1.Short title; table of
contents
(a)This Act may be cited as the Rural Hospital and Provider Equity Act of
2012
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Sense of the Congress.
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. Extension of Medicare incentive payment program for
physician scarcity areas.
Sec. 10. Extension of floor on Medicare work geographic
adjustment.
Sec. 11. Improving care planning for Medicare home health
services.
Sec. 12. Rural health clinic improvements.
Sec. 13. Temporary Medicare payment increase for home health
services furnished in a rural area.
Sec. 14. Extension of increased Medicare payments for rural
ground ambulance services.
Sec. 15. Extension of payment for technical component of
certain physician pathology services.
Sec. 16. Facilitating the provision of telehealth services
across State lines.
Sec. 17. Medicare Part A payment for anesthesiologist services
in certain rural hospitals based on CRNA pass-through rules.
Sec. 18. 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. 19. Revisions to standard for designation of sole
community hospitals.
Sec. 20. State offices of rural health.
Sec. 21. Ensuring proportional representation of interests of
rural areas on MEDPAC.
2.It is the sense of
the Congress 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.
3.Fairness in the
Medicare disproportionate share hospital (DSH) adjustment for rural
hospitalsSection
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,
2011, and before October 1, 2012.
.
4.Extension and
expansion of the Medicare hold harmless provision under the prospective payment
system for hospital outpatient department (HOPD) services for certain
hospitalsSection
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 striking
March 1, 2012
and inserting 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 in the last 10 months of 2012
; and
(2)in subclause
(III)—
(A)in the first
sentence—
(i)by striking
2009, and before March 1, 2012, for which
and inserting
2009, and before January 1, 2013, for which
; 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 striking 2010, and before March 1, 2012, the
preceding
and inserting 2010, and before January 1, 2013, the
preceding
.
5.Temporary
improvements to the Medicare inpatient hospital payment adjustment for
low-volume hospitalsSection
1886(d)(12) of the Social Security Act (42 U.S.C. 1395ww(d)(12)) is
amended—
(1)in subparagraph (C)(i), by inserting
and 2,000 discharges, respectively,
after 1,600
discharges
; 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 year 2011 and 2,000 discharges
with respect to discharges occurring in fiscal year 2012
.
6.Extension of
Medicare wage index reclassifications for certain hospitals
(a)Extension of
correction of mid-Year reclassification expiration for certain
hospitals
(1)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 September 30,
2012
for November 30, 2011
.
(2)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)The provisions of this section shall not be effected in a
budget-neutral manner.
7.Extension of Medicare reasonable costs
payments for certain clinical diagnostic laboratory tests furnished to hospital
patients in certain rural areasSection 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
striking the 2-year period beginning on July 1, 2010
and
inserting the 30-month period beginning on July 1, 2010
.
8.Elimination of
isolation test for cost-based ambulance reimbursement for critical access
hospitals
(a)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)The amendments made by this section shall apply to services
furnished on or after January 1, 2012.
9.Extension of Medicare
incentive payment program for physician scarcity areasSection 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 January 1, 2012, and before January 1, 2013
after
2008
.
10.Extension of
floor on Medicare work geographic adjustmentSection 1848(e)(1)(E) of the Social Security
Act (42 U.S.C. 1395w–4(e)(1)(E)) is amended by striking before March 1,
2012
and inserting before January 1, 2013
.
11.Improving care planning for Medicare home
health services
(a)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, 2012, 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 second sentence, by inserting
certified nurse-midwife,
after clinical nurse
specialist,
;
(3)in the third sentence—
(A)by striking physician
certification
and inserting certification
;
(B)by inserting (or on January 1, 2012,
in the case of regulations to implement the amendments made by section 11 of
the Rural Hospital and Provider Equity Act of
2012)
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 fourth sentence, by inserting
, nurse practitioner, clinical nurse specialist, certified
nurse-midwife, or physician assistant
after
physician
.
(b)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, 2012, 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, 2012,
in the case of regulations to implement the amendments made by section 11 of
the Rural Hospital and Provider Equity Act of
2012)
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)
(1)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)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 provisionsSection 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)The amendments made by
this section shall apply to items and services furnished on or after January 1,
2012.
12.Rural health
clinic improvementsSection
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 2012)
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 2012, at $101
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.
.
13.Temporary Medicare
payment increase for home health services furnished in a rural
areaSection 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 2016, 3 percent
and inserting
2011, and episodes and visits ending on or after January 1, 2013, and
before January 1, 2016, 3 percent
.
14.Extension of
increased Medicare payments for rural ground ambulance services
(a)Section
1834(l)(13)(A) of the Social Security Act (42 U.S.C. 1395m(l)(13)(A)) is
amended—
(1)in the matter
preceding clause (i)—
(A)by striking
2007, and for
and inserting 2007, for
; and
(B)by inserting
, and for such services described in clause (i) furnished on or after
March 1, 2012, and before January 1, 2013
after 2012
;
and
(2)in clause (i), by
inserting , or 5 percent if such service is furnished on or after March
1, 2012, and before January 1, 2013
after 2012
.
(b)Section 1834(l)(12)(A) of the Social Security Act (42
U.S.C. 1395m(l)(12)(A)) is amended by striking March 1, 2012
and
inserting January 1, 2013
.
15.Extension of
payment for technical component of certain physician pathology
servicesSection 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), section 105 of the Medicare and Medicaid
Extenders Act of 2010 (Public Law 111–309), and section 305 of the Temporary
Payroll Tax Cut Continuation Act of 2011 (Public Law 112–78) is amended by
striking the first two months of
.
16.Facilitating the
provision of telehealth services across State lines
(a)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)In
subsection (a):
(1)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)The terms physician and
practitioner have the meaning given those terms in subparagraphs
(D) and (E), respectively, of such section.
(3)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.).
17.Medicare Part A
payment for anesthesiologist services in certain rural hospitals based on CRNA
pass-through rules
(a)Section 1814 of the Social Security Act (42 U.S.C. 1395f)
is amended by adding at the end the following new subsection:
(m)Anesthesiologist services provided in certain rural
hospitals(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)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.
18.Temporary floor
on the practice expense geographic index for services furnished in rural areas
outside of frontier States under the Medicare physician fee
scheduleSection 1848(e)(1) of
the Social Security Act (42 U.S.C. 1395w–4(e)(1)) is amended—
(1)in subparagraph
(A), by striking and (I)
and inserting (I), and
(J)
; and
(2)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 StatesFor 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 January 1, 2012, and before January 1,
2013, 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.
.
19.Revisions to
standard for designation of sole community hospitalsSection 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.
.
20.State offices of
rural healthSection
338J(j)(1) of the Public Health Service Act (42 U.S.C. 254r(j)(1)) is amended
by inserting and 2012 through 2013
before the period.
21.Ensuring
proportional representation of interests of rural areas on MEDPAC
(a)Section 1805(c)(2) of the Social Security Act (42 U.S.C.
1395b–6(c)(2)) is amended—
(1)in subparagraph
(A), by inserting (consistent with the requirements of subparagraph
(E))
after rural representatives
; and
(2)by adding at the
end the following new subparagraph:
(E)Proportional
representation of interests of rural areasIn order to provide a
balance between urban and rural representatives under subparagraph (A), the
proportion of members who represent the interests of health care providers and
Medicare beneficiaries located in rural areas shall be no less than the
proportion of the total number of Medicare beneficiaries who reside in rural
areas.
.
(b)The amendments made by subsection (a) shall apply to
appointments made to the Medicare Payment Advisory Commission after the date of
the enactment of this Act.