residents of rural and frontier communities should have access to affordable, quality health care.
Amends title XVIII (Medicare) of the Social Security Act with respect to:
Amends the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 to provide for the extension of the payment for the technical component of certain physician pathology services under Medicare.
Directs the Secretary of Health and Human Services (HHS) to encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across state lines.
Amends title XVIII (Medicare) of the Social Security Act to extend Medicare part A (Hospital Insurance) coverage and payment, on a reasonable cost basis, to anesthesia services furnished by a physician anesthesiologist in certain rural hospitals in the same manner as payment is made for anesthesia services furnished by a certified registered nurse anesthetist (CRNA) in such hospitals.
Establishes the floor at 1.00 on the practice expense geographic index for services furnished during a specified period in certain rural areas outside of frontier states under the Medicare physician fee schedule.
Revises the standard for designation of sole community hospitals.
Amends the Omnibus Budget Reconciliation Act of 1986, as amended by the Omnibus Budget Reconciliation Act of 1989, to include standby and on-call time costs for CRNAs in determination of the reasonable costs incurred by a hospital or critical access hospital for CRNA services.
Amends the Public Health Service Act to extend the authorization of appropriations for grants to states for operation of offices of rural health.
Repeals the Medicare 96-hour physician certification requirement for inpatient critical access hospital services.
Directs the Secretary to continue to apply through 2014 a certain enforcement instruction on supervision requirements for outpatient therapeutic services in critical access and small rural hospitals.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2359 Introduced in Senate (IS)]
113th CONGRESS
2d Session
S. 2359
To amend title XVIII of the Social Security Act to protect and preserve
access of Medicare beneficiaries in rural areas to health care
providers under the Medicare program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 20, 2014
Mr. Franken (for himself, Mr. Roberts, Mr. Harkin, and Mr. Barrasso)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to protect and preserve
access of Medicare beneficiaries in rural areas to health care
providers under the Medicare program, 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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Craig Thomas Rural
Hospital and Provider Equity Act of 2014''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Sense of the Senate.
Sec. 3. Fairness in the Medicare disproportionate share hospital (DSH)
adjustment for rural hospitals.
Sec. 4. Extension and expansion of the Medicare hold harmless provision
under the prospective payment system for
hospital outpatient department (HOPD)
services for certain hospitals.
Sec. 5. Temporary improvements to the Medicare inpatient hospital
payment adjustment for low-volume
hospitals.
Sec. 6. Extension of Medicare wage index reclassifications for certain
hospitals.
Sec. 7. Extension of Medicare reasonable costs payments for certain
clinical diagnostic laboratory tests
furnished to hospital patients in certain
rural areas.
Sec. 8. Elimination of isolation test for cost-based ambulance
reimbursement for critical access
hospitals.
Sec. 9. Capital infrastructure revolving loan program.
Sec. 10. Extension of Medicare incentive payment program for physician
scarcity areas.
Sec. 11. Extension of floor on Medicare work geographic adjustment.
Sec. 12. Recognition of attending physician assistants as attending
physicians to serve hospice patients.
Sec. 13. Improving care planning for Medicare home health services.
Sec. 14. Rural health clinic improvements.
Sec. 15. Temporary Medicare payment increase for home health services
furnished in a rural area.
Sec. 16. Extension of increased Medicare payments for rural ground
ambulance services.
Sec. 17. Coverage of marriage and family therapist services and mental
health counselor services under Part B of
the Medicare program.
Sec. 18. Extension of payment for technical component of certain
physician pathology services.
Sec. 19. Facilitating the provision of telehealth services across State
lines.
Sec. 20. Medicare Part A payment for anesthesiologist services in
certain rural hospitals based on CRNA pass-
through rules.
Sec. 21. Temporary floor on the practice expense geographic index for
services furnished in rural areas outside
of frontier States under the Medicare
physician fee schedule.
Sec. 22. Revisions to standard for designation of sole community
hospitals.
Sec. 23. Medicare treatment of standby and on-call time for CRNA
services.
Sec. 24. State offices of rural health.
Sec. 25. Removing Medicare 96-hour physician certification requirement
for inpatient critical access hospital
services.
Sec. 26. Extension of enforcement instruction on supervision
requirements for outpatient therapeutic
services in critical access and small rural
hospitals through 2014.
SEC. 2. SENSE OF THE SENATE.
It is the sense of the Senate that--
(1) residents of rural and frontier communities should have
access to affordable, quality health care;
(2) rural and frontier communities face unique challenges
in health care delivery and financing;
(3) Federal health policy must reflect the unique needs of
residents of rural and frontier communities and such
communities in an equitable and sustainable manner; and
(4) stakeholders should work collectively to identify
innovative policies that address the availability, delivery,
and affordability of health care services in rural and frontier
communities.
SEC. 3. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE HOSPITAL (DSH)
ADJUSTMENT FOR RURAL HOSPITALS.
Section 1886(d)(5)(F)(xiv)(II) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended by adding at the end the
following new sentence: ``The preceding sentence shall not apply to any
hospital with respect to discharges occurring on or after October 1,
2014, and before October 1, 2015.''.
SEC. 4. EXTENSION AND EXPANSION OF THE MEDICARE HOLD HARMLESS PROVISION
UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL
OUTPATIENT DEPARTMENT (HOPD) SERVICES FOR CERTAIN
HOSPITALS.
Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C.
1395l(t)(7)(D)(i)) is amended--
(1) in subclause (II)--
(A) in the first sentence, by inserting ``and for
such services furnished on or after April 1, 2014, and
before April 1, 2015,'' after ``covered OPD services
furnished on or after January 1, 2006, and before
January 1, 2013,''; and
(B) in the second sentence--
(i) by striking ``and 85'' and inserting
``85''; and
(ii) by inserting the following before the
period at the end: ``, and 100 percent with
respect to such services furnished after April
1, 2014, and before April 1, 2015''; and
(2) in subclause (III)--
(A) in the first sentence--
(i) by inserting ``and for such services
furnished on or after April 1, 2014, and before
April 1, 2015,'' after ``covered OPD services
furnished on or after January 1, 2009, and
before January 1, 2013,''; and
(ii) by striking ``85 percent'' and
inserting ``the applicable percentage (as
determined under the second sentence of
subclause (II) for the year)''; and
(B) in the second sentence, by inserting ``and in
the case of such services furnished on or after April
1, 2014, and before April 1, 2015,'' after ``covered
OPD services furnished on or after January 1, 2010, and
before March 1, 2012,''.
SEC. 5. TEMPORARY IMPROVEMENTS TO THE MEDICARE INPATIENT HOSPITAL
PAYMENT ADJUSTMENT FOR LOW-VOLUME HOSPITALS.
Section 1886(d)(12) of the Social Security Act (42 U.S.C.
1395ww(d)(12)) is amended--
(1) in subparagraph (C)(i), by striking ``fiscal years 2011
through 2014 and fiscal year 2015 (before April 1, 2015), 1,600
discharges of individuals entitled to, or enrolled for,
benefits under part A'' and inserting ``fiscal years 2011
through 2013 and fiscal year 2014 (before April 1, 2014), 1,600
discharges of individuals entitled to, or enrolled for,
benefits under part A, or, with respect to fiscal year 2014
(after April 1, 2014), fiscal year 2015, and fiscal year 2016
(before January 1, 2016), 2,000 discharges of such
individuals''; and
(2) in subparagraph (D)--
(A) by striking ``1,600'' and inserting ``the
applicable number of''; and
(B) by adding at the end the following new
sentence: ``For purposes of the preceding sentence, the
term `applicable number of discharges' means 1,600
discharges with respect to discharges occurring in
fiscal years 2011, 2012, and 2013, and fiscal year 2014
(before April 1, 2014), and 2,000 discharges with
respect to discharges occurring in fiscal year 2014
(after April 1, 2014), fiscal year 2015, and fiscal
year 2016 (before January 1, 2016).''.
SEC. 6. EXTENSION OF MEDICARE WAGE INDEX RECLASSIFICATIONS FOR CERTAIN
HOSPITALS.
(a) Extension of Correction of Mid-Year Reclassification Expiration
for Certain Hospitals.--
(1) In general.--In the case of a hospital described in
paragraph (2), the Secretary of Health and Human Services shall
apply subsection (a) of section 106 of division B of the Tax
Relief and Health Care Act of 2006 (42 U.S.C. 1395ww note), as
amended by section 117 of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (Public Law 110-173), section 124 of the
Medicare Improvements for Patients and Providers Act of 2008
(Public Law 110-275), sections 3137(a) and 10317 of the Patient
Protection and Affordable Care Act (Public Law 111-148), and
section 102 of the Medicare and Medicaid Extenders Act of 2010
(Public Law 111-309), by substituting ``April 1, 2015'' for
``March 31, 2012''.
(2) Hospital described.--A hospital described in this
paragraph is--
(A) a hospital--
(i) that is described in subsection (a) of
such section 106; and
(ii)(I) that is located in a rural area;
and
(II) for which the Secretary of Health and
Human Services has determined the extension
under this subsection to be appropriate; or
(B) a sole community hospital located in a State
with less than 10 people per square mile that was
provided with a special exception reclassification
extension under section 117(a)(2) of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (Public Law
110-173).
(b) Not Budget Neutral.--The provisions of this section shall not
be effected in a budget-neutral manner.
SEC. 7. EXTENSION OF MEDICARE REASONABLE COSTS PAYMENTS FOR CERTAIN
CLINICAL DIAGNOSTIC LABORATORY TESTS FURNISHED TO
HOSPITAL PATIENTS IN CERTAIN RURAL AREAS.
Section 416(b) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (42 U.S.C. 1395l-4), as amended by section
105 of division B of the Tax Relief and Health Care Act of 2006 (42
U.S.C. 1395l note), section 107 of the Medicare, Medicaid, and SCHIP
Extension Act of 2007 (42 U.S.C. 1395l note), section 3122 of the
Patient Protection and Affordable Care Act (Public Law 111-148), and
section 109 of the Medicare and Medicaid Extenders Act of 2010 (Public
Law 111-309), is amended by inserting ``, the portion of fiscal year
2014 after April 1, 2014, or the portion of fiscal year 2015 before
April 1, 2015'' after ``the 2-year period beginning on July 1, 2010''.
SEC. 8. ELIMINATION OF ISOLATION TEST FOR COST-BASED AMBULANCE
REIMBURSEMENT FOR CRITICAL ACCESS HOSPITALS.
(a) In General.--Section 1834(l)(8) of the Social Security Act (42
U.S.C. 1395m(l)(8)) is amended--
(1) in subparagraph (B)--
(A) by striking ``owned and''; and
(B) by inserting ``(including when such services
are provided by the entity under an arrangement with
the hospital)'' after ``hospital''; and
(2) by striking the comma at the end of subparagraph (B)
and all that follows and inserting a period.
(b) Effective Date.--The amendments made by this section shall
apply to services furnished on or after January 1, 2015.
SEC. 9. 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 January 1, 2015.''.
(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:
``(15)(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. 10. 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 inserting ``, and such services furnished on
or after April 1, 2014, and before April 1, 2015'' after ``2008''.
SEC. 11. EXTENSION OF FLOOR ON MEDICARE WORK GEOGRAPHIC ADJUSTMENT.
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``April 1, 2015'' and inserting
``January 1, 2016''.
SEC. 12. RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS ATTENDING
PHYSICIANS TO SERVE HOSPICE PATIENTS.
(a) In General.--Section 1861(dd)(3)(B) of the Social Security Act
(42 U.S.C. 1395x(dd)(3)(B)) is amended--
(1) by striking ``or nurse practitioner'' and inserting ``,
the nurse practitioner''; and
(2) by inserting ``, or the physician assistant (as defined
in such subsection)'' after ``subsection (aa)(5))''.
(b) Permitting Physician Assistants When Delegated by a Physician
To Order Hospice Care.--Section 1814(a)(7)(A) of such Act (42 U.S.C.
1395f(a)(7)(A)) is amended--
(1) in clause (i)(I), by striking ``does not include a
nurse practitioner'' and inserting ``only includes a physician
assistant if a physician has delegated the authority to make
the certification required under this paragraph to such
physician assistant''; and
(2) by amending clause (ii) to read as follows:
``(ii) in a subsequent 90- or 60-day
period--
``(I) the medical director or
physician described in clause (i)(II);
``(II) a physician employed by the
hospice program providing (or arranging
for) the care or providing care to the
individual under arrangement with such
hospice program;
``(III) a nurse practitioner
employed by such hospice program or
providing care to the individual under
arrangement with such hospice program;
or
``(IV) a physician assistant
employed by such hospice program or
providing care to the individual under
arrangement with such hospice program,
provided that an individual described
in subclause (I) or (II) has delegated
the authority to make the
recertification required under this
clause to such physician assistant,
recertifies at the beginning of the period that
the individual is terminally ill based on such
clinical judgment;''.
(c) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2015.
SEC. 13. IMPROVING CARE PLANNING FOR MEDICARE HOME HEALTH SERVICES.
(a) Part A Provisions.--Section 1814(a) of the Social Security Act
(42 U.S.C. 1395f(a)) is amended--
(1) in paragraph (2)--
(A) in the matter preceding subparagraph (A), by
inserting ``, a nurse practitioner or clinical nurse
specialist who is working in collaboration with a
physician in accordance with State law, a certified
nurse-midwife (as defined in section 1861(gg)) as
authorized by State law, or a physician assistant (as
defined in section 1861(aa)(5)) under the supervision
of a physician'' after ``1866(j)''; and
(B) in subparagraph (C)--
(i) by inserting ``, a nurse practitioner,
a clinical nurse specialist, a certified nurse-
midwife, or a physician assistant (as the case
may be)'' after ``physician'' the first 2 times
it appears; and
(ii) by striking ``, and, in the case of a
certification made by a physician'' and all
that follows through ``face-to-face encounter''
and inserting ``, and, in the case of a
certification made by a physician after January
1, 2010, or by a nurse practitioner, clinical
nurse specialist, certified nurse-midwife, or
physician assistant (as the case may be) after
January 1, 2015, prior to making such
certification the physician, nurse
practitioner, clinical nurse specialist,
certified nurse-midwife, or physician assistant
must document that the physician, nurse
practitioner, clinical nurse specialist,
certified nurse-midwife, or physician assistant
has had a face-to-face encounter''; and
(2) in the flush matter following paragraph (8)--
(A) in the first sentence, by inserting ``certified
nurse-midwife,'' after ``clinical nurse specialist,'';
(B) in the second sentence--
(i) by striking ``physician certification''
and inserting ``certification'';
(ii) by inserting ``(or on January 1, 2015,
in the case of regulations to implement the
amendments made by section 13 of the Craig
Thomas Rural Hospital and Provider Equity Act
of 2014)'' after ``1981''; and
(iii) by striking ``a physician who'' and
inserting ``a physician, nurse practitioner,
clinical nurse specialist, certified nurse-
midwife, or physician assistant who''; and
(C) in the third sentence, by inserting ``, nurse
practitioner, clinical nurse specialist, certified
nurse-midwife, or physician assistant'' after
``physician''.
(b) Part B Provisions.--Section 1835(a) of the Social Security Act
(42 U.S.C. 1395n(a)) is amended--
(1) in paragraph (2)--
(A) in the matter preceding subparagraph (A), by
inserting ``, a nurse practitioner or clinical nurse
specialist (as those terms are defined in section
1861(aa)(5)) who is working in collaboration with a
physician in accordance with State law, a certified
nurse-midwife (as defined in section 1861(gg)) as
authorized by State law, or a physician assistant (as
defined in section 1861(aa)(5)) under the supervision
of a physician'' after ``1866(j)''; and
(B) in subparagraph (A)--
(i) in each of clauses (ii) and (iii) of
subparagraph (A) by inserting ``, a nurse
practitioner, a clinical nurse specialist, a
certified nurse-midwife, or a physician
assistant (as the case may be)'' after
``physician''; and
(ii) in clause (iv), by striking ``after
January 1, 2010'' and all that follows through
``face-to-face encounter'' and inserting ``made
by a physician after January 1, 2010, or by a
nurse practitioner, clinical nurse specialist,
certified nurse-midwife, or physician assistant
(as the case may be) after January 1, 2015,
prior to making such certification the
physician, nurse practitioner, clinical nurse
specialist, certified nurse-midwife, or
physician assistant must document that the
physician, nurse practitioner, clinical nurse
specialist, certified nurse-midwife, or
physician assistant has had a face-to-face
encounter'';
(2) in the third sentence, by inserting ``, nurse
practitioner, clinical nurse specialist, certified nurse-
midwife, or physician assistant (as the case may be)'' after
``physician'';
(3) in the fourth sentence--
(A) by striking ``physician certification'' and
inserting ``certification'';
(B) by inserting ``(or on January 1, 2015, in the
case of regulations to implement the amendments made by
section 13 of the Craig Thomas Rural Hospital and
Provider Equity Act of 2014)'' after ``1981''; and
(C) by striking ``a physician who'' and inserting
``a physician, nurse practitioner, clinical nurse
specialist, certified nurse-midwife, or physician
assistant who''; and
(4) in the fifth sentence, by inserting ``, nurse
practitioner, clinical nurse specialist, certified nurse-
midwife, or physician assistant'' after ``physician''.
(c) Definition Provisions.--
(1) Home health services.--Section 1861(m) of the Social
Security Act (42 U.S.C. 1395x(m)) is amended--
(A) in the matter preceding paragraph (1)--
(i) by inserting ``, a nurse practitioner
or a clinical nurse specialist (as those terms
are defined in subsection (aa)(5)), a certified
nurse-midwife (as defined in section 1861(gg)),
or a physician assistant (as defined in
subsection (aa)(5))'' after ``physician'' the
first place it appears; and
(ii) by inserting ``, a nurse practitioner,
a clinical nurse specialist, a certified nurse-
midwife, or a physician assistant'' after
``physician'' the second place it appears; and
(B) in paragraph (3), by inserting ``, a nurse
practitioner, a clinical nurse specialist, a certified
nurse-midwife, or a physician assistant'' after
``physician''.
(2) Home health agency.--Section 1861(o)(2) of the Social
Security Act (42 U.S.C. 1395x(o)(2)) is amended--
(A) by inserting ``, nurse practitioners or
clinical nurse specialists (as those terms are defined
in subsection (aa)(5)), certified nurse-midwives (as
defined in section 1861(gg)), or physician assistants
(as defined in subsection (aa)(5))'' after
``physicians''; and
(B) by inserting ``, nurse practitioner, clinical
nurse specialist, certified nurse-midwife, physician
assistant,'' after ``physician''.
(d) Home Health Prospective Payment System Provisions.--Section
1895 of the Social Security Act (42 U.S.C. 1395fff) is amended--
(1) in subsection (c)(1), by inserting ``, the nurse
practitioner or clinical nurse specialist (as those terms are
defined in section 1861(aa)(5)), the certified nurse-midwife
(as defined in section 1861(gg)), or the physician assistant
(as defined in section 1861(aa)(5)),'' after ``physician''; and
(2) in subsection (e)--
(A) in paragraph (1)(A), by inserting ``, a nurse
practitioner or clinical nurse specialist (as those
terms are defined in section 1861(aa)(5)), a certified
nurse-midwife (as defined in section 1861(gg)), or a
physician assistant (as defined in section
1861(aa)(5))'' after ``physician''; and
(B) in paragraph (2)--
(i) in the heading, by striking ``Physician
certification'' and inserting ``Rule of
construction regarding requirement for
certification''; and
(ii) by striking ``physician''.
(e) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2015.
SEC. 14. RURAL HEALTH CLINIC IMPROVEMENTS.
Section 1833(f) of the Social Security Act (42 U.S.C. 1395l(f)) is
amended--
(1) in paragraph (1), by striking ``, and'' at the end and
inserting a semicolon;
(2) in paragraph (2)--
(A) by inserting ``(before 2015)'' after ``in a
subsequent year''; and
(B) by striking the period at the end and inserting
a semicolon; and
(3) by adding at the end the following new paragraphs:
``(3) in 2015, at $101 per visit; and
``(4) for years following 2015, at the limit established
under this subsection for the previous year increased by the
percentage increase in the MEI (as so defined) applicable to
primary care services (as so defined) furnished as of the first
day of that year.''.
SEC. 15. TEMPORARY MEDICARE PAYMENT INCREASE FOR HOME HEALTH SERVICES
FURNISHED IN A RURAL AREA.
Section 421(a) of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2283), as
amended by section 5201(b) of the Deficit Reduction Act of 2005 (Public
Law 109-171; 120 Stat. 46) and section 3131(c) of the Patient
Protection and Affordable Care Act (Public Law 111-148; 124 Stat. 428),
is amended by striking ``January 1, 2016, 3 percent'' and inserting
``April 1, 2014, and episodes and visits ending on or after April 1,
2015, and before January 1, 2016, 3 percent''.
SEC. 16. EXTENSION OF INCREASED MEDICARE PAYMENTS FOR RURAL GROUND
AMBULANCE SERVICES.
(a) In General.--Section 1834(l)(13)(A)(i) of the Social Security
Act (42 U.S.C. 1395m(l)(13)(A)(i)) is amended by striking ``before
April 1, 2015'' and inserting ``before April 1, 2014, or 5 percent if
such service is furnished on or after April 1, 2014, and before January
1, 2016''.
(b) Super Rural Ambulance.--Section 1834(l)(12)(A) of the Social
Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended by striking ``April
1, 2015'' and inserting ``January 1, 2016''.
SEC. 17. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL
HEALTH COUNSELOR SERVICES UNDER PART B OF THE MEDICARE
PROGRAM.
(a) Coverage of Services.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)) is amended--
(A) in subparagraph (EE), by striking ``and'' after
the semicolon at the end;
(B) in subparagraph (FF), by inserting ``and''
after the semicolon at the end; and
(C) by adding at the end the following new
subparagraph:
``(GG) marriage and family therapist services (as defined
in subsection (iii)(1)) and mental health counselor services
(as defined in subsection (iii)(3));''.
(2) Definitions.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x) is amended by adding at the end the following
new subsection:
``Marriage and Family Therapist Services; Marriage and Family
Therapist; Mental Health Counselor Services; Mental Health Counselor
``(iii)(1) The term `marriage and family therapist services' means
services performed by a marriage and family therapist (as defined in
paragraph (2)) for the diagnosis and treatment of mental illnesses,
which the marriage and family therapist is legally authorized to
perform under State law (or the State regulatory mechanism provided by
State law) of the State in which such services are performed, as would
otherwise be covered if furnished by a physician or as an incident to a
physician's professional service, but only if no facility or other
provider charges or is paid any amounts with respect to the furnishing
of such services.
``(2) The term `marriage and family therapist' means an individual
who--
``(A) possesses a master's or doctoral degree which
qualifies for licensure or certification as a marriage and
family therapist pursuant to State law;
``(B) after obtaining such degree has performed at least 2
years of clinical supervised experience in marriage and family
therapy; and
``(C) in the case of an individual performing services in a
State that provides for licensure or certification of marriage
and family therapists, is licensed or certified as a marriage
and family therapist in such State.
``(3) The term `mental health counselor services' means services
performed by a mental health counselor (as defined in paragraph (4))
for the diagnosis and treatment of mental illnesses which the mental
health counselor is legally authorized to perform under State law (or
the State regulatory mechanism provided by the State law) of the State
in which such services are performed, as would otherwise be covered if
furnished by a physician or as incident to a physician's professional
service, but only if no facility or other provider charges or is paid
any amounts with respect to the furnishing of such services.
``(4) The term `mental health counselor' means an individual who--
``(A) possesses a master's or doctor's degree in mental
health counseling or a related field;
``(B) after obtaining such a degree has performed at least
2 years of supervised mental health counselor practice; and
``(C) in the case of an individual performing services in a
State that provides for licensure or certification of mental
health counselors or professional counselors, is licensed or
certified as a mental health counselor or professional
counselor in such State.''.
(3) Provision for payment under part b.--Section
1832(a)(2)(B) of the Social Security Act (42 U.S.C.
1395k(a)(2)(B)) is amended by adding at the end the following
new clause:
``(v) marriage and family therapist
services (as defined in section 1861(iii)(1))
and mental health counselor services (as
defined in section 1861(iii)(3));''.
(4) Amount of payment.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (Z)'' and inserting ``(Z)'';
and
(B) by inserting before the semicolon at the end
the following: ``, and (AA) with respect to marriage
and family therapist services and mental health
counselor services under section 1861(s)(2)(GG), the
amounts paid shall be 80 percent of the lesser of the
actual charge for the services or 75 percent of the
amount determined for payment of a psychologist under
subparagraph (L)''.
(5) Exclusion of marriage and family therapist services and
mental health counselor services from skilled nursing facility
prospective payment system.--Section 1888(e)(2)(A)(ii) of the
Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended
by inserting ``marriage and family therapist services (as
defined in section 1861(iii)(1)), mental health counselor
services (as defined in section 1861(iii)(3)),'' after
``qualified psychologist services,''.
(6) Inclusion of marriage and family therapists and mental
health counselors as practitioners for assignment of claims.--
Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C.
1395u(b)(18)(C)) is amended by adding at the end the following
new clauses:
``(vii) A marriage and family therapist (as defined in
section 1861(iii)(2)).
``(viii) A mental health counselor (as defined in section
1861(iii)(4)).''.
(b) Coverage of Certain Mental Health Services Provided in Certain
Settings.--
(1) Rural health clinics and federally qualified health
centers.--Section 1861(aa)(1)(B) of the Social Security Act (42
U.S.C. 1395x(aa)(1)(B)) is amended by striking ``or by a
clinical social worker (as defined in subsection (hh)(1))'' and
inserting ``, by a clinical social worker (as defined in
subsection (hh)(1)), by a marriage and family therapist (as
defined in subsection (iii)(2)), or by a mental health
counselor (as defined in subsection (iii)(4))''.
(2) Hospice programs.--Section 1861(dd)(2)(B)(i)(III) of
the Social Security Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) is
amended by inserting ``, marriage and family therapist, or
mental health counselor'' after ``social worker''.
(c) Authorization of Marriage and Family Therapists and Mental
Health Counselors To Develop Discharge Plans for Post-Hospital
Services.--Section 1861(ee)(2)(G) of the Social Security Act (42 U.S.C.
1395x(ee)(2)(G)) is amended by inserting ``, including a marriage and
family therapist and a mental health counselor who meets qualification
standards established by the Secretary'' before the period at the end.
(d) Effective Date.--The amendments made by this section shall
apply with respect to services furnished on or after January 1, 2015.
SEC. 18. EXTENSION OF PAYMENT FOR TECHNICAL COMPONENT OF CERTAIN
PHYSICIAN PATHOLOGY SERVICES.
Section 542(c) of 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), as amended by section 732 of the
Medicare Prescription Drug, Improvement, and Modernization Act of 2003
(42 U.S.C. 1395w-4 note), section 104 of division B of the Tax Relief
and Health Care Act of 2006 (42 U.S.C. 1395w-4 note), section 104 of
the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law
110-173), section 136 of the Medicare Improvements for Patients and
Providers Act of 2008 (Public Law 110-275), section 3104 of the Patient
Protection and Affordable Care Act (Public Law 111-148), and section
105 of the Medicare and Medicaid Extenders Act of 2010 (Public Law 111-
309), is amended by striking ``2010, and 2011'' and inserting ``2010,
2011, the portion of fiscal year 2014 after April 1, 2014, and the
portion of fiscal year 2015 before April 1, 2015''.
SEC. 19. FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS STATE
LINES.
(a) In General.--For purposes of expediting the provision of
telehealth services, for which payment is made under the Medicare
program, across State lines, the Secretary of Health and Human Services
shall, in consultation with representatives of States, physicians,
health care practitioners, and patient advocates, encourage and
facilitate the adoption of provisions allowing for multistate
practitioner practice across State lines.
(b) Definitions.--In subsection (a):
(1) Telehealth service.--The term ``telehealth service''
has the meaning given that term in subparagraph (F) of section
1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).
(2) Physician, practitioner.--The terms ``physician'' and
``practitioner'' have the meaning given those terms in
subparagraphs (D) and (E), respectively, of such section.
(3) Medicare program.--The term ``Medicare program'' means
the program of health insurance administered by the Secretary
of Health and Human Services under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
SEC. 20. MEDICARE PART A PAYMENT FOR ANESTHESIOLOGIST SERVICES IN
CERTAIN RURAL HOSPITALS BASED ON CRNA PASS-THROUGH RULES.
(a) In General.--Section 1814 of the Social Security 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
added by section 608(c)(2) of the Family Support Act of 1988 and
amended by section 6132 of the Omnibus Budget Reconciliation Act of
1989, (relating to payment on a reasonable cost, pass-through basis)
for certified registered nurse anesthetist services furnished by a
certified registered nurse anesthetist in a hospital described in such
section 9320(k).
``(2) No payment shall be made under any other provision of this
title for physicians' services for which payment 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 added and amended, except that--
``(A) any reference in such section to a `certified
registered nurse anesthetist' or an `anesthetist' is deemed a
reference to a `physician who is an anesthesiologist' or an
`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.
SEC. 21. TEMPORARY FLOOR ON THE PRACTICE EXPENSE GEOGRAPHIC INDEX FOR
SERVICES FURNISHED IN RURAL AREAS OUTSIDE OF FRONTIER
STATES UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.
Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)) is amended by adding at the end the following new
subparagraph:
``(J) Floor at 1.0 on practice expense geographic
index for services furnished in rural areas outside of
frontier states.--For purposes of payment for services
furnished in a rural area (other than a rural area
located in a State to which subparagraph (I) applies)
on or after April 1, 2014, and before April 1, 2015,
after calculating the practice expense index under
subparagraph (A)(i), the Secretary shall increase any
such index to 1.0 if such index would otherwise be less
than 1.0. The preceding sentence shall not be applied
in a budget neutral manner.''.
SEC. 22. REVISIONS TO STANDARD FOR DESIGNATION OF SOLE COMMUNITY
HOSPITALS.
Section 1886(d)(5)(D)(iv) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(D)(iv)) is amended by adding at the end the following new
sentence: ``Under such standard, the time required for an individual to
travel to the nearest alternative source of care shall be measured over
improved roads maintained by a local, State, or Federal Government
entity for use by the general public which is the most expeditious and
accessible route as designated by law enforcement for emergency vehicle
travel.''.
SEC. 23. MEDICARE TREATMENT OF STANDBY AND ON-CALL TIME FOR CRNA
SERVICES.
(a) In General.--Section 9320(k) of the Omnibus Budget
Reconciliation Act of 1986 (42 U.S.C. 1395k note), as added by section
608(c)(2) of the Family Support Act of 1988 and amended by section 6132
of the Omnibus Budget Reconciliation Act of 1989, is amended by adding
at the end the following:
``(3) In determining the reasonable costs incurred by a
hospital or critical access hospital for the services of a
certified registered nurse anesthetist under this subsection,
the Secretary shall include standby costs and on-call costs
incurred by the hospital or critical access hospital,
respectively, with respect to such nurse anesthetist.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to costs incurred in cost reporting periods beginning in fiscal
years after fiscal year 2005 and before fiscal year 2015.
SEC. 24. STATE OFFICES OF RURAL HEALTH.
Section 338J(j)(1) of the Public Health Service Act (42 U.S.C.
254r(j)(1)) is amended by inserting ``and 2015 through 2016'' before
the period.
SEC. 25. REMOVING MEDICARE 96-HOUR PHYSICIAN CERTIFICATION REQUIREMENT
FOR INPATIENT CRITICAL ACCESS HOSPITAL SERVICES.
(a) In General.--Section 1814(a) of the Social Security Act (42
U.S.C. 1395f(a)), as amended by sections 12 and 13, is further
amended--
(1) in paragraph (6), by adding ``and'' at the end;
(2) in paragraph (7), at the end of subparagraph (D)(ii),
by striking ``; and'' and inserting a period; and
(3) by striking paragraph (8).
(b) Application.--The amendments made by subsection (a) shall apply
with respect to items and services furnished on or after January 1,
2014.
SEC. 26. EXTENSION OF ENFORCEMENT INSTRUCTION ON SUPERVISION
REQUIREMENTS FOR OUTPATIENT THERAPEUTIC SERVICES IN
CRITICAL ACCESS AND SMALL RURAL HOSPITALS THROUGH 2014.
The Secretary of Health and Human Services shall continue to apply
through calendar year 2014 the enforcement instruction described in the
notice of the Centers for Medicare & Medicaid Services entitled
``Enforcement Instruction on Supervision Requirements for Outpatient
Therapeutic Services in Critical Access and Small Rural Hospitals for
CY 2013'', dated November 1, 2012 (providing for an exception to the
restatement and clarification under the final rulemaking changes to the
Medicare hospital outpatient prospective payment system and calendar
year 2009 payment rates (published in the Federal Register on November
18, 2008, 73 Fed. Reg. 68702 through 68704) with respect to
requirements for direct supervision by physicians for therapeutic
hospital outpatient services).
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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