[Congressional Record Volume 146, Number 64 (Monday, May 22, 2000)]
[Senate]
[Pages S4237-S4238]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. SNOWE:
  S. 2600. A bill to amend title XVIII of the Social Security Act to 
make enhancements to the critical access hospital program under the 
Medicare Program; to the Committee on Finance.


                CRITICAL ACCESS HOSPITAL ENHANCEMENT ACT

 Ms. SNOWE. Mr. President, I rise today to introduce the 
Critical Access Hospital Enhancement Act of 2000. This bill provides 
some much-needed program flexibility and refinements to the Medicare 
Critical Access Hospital Program.
  Congress created the Critical Access Hospital Program three years ago 
when we passed the Balanced Budget Act of 1997 (P.L. 105-33). Under 
current law, a Critical Access Hospital must be located at a distance 
of over 35 miles from the nearest hospital; have emergency room and 
inpatient services provided by physicians, physician assistants and 
nurse practitioners; have fifteen or fewer inpatient beds; and 
inpatient stays must be limited to an average of 96 hours (four days).
  The Critical Access Hospital program enables eligible rural hospitals 
to receive higher reimbursement rates for acute medical care. Through 
special allowances for staffing and reimbursements, designation as a 
Critical Access Hospital means that a community may be able to maintain 
local health care access which would otherwise be lost.
  Many rural patients are Medicare and Medicaid participants and 
reduced reimbursements hit hospitals and medical centers hard: for 
example, two-thirds of the patients at Blue Hill Memorial Hospital in 
my home state of Maine are enrolled in Medicare or Medicaid. 
Designation as a Critical Access Hospital is especially important to 
these small, rural hospitals because it provides higher reimbursement 
rates
  To date, there are 165 hospitals across the country that have been 
designated as Critical Access Hospitals, and three in Maine: Blue Hill 
Memorial in Blue Hill, St. Andrews Hospital in Boothbay Harbor, and 
C.A. Dean Memorial Hospital in Greenville. Without the Critical Access 
Hospital program many small, rural hospitals--many of which are often 
the only point of care for miles--will be lost. My bill seeks to 
strengthen this program; it is my hope that with passage of the 
legislation I introduce today, more of our nation's small, rural 
hospitals will be able to participate in this valuable program.
  This bill will bring increased flexibility and programmatic 
refinements to the Critical Access Hospital Program through the 
restoration of bad debt payments, extending cost-based reimbursement to 
ambulance and home health services associated with Critical Access 
Hospitals, and modifying the provisions related to swing bed and 
laboratory services. In addition, I propose including a seasonality 
adjustment for hospitals that are based in communities that experience 
large seasonal population fluctuations.
  Rural residents are often poorer and more likely to lack private 
health insurance when compared with their urban neighbors. As a result, 
rural hospitals disproportionately incur bad debt expenses. The BBA 
reduced bad debt payments for hospitals and the Health Care Financing 
Administration has interpreted this provision to apply to Critical 
Access Hospitals. My bill restores bad debt payments as a way to 
improve participation rates in the Critical Access Hospital program.

  Emergency medical care is a crucial component in the Critical Access 
Hospital health care delivery system. Congress clearly stated that all 
outpatient departmental services furnished by Critical Access Hospitals 
should be reimbursed on the basis of reasonable costs, but HCFA has 
carved out ambulance services. My bill extends cost-based reimbursement 
to ambulance services associated with Critical Access Hospitals as it 
follows Congress's original legislative intent.
  Critical Access Hospitals are often the sole sponsor of home health 
services in remote areas. If a Critical Access Hospital is the only 
home health provider in a rural community, then it would be useful to 
reimburse those services on the basis of reasonable costs. This bill 
will extend cost-based reimbursement to home health services associated 
with Critical Access Hospitals and will help maintain access to post-
acute medical care for Medicare beneficiaries.
  Critical Access Hospitals are currently required to comply with 
extensive minimum data set standards under the skilled nursing facility 
(SNF) prospective payment system (PPS). This bill will provide cost 
based reimbursement to swing bed services furnished by Critical Access 
Hospitals to help alleviate some of the administrative expenses 
associated with SNF PPS.
  Laboratory services furnished by Critical Access Hospitals have 
historically been reimbursed on the basis of reasonable costs. In an 
attempt to clarify the statute and eliminate the collection of 
beneficiary coinsurance, the Balanced Budget Refinement Act (P.L. 106-
113) that we passed last November inadvertently referenced the fee 
schedule. Consequently, HCFA has interpreted the provision to mean 
laboratory services now will be reimbursed at the fee schedule rate. 
Correcting this provision is critical to ensuring that Medicare 
beneficiaries have access to important laboratory tests, and my bill 
does just that.
  Seasonal fluctuations can occur in places likes coastal Maine where 
tourism swells the population in an area or in a small town near a ski 
resort. This seasonal population increase makes many otherwise tiny 
hospitals ineligible for the Critical Access Hospital Program. We must 
ensure that hospitals are available year round for a community's 
permanent population. It seems to me that if a hospital generally 
serves a community with a population of 2,000 but is seasonally faced 
with substantially much larger population, it should not de facto be 
made

[[Page S4238]]

ineligible for the benefits of the Critical Access Hospital Program.
  The final provision in The Critical Access Hospital Enhancement Act 
will allow a state flexibility in designating a hospital with more than 
15 beds as a Critical Access Hospital if those additional beds are used 
only for seasonal fluctuations in admissions, and if the average annual 
occupancy is not more than 15.
  Mr. President, small hospitals across the country are facing an 
increasingly uncertain future, and we must lend additional support to 
our rural health care providers. Refining the Critical Access Hospital 
program will ensure that the Critical Access Hospital designation is 
flexible enough for most rural areas. Expanding the Critical Access 
Hospital Program is critical to these small hospitals and the 
communities they serve.
                                 ______