[Congressional Record Volume 151, Number 54 (Thursday, April 28, 2005)]
[Senate]
[Page S4549]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BROWNBACK (for himself and Mr. Nelson of Nebraska):
  S. 933. A bill to amend title XVIII of the Social Security Act to 
provide for improvements in access to services in rural hospitals and 
critical access hospitals; to the Committee on Finance.
  Mr. NELSON of Nebraska. Mr. President, today I join Senator Brownback 
in introducing The Rural Community Hospital Assistance Act. This 
legislation is intended to ensure the future of small rural hospitals 
by restructuring the way they are reimbursed for Medicare services by 
basing the reimbursements on actual costs instead of the current pre-
set cost structure.
  Current law allows for very small hospitals--designated Critical 
Access Hospitals (CAH) to receive cost-based Medicare reimbursements. 
To qualify as a CAH the facility must have no more than 25 acute care 
beds.
  In rural communities, hospital facilities that are slightly larger 
than the 25 bed limit share with Critical Access Hospitals the same 
economic conditions, the same treatment challenges, the same disparity 
in coverage area but do not share the same reimbursement arrangement. 
These rural hospitals have to compete with larger urban-based hospitals 
that can perform the same services at drastically reduced costs. They 
are also discouraged from investing in technology and other methods to 
improve the quality of care in their communities because those 
investments are not supported by Medicare reimbursement procedures.
  The legislation would provide enhanced cost-based Medicare 
reimbursement by creating a new ``rural'' designation under the 
Medicare reimbursement system. This new designation would benefit five 
Nebraska hospitals. Hospitals in McCook, Beatrice, Columbus, Holdrege 
and Lexington would fall under this new designation, and would have 
similar benefits provided to nearly sixty other Nebraska hospitals 
classified under the CAH system.
  The legislation would also improve the hospitals with critical access 
status. Sixty CAH facilities in Nebraska already receive enhanced cost-
based reimbursements for inpatient and outpatient services. The 
legislation would further assist these existing CAH facilities by 
extending the enhanced cost-based reimbursement to certain post-acute 
and ambulance services and eliminating the current 35-mile test.
  Rural hospitals cannot continue to provide these services without 
having Medicare cover the costs. If something is not done, the larger 
hospitals may be forced to cut back on the number of beds they keep--
and the number of people they care for, and others may be forced to 
close their doors. These hospitals provide jobs, good wages, health 
care and economic development opportunity for these communities. 
Without access to these hospitals, these communities would not survive. 
The Rural Community Hospital Assistance Act will ensure that the 
community has access to high quality health care that is affordable to 
the patient and the provider.
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