[Congressional Record Volume 160, Number 30 (Monday, February 24, 2014)]
[Senate]
[Pages S1007-S1008]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROBERTS (for himself, Mr. Tester, Mr. Inhofe, Mr. Durbin, 
        Mr. Enzi, Ms. Baldwin, Mr. Moran, Mr. Franken, Mr. Grassley, 
        Mr. Barrasso, Mrs. Fischer, Ms. Collins, Mr. Johanns, Ms. 
        Klobuchar, Mr. Hoeven, and Mr. Kirk):
  S. 2037. A bill to amend title XVIII of the Social Security Act to 
remove the 96-hour physician certification requirement for inpatient 
critical access hospital services; to the Committee on Finance.
  Mr. ROBERTS. Mr. President, I started my public service career 
fighting for rural health. In a State that has many rural hospitals, 
the rural health care delivery system is especially important to 
Kansas. One of my first speeches was to rural hospitals. Since that 
time, I have been beating the drum, so to speak, for our rural areas 
about how important it is to focus on rural health.
  I have always said that people in rural towns deserve the same access 
to care and level of treatment as their urban counterparts. I have made 
it my mission to protect our rural health system and patient access to 
the best possible care. I am honored to serve as the cochair of the 
Senate Rural Health Caucus where I work with my colleagues to fight for 
our rural health care system every day.
  Unfortunately, these days it feels as though rural health care, and 
all of those involved in it, face an uphill battle. Over the past few 
years, the rural health system has continued to face even more 
challenges.
  Funding for rural health care programs has been targeted again and 
again. This year the Senate Finance Committee held a markup with 
regular order where we considered some of the rural extenders that are 
absolutely vital to our rural communities. Regrettably, we have more 
work to do. We have to convince and educate our colleagues, this 
administration, and everyone else about the importance of rural health 
care. We have been successful in protecting some of the ideas I have 
championed, especially on the rural extenders side, but we have more 
work to do. As this process moves forward, we need to ensure we follow 
regular order on the floor of the Senate and for any pay-fors for the 
doc fix package. While I was pleased with some of the additions that 
addressed rural health care in the package passed out of committee, I 
have concerns that these issues were not included or addressed in the 
most recent package introduced in the House and in the Senate.
  In addition to ensuring rural health is part of any moving 
legislation, I wish to ensure it is a package that is offset and paid 
for, and this has to be done before I can support it. But the bottom 
line is that we, the Senate, need to return to regular order and ensure 
that practice does continue.
  As will many of my colleagues in the Senate, I will continue to 
vigorously fight to rein in Federal spending and to

[[Page S1008]]

reduce the deficit. In order to address this fiscal crisis, I think 
Congress must enact basic structural changes to entitlement programs 
that will strengthen and preserve these programs for future generations 
while protecting current participants. Without real tangible reform and 
cuts in Federal spending, we will bankrupt the country. At the same 
time, we need to ensure that any of those policies we put in place do 
not result in a disproportionate impact on our rural health care system 
or restrict patients' access to the care they need. As I started saying 
today, this is going to be an uphill battle. But I, for one, am ready 
to lead the charge.
  As a member of both the Finance and HELP Committees, as well as the 
cochair of the Rural Health Caucus, I have tried to be a leader in the 
discussion about the need to address the entire health system.
  I have made it a point that within our health care system 
discussions, we need to talk about the differences between our rural 
areas and the care and treatment provided in those rural settings and 
their urban counterparts. We need to address common misconceptions 
about funding challenges in rural communities before taking a Lizzie 
Borden ax to the funding streams.
  Throughout my career in public office, I have made it a point to 
always fight for Kansas and rural health care providers. This has been 
one of my top priorities in Congress. I understand the important role 
of rural health in America and continue to advocate for policies that 
protect and preserve these benefits.
  Most recently, the Centers for Medicare and Medicaid Services--CMS--
have made some changes that will be particularly harmful to rural 
health. More specifically, their changes will force doctors into a 
guessing game about their patients. The condition of payment changes 
CMS is making would require the physician, and no other level provider, 
to not only predict at the time of admission to the critical access 
hospital that the patient will require hospital care for more than two 
midnights, but also that the patient can be cared for and discharged in 
less than 96 hours. This is an extremely narrow CMS window for the 
physician to make a determination about that patient's future needs--
extremely difficult, if not impossible. A physician may certify that 
they expect the patient to be treated and discharged within 96 hours, 
but, unfortunately, the patient's situation may change and they may 
need to be kept longer. The physician's concern will be that they have 
failed to meet the terms of their certification according to CMS. This 
is likely to lead to premature discharges and readmissions, both of 
which CMS has taken actions to minimize.
  A CEO for one of our critical access hospitals in Council Grove, KS, 
writes:

       This new ``condition of payment'' rule causes potential 
     conflicts with what is best for the patient, causes issues 
     for the physician in having to predict outcomes at admission 
     in complex cases, and may cause increased expense for 
     medically unnecessary transfers to more costly care centers.

  Today I am introducing the Critical Access Hospital Relief Act of 
2014. My bipartisan legislation would remove the condition of payment 
for critical access hospitals that requires a physician to certify that 
each patient will be discharged or transferred in less than 96 hours. 
This is another example of having to tell CMS, ``If it isn't broken, 
then there is no need to fix it.'' We need to focus on ensuring rural 
patients have access to their health system, not coming up with 
bureaucratic ways to make it harder for patients in rural areas to get 
quality care from their doctors.
  I urge my colleagues to cosponsor the Critical Access Hospital Relief 
Act of 2014.

                          ____________________