[Congressional Record Volume 147, Number 17 (Wednesday, February 7, 2001)]
[Senate]
[Pages S1125-S1126]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Jeffords, Mr. Levin, Mr. 
        Brownback, and Mr. Helms):
  S. 270. A bill to amend title XVIII of the Social Security Act to 
provide a transitional adjustment for certain sole community hospitals 
in order to limit any decline in payment under the prospective payment 
system for hospital outpatient department services; to the Committee on 
Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce, along with my 
colleagues Senators Jeffords, Levin, Brownback, and Helms the ``Rural 
Hospital and Health Network Preservation Act of 2001.''
  As you are aware, rural health care providers have operating margins 
that are often much lower and more dependent upon Medicare and Medicaid 
reimbursement then suburban or urban providers. The Balanced Budget 
Refinement Act of 1999 (BBRA 99) allowed rural hospitals of less than 
100 beds to be held harmless in the conversion to the new outpatient 
Prospective Payment System by allowing them to choose to stay 
essentially under the old fee-for-service program which provided them 
with increased revenue. However, that 100-bed limit seems arbitrary and 
will actually result in many slightly larger rural hospitals, that have 
even higher per patient costs and lower per patient margins, being 
squeezed even harder under BBA 97 rules.
  With passage of the Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000, several additional fixes were 
put in place for rural providers. While these were steps in the right 
direction, rural hospitals with between 100 and 400 beds are still not 
being held harmless in the conversion to the new outpatient Prospective 
Payment System. This group of hospitals is still suffering under 
provisions of the BBA of 1997.
  Rural hospitals, and all hospitals for that matter, operate on very 
slim margins yet manage to bring cutting-edge medical care to the 
communities they serve. But changes in Medicare payments to hospitals 
have put many institutions in a bind.
  The bill I am introducing today will extend the BBRA of 99 hold-
harmless provisions to rural hospitals of up to 400 beds that are both 
Rural Referral Centers and Sole Community Hospitals. This will bring 
outpatient reimbursement rates for these critical health care providers 
closer in line to the actual health care costs incurred in rural 
America by these valued providers.
  Rural communities across New Mexico have felt the negative impact of 
the BBA of 97. The Carlsbad Regional Medical Center, Eastern New Mexico 
Medical Center, San Juan Regional Medical Center, and Lea Regional 
Hospital have

[[Page S1126]]

all been suffering because of the BBA of 97. They tell me that they are 
bearing substantially higher expenses per patient due to diseconomies 
of scale for the technically intensive speciality care that is required 
at these types of facilities. In addition, they face difficulties in 
recruiting qualified health professionals, as well as qualified coders 
and compliance experts that are required under the new outpatient 
Prospective Payment System given Medicare's complexity. This is not a 
New Mexico only problem. There are at least sixty-one other rural 
hospitals that fall in this same category across the United States that 
are also suffering.
  While the positive restorative effects of BBRA of 99 and the recently 
enacted ``Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act of 2000'' were very helpful, they are not enough to 
protect rural providers. We must prevent rural hospitals from reducing 
services or closing completely. When a rural hospital reduces services, 
or worse yet closes, local residents lose access to preventive, 
routine, and even emergency services. Doctors and other highly trained 
professionals move away. Then people must drive a hundred miles or more 
in some cases to get the care city dwellers take for granted. Local 
economies suffer when jobs are lost. Existing businesses may have to 
move, and new businesses won't locate in places where health care is 
unavailable. Hospital closure can be a death-knell for struggling 
towns. We must move forward to preserve and strengthen the ability of 
our Nation's rural hospitals and other Medicare providers to provide 
adequate health care to their patients.
  I urge my colleagues to support and pass the Rural Hospital and 
Health Network Preservation Act of 2001.
  I ask consent that the text of the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 270

       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 ``Rural Hospital and Health 
     Network Preservation Act of 2001''.

     SEC. 2. TEMPORARY TREATMENT OF CERTAIN SOLE COMMUNITY 
                   HOSPITALS TO LIMIT DECLINE IN PAYMENT UNDER THE 
                   OPD PPS.

       (a) Hold Harmless Provision.--Section 1833(t)(7)(D)(i) of 
     the Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)) is 
     amended by inserting ``(or not more than 400 beds if such 
     hospital is a sole community hospital (as defined in section 
     1886(d)(5)(D)(iii)) and is classified as a rural referral 
     center under section 1886(d)(5)(C))'' after ``100 beds''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect as if included in the amendments made by 
     section 202(a) of the Medicare, Medicaid, and SCHIP Balanced 
     Budget Refinement Act of 1999 (113 Stat. 1501A-342), as 
     enacted into law by section 1000(a)(6) of Public Law 106-113.
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