S. 933Senate109th Congress (2005-2007)In Committee

Rural Community Hospital Assistance Act of 2005

Introduced April 28, 2005

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SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance.

April 28, 2005

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SenateIntro Referral

Introduced in Senate

April 28, 2005

SenateIntro Referral

Sponsor introductory remarks on measure. (CR S4549)

April 28, 2005

SenateIntro Referral

Read twice and referred to the Committee on Finance.

April 28, 2005

Floor Debate

23 members

What members said about S. 933 on the floor

7 Republicans16 Democrats
Joseph I. Lieberman
Sen. Joseph I. LiebermanD-CT · Apr 28, 2005

Mr. President, Senator Hatch, Senator Brownback and I are pleased to introduce today the Project BioShield II Act of 2005. This is the fourth bill I have introduced on this subject, and the third…

Russell D. Feingold
Sen. Russell D. FeingoldD-WI · Apr 28, 2005

Mr. President, today I am pleased to be joined by the Senator from South Carolina, Mr. Graham, in introducing legislation that requires Congress to act on what may be the most pressing domestic…

Michael B. Enzi
Sen. Michael B. EnziR-WY · Apr 28, 2005

Mr. President, whenever there is a crisis the media has always served to focus the nation's attention on the problem and who has been affected by it. Then it has been up to us, in the Congress, to…

Orrin G. Hatch
Sen. Orrin G. HatchR-UT · Apr 28, 2005

Mr. President, I rise today to introduce the CLEAR ACT, the Clean Efficient Automobiles Resulting from Advanced Car Technologies Act of 2005. This bill passed the Senate as part of the omnibus energy…

Chuck Grassley
Sen. Chuck GrassleyR-IA · Apr 28, 2005

Mr. President, I rise today to introduce ``The Jetseta Gage Prevention and Deterrence of Crimes Against Children Act of 2005''. This is a very important bill that will protect our children from the…

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Dianne Feinstein
Sen. Dianne FeinsteinD-CA · Apr 28, 2005

Mr. President, I rise to introduce the Fifty Caliber Sniper Weapons Regulation Act of 2005. I am joined by Senators Corzine and Durbin. This bill would add the .50-caliber sniper rifle to the list of…

Patrick J. Leahy
Sen. Patrick J. LeahyD-VT · Apr 28, 2005

Mr. President, I introduce today the Leahy-Sununu E-mail Privacy Act to ensure that last year's decision by the First Circuit Court of Appeals in a case called United States v. Councilman does not…

Jon S. Corzine
Sen. Jon S. CorzineD-NJ · Apr 28, 2005

Mr. President, I rise today on Workers Memorial Day to reintroduce the ``Workplace Wrongful Death Accountability Act,'' legislation that would, among other things, increase the maximum criminal…

John D. Rockefeller IV
Sen. John D. Rockefeller IVD-WV · Apr 28, 2005

Mr. President, I am proud today with Senator Biden and several of our colleagues to introduce a bill to reauthorize the Community Oriented Police Services (COPS) program, which has been so vitally…

Joseph R. Biden Jr.
Sen. Joseph R. Biden Jr.D-DE · Apr 28, 2005

Mr. President, today, I rise to introduce legislation to reauthorize the Department of Justice's Office of Community Oriented Policing Services (COPS). This program has achieved what my colleagues…

Susan M. Collins
Sen. Susan M. CollinsR-ME · Apr 28, 2005

Mr. President, the people of Maine have always been faithful stewards of the forest because we understand its tremendous value to our economy and to our way of life. From the vast tracts of…

Jeff Bingaman
Sen. Jeff BingamanD-NM · Apr 28, 2005

Mr. President. I am introducing important legislation to address a crisis in the delivery of health care at the Albuquerque Indian Health Center, or AIHC, which provides critical primary, urgent, and…

Barack Obama
Sen. Barack ObamaD-IL · Apr 28, 2005

Mr. President, today I am introducing the Attacking Viral Influenza Across Nations Act of 2005, or the AVIAN Act. The Nation is becoming increasingly aware of the very serious threat we face from…

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John Cornyn
Sen. John CornynR-TX · Apr 28, 2005

Mr. President, I rise to introduce legislation to combat the scourge of sex trafficking within our borders, by targeting and reducing demand. The bill is entitled the End Demand for Sex Trafficking…

Ron Wyden
Sen. Ron WydenD-OR · Apr 28, 2005

Mr. President, I strongly believe that parents in our country should have more wholesome entertainment choices for their children. To make that possible, I am today introducing legislation to require…

Edward M. Kennedy
Sen. Edward M. KennedyD-MA · Apr 28, 2005

Mr. President, today, on Workers' Memorial Day, we remember and honor the working men and women here at home who have died or been injured on the job in the past year. We also think of their families…

Mary L. Landrieu
Sen. Mary L. LandrieuD-LA · Apr 28, 2005

Mr. President, today I rise with the Senator from Tennessee, Mr. Alexander, my colleague from Louisiana, Mr. Vitter, and the senior Senator from South Dakota, Mr. Johnson, to introduce legislation…

Paul S. Sarbanes
Sen. Paul S. SarbanesD-MD · Apr 28, 2005

Mr. President, today I am introducing two measures to commemorate America's second war of independence--the War of 1812--and aid in the efforts to preserve sites related to this important period in…

John Warner
Sen. John WarnerR-VA · Apr 28, 2005

Mr. President, I rise today to introduce an important piece of legislation for my State, the Virginia Ridge and Valley Act of 2005. This bill will add seven new wilderness areas, six additions to…

Barbara Boxer
Sen. Barbara BoxerD-CA · Apr 28, 2005

Mr. President, I am pleased to introduce legislation to name the Federal courthouse building now being completed at Tulare and ``O'' Streets in downtown Fresno, CA the ``Robert E. Coyle United States…

Ben Nelson
Sen. Ben NelsonD-NE · Apr 28, 2005

Mr. President, today I join Senator Brownback in introducing The Rural Community Hospital Assistance Act. This legislation is intended to ensure the future of small rural hospitals by restructuring…

Ben Nelson
Sen. Ben NelsonD-NE · Apr 28, 2005

Mr. President, today I join Senator Brownback in introducing The Rural Community Hospital Assistance Act. This legislation is intended to ensure the future of small rural hospitals by restructuring…

Richard J. Durbin
Sen. Richard J. DurbinD-IL · Apr 28, 2005

Mr. President, I rise today to submit legislation along with my colleague, Senator Barack Obama, to establish the Abraham Lincoln National Heritage Area in Illinois. Illinois has long been known as…

Gordon H. Smith
Sen. Gordon H. SmithR-OR · Apr 28, 2005

Mr. President, I am pleased today to introduce the Small Business Growth and Opportunity Act of 2004 along with my Finance Committee colleague, Senator Blanche Lincoln. This legislation will allow S…

Bill Text

Latest available legislative text

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Latest
Introduced in SenateIssued April 28, 2005
        [Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 933 Introduced in Senate (IS)]

109th CONGRESS
1st Session
S. 933

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 SENATE OF THE UNITED STATES

April 28, 2005

Mr. Brownback (for himself and Mr. Nelson of Nebraska) 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 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.
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