[Congressional Record Volume 148, Number 68 (Thursday, May 23, 2002)]
[Senate]
[Pages S4843-S4844]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BAUCUS:
  S. 2555. A bill to amend title XVIII of the Social Security Act to 
enhance beneficiary access to quality health care services under the 
Medicare Program; to the Committee on Finance.
  Mr. BAUCUS. Mr. President, Congress has its hands full with health 
policy issues this year, ranging from health insurance for workers 
displaced by trade policies, to the Patients' Bill of Rights, to 
Medicare prescription drugs. All of these issues are pressing. But 
Congress must not lose sight of another pressing issue in health 
policy: supporting patients in rural America and the health care 
providers who care for them.
  Under current law, rural areas are confronted with a series of 
inequities in Medicare payment policy. Few of these inequities have any 
basis in sound policy; and all of them take away precious resources 
from rural communities.
  Today, I am introducing legislation to level the rural playing field. 
The Revitalizing Underserved Rural Areas and Localities Act, the RURAL 
Act, would fix many of the inequities that exist under the current 
system and offer extra help to certain providers who struggle to 
operate in a rural, low-volume environment.
  Many of these changes would impact Medicare payments to hospitals. 
First, the bill provides a full inflation update for small urban and 
rural hospitals. Under current law, hospitals are scheduled to receive 
a payment increase that is 0.55 percent less than the rate of inflation 
next year. The RURAL Act would erase that reduction in Fiscal Year 
2003. My bill would also equalize the base payment amount for hospital 
inpatient services. Under current law, the base payment amount, also 
known as the ``standardized amount,'' is lower for rural and small 
urban hospitals than for urban providers. This system unfairly 
penalizes smaller facilities, and I want to change to a single, equal 
rate.
  The RURAL Act would also make gradual changes to the hospital wage 
index, so that the true cost of providing care in rural areas can be 
more accurately measured. And the bill recognizes the special needs of 
providers with low patient volumes, by giving them incremental payment 
increases based on their patient volume.
  My bill also addresses several ambulance issues that I've heard a lot 
about from the rural health care community. It makes clear that when 
providers have a reasonable medical basis for using an air ambulance, 
they should receive proper payment for that service. And it would allow 
hospitals with 25 beds or less to be reimbursed on a cost basis for 
ambulance services.
  The bill contains special provisions for the roughly 600 critical 
access hospitals, or CAHs, nationwide. First, it says that when a 
patient is referred to a CAH for lab services, the hospital is 
reimbursed on a cost basis. It would also modify the emergency room on-
call rules to allow reimbursements to physician assistants, nurse 
practitioners, and clinical nurse specialists. And it would remove 
CAHs' 35-mile requirement for cost-based ambulance reimbursement.
  I also recognize the enormous challenges of delivering home health 
services in rural and frontier areas, where distance and volume 
constantly work against the provider. That's why my

[[Page S4844]]

bill would extend the 10 percent add-on for home health services 
delivered in rural areas for another three years. And for agencies in 
so-called ``frontier'' areas, there would be a 20 percent add-on.
  Finally, my bill includes provisions aimed at helping physicians who 
practice in rural areas. Under the existing system, payments under the 
physician fee schedule are reduced for rural doctors, often 
substantially, by a factor known as the Geographic Practice Cost Index, 
or GPCI. My bill would put a floor on this factor, increasing payments 
to rural physicians. The bill would also improve the Medicare Incentive 
Payment Program, MIPP, an important initiative intended to facilitate 
recruitment and retention of physicians in rural areas. Finally, while 
the sustainable growth rate payment formula is not addressed in this 
legislation, I believe it is critical that Congress act this year to 
mitigate the drastic cuts in payments under the Medicare physician fee 
schedule.
  This bill represents a starting point, a first step towards 
correcting flawed policies that punish rural areas. As the Finance 
Committee considers Medicare legislation in the coming months, I urge 
my colleagues to support these important rural provisions.
                                 ______