[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2600 Introduced in Senate (IS)]
106th CONGRESS
2d Session
S. 2600
To amend title XVIII of the Social Security Act to make enhancements to
the critical access hospital program under the medicare program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 22, 2000
Ms. Snowe 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 make enhancements to
the critical access hospital program under the medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Critical Access Hospital Enhancement
Act of 2000''.
SEC. 2. ENHANCEMENTS TO CRITICAL ACCESS HOSPITAL (CAH) PROGRAM.
(a) Exemption From Bad Debt Reductions.--Section 1861(v)(1)(T) of
the Social Security Act (42 U.S.C. 1395x(v)(1)(T)) is amended--
(1) by redesignating clauses (i), (ii), and (iii) as
subclauses (I), (II), and (III), respectively;
(2) by inserting ``(i)'' after ``(T)''; and
(3) by adding at the end the following new clause:
``(ii) The reductions required by clause (i) shall not apply to
critical access hospitals for cost reporting periods beginning on or
after October 1, 1998.''.
(b) Exemption From Payment Reductions and Fee Schedule for
Ambulance Services.--
(1) Exemption from fee schedule.--
(A) In general.--Section 1834(l) of the Social
Security Act (42 U.S.C. 1395m(l)) is amended by adding
at the end the following new paragraph:
``(8) Inapplicability of fee schedule to certain
services.--In the case of ambulance services (described in
section 1861(s)(7)) that are provided in a locality by a
critical access hospital that is the only provider of ambulance
services in the locality, or by an entity that is owned and
operated by such a critical access hospital--
``(A) the fee schedule established under this
subsection shall not apply; and
``(B) payment under this part shall be paid on the
basis of the reasonable costs incurred in providing
such services.''.
(B) Conforming amendment.--Section 1833(a)(1)(R) of
the Social Security Act (42 U.S.C. 1395l(a)(1)(R)) is
amended by inserting ``(other than the ambulance
services described in section 1834(l)(8))'' after
``ambulance service''.
(C) Effective date.--The amendments made by this
paragraph shall take effect as if included in the
enactment of the Balanced Budget Act of 1997 (Public
Law 105-33; 111 Stat. 251).
(2) Exemption from reasonable cost reductions.--Section
1861(v)(1)(U) of the Social Security Act (42 U.S.C.
1395x(v)(1)(U)) is amended by inserting after the first
sentence the following new sentence: ``The reductions required
by the preceding sentence shall not apply in the case of
ambulance services that are provided in a locality on or after
October 1, 1998, by a critical access hospital that is the only
provider of ambulance services in the locality, or by an entity
that is owned and operated by such a critical access
hospital.''.
(c) Exemption From Home Health Payment Limits and PPS.--
(1) Exemption from cost limits.--Section 1861(v)(1)(L) of
the Social Security Act (42 U.S.C. 1395x(v)(1)(L)) (as amended
by section 303 of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999 (113 Stat. 1501A-360), as enacted
into law by section 1000(a)(6) of Public Law 106-113) is
amended by adding at the end the following new clause:
``(xi) The preceding provisions of this subparagraph shall not
apply to home health services that are furnished on or after October 1,
1998, by a home health agency that is--
``(I) the only home health agency serving a locality; and
``(II) owned and operated by a critical access hospital.''.
(2) Exemption from pps.--
(A) In general.--Section 1895 of the Social
Security Act (42 U.S.C. 1395fff) is amended by adding
at the end the following new subsection:
``(e) Exception.--The prospective payment system established under
this section shall not apply in determining payments for home health
services furnished by a home health agency that is--
``(1) the only home health agency serving a locality; and
``(2) owned and operated by a critical access hospital.''.
(B) Conforming amendment.--Section 1833(a)(2)(A) of
the Social Security Act (42 U.S.C. 1395l(a)(2)(A)) is
amended by inserting ``home health services described
in section 1895(e) and'' after ``other than''.
(C) Effective date.--The amendments made by this
paragraph shall take effect as if included in the
enactment of the Balanced Budget Act of 1997 (Public
Law 105-33; 111 Stat. 251).
(d) Payment for Swing Bed Services.--
(1) Exemption from pps for skilled nursing facility
services.--Section 1888(e)(7) of the Social Security Act (42
U.S.C. 1395yy(e)(7)) is amended--
(A) in the heading, by striking ``Transition for''
and inserting ``Treatment of'';
(B) in subparagraph (A), by striking ``In
general.--The'' and inserting ``Transition.--Except as
provided in subparagraph (C), the'';
(C) in subparagraph (B), by striking ``1883'' and
all that follows through ``date)'' and inserting ``1883
(other than critical access hospitals)''; and
(D) by adding at the end the following:
``(C) Treatment of swing-bed services furnished by
critical access hospitals.--The prospective payment
system established under this subsection shall not
apply to services furnished by a critical access
hospital pursuant to an agreement described in section
1883.''.
(2) Payment basis for swing bed services furnished by
critical access hospitals.--Section 1883(a) of the Social
Security Act (42 U.S.C 1395tt(a)) is amended--
(A) in paragraph (2)(A), by inserting ``(other than
a critical access hospital)'' after ``any hospital'';
and
(B) by adding at the end the following new
paragraph:
``(3) Notwithstanding any other provision of this title, a
critical access hospital shall be paid for services furnished
under an agreement entered into under this section on the basis
of the reasonable costs of such services (as determined under
section 1861(v)).''.
(3) Effective dates.--
(A) The amendments made by paragraph (1) shall take
effect as if included in the enactment of the Balanced
Budget Act of 1997 (Public Law 105-33; 111 Stat. 251).
(B) The amendments made by paragraph (2) shall
apply to cost reporting periods beginning on or after
October 1, 1998.
(e) Payment Basis for Outpatient Laboratory Tests.--
(1) Payment on cost basis without beneficiary cost-
sharing.--
(A) In general.--Section 1833(a)(6) of the Social
Security Act (42 U.S.C. 1395l(a)(6)) is amended by
inserting ``(including clinical diagnostic laboratory
services furnished by a critical access hospital)''
after ``outpatient critical access hospital services''.
(B) No beneficiary cost-sharing.--
(i) In general.--Section 1834(g) of the
Social Security Act (42 U.S.C. 1395m(g)) is
amended by inserting ``(except that in the case
of clinical diagnostic laboratory services
furnished by a critical access hospital the
amount of payment shall be equal to 100 percent
of the reasonable costs of the critical access
hospital in providing such services)'' before
the period at the end.
(ii) BBRA amendment.--Section 1834(g) of
the Social Security Act (42 U.S.C. 1395m(g))
(as amended by section 403(d) of the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement
Act of 1999 (113 Stat. 1501A-371), as enacted
into law by section 1000(a)(6) of Public Law
106-113) is amended--
(I) in paragraph (1), by inserting
``(except that in the case of clinical
diagnostic laboratory services
furnished by a critical access hospital
the amount of payment shall be equal to
100 percent of the reasonable costs of
the critical access hospital in
providing such services)'' after ``such
services,''; and
(II) in paragraph (2)(A), by
inserting ``(except that in the case of
clinical diagnostic laboratory services
furnished by a critical access hospital
the amount of payment shall be equal to
100 percent of the reasonable costs of
the critical access hospital in
providing such services)'' before the
period at the end.
(2) Conforming amendments.--Paragraphs (1)(D)(i) and
(2)(D)(i) of section 1833(a) of the Social Security Act (42
U.S.C. 1395l(a)(1)(D)(i); 1395l(a)(2)(D)(i)) (as amended by
section 403(e) of the Medicare, Medicaid, and SCHIP Balanced
Budget Refinement Act of 1999 (113 Stat. 1501A-371), as enacted
into law by section 1000(a)(6) of Public Law 106-113) are
amended by striking ``or which are furnished on an outpatient
basis by a critical access hospital'' each place it appears.
(3) Effective dates.--
(A) In general.--Except as provided in subparagraph
(B), the amendments made by this subsection shall apply
to services furnished on or after November 29, 1999.
(B) BBRA amendment.--The amendment made by
paragraph (1)(B)(ii) shall take effect as if included
in the enactment of section 403(d) of the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of
1999 (113 Stat. 1501A-371), as enacted into law by
section 1000(a)(6) of Public Law 106-113.
(f) Alternative to 15-Bed Limit.--Section 1820 of the Social
Security Act (42 U.S.C. 1395i-4) is amended--
(1) in subsection (c)--
(A) in paragraph (2)(B)(iii), by striking
``provides'' and inserting ``subject to paragraph (3),
provides''; and
(B) by adding at the end the following new
paragraph:
``(3) Flexibility on bed limits for certain facilities.--
Notwithstanding clause (iii) and subsection (f), a State may
designate (and the Secretary may certify) a facility with more
than 15 (or in the case of a facility under an agreement
described in subsection (f), 25) acute care inpatient beds as a
critical access hospital if--
``(A) the service area of the facility experiences
substantial seasonal fluctuations in population;
``(B) the number of beds used by the facility for
acute care inpatient services, determined on an average
annual basis, does not exceed 15; and
``(C) in the case of a facility under an agreement
described in subsection (f), the total number of beds
used by the facility for either acute care or extended
care services, determined on an average annual basis,
does not exceed 25.''; and
(2) in subsection (f), by inserting ``(or, in the case of a
facility with a service area that experiences substantial
seasonal fluctuations in population, so long as the facility
meets the requirements of subparagraphs (B) and (C) of
subsection (c)(3)'' after ``15 beds''.
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