[Congressional Record Volume 162, Number 142 (Tuesday, September 20, 2016)]
[House]
[Pages H5681-H5682]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
CONTINUING ACCESS TO HOSPITALS ACT OF 2016
Ms. JENKINS of Kansas. Mr. Speaker, I move to suspend the rules and
pass the bill (H.R. 5613) to provide for the extension of the
enforcement instruction on supervision requirements for outpatient
therapeutic services in critical access and small rural hospitals
through 2016, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 5613
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 ``Continuing Access to
Hospitals Act of 2016'' or the ``CAH Act of 2016''.
SEC. 2. EXTENSION OF ENFORCEMENT INSTRUCTION ON SUPERVISION
REQUIREMENTS FOR OUTPATIENT THERAPEUTIC
SERVICES IN CRITICAL ACCESS AND SMALL RURAL
HOSPITALS THROUGH 2016.
Section 1 of Public Law 113-198, as amended by section 1 of
Public Law 114-112, is amended--
(1) in the heading, by striking ``2014 AND 2015'' and
inserting ``2016''; and
(2) by striking ``and 2015'' and inserting ``, 2015, and
2016''.
SEC. 3. REPORT.
Not later than one year after the date of the enactment of
this Act, the Medicare Payment Advisory Commission
(established under section 1805 of the Social Security Act
(42 U.S.C. 1395b-6)) shall submit to Congress a report
analyzing the effect of the extension of the enforcement
instruction under section 1 of Public Law 113-198, as amended
by section 1 of Public Law 114-112 and section 2 of this Act,
on the access to health care by Medicare beneficiaries, on
the economic impact and the impact upon hospital staffing
needs, and on the quality of health care furnished to such
beneficiaries.
The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from
Kansas (Ms. Jenkins) and the gentleman from Iowa (Mr. Loebsack) each
will control 20 minutes.
The Chair recognizes the gentlewoman from Kansas.
General Leave
Ms. JENKINS of Kansas. Mr. Speaker, I ask unanimous consent that all
Members have 5 legislative days to revise and extend their remarks and
include any extraneous material on H.R. 5613, currently under
consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Kansas?
There was no objection.
Ms. JENKINS of Kansas. Mr. Speaker, I yield myself such time as I may
consume.
I rise today in support of H.R. 5613, the Continuing Access to
Hospitals Act of 2016, a policy this Congress has passed unanimously in
2014 and 2015.
Every year across Kansas, hospitals in rural communities must wait to
see if they will have to comply with a burdensome Federal regulation
that makes caring for patients more difficult, while providing no
additional benefits.
Back in January 2014, the Centers for Medicare and Medicaid Services
began enforcing a requirement that physicians must supervise outpatient
therapeutic services at critical access hospitals and other small rural
hospitals. This meant that routine outpatient therapeutic procedures,
such as the application of a splint to a finger or a demonstration of
how to use a nebulizer, had to be directly supervised by a physician.
Thankfully, Congress passed an extension of a moratorium on that
supervision requirement in 2014 and again in 2015. Here we are again
today to try to give a little bit of certainty to these very important
rural and critical access hospitals.
There are over 1,300 critical access hospitals that serve rural
Americans in nearly every State, and these facilities simply lack the
resources to fulfill this burdensome mandate. Before 2014, physicians
at rural hospitals were not required to directly supervise these types
of outpatient therapeutic services, and asking them to do so now, after
unanimously passing identical extensions the past 2 years, will only
jeopardize access to care.
I reserve the balance of my time.
Mr. LOEBSACK. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in strong support of H.R. 5613, the
Continuing Access to Hospitals Act. I am pleased the House is
considering this bipartisan legislation, which I introduced with Ms.
Jenkins of Kansas.
Many of Iowa's rural hospitals, just like the rural hospitals in
Kansas and other parts of America, are struggling in these economic
times. I have made it a point to visit all of the hospitals in my
district on many occasions in order to hear directly from them about
the issues they are facing and how I, as their Congressman, can help.
I have seen firsthand that rural hospitals are bedrocks of their
communities, providing more than just high-quality, local access to
health care. Rural hospitals also stimulate the local economy, creating
jobs in the hospital and in the larger community. Without quality local
health care, lives and communities are lost.
One issue I consistently hear about is the Centers for Medicare and
Medicaid Services' rule strictly requiring direct supervision of
outpatient therapeutic services. The enforcement of this rule will
cause rural facilities to reduce therapy services, threatening access
to needed procedures for rural Americans.
That is why I was proud that, last year, the legislation that
Congresswoman Jenkins and I introduced to continue the prohibition on
CMS from enforcing the unreasonable supervision requirements for 2015
was signed into law. That bill, however, was only a fix for 2015, as
Congresswoman Jenkins pointed out. I am committed to making sure this
is also solved in 2016, as well as working toward a permanent fix to
provide certainty for our critical access hospitals, again, not just in
Iowa or Kansas, but around the country.
The services covered by this legislation have always been provided by
licensed, skilled professionals under the overall direction of a
physician and with the assurance of rapid assistance from a team of
caregivers, including a physician. While there is some need for direct
supervision for certain outpatient services that pose a high risk or
are very complex, CMS' policy generally applies to even the lowest risk
services.
This legislation will provide temporary relief that will go far in
relieving the regulatory burden of direct supervision of outpatient
therapeutic services for rural hospitals. This legislation, fittingly,
protects hospitals that were providing and are providing quality,
responsible care during the period in question.
I urge all my colleagues to support this bill today.
Again, I thank Congresswoman Jenkins. We have worked together on this
now for a couple of years. I think it proves that, if folks from both
parties put their heads together and offer commonsense legislation, we
can get it passed. Most importantly, it proves that we can help our
local hospitals and folks who live in these rural areas who need that
access to those local hospitals.
I reserve the balance of my time.
Ms. JENKINS of Kansas. Mr. Speaker, I yield such time as he may
consume to the gentleman from Nebraska (Mr. Smith), an esteemed member
of the House Ways and Means Committee.
Mr. SMITH of Nebraska. Mr. Speaker, I rise today in support of H.R.
5613 to once again delay enforcement of supervision requirements on
critical access hospitals.
It has unfortunately become an annual ritual for us to pass
legislation to block this arbitrary regulation which requires a
physician to be on-site and present for the administration of most
procedures, no matter how basic.
As a condition of participation in the critical access program, a
facility must have 25 or fewer beds, be distant from the next closest
hospital, and have a physician on call and available within
[[Page H5682]]
30 minutes. The individuals who practice at these facilities, including
doctors, nurses, physician's assistants, and nurse practitioners, have
a very strong understanding of what care can be safely provided in
their critical access setting and which cases should be transferred to
a larger facility.
However, CMS' efforts to accommodate the concerns of rural providers
hasn't been to empower these professionals, but to create a limited
list of procedures which can be done without a physician on-site. For
this reason, I appreciate the chairman and the gentlewoman from Kansas
(Ms. Jenkins) for working with me to incorporate language into this
bill, which requires MedPAC to report on the economic and staffing
impacts of these regulations on rural hospitals.
Based on discussions I have had with hospitals across Nebraska's
Third District, I expect MedPAC's findings will make a strong case for
repealing this regulation outright.
I urge passage of this bill, which is vital to communities across
rural America.
Mr. LOEBSACK. Mr. Speaker, I want to thank the gentleman from
Nebraska (Mr. Smith). We came into Congress at the same time, and it is
great we can work on this bill together. It is a commonsense bill.
Again, in Iowa, we have over 80 critical access hospitals. The
gentleman pointed out the importance that these are small hospitals, 25
or fewer beds. Their resources are limited. I thank the gentleman from
Nebraska (Mr. Smith) for supporting this bill. I really appreciate it.
I yield back the balance of my time.
Ms. JENKINS of Kansas. Mr. Speaker, I yield myself such time as I may
consume.
Congressman Loebsack and I worked together to introduce this measure,
once again, in a bipartisan fashion. I, too, want to thank him for
understanding the problem rural doctors face with this supervision
mandate and for his willingness to work with me to introduce this bill.
I urge my colleagues in the House to pass this measure, once again,
unanimously, so that we can provide the rural doctors of this country
with a little more certainty and take away the threat of an unnecessary
burden.
I yield back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentlewoman from Kansas (Ms. Jenkins) that the House suspend the rules
and pass the bill, H.R. 5613, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. AMASH. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this motion will be postponed.
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