[Congressional Record Volume 155, Number 13 (Thursday, January 22, 2009)]
[Senate]
[Pages S791-S792]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WYDEN (for himself and Mr. Crapo):
  S. 307. A bill to amend title XVIII of the Social Security Act to 
provide flexibility in the manner in which beds are counted for 
purposes of determining whether a hospital may be designated as a 
critical access hospital under the Medicare program and to exempt from 
the critical access hospital inpatient bed limitation the number of 
beds provided for certain veterans; to the Committee on Finance.
  Mr. WYDEN. Mr. President, I am pleased to be joined today by my 
colleague Senator Mike Crapo, to introduce this important piece of 
legislation for America's rural hospitals. I first introduced this 
legislation in 2007 with Senator Smith, and I am proud to continue our 
fight for rural hospitals in this Congress. Today, my fellow Oregonian, 
Representative Greg Walden, is introducing this same bill in the House 
of Representatives.
  The Medicare program is turning rural communities into ``health care 
sacrifice'' zones. Under current law, critical access hospitals either 
have to risk their financial viability or their patient's health if a 
26th patient walks in their door. Rural hospitals need greater 
flexibility from the Medicare program to fulfill their obligations to 
their communities--especially, but not limited to, their veterans--in 
times of public health emergencies.
  The Balanced Budget Act of 1997 merged a Montana initiative, the 
medical assistance facility demonstration, and the Rural Primary Care 
Hospital program into a new category of hospitals called critical 
access hospitals CAH. By design, the Critical Access Hospital program 
in Medicare ensures that rural communities have access to acute care 
and emergency services 24 hours a day, 7 days a week.
  In order to obtain this designation, hospitals must meet certain 
requirements, such as being located more than 35 miles from any other 
hospital, or receiving certification by the state to be a ``necessary 
provider.'' Critical access hospitals must also provide 24-hour 
emergency care services.
  As a designated critical access hospital, Medicare pays these 
hospitals based on its reported costs. Each critical access hospital 
receives 101 percent of its costs for outpatient, inpatient, 
laboratory, and therapy services. There are nearly 1,300 hospitals 
across the United States in 47 states that operate under a critical 
access hospital designation. Twenty-five of them are in Oregon.
  One requirement of this program is that there be no more than 25 beds 
occupied by patients at any one time. This requirement has proven to be 
too constricting for facilities during times of unexpected need, such 
as during an influenza outbreak or an influx of tourism to the 
community.
  Critical access hospital administrators in Oregon, especially Dennis 
Burke from Good Shepherd Medical Center in Hermiston and Jim Mattes at 
Grande Ronde Hospital in LaGrande, have expressed to me how this 
restriction has lead to unnecessary risks to patient safety and health. 
Hospital administrators have been forced to divert the 26th and 27th 
patient in their hospitals to a hospital much farther from their homes 
and families.
  This legislation makes two important changes to the Medicare Critical 
Access Hospital Program. First, this bill will provide the flexibility 
necessary for a critical access hospital to either choose to meet 
either the 25-bed-per-day limit or work with a limit of 20-beds-per-day 
averaged throughout the year. During times of spikes in public health 
need, these hospitals would be able to care for more patients even if 
the hospital would exceed the use of 25 beds.
  Second, this bill exempts beds used by veterans whose care is paid 
for or coordinated by the Department of Veterans Affairs, VA, from 
counting against the 25-bed limit or 20-bed yearly average. This change 
gives CAHs the flexibility they need to treat America's military 
veterans at a time when the VA has divested in hospital care for our 
rural veterans, forcing them into these already tightly restricted 
community hospitals.
  This bill also ensures that these hospitals are meeting the 
requirements under the law without breaking the bank. This new yearly 
average of 20 beds is set lower than the daily limit, 25 beds, to 
ensure that Medicare does not inappropriately expand this program. For 
example, Grande Ronde Hospital would save Medicare an average of 
$100,000 each year for ambulance transfers of Medicare/Medicaid 
patients, all of whom could be treated within their facility had it 
been able to be flexible on counting bed days.
  I believe that these simple changes in the current law are critically 
important to keeping our rural hospitals open and their communities' 
health care needs served. As we look to expand access to health 
coverage, this bill will ensure that the nearly 1,300 critical access 
hospitals in the country have the flexibility they need to remain open 
for the millions of Americans who depend on them.
  I hope my colleagues will join me in supporting this bill, and I look 
forward to working with Chairman Baucus and Ranking Member Grassley and 
other members of the Finance Committee to secure passage of this 
important bill.
  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. 307

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Critical Access Hospital 
     Flexibility Act of 2009''.

     SEC. 2. FLEXIBILITY IN THE MANNER IN WHICH BEDS ARE COUNTED 
                   FOR PURPOSES OF DETERMINING WHETHER A HOSPITAL 
                   MAY BE DESIGNATED AS A CRITICAL ACCESS HOSPITAL 
                   UNDER THE MEDICARE PROGRAM.

       (a) In General.--Section 1820(c)(2)(B) of the Social 
     Security Act (42 U.S.C. 1395i-4(c)(2)(B)) is amended--
       (1) in clause (iii), by inserting ``(or 20, as determined 
     on an annual, average basis)'' after ``25''; and
       (2) by adding at the end the following flush sentence:
     ``In determining the number of beds for purposes of clause 
     (iii), only beds that are occupied shall be counted.''.
       (b) Effective Date.--The amendments made by this section 
     take effect on January 1, 2010.

     SEC. 3. CRITICAL ACCESS HOSPITAL INPATIENT BED LIMITATION 
                   EXEMPTION FOR BEDS PROVIDED TO CERTAIN 
                   VETERANS.

       (a) In General.--Section 1820(c) of the Social Security Act 
     (42 U.S.C. 1395i-4(c)) is amended by adding at the end the 
     following new paragraph:

[[Page S792]]

       ``(3) Exemption from bed limitation.--For purposes of this 
     section, no acute care inpatient bed shall be counted against 
     any numerical limitation specified under this section for 
     such a bed (or for inpatient bed days with respect to such a 
     bed) if the bed is provided for an individual who is a 
     veteran and the Department of Veterans Affairs referred the 
     individual for care in the hospital or is coordinating such 
     care with other care being provided by such Department.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to cost reporting periods beginning on or after 
     the date of the enactment of this Act.

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