[Congressional Record Volume 155, Number 82 (Wednesday, June 3, 2009)]
[Senate]
[Page S6033]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. PRYOR (for himself, Mr. Brownback, Mr. Bayh, Mr. Isakson, 
        Mr. Chambliss, Mr. Lugar, and Mr. Inhofe):
  S. 1171. A bill to amend title XVIII of the Social Security Act to 
restore State authority to waive the 35-mile rule for designating 
critical access hospitals under the Medicare Program; to the Committee 
on Finance.
  Mr. PRYOR. Mr. President, I rise today to introduce legislation with 
Senators Brownback, Bayh, Isakson, and Chambliss. The Critical Access 
Flexibility Act of 2009 will return to States the flexibility needed to 
help preserve local hospitals that serve rural communities.
  Hospitals are often the largest employers in rural America. They 
provide much needed jobs and are facing serious financial difficulties 
during this economic downturn. Without immediate relief, many small 
hospitals are at serious risk of closure, job loss, or reductions in 
patient services. Rural areas most often have sicker, older, and poorer 
populations. In these difficult times, it is crucial that we protect 
hospitals serving our rural communities.
  A Critical Access Hospital, CAH, is a hospital that is certified to 
receive cost-based reimbursement from Medicare. The reimbursement that 
CAHs receive is intended to improve their financial performance and 
thereby reduce hospital closures. CAHs are certified under a different 
set of Medicare conditions of participation that are more flexible than 
those used for acute care hospitals. In order for a hospital to be 
classified as a CAH, it must meet a number of conditions including a 
distance requirement that it must be 35 miles away from the nearest 
hospital. Prior to enactment of the 2003 Medicare Modernization Act, 
MMA, hospitals that were designated as ``necessary providers'' by a 
State could be exempt from the distance requirement.
  I am joining with Senators Brownback, Bayh, and Isakson today to 
introduce legislation that restores a state's authority to waive the 
mileage requirements if all other requirements are met and the State 
designates the facility as a necessary provider. Existing requirements 
that cannot be waived include requiring that CAHs be nonprofit or 
public hospitals in a rural area, offer 24-hour emergency room 
services, and have no more than 25 acute care inpatient beds.
  There are at least two communities in my State where changing 
conditions are threatening small town hospitals, and restoring the 
flexibility for States to make exemptions for the distance requirement 
would help residents of these communities continue to be able to 
receive necessary medical care from a local hospital. I know from 
talking to my colleagues in the Senate and to health care providers 
that this is the case throughout rural America. In recent years, there 
have been legislative efforts for single hospitals to be singled out 
and granted an exemption to the distance requirement. I believe the 
best way to address this problem is to have a uniform national policy 
that gives States the flexibility they need.
  I want to thank Senators Brownback, Bayh, Isakson, and Chambliss for 
their work, leadership and support on this very important legislation, 
and I urge the rest of my colleagues to support this effort.
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