[Congressional Record Volume 152, Number 87 (Thursday, June 29, 2006)]
[Senate]
[Pages S6791-S6793]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN:
  S. 3606. A bill to amend title XVIII of the Social Security Act to 
provide fair payments for care provided in a hospital emergency 
department; to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce legislation 
entitled the Save Our Safety--SOS--Net Act of 2006. This legislation 
will help repair the fraying safety net that provides critical health 
care to patients throughout the United States. This legislation is 
important to the continued survival of many of our Nation's emergency 
departments and rural hospitals that provide services to millions of 
American's on a daily basis. It is these facilities that are there for 
us in the most remote regions of the country, it is these facilities 
that are there for us at all times of day and night, and it is these 
facilities that will be there for us in time of disaster. We need to 
take the steps to ensure the survival of this safety net.
  This week, The Institute of Medicine's--IOM--Committee on the Future 
of Emergency Care in the United States Health System released a series 
of reports detailing the problems facing emergency care in the U.S. 
These reports make it clear that emergency departments--EDs--struggle 
daily with overcrowding, ambulance diversion, the boarding of admitted 
patients in the ED, limited staffing, and poor reimbursement. They face 
all of these challenges while continuing to provide access to safe, 
high-quality care without regard to ability of the patient to

[[Page S6792]]

pay for their care. Similarly, rural hospitals face shortages of staff 
and specialists, poor reimbursement, and the isolation that sometimes 
complicates medical care. This system is stressed and is poorly 
prepared to accept the additional burdens that could occur in a 
disaster or terrorist attack. These safety net systems and the people 
who work within them deserve our support and yet the trends are not 
promising.
  The demand for emergency departments has been growing fast. In the 
recent study conducted by the Institute of Medicine, emergency 
department visits grew by 26 percent between 1993 and 2003, but due to 
lack of funding 425 emergency departments have closed resulting in 
almost 200,000 less hospital beds in the U.S. In my own State of New 
Mexico, we have seen a decrease from 4.2 to 3.6 beds per 1,000 
population from 1990 to 2002. Ambulances are frequently diverted from 
overcrowded emergency departments an average of once every minute. With 
the growth of the number of elderly patients and the growth of 
uninsured patients seeking care in the ED, these statistics will only 
worsen if nothing is done.
  There are approximately 535 sole community hospitals in 46 States. 
Congress has long recognized the special role of these facilities, 
because they serve as safety net providers offering hospital services 
to isolated communities and regions. These hospitals struggle with poor 
reimbursement and difficulty finding staff. Despite the service they 
provide, these facilities face the possibility of closing on a yearly 
basis.
  To improve the ability of our safety net facilities to function, this 
bill proposes several steps. By improving Medicare payments for 
emergency department services, this bill would provide SOS payments to 
physicians and hospitals for the care that is provided in the emergency 
department. It would improve reimbursement to emergency departments by 
an additional 10 percent for outpatient services delivered to Medicare 
beneficiaries.
  This legislation will also permanently extend outpatient hold 
harmless payment protections to some of the Nation's most vulnerable 
institutions, small rural hospitals and sole community hospitals that 
serve as safety net providers in rural communities.
  Finally, to further strengthen the rural hospital safety net, this 
bill will improve disproportionate share hospital--DSH--payments to 
these facilities. Congress has historically provided additional 
payments to health care providers who treat large numbers of indigent 
patients. Disproportionate share hospital payments are made in addition 
to the base payments hospitals receive from the Medicare and Medicaid 
Programs for inpatient services. This bill will eliminate the cap that 
is present on DSH add-on payments to rural hospitals. This will remove 
some of the inequities between urban and rural hospitals.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 3606

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Save Our 
     Safety Net Act of 2005''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Ensuring adequate physician payment for emergency department 
              visits.
Sec. 3. Ensuring adequate hospital outpatient fee schedule amounts for 
              clinic and emergency department visits.
Sec. 4. Permanent extension of adjustment to limit decline in payments 
              for certain hospitals under hospital outpatient PPS.
Sec. 5. Fairness in the Medicare disproportionate share hospital (DSH) 
              adjustment for rural hospitals.

     SEC. 2. ENSURING ADEQUATE PHYSICIAN PAYMENT FOR EMERGENCY 
                   DEPARTMENT VISITS.

       Section 1833 of the Social Security Act (42 U.S.C. 1395l) 
     is amended by adding at the end the following new subsection:
       ``(v) Save Our Safety Net Payments for Physicians' Services 
     Provided in an Emergency Department.--In the case of 
     physicians' services furnished to an individual covered under 
     the insurance program established by this part in an 
     emergency department on or after January 1, 2006, in addition 
     to the amount of payment that would otherwise be made for 
     such services under this part, there also shall be paid to 
     the physician or other person (or to an employer or entity in 
     the cases described in clause (A) of section 1842(b)(6)) from 
     the Federal Supplementary Insurance Trust Fund an amount 
     equal to 10 percent of the payment amount for the service 
     under this part.''.

     SEC. 3. ENSURING ADEQUATE HOSPITAL OUTPATIENT FEE SCHEDULE 
                   AMOUNTS FOR CLINIC AND EMERGENCY DEPARTMENT 
                   VISITS.

       (a) In General.--Section 1833(t) of the Social Security Act 
     (42 U.S.C. 1395l(t)) is amended--
       (1) in paragraph (3)(C)(ii), by striking ``paragraph 
     (8)(B)'' and inserting ``paragraphs (8)(B), (11)(B), and 
     (13)(A)(i)'';
       (2) in paragraph (3)(C)(iii), by inserting ``(but not the 
     conversion factor computed under paragraph (13)(B))'' after 
     ``this subparagraph'';
       (3) in paragraph (3)(D)--
       (A) in clause (i), by striking ``conversion factor computed 
     under subparagraph (C) for the year'' and inserting 
     ``applicable conversion factor computed under subparagraph 
     (C), paragraph (11)(B), or paragraph (13)(B) for the year''; 
     and
       (B) in clause (ii), by inserting ``, paragraph (9)(A), or 
     paragraph (13)(C)'' after ``paragraph (2)(C)'';
       (4) in paragraph (9), by amending subparagraph (B) to read 
     as follows:
       ``(B) Budget neutrality adjustment.--
       ``(i) In general.--If the Secretary makes revisions under 
     subparagraph (A), then the revisions for a year may not cause 
     the estimated amount of expenditures under this part for the 
     year to increase or decrease from the estimated amount of 
     expenditures under this part (including expenditures 
     attributable to the special rules specified in paragraph 
     (13)) that would have been made if the revisions had not been 
     made.
       ``(ii) Exemption from reduction.--The relative payment 
     weights determined under paragraph (13)(C) and the conversion 
     factor computed under paragraph (13)(B) shall not be reduced 
     by any budget neutrality adjustment made pursuant to this 
     subparagraph.''; and
       (5) by redesignating paragraphs (13) through (16) as 
     paragraphs (14) through (17), respectively, and by inserting 
     after paragraph (12) the following new paragraph:
       ``(13) Special rules for calculating medicare opd fee 
     schedule amount for clinic and emergency visits.--
       ``(A) In general.--In computing the medicare OPD fee 
     schedule amount under paragraph (3)(D) for covered OPD 
     services that are furnished on or after January 1, 2006, and 
     classified within a group established or revised under 
     paragraph (2)(B) or (9)(A), respectively, for clinic and 
     emergency visits (as described in subparagraph (D)), the 
     Secretary shall--
       ``(i) substitute for the conversion factor calculated under 
     paragraph (3)(C) the conversion factor calculated under 
     subparagraph (B); and
       ``(ii) substitute for the relative payment weight 
     established or revised under paragraph (2)(C) or (9)(A), 
     respectively, the relative payment weight determined under 
     subparagraph (C) for such group.
       ``(B) Calculation of conversion factor.--For purposes of 
     subparagraph (A)(i), the conversion factor calculated under 
     this subparagraph is--
       ``(i) for services furnished during 2006, an amount equal 
     to the product of--

       ``(I) the conversion factor specified for such year in the 
     final rule published on November 10, 2005, increased by the 
     percentage by which such conversion factor is reduced for 
     such year pursuant to paragraph (2)(E), and not taking into 
     account any subsequent amendments to such final rule; and
       ``(II) 1.10; and

       ``(ii) for services furnished in a year beginning on or 
     after January 1, 2007, the conversion factor computed under 
     this subparagraph for the previous year increased by the OPD 
     fee schedule increase factor specified under paragraph 
     (3)(C)(iv) for the year involved.
       ``(C) Determination of relative payment weights.--For 
     purposes of subparagraph (A)(ii), the relative payment weight 
     determined under this subparagraph for a covered OPD service 
     that is classified within such a group is--
       ``(i) for services furnished during 2006, the relative 
     payment weight specified for such group for such period in 
     the final rule published November 10, 2005, and not taking 
     into account any subsequent amendments to such final rule; 
     and
       ``(ii) for services furnished in a year beginning on or 
     after January 1, 2007--

       ``(I) for ambulatory patient classification group 0601 
     (relating to mid-level clinic visits), or a successor to such 
     group, the relative payment weight specified for such group 
     in the final rule referred to in clause (i); and
       ``(II) for other ambulatory patient classification groups 
     described in subparagraph (D), the relative payment weight 
     established or revised under paragraph (2)(C) or (9)(A), 
     respectively, for such group for such year (but without 
     regard to any budget neutrality adjustment under paragraph 
     (9)(B)).

       ``(D) Groups for clinic and emergency visits.--For purposes 
     of this paragraph, the groups established or revised under 
     paragraph (2)(B) or (9)(A), respectively, for clinic and 
     emergency visits are ambulatory patient

[[Page S6793]]

     classification groups 0600, 0601, 0602, 0610, 0611, 0612, and 
     0620 as defined for purposes of the final rule referred to in 
     subparagraph (C)(i) (and any successors to such groups).''.
       (b) Limitation on Secretarial Authority.--Notwithstanding 
     section 1833(t) of the Social Security Act (42 U.S.C. 
     1395l(t)), as amended by subsection (a), the Secretary of 
     Health and Human Services may not make any adjustment under--
       (1) paragraph (2)(F), (3)(C)(iii), (9)(B), or (9)(C) of 
     section 1833(t) of the Social Security Act (42 U.S.C. 1395 
     l(t)); or
       (2) any other provision of such section;

     to ensure that the amendments made by subsection (a) do not 
     cause the estimated amount of expenditures under part B of 
     title XVIII of such Act (42 U.S.C. 1395j et seq.) to exceed 
     the estimated amount of expenditures that would have been 
     made under such part but for such amendments.

     SEC. 4. PERMANENT EXTENSION OF ADJUSTMENT TO LIMIT DECLINE IN 
                   PAYMENTS FOR CERTAIN HOSPITALS UNDER HOSPITAL 
                   OUTPATIENT PPS.

       (a) In General.--Section 1833(t)(7)(D)(i) of the Social 
     Security Act (42 U.S.C. 1395l(t)(7)(D)(i)), as amended by 
     section 5105 of the Deficit Reduction Act of 2005 (Public Law 
     109-171), is amended--
       (1) in the clause heading--
       (A) by striking ``Temporary'' and inserting ``Permanent''; 
     and
       (B) by striking ``Rural''
       (2) by striking subclause (II);
       (3) by striking ``(I) In the case'' and inserting ``In the 
     case'';
       (4) by striking ``located in a rural area, for'' and 
     inserting ``, for''; and
       (5) by striking ``furnished before January 1, 2006''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to covered OPD services furnished on or after 
     January 1, 2006.

     SEC. 5. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE 
                   HOSPITAL (DSH) ADJUSTMENT FOR RURAL HOSPITALS.

       Section 1886(d)(5)(F)(xiv)(II) of the Social Security Act 
     (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended--
       (1) by striking ``or, in the case'' and all that follows 
     through ``subparagraph (G)(iv)''; and
       (2) by inserting at the end the following new sentence: 
     ``The preceding sentence shall not apply to any hospital with 
     respect to discharges occurring on or after October 1, 
     2006.''.
                                 ______