[Congressional Record Volume 141, Number 103 (Thursday, June 22, 1995)]
[Senate]
[Page S8846]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


                         SMALL RURAL HOSPITALS

  Mr. GRASSLEY. Mr. President, I will join Senator Baucus and Senator 
Rockefeller in introducing the Rural Health Improvement Act of 1995.
  The purpose of this legislation is to establish within Medicare a 
rural hospital flexibility program.
  Such a program is badly needed. Many smaller rural communities, and 
their hospitals, are unable to sustain the full range of hospital 
services necessary to qualify for participation in the Medicare 
Program. There are several reasons for this. Among the most important 
is that the Medicare rules and requirements for full service hospitals 
are burdensome and inflexible. Compliance with them is difficult for 
smaller rural facilities. Furthermore, Medicare reimbursement is 
inadequate. This latter problem is compounded by the fact that these 
hospitals are likely to be dependent on the program--most of their 
patients in any given year are likely to be Medicare beneficiaries. 
Thus, most of their reimbursement comes from the Medicare Program.
  As a consequence, under the current Medicare rules and reimbursement 
levels, many of these small, rural hospitals across the country could 
go out of business. If they do, their communities would lose their 
current access to emergency medical services.
  This legislation could make the difference between survival and 
closure for these hospitals. In Iowa, there are at least 10 hospitals, 
perhaps more, which could qualify for participation in the program this 
legislation would establish.
  This legislation would help those hospitals to continue offering 
essential hospital services in at least four ways: It would provide 
more appropriate and flexible staffing and licensure standards. It 
would reimburse both inpatient and outpatient services on a reasonable 
cost basis. It would promote integration of these hospitals in broader 
networks by requiring participating States to develop at least one 
rural health network in which the rural critical access hospital would 
participate. And it would require the Secretary of Health and Human 
Services to recommend to the Congress an appropriate reimbursement 
methodology under Medicare for telemedicine services.
  Hospitals which participate in this program could thus continue to 
provide an essential point of access to hospital level services in 
their rural communities. Essentially, these hospitals could pare back 
the services they offer to emergency care services and to 24-hour 
nursing services, while continuing to participate in the Medicare 
Program on a reasonable cost basis. In this way, they would continue to 
be the major point of access to emergency medical care in their 
communities.
  Again, I am pleased to join my colleagues, Senator Baucus and Senator 
Rockefeller, and I commend their leadership on this problem.
  Mr. FRIST addressed the Chair.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. FRIST. Mr. President, I ask unanimous consent to speak as if in 
morning business for 6 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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