[Congressional Record Volume 155, Number 121 (Wednesday, August 5, 2009)]
[Senate]
[Page S8871]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN:
  S. 1585. A bill to permit pass-through payment for reasonable costs 
of certified registered nurse anesthetist services in critical access 
hospitals notwithstanding the reclassification of such hospitals as 
urban hospitals, including hospitals located in ``Lugar counties'', and 
for on-call and standby costs for such services; to the Committee on 
Finance.
  Mr. DURBIN. Mr. President, today I'm introducing the Rural Access to 
Nurse Anesthesia Services Act to ensure patients in rural communities 
can access the health care services they need. The bill would restore 
rural healthcare by making improvements to the Medicare Part A 
reasonable cost-based, pass-through program for nurse anesthesia 
services in rural and critical access hospitals.
  Throughout the Nation, 1,300 critical access hospitals provide 
essential health care services to the elderly and medically underserved 
communities in rural areas. In my State of Illinois, 51 Critical Access 
Hospitals provide emergency, primary care, and surgery services 
directly to rural communities, covering over 60 percent of the counties 
in the State and reaching over 1 million rural residents.
  For the majority of Critical Access Hospitals, Certified Registered 
Nurse Anesthetists are the sole providers of anesthesia services. The 
nurse anesthetists make it possible for these hospitals to offer 
surgical, obstetrical, trauma stabilization, interventional diagnostic 
and pain management capabilities.
  Critical Access Hospitals depend on the work of nurse anesthetists to 
deliver quality care, even while the hospitals are pressed for 
resources. Because of the limited availability of nurse anesthetists 
and fewer patients in their rural communities, Critical Access 
Hospitals do not have anesthesia in the hospital 24/7. They rely on 
anesthesia and other surgery staff to be on call and available to the 
hospital within 15 minutes to cover emergency surgery procedures and 
obstetric services.
  As an incentive to continue serving Medicare beneficiaries in rural 
areas, critical access hospitals were given permission to use 
reasonable, cost-based funding for anesthesia services performed by 
nurse anesthetists. However, recent changes in CMS policy have denied 
Critical Access Hospitals' claims for tens of thousands of dollars each 
in annual Medicare funding that they had come to rely on. In Illinois, 
Critical Access Hospitals lost $50,000-$100,000 per hospital.
  These hospitals aren't just looking for a handout. Without being able 
to pay nurse anesthetists, the rural hospitals have to turn away 
patients whose procedures call for anesthesia. Patients have to travel 
to the next nearest hospital, which is a terrible option when dealing 
with trauma stabilization, obstetrical care, or even pain management, 
particularly for elderly patients.
  In addition, despite previously reimbursing Critical Access Hospitals 
for the costs of having a nurse anesthetist available or on call for 
emergency services, CMS recently began to deny payments for this 
service. How is a hospital able to retain the few nurse anesthetists 
who are available if they can't at least keep them on call?
  The Rural Access to Nurse Anesthesia Services Act will enable 
hospitals to offer the highest quality of care and availability of 
services to patients of Critical Access Hospitals. For decades, the 
Medicare Part A reasonable cost based pass-through program has 
successfully and safely ensured the availability of anesthesia services 
for Medicare patients in rural areas. Because of the program's success 
and impact, the Rural Access to Nurse Anesthesia Services Act is 
supported by the American Association of Nurse Anesthetists and the 
American Hospital Association. I hope my colleagues will join me in 
supporting this bill and work to protect anesthesia services for 
patients in rural communities.
  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. 1585

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

     SECTION 1. MEDICARE PASS-THROUGH PAYMENTS FOR CRNA SERVICES.

       (a) Treatment of Critical Access Hospitals as Rural in 
     Determining Eligibility for CRNA Pass-Through Payments.--
     Section 9320(k) of the Omnibus Budget Reconciliation Act of 
     1986 (42 U.S.C. 1395k note), as added by section 608(c)(2) of 
     the Family Support Act of 1988 and amended by section 6132 of 
     the Omnibus Budget Reconciliation Act of 1989, is amended by 
     adding at the end the following:
       ``(3) Any facility that qualifies as a critical access 
     hospital (as defined in section 1861(mm)(1) of the Social 
     Security Act) shall be treated as being located in a rural 
     area for purposes of paragraph (1) regardless of any 
     geographic reclassification of the facility, including such a 
     reclassification of the county in which the facility is 
     located as an urban county (also popularly known as a Lugar 
     county) under section 1886(d)(8)(B) of the Social Security 
     Act (42 U.S.C. 1395ww(d)(8)(B)).''.
       (b) Treatment of Standby and On-Call Costs.--Such section 
     9320(k), as amended by subsection (a), is further amended by 
     adding at the end the following:
       ``(4) In determining the reasonable costs incurred by a 
     hospital or critical access hospital for the services of a 
     certified registered nurse anesthetist under this subsection, 
     the Secretary shall include standby costs and on-call costs 
     incurred by the hospital or critical access hospital, 
     respectively, with respect to such nurse anesthetist.''.
       (c) Effective Dates.--
       (1) Treatment of cahs as rural in determining crna pass-
     through eligibility.--The amendment made by subsection (a) 
     shall apply to calendar years beginning on or after the date 
     of the enactment of this Act (regardless of whether the 
     geographic reclassification of a critical access hospital 
     occurred before, on, or after such date).
       (2) Inclusion of standby costs and on-call costs in 
     determining reasonable costs of crna services.--The amendment 
     made by subsection (b) shall apply to costs incurred in cost 
     reporting periods beginning in fiscal years after fiscal year 
     2003.

                          ____________________