[Congressional Record Volume 148, Number 42 (Tuesday, April 16, 2002)]
[Senate]
[Pages S2727-S2728]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BAUCUS (for himself, Mr. Grassley, Mr. Daschle, Mr. 
        Conrad, Mr. Thomas, Mr. Jeffords, Mr. Rockefeller, Mr. 
        Bingaman, Mr. Harkin, Mr. Johnson, and Mr. Roberts):
  S. 2135. A bill to amend title X of the Social Security Act to 
provide for a 5-year extension of the authorization for appropriations 
for certain Medicare rural grants; to the Committee on Finance.
 Mr. BAUCUS. Mr. President, I rise today to introduce the Rural 
Hospital Access and Improvement Act of 2002. I am pleased to be joined 
by Senators Grassley, Daschle, Thomas, Conrad, Jeffords, Rockefeller, 
Bingaman, Harkin, Johnson, and Roberts in sponsoring this important 
legislation.
  Simply put, this bill is about keeping small hospitals open in rural 
areas. It's about preserving access to quality health care for farmers 
and ranchers and their families. It's about protecting the health of 
folks who live in small towns and hamlets across our Nation.
  I think these are goals that every one of us can agree on.
  But the fight to preserve access to health care in rural America has 
never been an easy one. Hospitals in rural areas constantly struggle 
with the difficulties of operating in a low-volume environment. Their 
emergency rooms might see two or three patients a day. Or some days, 
none at all. They lack the economies of scale that urban and suburban 
facilities enjoy. They have a hard time hiring health professionals. 
And with every passing year, they face a growing regulatory burden that 
takes time and energy away from patients.
  In the face of all these obstacles, many small, rural communities 
have confronted the unthinkable: losing their hospital altogether. I 
have no doubt that I speak for the vast majority of Senators when I say 
we should never let this happen. We should never allow a community to 
go without the health care services it needs to stay healthy. To borrow 
from the flight director of Apollo 13, I suggest that failure is not an 
option.
  This was the message that Congress sent fives years ago, when it took 
two giant strides towards helping rural communities keep their 
hospitals. First, it passed legislation allowing small hospitals in 
rural and frontier areas to become Critical Access Hospitals, or CAHs. 
CAHs are reimbursed by Medicare based on their actual costs, not fixed 
or limited payments. They can organize their staff and facilities based 
on their patients' needs, not on rules made for large, urban 
facilities. In short, they are given flexibility to adapt to the unique 
challenges of providing health care in rural areas.
  This concept was a perfect fit for rural America. In the past five 
years, over 500 facilities have converted to CAH status. By taking 
advantage of the CAH option, these hospitals have remained open and 
continue to serve patients. This success is not surprising. After all, 
the Critical Access Hospital concept was modeled on a demonstration 
project that had already been working for years in hospitals across 
Montana.
  The second step Congress took in 1997 was to authorize $25 million a 
year for the Rural Hospital Flexibility Grant Program, or, as I like to 
call it, the Flex grant. This program awards grants to States to help 
hospitals convert to CAH status. Already, over 1,000 health care 
facilities have been assisted by these funds. In my State nearly half 
of our hospitals, about two dozen facilities, have converted to CAH 
status. About a dozen more are on the way.

  Now the Senate has an opportunity to renew its commitment to rural 
health care. The legislation I have introduced today would reauthorize 
the Flex grant at a level of $40 million a year. This would continue 
the work that we have already begun, by helping hundreds more rural 
hospitals covert to CAH status.
  In the latest count, nearly 600 hospitals across the Nation were 
eligible to become CAHs, but have not yet converted. By increasing the 
size of the Flex grant program, Congress can reach out to these 
facilities. At the same time, Congress will continue its support for 
existing CAHs by providing technical assistance and helping them access 
capital for their physical plants. These funds will also advance the 
important process of coordinating between emergency medical services 
providers and other health care providers in rural areas. In the wake 
of September 11 and the bioterrorist attacks of last fall, this work 
must move forward without delay.
  I want to thank my colleagues for their support of the Critical 
Access Hospital program and the Flex grant over the past five years. 
Through their efforts, over 500 rural communities have kept their 
hospitals up and running. Now, I hope they will continue this work by 
supporting the Rural Hospital Access and Improvement Act of 2002 an 
reauthorizing the Flex grant at a level of $40 million a year.
 Mr. THOMAS. Mr. President, I am pleased to rise today to 
introduce the Rural Hospital Access and Improvement Act of 2002, along 
with Finance Committee Chairman Baucus and Ranking Member Grassley, in 
addition to other distinguished colleagues with an interest in rural 
health care. This legislation reauthorizes the Medicare Rural Hospital 
Flexibility program, known as the ``flex'' program, which has become a 
key component in stabilizing rural health care delivery networks.
  The ``flex'' program was created in the Balanced Budget Act of 1997 
to improve access to essential health care services through the 
establishment of Critical Access Hospitals, (CAHs), rural health 
networks and rural emergency medical services. To date, flex grants 
have provided assistance to 1,170 rural hospitals for technical 
assistance and education, 881 rural emergency medical services projects 
and 557 communities for needs assessment and community development 
activities. As a result, almost 600 hospitals that were on the verge of 
closing have been certified as Critical Access Hospitals. Over half of 
CAHs serve counties that are designated as a Health Professional 
Shortage Area. It is quite obvious that this innovative program works 
and merits continued congressional support.

[[Page S2728]]

  In my State of Wyoming, the South Big Horn County Hospital District 
has been certified as a Critical Access Hospital and several more are 
interested in converting to CAH status. Additionally, my State has used 
flex grant dollars to shore up rural emergency medical services in many 
of our frontier communities.
  The bill I am introducing today with several of my colleagues will 
continue to build upon the early success of this program by increasing 
the annual funding authorization from $25 million to $40 million. 
Additional funding is necessary to expand quality improvement 
initiatives within network development plans, enhance the development 
of rural emergency medical services and continue technical support to 
Critical Access Hospitals. I strongly urge all my colleagues to 
cosponsor this important rural health care legislation.
                                 ______