[Congressional Record Volume 151, Number 8 (Tuesday, February 1, 2005)]
[Senate]
[Pages S744-S745]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. NELSON of Nebraska (for himself, Ms. Collins, Ms. 
        Cantwell, and Mrs. Murray):
  S. 236. A bill to amend title XVIII of the Social Security Act to 
clarify the treatment of payment under the medicare program for 
clinical laboratory tests furnished by critical access hospitals; to 
the Committee on Finance.
  Mr. NELSON of Nebraska. Mr. President. Today, I introduce legislation 
that will overturn a new regulation that is putting critical access 
hospitals (CAH) at risk by arbitrarily lowering the Medicare 
reimbursement for laboratory services. Sixty rural hospitals in 
Nebraska will be negatively impacted unless this regulation is 
reversed.
  This legislation would repeal a Center for Medicare and Medicaid 
Services' (CMS) regulation that would prohibit critical access 
hospitals from being reimbursed at-cost for laboratory services, unless 
patients are ``physically present in a critical access hospital'' when 
laboratory specimens are collected. Many CAHs provide laboratory 
services in rural health clinics (RHCs) and nursing homes in smaller, 
neighboring communities, as well as in home-health settings; however, 
the elimination of cost-based reimbursement may make it prohibitive for 
them to continue offering off-site laboratory testing. In short, under 
the new regulation, lab services would not be reimbursed by CMS unless 
the patient is at the facility where testing will occur.
  This change jeopardizes rural Americans' access to care by imposing 
an additional burden on the frail elderly by requiring them to visit 
the hospital to get simple lab tests done. The additional time and 
expense incurred by the patient is unnecessary if the CAR is willing 
and able to conduct tests at the point of patient care and transport it 
back to the hospital for analysis.
  Congress created the CAR program in 1997 to ensure that those in 
isolated, rural communities have access to health care. To protect the 
viability of these hospitals, often a community's only source of vital 
health care services, Congress established cost-based reimbursement for 
Medicare inpatient and outpatient services--regardless of where the 
services are provided. The new regulation would fundamentally alter 
this well-established practice.
  We have tried to work with CMS to change the rule. In November of 
2003, I was joined by 28 Senators in a bipartisan letter to the 
Administrator of CMS asking for his assistance in constructing a rule 
that does not penalize CAHs for offering off-site laboratory services. 
Unfortunately, CMS responded that the rule would stay intact.
  I am pleased to be joined in this effort by Senator Susan Collins. 
Senator Collins has been a strong advocate for rural health care, and I 
look forward to working together on this legislation.
  The Nebraska critical access hospitals affected by the regulation 
are:
  Harlan County Health System in Alma
  Fillmore County Hospital in Geneva
  Pawnee County Memorial Hospital in Pawnee City
  Niobrara Valley Hospital Corporation in Lynch
  Thayer County Health Services in Hebron
  Kimball County Hospital in Kimball
  Kearney County Health Services/Hospital in Minden
  Saunders County Health Services in Wahoo
  Henderson Health Care Services in Henderson

[[Page S745]]

  Community Memorial Hospital in Syracuse
  Garden County Hospital & Nursing Home in Oshkosh
  Franklin County Memorial Hospital in Franklin
  Genoa Community Hospital in Genoa
  Gothenburg Memorial Hospital in Gothenburg
  Annie Jeffrey Memorial County Health Center in Osceola
  Brodstone Memorial Nuckolls County Hospital in Superior
  Webster County Community Hospital in Red Cloud
  Tilden Community Hospital in Tilden
  Morrill County Community Hospital in Bridgeport
  Jefferson Community Health Center in Fairbury
  Memorial Hospital in Aurora
  Oakland Memorial Hospital in Oakland
  St. Francis Memorial Hospital in West Point
  Alegent Health Memorial Hospital in Schuyler
  Nemaha County Hospital in Auburn
  Brown County Hospital in Ainsworth
  Antelope Memorial Hospital in Neligh
  Cozad Community Hospital in Cozad
  Litzenberg Memorial County Hospital in Central City
  Avera St. Anthony's Hospital in O'Neill
  Warren Memorial Hospital in Friend
  Creighton Area Health Services in Creighton
  Butler County Health Care Center in David City
  Rock County Hospital in Bassett
  Boone County Health Center in Albion
  Callaway District Hospital in Callaway
  York General Hospital in York
  Howard County Community Hospital in St. Paul
  Memorial Hospital CAH in Seward
  Dundy County Hospital in Benkelman
  Chadron Community Hospital Health Services in Chadron
  St. Mary's Hospital in Nebraska City
  West Holt Memorial Hospital in Atkinson
  Cherry County Hospital in Valentine
  Providence Medical Center in Wayne
  Plainview Public Hospital in Plainview
  Osmond General Hospital in Osmond
  Tri Valley Health System in Cambridge
  Pender Community Hospital in Pender
  Johnson County Hospital in Tecumseh
  Chase County Community Hospital in Imperial
  Community Medical Center in Falls City
  Valley County Hospital in Ord
  Crete Area Medical Center in Crete
  Ogallala Community Hospital in Ogallala
  Perkins County Health Services in Grant
  Memorial Health Center in Sidney
  Gordon Memorial Hospital District in Gordon
  Memorial Community Hospital in Blair
  Box Butte General Hospital in Alliance
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