[Congressional Record Volume 143, Number 148 (Wednesday, October 29, 1997)]
[Senate]
[Page S11358]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. MURKOWSKI (for himself and Mr. Thomas):
  S. 1342. A bill to amend title XVIII of the Social Security Act to 
increase access to quality health care in frontier communities by 
allowing health clinics and health centers greater Medicare flexibility 
and reimbursement; to the Committee on Finance.


       THE MEDICARE FRONTIER HEALTH CLINIC AND CENTER ACT OF 1997

  Mr. MURKOWSKI. Mr. President, I rise today to introduce the Medicare 
Frontier Health Clinic and Center Act of 1997. I am pleased that the 
junior Senator from Wyoming, Senator Thomas is cosponsoring this bill.
  Our bill clarifies the intent of Congress to allow health clinics to 
participate in the new Medicare Rural Hospital Flexibility Program.
  Mr. President, great advances in health care have occurred during the 
past decades, however, some communities in remote areas continue to 
struggle to provide primary care services. These communities face 
unparalleled geographic, climatic and economic barriers to quality 
health care. They simply do not have the resources, surface 
transportation nor the demand to provide full service inpatient and 
outpatient care--yet the community might be located hours from an acute 
care hospital in an urban center.
  The Medicare Rural Hospital Flexibility Program in the Balanced 
Budget Act of 1997 addresses part of this dilemma. It exempts many 
rural hospitals from burdensome Medicare regulations designed for large 
urban hospitals and does not straight jacket them under the prospective 
payment system. This limited-service model has already helped to reduce 
unnecessary overhead and prevent cost shifting in eight States.
  The Medicare Rural Hospital Flexibility Act means that extremely 
rural communities will finally be able to provide more complete health 
care to the elderly. However, Mr. President, this important Medicare 
provision needs legislative clarification. The Medicare Rural Hospital 
Flexibility Program addresses part of the dilemma faced by communities 
located in remote areas, but misses a piece of the health care puzzle 
for our frontier communities--health clinics.
  Frontier communities face conditions even more extreme than rural 
communities. For example, the communities on the Fox Islands in Alaska 
are 400 miles from the nearest limited-service hospital and 650 miles 
from the nearest major, acute care hospital. There are no hospitals or 
even limited-service hospitals on the Fox Islands--just health clinics.
  This legislation will enable clinics in frontier communities such as 
the Fox Islands to participate in the program. A frontier area is 
defined in the bill as borough with six or fewer people per square 
mile. Additionally, to ensure this extension goes to frontier 
communities who are truly in need, participating clinics must be 
located in health professional shortage areas, and be more than a 50-
mile drive from another facility.
  Mr. President, the Medicare Frontier Health Clinic and Center Act of 
1997 is the answer for ensuring health care for our elderly who live in 
extremely rural and frontier areas. Demonstrations conducted by the 
Health Care Financing Administration have already proven the cost 
effectiveness of limited-service facilities.
  I would also point out that yesterday, the National Rural Health 
Association [NRHA], in a letter to Nancy-Ann Min DeParle, the nominee 
to be Administrator of the Health Care Financing Administration, 
endorsed the concept of allowing rural clinics to participate in this 
program.
  I urge my colleagues to consider the health care needs of frontier 
communities and adopt this bill.
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