[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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