[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9642 Introduced in House (IH)]
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119th CONGRESS
2d Session
H. R. 9642
To amend title XVIII of the Social Security Act to provide payment
under part A of the Medicare program on a reasonable cost basis for
anesthesia services furnished by an anesthesiologist in certain rural
hospitals and critical access hospitals.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 13, 2026
Mr. Moolenaar introduced the following bill; which was referred to the
Committee on Ways and Means
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A BILL
To amend title XVIII of the Social Security Act to provide payment
under part A of the Medicare program on a reasonable cost basis for
anesthesia services furnished by an anesthesiologist in certain 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.
This Act may be cited as the ``Medicare Access to Rural
Anesthesiology Act''.
SEC. 2. MEDICARE PART A PAYMENT FOR ANESTHESIOLOGIST SERVICES IN
CERTAIN RURAL HOSPITALS AND CRITICAL ACCESS HOSPITALS.
(a) Subsection (d) Hospitals.--
(1) In general.--Section 1886(d)(5) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)) is amended by adding at the end
the following new subparagraph:
``(N)(i) For cost reporting periods beginning on or after the date
that is 1 year after the date of the enactment of the Medicare Access
to Rural Anesthesiology Act, in the case of a subsection (d) hospital
described in clause (ii), payment to such hospital for physicians'
services that are anesthesia services furnished by a physician who is
an anesthesiologist in such hospital shall be made on a reasonable cost
basis.
``(ii)(I) Subject to subclause (II), for purposes of clause (i), a
subsection (d) hospital described in this clause is, with respect to a
year (beginning with 2026), a subsection (d) hospital that is located
in a rural area (as defined in paragraph (2)(D)) (but not including any
hospital that is treated as being located in such an area pursuant to
paragraph (8)(E)) that establishes, at any time before the year, to the
satisfaction of the Secretary, that--
``(aa) as of the date of the enactment of the Medicare
Access to Rural Anesthesiology Act, the hospital employed or
contracted with a physician who is an anesthesiologist (but not
more than one full-time equivalent physician);
``(bb) in 2026, the hospital had a volume of surgical
procedures (including inpatient and outpatient procedures)
requiring anesthesia services that did not exceed 800 (or such
higher number as the Secretary determines to be appropriate);
and
``(cc) each physician who is an anesthesiologist employed
by, or under contract with, the hospital has agreed not to bill
under part B for professional services furnished by the
anesthesiologist at the hospital.
``(II) With respect to a year (after 2027), a hospital is not a
subsection (d) hospital described in this clause unless the hospital
establishes, before the beginning of the year, that the hospital has
had a volume of surgical procedures (including inpatient and outpatient
procedures) requiring anesthesia services in the previous year that did
not exceed 800 (or such higher number as the Secretary determines to be
appropriate).''.
(2) Treated as part of inpatient hospital services.--
Section 1861(b) of the Social Security Act (42 U.S.C. 1395x(b))
is amended--
(A) in paragraph (6), by striking ``or'' at the
end;
(B) in paragraph (7), by striking the period at the
end and inserting ``; or''; and
(C) by adding at the end the following new
paragraph:
``(8) a physician who is an anesthesiologist where the
hospital is a subsection (d) hospital described in section
1886(d)(5)(N)(ii).''.
(3) Excluded from operating costs of inpatient hospital
services.--Section 1886(a)(4) of the Social Security Act (42
U.S.C. 1395ww(a)(4)) is amended in the second sentence by
inserting ``for cost reporting periods beginning on or after
the date that is 1 year after the date of the enactment of the
Medicare Access to Rural Anesthesiology Act, costs of
physicians' services that are anesthesia services furnished by
a physician who is an anesthesiologist in a subsection (d)
hospital described in subsection (d)(5)(N)(ii),'' before ``or
costs with respect to administering blood clotting factors''.
(b) Critical Access Hospitals.--Section 1861(mm) of the Social
Security Act (42 U.S.C. 1395x(mm)) is amended--
(1) in paragraph (2), by adding at the end the following
new sentence: ``For cost reporting periods beginning on or
after the date that is 1 year after the date of the enactment
of the Medicare Access to Rural Anesthesiology Act, such term
includes physicians' services that are anesthesia services
furnished by a physician who is an anesthesiologist in a
critical access hospital described in paragraph (4).''; and
(2) by adding at the end the following new paragraph:
``(4)(A) Subject to subparagraph (B), for purposes of paragraph
(2), a critical access hospital described in this paragraph is, with
respect to a year (beginning with 2027), a critical access hospital
that establishes, at any time before the year, to the satisfaction of
the Secretary, that--
``(i) as of the date of the enactment of the Medicare
Access to Rural Anesthesiology Act, the critical access
hospital employed or contracted with a physician who is an
anesthesiologist (but not more than one full-time equivalent
physician);
``(ii) in 2026, the critical access hospital had a volume
of surgical procedures (including inpatient and outpatient
procedures) requiring anesthesia services that did not exceed
800 (or such higher number as the Secretary determines to be
appropriate); and
``(iii) each physician who is an anesthesiologist employed
by, or under contract with, the critical access hospital has
agreed not to bill under part B for professional services
furnished by the anesthesiologist at the critical access
hospital.
``(B) With respect to a year (after 2027), a critical access
hospital is not a critical access hospital described in this paragraph
unless the critical access hospital establishes, before the beginning
of the year, that the critical access hospital has had a volume of
surgical procedures (including inpatient and outpatient procedures)
requiring anesthesia services in the previous year that did not exceed
800 (or such higher number as the Secretary determines to be
appropriate).''.
(c) Excluded From Medical and Other Health Services.--Section
1861(s)(1) of the Social Security Act (42 U.S.C. 1395x(s)(1)) is
amended by inserting ``(other than physicians' services that are
anesthesia services furnished during a cost reporting period beginning
on or after the date that is 1 year after the date of the enactment of
the Medicare Access to Rural Anesthesiology Act by a physician who is
an anesthesiologist in a subsection (d) hospital described in section
1886(d)(5)(N)(ii) or a critical access hospital described in section
1861(mm)(4))'' before the semicolon.
(d) Regulations.--The Secretary of Health and Human Services shall
revise the regulations promulgated for purposes of section 1862(a)(14)
of the Social Security Act (42 U.S.C. 1395y(a)(14)) such that, for cost
reporting periods beginning on or after the date that is 1 year after
the date of the enactment of this section, such regulations define the
term ``physicians' services'' to exclude physicians' services that are
anesthesia services furnished by a physician who is an anesthesiologist
in--
(1) a subsection (d) hospital described in subparagraph
(N)(ii) of section 1886(d)(5) of such Act (42 U.S.C.
1395ww(d)(5)), as added by subsection (a); or
(2) a critical access hospital described in paragraph (4)
of section 1861(mm) of such Act (42 U.S.C. 1395x(mm)), as added
by subsection (b).
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