[Congressional Record Volume 159, Number 113 (Thursday, August 1, 2013)]
[Senate]
[Pages S6221-S6222]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WYDEN (for himself and Mr. Isakson):
  S. 1444. A bill to amend title XVIII of the Social Security Act to 
provide payment under part A of the Medicare Program on a reasonable 
cost basis for anesthesia services furnished by an anesthesiologist in 
certain rural hospitals in the same manner as payments are provided for 
anesthesia services furnished by anesthesiologist assistants and 
certified anesthetists in such hospitals; to the Committee on Finance.
  Mr. WYDEN. Mr. President. I am honored to join my colleague from 
Georgia, Senator Johnny Isakson, in introducing a bill essential to 
expanding health care options for rural hospitals and beneficiaries 
living in rural areas, the Medicare Access to Rural Anesthesiology Act.
  As it stands today, low Medicare Part B anesthesia payments and low 
patient volume in rural areas makes it difficult for rural hospitals to 
attract and retain anesthesiologists. Our legislation would take an 
important step towards leveling the playing field between urban and 
rural health care by ensuring that rural Medicare beneficiaries have 
similar access to anesthesia services.
  Generally, Medicare pays for anesthesia services under the Medicare 
Part B fee schedule, but in order to attract anesthesia providers to 
rural areas, a statutory exception was created in the 1980s that allows 
eligible rural hospital to use Part A funds to employ or contract with 
non-physician anesthesiologist assistants, AA, or certified registered 
nurse anesthetists, CRNA. This policy however, does not permit eligible 
hospitals to use pass-through funds to pay anesthesiologists. Leaving 
anesthesiologists out also prevents AAs from receiving pass through 
payment because AAs must have an anesthesiologist on premises in order 
to practice. As a result, many folks in rural areas only have access to 
one type of anesthesia provider compared to folks in urban areas who 
can easily visit an anesthesiologist, CRNA, or an AA.
  Our legislation would allow eligible rural hospitals to use ``pass-
through'' Part A funds to employ CRNAs, AAs, and anesthesiologists. 
This common

[[Page S6222]]

sense change would give eligible rural hospitals the power to choose 
the anesthesia providers that best suit the medical needs of their 
patients, and would provide these hospitals with another tool to 
recruit and retain anesthesiology professionals as well as expand the 
availability of anesthesiology care in medically underserved areas.
  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. 1444

       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 ``Medicare Access to Rural 
     Anesthesiology Act of 2013''.

     SEC. 2. MEDICARE PART A PAYMENT FOR ANESTHESIOLOGIST SERVICES 
                   IN CERTAIN RURAL HOSPITALS BASED ON CRNA PASS-
                   THROUGH RULES.

       (a) In General.--Section 1814 of the Social Security Act 
     (42 U.S.C. 1395f) is amended by adding at the end the 
     following new subsection:

    ``Anesthesiologist Services Provided in Certain Rural Hospitals

       ``(m)(1) Notwithstanding any other provision of this title, 
     coverage and payment shall be provided under this part for 
     physicians' services that are anesthesia services furnished 
     by a physician who is an anesthesiologist in a rural hospital 
     described in paragraph (3) in the same manner as payment is 
     made under the exception provided in section 9320(k) of the 
     Omnibus Budget Reconciliation Act of 1986, as amended by 
     section 6132 of the Omnibus Budget Reconciliation Act of 1989 
     (42 U.S.C. 1395k note) (relating to payment on a reasonable 
     cost, pass-through basis), for certified registered nurse 
     anesthetist services furnished by a certified registered 
     nurse anesthetist in a hospital described in such section.
       ``(2) No payment shall be made under any other provision of 
     this title for physicians' services for which payment is made 
     under this subsection.
       ``(3) A rural hospital described in this paragraph is a 
     hospital described in section 9320(k) of the Omnibus Budget 
     Reconciliation Act of 1986, as so amended (42 U.S.C. 1395k 
     note), except that--
       ``(A) any reference in such section to a `certified 
     registered nurse anesthetist' or `anesthetist' is deemed a 
     reference to a `physician who is an anesthesiologist' or 
     `anesthesiologist', respectively; and
       ``(B) any reference to `January 1, 1988' or `1987' is 
     deemed a reference to such date and year as the Secretary 
     shall specify.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to services furnished during cost reporting 
     periods beginning on or after the date of the enactment of 
     this Act.
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