[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[S. 1030 Introduced in Senate (IS)]
107th CONGRESS
1st Session
S. 1030
To improve health care in rural areas by amending title XVIII of the
Social Security Act and the Public Health Service Act, and for other
purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 13, 2001
Mr. Conrad (for himself, Mr. Thomas, Mr. Daschle, Mr. Roberts, Mr.
Johnson, Mr. Jeffords, Mr. Crapo, Mr. Rockefeller, Mr. Harkin, Mr.
Dorgan, Mr. Wellstone, Mr. Bond, Mr. Helms, Mr. Cochran, Mr. Edwards,
Mr. Hutchinson, Mr. Domenici, Mr. Burns, Mr. Bingaman, and Mrs.
Lincoln) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To improve health care in rural areas by amending title XVIII of the
Social Security Act and the Public Health Service Act, 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 ``Rural Health Care
Improvement Act of 2001''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--RURAL MEDICARE REFORMS
Sec. 101. Medicare inpatient payment adjustment for low-volume
hospitals.
Sec. 102. Fairness in the medicare disproportionate share hospital
(DSH) adjustment for rural hospitals.
Sec. 103. Establishing a single standardized amount under the medicare
inpatient hospital PPS.
Sec. 104. Hospital geographic reclassification for labor costs for all
items and services reimbursed under
medicare prospective payment systems.
Sec. 105. Treatment of certain physician pathology services under
medicare.
Sec. 106. One-time opportunity of critical access hospitals to return
to the medicare inpatient hospital PPS.
TITLE II--RURAL GRANT AND LOAN PROGRAMS FOR INFRASTRUCTURE, TECHNOLOGY,
AND TELEHEALTH
Sec. 201. Capital infrastructure revolving loan program.
Sec. 202. High technology acquisition grant and loan program.
Sec. 203. Establishment of telehealth resource centers.
TITLE III--RURAL HEALTH CLINIC IMPROVEMENTS
Sec. 301. Improvement in rural health clinic reimbursement under
medicare.
Sec. 302. Exclusion of certain rural health clinic and Federally
qualified health center services from the
medicare PPS for skilled nursing
facilities.
TITLE I--RURAL MEDICARE REFORMS
SEC. 101. MEDICARE INPATIENT PAYMENT ADJUSTMENT FOR LOW-VOLUME
HOSPITALS.
Section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) is
amended by adding at the end the following new paragraph:
``(12) Payment adjustment for low-volume hospitals.--
``(A) Payment adjustment.--
``(i) In general.--Notwithstanding any other
provision of this section, for each cost reporting
period (beginning with the cost reporting period that
begins in fiscal year 2002), the Secretary shall
provide for an additional payment amount to each low-
volume hospital (as defined in clause (iii)) for
discharges occurring during that cost reporting period
to increase the amount paid to such hospital under this
section for such discharges by the applicable
percentage increase determined under clause (ii).
``(ii) Applicable percentage increase.--The
Secretary shall determine a percentage increase
applicable under this paragraph that ensures that--
``(I) no percentage increase in payments
under this paragraph exceeds 25 percent of the
amount of payment that would otherwise be made
to a low-volume hospital under this section for
each discharge (but for this paragraph);
``(II) low-volume hospitals that have the
lowest number of discharges during a cost
reporting period receive the highest percentage
increase in payments due to the application of
this paragraph; and
``(III) the percentage increase in payments
due to the application of this paragraph is
reduced as the number of discharges per cost
reporting period increases.
``(iii) Low-volume hospital defined.--For purposes
of this paragraph, the term `low-volume hospital'
means, for a cost reporting period, a subsection (d)
hospital (as defined in paragraph (1)(B)) other than a
critical access hospital (as defined in section
1861(mm)(1)) that--
``(I) the Secretary determines--
``(aa) had an average of less than
800 discharges during the 3 most recent
cost reporting periods for which data
are available that precede the cost
reporting period to which this
paragraph applies; and
``(bb) is located at least 15 miles
from a similar hospital; or
``(II) the Secretary deems meets the
requirements of subclause (I) by reason of such
factors as the Secretary determines
appropriate, including the time required for an
individual to travel to the nearest alternative
source of appropriate inpatient care (taking
into account the location of such alternative
source of inpatient care and any weather or
travel conditions that may affect such travel
time).
``(B) Prohibiting certain reductions.--Notwithstanding
subsection (e), the Secretary shall not reduce the payment
amounts under this section to offset the increase in payments
resulting from the application of subparagraph (A).''.
SEC. 102. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE HOSPITAL
(DSH) ADJUSTMENT FOR RURAL HOSPITALS.
(a) Equalizing DSH Payment Amounts.--
(1) In general.--Section 1886(d)(5)(F)(vii) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)(F)(vii)) is amended by
inserting ``, and, after October 1, 2001, for any other
hospital described in clause (iv),'' after ``clause (iv)(I)''.
(2) Conforming amendments.--Section 1886(d)(5)(F) of such
Act (42 U.S.C. 1395ww(d)(5)(F)), as amended by section 211 of
the Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000 (114 Stat. 2763A-483), as enacted into
law by section 1(a)(6) of Public Law 106-554, is amended--
(A) in clause (iv)--
(i) in subclause (II), by inserting ``or,
for discharges occurring on or after October 1,
2001, is equal to the percent determined in
accordance with the applicable formula
described in clause (vii)'' after ``clause
(xiii)'';
(ii) in subclause (III), by inserting ``or,
for discharges occurring on or after October 1,
2001, is equal to the percent determined in
accordance with the applicable formula
described in clause (vii)'' after ``clause
(xii)'';
(iii) in subclause (IV), by inserting ``or,
for discharges occurring on or after October 1,
2001, is equal to the percent determined in
accordance with the applicable formula
described in clause (vii)'' after ``clause (x)
or (xi)'';
(iv) in subclause (V), by inserting ``or,
for discharges occurring on or after October 1,
2001, is equal to the percent determined in
accordance with the applicable formula
described in clause (vii)'' after ``clause
(xi)''; and
(v) in subclause (VI), by inserting ``or,
for discharges occurring on or after October 1,
2001, is equal to the percent determined in
accordance with the applicable formula
described in clause (vii)'' after ``clause
(x)'';
(B) in clause (viii), by striking ``The formula''
and inserting ``For discharges occurring before October
1, 2001, the formula''; and
(C) in each of clauses (x), (xi), (xii), and
(xiii), by striking ``For purposes'' and inserting
``With respect to discharges occurring before October
1, 2001, for purposes''.
(b) Effective Date.--The amendments made by this section shall
apply with respect to discharges occurring on or after October 1, 2001.
SEC. 103. ESTABLISHING A SINGLE STANDARDIZED AMOUNT UNDER THE MEDICARE
INPATIENT HOSPITAL PPS.
(a) In General.--Section 1886(d)(3)(A) of the Social Security Act
(42 U.S.C. 1395ww(d)(3)(A)) is amended--
(1) in clause (iv), by inserting ``and ending on or before
September 30, 2001,'' after ``October 1, 1995,''; and
(2) by redesignating clauses (v) and (vi) as clauses (vii)
and (viii), respectively, and inserting after clause (iv) the
following new clauses:
``(v) For discharges occurring in the fiscal year beginning
on October 1, 2001, the average standardized amount for
hospitals located in areas other than a large urban area shall
be equal to the average standardized amount for hospitals
located in a large urban area.
``(vi) For discharges occurring in a fiscal year beginning
on or after October 1, 2002, the Secretary shall compute an
average standardized amount for hospitals located in all areas
within the United States equal to the average standardized
amount computed under clause (v) or this clause for the
previous fiscal year increased by the applicable percentage
increase under subsection (b)(3)(B)(i) for the fiscal year
involved.''.
(b) Conforming Amendments.--
(1) Update factor.--Section 1886(b)(3)(B)(i)(XVII) of the
Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(i)(XVII)) is
amended by striking ``for hospitals in all areas,'' and
inserting ``for hospitals located in a large urban area,''.
(2) Computing drg-specific rates.--
(A) In general.--Section 1886(d)(3)(D) of such Act
(42 U.S.C. 1395ww(d)(3)(D)) is amended--
(i) in the heading, by striking ``in
different areas'';
(ii) in the matter preceding clause (i)--
(I) by inserting ``, for fiscal
years before fiscal year 1997,'' before
``a regional DRG prospective payment
rate for each region,''; and
(II) by striking ``each of which
is'';
(iii) in clause (i)--
(I) in the matter preceding
subclause (I), by inserting ``for
fiscal years before fiscal year 2002,''
before ``for hospitals''; and
(II) in subclause (II), by striking
``and'' after the semicolon at the end;
(iv) in clause (ii)--
(I) in the matter preceding
subclause (I), by inserting ``for
fiscal years before fiscal year 2002,''
before ``for hospitals''; and
(II) in subclause (II), by striking
the period at the end and inserting ``;
and''; and
(v) by adding at the end the following new
clause:
``(iii) for a fiscal year beginning after fiscal
year 2001, for hospitals located in all areas, to the
product of--
``(I) the applicable average standardized
amount (computed under subparagraph (A)),
reduced under subparagraph (B), and adjusted or
reduced under subparagraph (C) for the fiscal
year; and
``(II) the weighting factor (determined
under paragraph (4)(B)) for that diagnosis-
related group.''.
(B) Technical conforming sunset.--Section
1886(d)(3) of such Act (42 U.S.C. 1395ww(d)(3)) is
amended in the matter preceding subparagraph (A), by
inserting ``, for fiscal years before fiscal year
1997,'' before ``a regional adjusted DRG prospective
payment rate''.
SEC. 104. HOSPITAL GEOGRAPHIC RECLASSIFICATION FOR LABOR COSTS FOR ALL
ITEMS AND SERVICES REIMBURSED UNDER MEDICARE PROSPECTIVE
PAYMENT SYSTEMS.
Section 1886(d)(10)(D) of the Social Security Act (42 U.S.C.
1395ww(d)(10)(D)), as amended by section 304(a) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
(114 Stat. 2763A-494), as enacted into law by section 1(a)(6) of Public
Law 106-554, is amended by adding at the end the following new clause:
``(vii)(I) Any decision of the Board to reclassify a subsection (d)
hospital for purposes of the adjustment factor described in
subparagraph (C)(i)(II) for fiscal year 2001 or any fiscal year
thereafter shall apply for purposes of adjusting payments for
variations in costs that are attributable to wages and wage-related
costs for PPS-reimbursed items and services.
``(II) For purposes of subclause (I), the term `PPS-reimbursed
items and services' means, for the fiscal year for which the Board has
made a decision described in such subclause, each item and service for
which payment is made under this title on a prospective basis and
adjusted for variations in costs that are attributable to wages or
wage-related costs that is furnished by the hospital to which such
decision applies, or by a provider-based entity or department of that
hospital (as determined by the Secretary).''.
SEC. 105. TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES UNDER
MEDICARE.
(a) In General.--Section 1848(i) of the Social Security Act (42
U.S.C. 1395w-4(i)) is amended by adding at the end the following new
paragraph:
``(4) Treatment of certain physician pathology services.--
``(A) In general.--With respect to services
furnished on or after January 1, 2001, if an
independent laboratory furnishes the technical
component of a physician pathology service to a fee-
for-service medicare beneficiary who is an inpatient or
outpatient of a covered hospital, the Secretary shall
treat such component as a service for which payment
shall be made to the laboratory under this section and
not as an inpatient hospital service for which payment
is made to the hospital under section 1886(d) or as a
hospital outpatient service for which payment is made
to the hospital under section 1834(t).
``(B) Definitions.--In this paragraph:
``(i) Covered hospital.--
``(I) In general.--The term
`covered hospital' means, with respect
to an inpatient or outpatient, a
hospital that had an arrangement with
an independent laboratory that was in
effect as of July 22, 1999, under which
a laboratory furnished the technical
component of physician pathology
services to fee-for-service medicare
beneficiaries who were hospital
inpatients or outpatients,
respectively, and submitted claims for
payment for such component to a carrier
with a contract under section 1842 and
not to the hospital.
``(II) Change in ownership does not
affect determination.--A change in
ownership with respect to a hospital on
or after the date referred to in
subclause (I) shall not affect the
determination of whether such hospital
is a covered hospital for purposes of
such subclause.
``(ii) Fee-for-service medicare
beneficiary.--The term `fee-for-service
medicare beneficiary' means an individual who
is entitled to benefits under part A, or
enrolled under this part, or both, but who is
not enrolled in any of the following:
``(I) A Medicare+Choice plan under
part C.
``(II) A plan offered by an
eligible organization under section
1876.
``(III) A program of all-inclusive
care for the elderly (PACE) under
section 1894.
``(IV) A social health maintenance
organization (SHMO) demonstration
project established under section
4018(b) of the Omnibus Budget
Reconciliation Act of 1987 (Public Law
100-203).''.
(b) Conforming Amendment.--Section 542 of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000 (114 Stat.
2763A-550), as enacted into law by section 1(a)(6) of Public Law 106-
554, is repealed.
(c) Effective Dates.--The amendments made by this section shall
take effect as if included in the enactment of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000 (114 Stat.
2763A-463 et seq.), as enacted into law by section 1(a)(6) of Public
Law 106-554.
SEC. 106. ONE-TIME OPPORTUNITY OF CRITICAL ACCESS HOSPITALS TO RETURN
TO THE MEDICARE INPATIENT HOSPITAL PPS.
(a) In General.--Notwithstanding section 1814(l) of the Social
Security Act (42 U.S.C. 1395f(l)), the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'') shall pay
each critical access hospital having an application approved under
subsection (b)(2) under the prospective payment system for inpatient
hospital services under section 1886(d) of such Act (42 U.S.C.
1395ww(d)) rather than under such section 1814(l).
(b) One-Time Application and Approval.--
(1) Application.--Not later than the date that is 6 months
after the date of enactment of this Act, each eligible critical
access hospital (as defined in subsection (c)) that desires to
receive payment under the prospective payment system for
inpatient hospital services under section 1886(d) of the Social
Security Act (42 U.S.C. 1395ww(d)) instead of receiving payment
of the reasonable costs for such services under section 1814(l)
of such Act (42 U.S.C. 1395f(l)) shall submit an application to
the Secretary in such manner and containing such information as
the Secretary may require.
(2) Approval.--Not later than the date that is 3 months
after the date on which the Secretary receives the application
submitted under paragraph (1), the Secretary shall approve or
deny the application.
(c) Eligible Critical Access Hospital Defined.--In this section,
the term ``eligible critical access hospital'' means a critical access
hospital (as defined in section 1861(mm)(1) of the Social Security Act
(42 U.S.C. 1395x(mm)(1))) that received payments under the prospective
payment system for inpatient hospital services under section 1886(d) of
such Act (42 U.S.C. 1395ww(d)) prior to its designation as a critical
access hospital under section 1820(c)(2) of such Act (42 U.S.C. 1395i-
4(c)(2)).
TITLE II--RURAL GRANT AND LOAN PROGRAMS FOR INFRASTRUCTURE, TECHNOLOGY,
AND TELEHEALTH
SEC. 201. CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM.
(a) In General.--Part A of title XVI of the Public Health Service
Act (42 U.S.C. 300q et seq.) is amended by adding at the end the
following new section:
``capital infrastructure revolving loan program
``Sec. 1603. (a) Authority To Make and Guarantee Loans.--
``(1) Authority to make loans.--The Secretary may make
loans from the fund established under section 1602(d) to any
rural entity for projects for capital improvements, including--
``(A) the acquisition of land necessary for the
capital improvements;
``(B) the renovation or modernization of any
building;
``(C) the acquisition or repair of fixed or major
movable equipment; and
``(D) such other project expenses as the Secretary
determines appropriate.
``(2) Authority to guarantee loans.--
``(A) In general.--The Secretary may guarantee the
payment of principal and interest for loans made to
rural entities for projects for any capital improvement
described in paragraph (1) to any non-Federal lender.
``(B) Interest subsidies.--In the case of a
guarantee of any loan made to a rural entity under
subparagraph (A), the Secretary may pay to the holder
of such loan and for and on behalf of the project for
which the loan was made, amounts sufficient to reduce
by not more than 3 percent of the net effective
interest rate otherwise payable on such loan.
``(b) Amount of Loan.--The principal amount of a loan directly made
or guaranteed under subsection (a) for a project for capital
improvement may not exceed $5,000,000.
``(c) Funding Limitations.--
``(1) Government credit subsidy exposure.--The total of the
Government credit subsidy exposure under the Credit Reform Act
of 1990 scoring protocol with respect to the loans outstanding
at any time with respect to which guarantees have been issued,
or which have been directly made, under subsection (a) may not
exceed $50,000,000 per year.
``(2) Total amounts.--Subject to paragraph (1), the total
of the principal amount of all loans directly made or
guaranteed under subsection (a) may not exceed $250,000,000 per
year.
``(d) Capital Assessment and Planning Grants.--
``(1) Nonrepayable grants.--Subject to paragraph (2), the
Secretary may make a grant to a rural entity, in an amount not
to exceed $50,000, for purposes of capital assessment and
business planning.
``(2) Limitation.--The cumulative total of grants awarded
under this subsection may not exceed $2,500,000 per year.
``(e) Termination of Authority.--The Secretary may not directly
make or guarantee any loan under subsection (a) or make a grant under
subsection (d) after September 30, 2006.''.
(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, but
less than 50 beds that is located in--
``(I) a county that is not part of a
metropolitan statistical area; or
``(II) a rural census tract of a
metropolitan statistical area (as determined
under the most recent modification of the
Goldsmith Modification, originally published in
the Federal Register on February 27, 1992 (57
Fed. Reg. 6725));
``(iii) a hospital that is classified as a rural,
regional, or national referral center under section
1886(d)(5)(C) of the Social Security Act; and
``(iv) a hospital that is a sole community hospital
(as defined in section 1886(d)(5)(D)(iii) of the Social
Security Act).
``(B) For purposes of subparagraph (A), the fact that a
clinic, facility, or hospital has been geographically
reclassified under the medicare program under title XVIII of
the Social Security Act shall not preclude a hospital from
being considered a rural entity under clause (i) or (ii) of
subparagraph (A).''.
(c) Conforming Amendments.--Section 1602 of the Public Health
Service Act (42 U.S.C. 300q-2) is amended--
(1) in subsection (b)(2)(D), by inserting ``or
1603(a)(2)(B)'' after ``1601(a)(2)(B)''; and
(2) in subsection (d)--
(A) in paragraph (1)(C), by striking ``section
1601(a)(2)(B)'' and inserting ``sections 1601(a)(2)(B)
and 1603(a)(2)(B)''; and
(B) in paragraph (2)(A), by inserting ``or
1603(a)(2)(B)'' after ``1601(a)(2)(B)''.
SEC. 202. HIGH TECHNOLOGY ACQUISITION GRANT AND LOAN PROGRAM.
Subpart I of part D of title III of the Public Health Service Act
(42 U.S.C. 241 et seq.), as amended by section 1501 of the Children's
Health Act of 2000 (Public Law 106-310; 114 Stat. 1146), is amended by
adding at the end the following section:
``SEC. 330I. HIGH TECHNOLOGY ACQUISITION GRANT AND LOAN PROGRAM.
``(a) Establishment of Program.--The Secretary, acting through the
Director of the Office of Rural Health Policy of the Health Resources
and Services Administration, shall establish a high technology
acquisition grant and loan program for the purpose of--
``(1) improving the quality of health care in rural areas
through the acquisition of advanced medical technology;
``(2) fostering the development of the networks described
in section 330A;
``(3) promoting resource sharing between urban and rural
facilities; and
``(4) improving patient safety and outcomes through the
acquisition of high technology, including software, information
services, and staff training.
``(b) Grants and Loans.--Under the program established under
subsection (a), the Secretary, acting through the Director of the
Office of Rural Health Policy, may award grants and make loans to any
eligible entity (as defined in subsection (d)(1)) for any costs
incurred by the eligible entity in acquiring eligible equipment and
services (as defined in subsection (d)(2)).
``(c) Limitations.--
``(1) In general.--Subject to paragraph (2), the total
amount of grants and loans made under this section to an
eligible entity may not exceed $100,000.
``(2) Federal sharing.--
``(A) Grants.--The amount of any grant awarded
under this section may not exceed 70 percent of the
costs to the eligible entity in acquiring eligible
equipment and services.
``(B) Loans.--The amount of any loan made under
this section may not exceed 90 percent of the costs to
the eligible entity in acquiring eligible equipment and
services.
``(d) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means a
hospital, health center, or any other entity that the Secretary
determines is appropriate that is located in a rural area or
region.
``(2) Eligible equipment and services.--The term `eligible
equipment and services' includes--
``(A) unit dose distribution systems;
``(B) software, information services, and staff
training;
``(C) wireless devices to transmit medical orders;
``(D) clinical health care informatics systems,
including bar code systems designed to avoid medication
errors and patient tracking systems;
``(E) telemedicine technology; and
``(F) any other technology that improves the
quality of health care provided in rural areas
including systems to improve privacy and address
administrative simplification needs.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 2002 through 2007.''.
SEC. 203. ESTABLISHMENT OF TELEHEALTH RESOURCE CENTERS.
Subpart I of part D of title III of the Public Health Service Act
(42 U.S.C. 254b et seq.), as amended by section 202, is amended by
adding at the end the following:
``SEC. 330J. TELEHEALTH RESOURCE CENTERS.
``(a) Program Authorized.--The Secretary, acting through the
Director of the Office for the Advancement of Telehealth of the Health
Resources and Services Administration, shall award grants to eligible
entities to establish telehealth resource centers in accordance with
this section.
``(b) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means a
public or nonprofit private entity.
``(2) Telehealth.--The term `telehealth' means the use of
electronic information and telecommunications technologies to
support long-distance clinical health care, patient and
professional health-related education, public health, and
health administration.
``(c) Amount.--Each entity that receives a grant under subsection
(a) shall receive an amount not to exceed $1,500,000.
``(d) Equitable Distribution.--In awarding grants under subsection
(a), the Secretary shall ensure, to the greatest extent possible, that
such grants are equitably distributed among the geographical regions of
the United States.
``(e) Preference.--In awarding grants under subsection (a), the
Secretary shall give preference to eligible entities that have a
demonstrated record of providing or supporting the provision of health
care services for populations in rural areas.
``(f) Use of Funds.--An entity that receives a grant under
subsection (a) shall use funds from such grant to establish a
telehealth resource center that shall--
``(1) provide technical assistance, training, and support
to health care providers and a range of health care entities
that provide or will provide telehealth services for a
medically underserved community, including hospitals,
ambulatory care entities, long-term care facilities, public
health clinics, and schools;
``(2) provide for the dissemination of information and
research findings related to the use of telehealth
technologies;
``(3) provide for the dissemination of information
regarding the latest developments in health care;
``(4) conduct evaluations to determine the best application
of telehealth technologies to meet the health care needs of the
medically underserved community;
``(5) promote the integration of clinical information
systems with other telehealth technologies;
``(6) foster the use of telehealth technologies to provide
health care information and education for health care
professionals and consumers in a more effective manner; and
``(7) provide timely and appropriate evaluations to the
Office for the Advancement of Telehealth on lessons learned and
best telehealth practices in any areas served.
``(g) Collaboration.--In providing the services described in
subsection (f)(5), such entity shall collaborate, if feasible, with
private and public organizations and centers or programs that receive
Federal assistance and provide telehealth services.
``(h) Application.--An entity that desires a grant under subsection
(a) shall submit an application to the Secretary at such time, in such
manner, and containing such information as the Secretary may require,
including--
``(1) a description of the manner in which the entity shall
establish and administer a telehealth resource center to meet
the requirements of this subsection; and
``(2) a description of the manner in which the activities
carried out by such center will meet the health care needs of
individuals in rural communities.
``(i) Report.--Not later than 5 years after the date of enactment
of this section, the Secretary shall submit to the appropriate
committees of Congress a report on each activity funded with a grant
under this section.
``(j) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section--
``(1) for fiscal year 2002, $30,000,000; and
``(2) for fiscal years 2003 through 2008, such sums as may
be necessary.''.
TITLE III--RURAL HEALTH CLINIC IMPROVEMENTS
SEC. 301. IMPROVEMENT IN RURAL HEALTH CLINIC REIMBURSEMENT UNDER
MEDICARE.
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 striking ``in a subsequent year'' and
inserting ``in 1989 through 2001''; 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 2002, at $79 per visit; and
``(4) in a subsequent year, 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. 302. EXCLUSION OF CERTAIN RURAL HEALTH CLINIC AND FEDERALLY
QUALIFIED HEALTH CENTER SERVICES FROM THE MEDICARE PPS
FOR SKILLED NURSING FACILITIES.
(a) In General.--Section 1888(e) of the Social Security Act (42
U.S.C. 1395yy(e)) is amended--
(1) in paragraph (2)(A)(i)(II), by striking ``clauses (ii)
and (iii)'' and inserting ``clauses (ii), (iii), and (iv)'';
and
(2) by adding at the end of paragraph (2)(A) the following
new clause:
``(iv) Exclusion of certain rural health
clinic and federally qualified health center
services.--Services described in this clause
are--
``(I) rural health clinic services
(as defined in paragraph (1) of section
1861(aa)); and
``(II) Federally qualified health
center services (as defined in
paragraph (3) of such section);
that would be described in clause (ii) if such
services were not furnished by an individual
affiliated with a rural health clinic or a
Federally qualified health center.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to services furnished on or after January 1, 2002.
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