S 2786 ISCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas.CommentsClose CommentsPermalink

March 13, 2008

Mr. GRASSLEY introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to improve access to health care under the Medicare program for beneficiaries residing in rural areas.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the `Medicare Rural Health Access Improvement Act of 2008'.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents of this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink

TITLE I--PROVISIONS RELATING TO MEDICARE PART A

Sec. 101. Extension of Medicare FLEX grants.CommentsClose CommentsPermalink





Sec. 102. Improvements to the medicare-dependent hospital (MDH) program.CommentsClose CommentsPermalink





Sec. 103. Rebasing for sole community hospitals.CommentsClose CommentsPermalink





Sec. 104. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals.CommentsClose CommentsPermalink





Sec. 105. Temporary elimination of the DSH adjustment cap.CommentsClose CommentsPermalink

TITLE II--PROVISIONS RELATING TO MEDICARE PART B

Sec. 201. Extension and expansion of the Medicare hold harmless provision under the prospective payment system for hospital outpatient department (HOPD) services for certain hospitals.CommentsClose CommentsPermalink





Sec. 202. Treatment of rural sole community hospitals and medicare dependent, small rural hospitals under the prospective payment system for hospital outpatient department (HOPD) services.CommentsClose CommentsPermalink





Sec. 203. Permanent treatment of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas.CommentsClose CommentsPermalink





Sec. 204. Clarification of payment for clinical laboratory tests furnished by critical access hospitals.CommentsClose CommentsPermalink





Sec. 205. Extension of Medicare incentive payment program for physician scarcity areas.CommentsClose CommentsPermalink





Sec. 206. Revisions to the work geographic adjustment under the Medicare physician fee schedule.CommentsClose CommentsPermalink





Sec. 207. Revisions to the practice expense geographic adjustment under the Medicare physician fee schedule.CommentsClose CommentsPermalink





Sec. 208. Extension of treatment of certain physician pathology services under Medicare.CommentsClose CommentsPermalink





Sec. 209. Extension of increased Medicare payments for rural ground ambulance services.CommentsClose CommentsPermalink





Sec. 210. Adding hospital-based renal dialysis centers (including satellites) as originating sites for payment of telehealth services.CommentsClose CommentsPermalink





Sec. 211. Adding skilled nursing facilities as originating sites for payment of telehealth services.CommentsClose CommentsPermalink





Sec. 212. Rural health clinic improvements.CommentsClose CommentsPermalink





Sec. 213. Exemption for suppliers in small MSAs and rural areas.CommentsClose CommentsPermalink





Sec. 214. Permitting physician assistants to order post-hospital extended care services and to provide for recognition of attending physician assistants as attending physicians to serve hospice patients.CommentsClose CommentsPermalink

TITLE I--PROVISIONS RELATING TO MEDICARE PART A

SEC. 101. EXTENSION OF MEDICARE FLEX GRANTS.

Section 1820(j) of the Social Security Act (42 U.S.C. 1395i-4(j)) is amended by striking `2008' and inserting `2009'.CommentsClose CommentsPermalink

SEC. 102. IMPROVEMENTS TO THE MEDICARE-DEPENDENT HOSPITAL (MDH) PROGRAM.

(a) Use of Non-Wage Adjusted PPS Rate- Section 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended by adding at the end the following new clause:CommentsClose CommentsPermalink





`(v) In the case of discharges occurring on or after October 1, 2008, and before October 1, 2011, in determining the amount under paragraph (1)(A)(iii) for purposes of clauses (i) and (ii)(II), such amount shall, if it results in greater payments to the hospital, be determined without regard to any adjustment for different area wage levels under paragraph (3)(E).'.CommentsClose CommentsPermalink





(b) Enhanced Payment for Amount by Which the Target Exceeds the PPS Rate- Section 1886(d)(5)(G)(ii)(II) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(G)(ii)(II)) is amended by inserting `and before October 1, 2008, or 85 percent in the case of discharges occurring on or after October 1, 2008, and before October 1, 2011' after `October 1, 2006'.CommentsClose CommentsPermalink

SEC. 103. REBASING FOR SOLE COMMUNITY HOSPITALS.

(a) Rebasing Permitted- Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)) is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(L)(i) For cost reporting periods beginning on or after October 1, 2008, in the case of a sole community hospital there shall be substituted for the amount otherwise determined under subsection (d)(5)(D)(i) of this section, if such substitution results in a greater amount of payment under this section for the hospital, the subparagraph (L) rebased target amount.CommentsClose CommentsPermalink





`(ii) For purposes of this subparagraph, the term `subparagraph (L) rebased target amount' has the meaning given the term `target amount' in subparagraph (C), except that--CommentsClose CommentsPermalink





`(I) there shall be substituted for the base cost reporting period the 12-month cost reporting period beginning during fiscal year 2002;CommentsClose CommentsPermalink





`(II) any reference in subparagraph (C)(i) to the `first cost reporting period' described in such subparagraph is deemed a reference to the first cost reporting period beginning on or after October 1, 2008; andCommentsClose CommentsPermalink





`(III) the applicable percentage increase shall only be applied under subparagraph (C)(iv) for discharges occurring in fiscal years beginning with fiscal year 2009.'.CommentsClose CommentsPermalink





(b) Conforming Amendments- Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)) is amended--CommentsClose CommentsPermalink





(1) in subparagraph (C), in the matter preceding clause (i), by striking `subparagraph (I)' and inserting `subparagraphs (I) and (L)'; andCommentsClose CommentsPermalink





(2) in subparagraph (I)(i), in the matter preceding subclause (I), by striking `For' and inserting `Subject to subparagraph (L), for'.CommentsClose CommentsPermalink

SEC. 104. TEMPORARY IMPROVEMENTS TO THE MEDICARE INPATIENT HOSPITAL PAYMENT ADJUSTMENT FOR LOW-VOLUME HOSPITALS.

Section 1886(d)(12) of the Social Security Act (42 U.S.C. 1395ww(d)(12)) is amended--CommentsClose CommentsPermalink





(1) in subparagraph (A), by inserting `or (D)' after `subparagraph (B)';CommentsClose CommentsPermalink





(2) in subparagraph (B), by striking `The Secretary' and inserting `For discharges occurring in fiscal years 2005 through 2008 and for discharges occurring in fiscal year 2011 and subsequent fiscal years, the Secretary';CommentsClose CommentsPermalink





(3) in subparagraph (C)(i)--CommentsClose CommentsPermalink





(A) by inserting `(or, with respect to fiscal years 2009 and 2010, 15 road miles)' after `25 road miles'; andCommentsClose CommentsPermalink





(B) by inserting `(or, with respect to fiscal years 2009 and 2010, 2,000 discharges of individuals entitled to, or enrolled for, benefits under part A)' after `800 discharges'; andCommentsClose CommentsPermalink





(4) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(D) TEMPORARY APPLICABLE PERCENTAGE INCREASE- For discharges occurring in fiscal years 2009 or 2010, the Secretary shall determine an applicable percentage increase for purposes of subparagraph (A) using a linear sliding scale ranging from 25 percent for low-volume hospitals with fewer than an appropriate number (as determined by the Secretary) of discharges of individuals entitled to, or enrolled for, benefits under part A in the fiscal year to 0 percent for low-volume hospitals with greater than 2,000 discharges of such individuals in the fiscal year.'.CommentsClose CommentsPermalink

SEC. 105. TEMPORARY ELIMINATION OF THE DSH ADJUSTMENT CAP.

Section 1886(d)(5)(F)(xiv)(II) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended by adding at the end the following new sentence: `The preceding sentence shall not apply to any hospital in the case of discharges occurring on or after October 1, 2008, and before October 1, 2010.'.CommentsClose CommentsPermalink

TITLE II--PROVISIONS RELATING TO MEDICARE PART B

SEC. 201. EXTENSION AND EXPANSION OF THE MEDICARE HOLD HARMLESS PROVISION UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT (HOPD) SERVICES FOR CERTAIN HOSPITALS.

Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)) is amended--CommentsClose CommentsPermalink





(1) in subclause (II)--CommentsClose CommentsPermalink





(A) in the first sentence, by striking `2009' and inserting `2010'; andCommentsClose CommentsPermalink





(B) by striking the second sentence and inserting the following new sentence: `For purposes of the preceding sentence, the applicable percentage shall be 95 percent with respect to covered OPD services furnished in 2006, 90 percent with respect to such services furnished in 2007, 85 percent with respect to such services furnished in 2008, 100 percent with respect to such services furnished in 2009, and 100 percent with respect to such services furnished in 2010.'; andCommentsClose CommentsPermalink





(2) by adding at the end the following new subclause:CommentsClose CommentsPermalink





`(III) In the case of a sole community hospital (as defined in section 1886(d)(5)(D)(iii)), for covered OPD services furnished on or after January 1, 2009, and before January 1, 2011, for which the PPS amount is less than the pre-BBA amount, the amount of payment under this subsection shall be increased by 100 percent of the amount of such difference.'.CommentsClose CommentsPermalink

SEC. 202. TREATMENT OF RURAL SOLE COMMUNITY HOSPITALS AND MEDICARE DEPENDENT, SMALL RURAL HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT (HOPD) SERVICES.

Section 1833(t)(13) of the Social Security Act (42 U.S.C. 1395l(t)(13)) is amended--CommentsClose CommentsPermalink





(1) in the heading, by striking `AUTHORIZATION OF ADJUSTMENT' and inserting `ADJUSTMENT';CommentsClose CommentsPermalink





(2) in subparagraph (B)--CommentsClose CommentsPermalink





(A) in the heading, by inserting `FOR 2006, 2007, AND 2008' after `ADJUSTMENT'; andCommentsClose CommentsPermalink





(B) by adding at the end the following new sentence: `Such authority shall apply with respect to services furnished in 2006, 2007, or 2008.'; andCommentsClose CommentsPermalink





(3) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(C) ADJUSTMENT FOR 2009 AND SUBSEQUENT YEARS FOR CERTAIN RURAL HOSPITALS-CommentsClose CommentsPermalink





`(i) ADJUSTMENT-CommentsClose CommentsPermalink





`(I) IN GENERAL- Subject to clause (ii), in the case of covered OPD services furnished on or after January 1, 2009, by a sole community hospital (as defined in subparagraph (D)(iii) of section 1886(d)(5)) located in a rural area or a medicare-dependent, small rural hospital (as defined in subparagraph (G)(iv) of such section, the amount of payment that would otherwise be made for such service under this subsection shall be increased by an amount equal to 7.1 percent of such amount. Such increase shall be applied before calculating outliers and coinsurance.CommentsClose CommentsPermalink





`(II) REVISION WITH NOTICE AND COMMENT- In the case of covered OPD services furnished on or after January 1, 2010, the Secretary may revise the percent described in subclause (I) through the promulgation of a regulation.CommentsClose CommentsPermalink





`(ii) NOT APPLICABLE TO PASS-THROUGH DEVICES, DRUGS, AND BIOLOGICALS- The increase under clause (i) shall not apply to the payment for a device, drug, or biological described in clause (i), (ii), (iii), or (iv) of paragraph (6)(A).CommentsClose CommentsPermalink





`(iii) EXEMPTION FROM BUDGET NEUTRALITY- The provisions of this subparagraph shall not be effected in a budget-neutral manner under this subsection.'.CommentsClose CommentsPermalink

SEC. 203. PERMANENT TREATMENT OF MEDICARE REASONABLE COSTS PAYMENTS FOR CERTAIN CLINICAL DIAGNOSTIC LABORATORY TESTS FURNISHED TO HOSPITAL PATIENTS IN CERTAIN RURAL AREAS.

Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





`(v) Reasonable Costs Payments for Certain Clinical Diagnostic Laboratory Tests Furnished to Hospital Patients in Certain Rural Areas-CommentsClose CommentsPermalink





`(1) IN GENERAL- Notwithstanding subsections (a), (b), and (h) and section 1834(d)(1), in the case of a clinical diagnostic laboratory test covered under this part that is furnished during a cost reporting period beginning on or after July 1, 2008, by a hospital with fewer than 50 beds that is located in a qualified rural area (identified under paragraph (12)(B)(iii) of section 1834(l)) as part of outpatient services of the hospital, the amount of payment for such test shall be 100 percent of the reasonable costs of the hospital in furnishing such test.CommentsClose CommentsPermalink





`(2) PROVISION AS PART OF OUTPATIENT HOSPITAL SERVICES- For purposes of paragraph (1), in determining whether clinical diagnostic laboratory services are furnished as part of outpatient services of a hospital, the Secretary shall apply the same rules that are used to determine whether clinical diagnostic laboratory services are furnished as an outpatient critical access hospital service under section 1834(g)(4) (determined without regard to the amendments made by section 204 of the Medicare Rural Health Access Improvement Act of 2008).CommentsClose CommentsPermalink





`(3) REFERENCE- For the treatment of certain clinical diagnostic laboratory tests furnished prior to July 1, 2007, see section 416 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, as extended by section 105 of division B of the Tax Relief and Health Care Act of 2006 and section 107 of the Medicare, Medicaid, and SCHIP Extension Act of 2007.'.CommentsClose CommentsPermalink

SEC. 204. CLARIFICATION OF PAYMENT FOR CLINICAL LABORATORY TESTS FURNISHED BY CRITICAL ACCESS HOSPITALS.

(a) In General- Section 1834(g)(4) of the Social Security Act (42 U.S.C. 1395m(g)(4)) is amended--CommentsClose CommentsPermalink





(1) in the heading, by striking `NO BENEFICIARY COST-SHARING FOR' and inserting `TREATMENT OF'; andCommentsClose CommentsPermalink





(2) by adding at the end the following new sentence: `For purposes of the preceding sentence and section 1861(mm)(3), clinical diagnostic laboratory services furnished by a critical access hospital shall be treated as being furnished as part of outpatient critical access services without regard to whether the individual with respect to whom such services are furnished is physically present in the critical access hospital at the time the specimen is collected or was in a skilled nursing facility or a clinic that is owned by, or co-located with, the critical access hospital.'.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by subsection (a) shall apply to services furnished on or after January 1, 2009.CommentsClose CommentsPermalink

SEC. 205. EXTENSION OF MEDICARE INCENTIVE PAYMENT PROGRAM FOR PHYSICIAN SCARCITY AREAS.

Section 1833(u) of the Social Security Act (42 U.S.C. 1395l(u)), as amended by section 102 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), is amended--CommentsClose CommentsPermalink





(1) in paragraph (1), by striking `before July 1, 2008' and inserting `before January 1, 2010'; andCommentsClose CommentsPermalink





(2) in paragraph (4)(D), by striking `before July 1, 2008' and inserting `before January 1, 2010'.CommentsClose CommentsPermalink

SEC. 206. REVISIONS TO THE WORK GEOGRAPHIC ADJUSTMENT UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.

(a) Extension of Floor- Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-4(e)(1)(E)), as amended by section 103 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), is amended by striking `before July 1, 2008' and inserting `before January 1, 2010'.CommentsClose CommentsPermalink





(b) Recognition of Equality of Physician Work in All Geographic Areas- Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-4(e)(1)) is amended--CommentsClose CommentsPermalink





(1) in subparagraph (A), in the matter preceding clause (i), by striking `subparagraphs (B)' through `the Secretary' and inserting `the succeeding provisions of this paragraph, the Secretary'; andCommentsClose CommentsPermalink





(2) by inserting after subparagraph (E) the following new subparagraph:CommentsClose CommentsPermalink





`(F) RECOGNITION OF EQUALITY OF PHYSICIAN WORK IN ALL GEOGRAPHIC AREAS- In recognition of the fact that the physician work for a service is the same in all geographic areas, and should be similarly valued under this title, for services furnished on or after January 1, 2010, the geographic index for physician work under subparagraph (A)(iii) shall be 1.0 in all fee schedule areas.'.CommentsClose CommentsPermalink

SEC. 207. REVISIONS TO THE PRACTICE EXPENSE GEOGRAPHIC ADJUSTMENT UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.

(a) Establishment of Floor- Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-4(e)(1)) is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(H) FLOOR AT 1.0 ON PRACTICE EXPENSE GEOGRAPHIC INDEX- After calculating the practice expense geographic index in subparagraph (A)(i), for purposes of payment for services furnished in 2009, the Secretary shall increase the practice expense geographic index to 1.0 for any locality for which such practice expense geographic index is less than 1.0.'.CommentsClose CommentsPermalink





(b) More Appropriate Recognition of Practice Expense Differences in Employee Wages and Office Rents Among Geographic Areas- Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w-4(e)(1)), as amended by subsection (a), is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





`(I) MORE APPROPRIATE RECOGNITION OF DIFFERENCES IN EMPLOYEE WAGES AND OFFICE RENTS AMONG AREAS-CommentsClose CommentsPermalink





`(i) IN GENERAL- In recognition of the limitations on available data (as described in clause (ii)) for use as the employee wage and office rent proxies in the practice expense geographic index described in subparagraph (A)(i), and in order to more appropriately reflect differences among different fee schedule areas, for services furnished on or after January 1, 2010, such practice expense geographic index shall be an index which reflects 1/2 of the difference between the relative costs of employee wages and rents in each of the different fee schedule areas and the national average of such employee wages and rents.CommentsClose CommentsPermalink





`(ii) LIMITATIONS ON AVAILABLE DATA- The limitations on available data described in this clause are the following:CommentsClose CommentsPermalink





`(I) The need to use proxy data to reflect differences in employee wages and rents among areas.CommentsClose CommentsPermalink





`(II) Wages for some categories of employees being determined in national markets.CommentsClose CommentsPermalink





`(III) Physicians having to compete for some employees in market areas that cross fee schedule areas.CommentsClose CommentsPermalink





`(IV) Physicians in rural areas frequently having to locate their offices close to urban areas and competing with urban rent markets.'.CommentsClose CommentsPermalink

SEC. 208. EXTENSION OF TREATMENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES UNDER MEDICARE.

Section 542(c) of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (as enacted into law by section 1(a)(6) of Public Law 106-554), as amended by section 732 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395w-4 note), section 104 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395w-4 note), and section 104 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), is amended by striking `2007, and the first 6 months of 2008' and inserting `2007, 2008, and 2009'.CommentsClose CommentsPermalink

SEC. 209. EXTENSION OF INCREASED MEDICARE PAYMENTS FOR RURAL GROUND AMBULANCE SERVICES.

Section 1834(l)(13) of the Social Security Act (42 U.S.C. 1395m(l)(13)) is amended--CommentsClose CommentsPermalink





(1) in subparagraph (A), in the heading, by striking `IN GENERAL' and inserting `FOR THE SECOND HALF OF 2004 AND FOR 2005 AND 2006';CommentsClose CommentsPermalink





(2) by redesignating subparagraph (B) as subparagraph (C);CommentsClose CommentsPermalink





(3) by inserting the following after subparagraph (A):CommentsClose CommentsPermalink





`(B) FOR THE SECOND HALF OF 2008 AND FOR 2009 WITH RESPECT TO RURAL AREAS- After computing the rates with respect to ground ambulance services under the other applicable provisions of this subsection, in the case of such services furnished on or after July 1, 2008, and before January 1, 2010, for which the transportation originates in a rural area described in paragraph (9) or in a rural census tract described in such paragraph, the fee schedule established under this section shall provide that the rate for the service otherwise established, after application of any increase under paragraphs (11) and (12), shall be increased by 5 percent.'; andCommentsClose CommentsPermalink





(4) in subparagraph (C), as redesignated by paragraph (2)--CommentsClose CommentsPermalink





(A) in the heading, by striking `APPLICATION OF INCREASED PAYMENTS AFTER 2006' and inserting `NO EFFECT ON SUBSEQUENT PERIODS'; andCommentsClose CommentsPermalink





(B) by adding at the end the following new sentence: `The increased payments under subparagraph (B) shall not be taken into account in calculating payments for services furnished after the period specified in such subparagraph.'.CommentsClose CommentsPermalink

SEC. 210. ADDING HOSPITAL-BASED RENAL DIALYSIS CENTERS (INCLUDING SATELLITES) AS ORIGINATING SITES FOR PAYMENT OF TELEHEALTH SERVICES.

(a) In General- Section 1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end the following new subclause:CommentsClose CommentsPermalink





`(VI) A hospital-based or critical access hospital-based renal dialysis center (including satellites).'.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by this section shall apply to services furnished on or after January 1, 2009.CommentsClose CommentsPermalink

SEC. 211. ADDING SKILLED NURSING FACILITIES AS ORIGINATING SITES FOR PAYMENT OF TELEHEALTH SERVICES.

(a) Addition-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)), as amended by section 210, is amended by adding at the end the following new subclause:CommentsClose CommentsPermalink





`(VII) A skilled nursing facility (as defined in section 1819(a)).'.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENT- Section 1888(e)(2)(A)(ii) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting `telehealth services furnished under section 1834(m)(4)(C)(ii)(VII),' after `section 1861(s)(2),'.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by subsection (a) shall apply to telehealth services furnished on or after January 1, 2009.CommentsClose CommentsPermalink

SEC. 212. RURAL HEALTH CLINIC IMPROVEMENTS.

Section 1833(f) of the Social Security Act (42 U.S.C. 1395l(f)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1), by striking `, and' at the end and inserting a semicolon;CommentsClose CommentsPermalink





(2) in paragraph (2)--CommentsClose CommentsPermalink





(A) by inserting `(before 2009)' after `in a subsequent year'; andCommentsClose CommentsPermalink





(B) by striking the period at the end and inserting a semicolon; andCommentsClose CommentsPermalink





(3) by adding at the end the following new paragraphs:CommentsClose CommentsPermalink





`(3) in 2009, at $92 per visit; andCommentsClose CommentsPermalink





`(4) in a subsequent year, at the limit established under this subsection for the previous year increased by the percentage increase in the MEI (as so defined) furnished as of the first day of that year.'.CommentsClose CommentsPermalink

SEC. 213. EXEMPTION FOR SUPPLIERS IN SMALL MSAS AND RURAL AREAS.

(a) Exemption- Section 1847(a)(3) of the Social Security Act (42 U.S.C. 1395w-3(a)(3)) is amended--CommentsClose CommentsPermalink





(1) in the matter preceding subparagraph (A), by striking `may' and inserting `shall'; andCommentsClose CommentsPermalink





(2) by striking subparagraph (A) and inserting the following:CommentsClose CommentsPermalink





`(A) rural areas and small metropolitan statistical areas with a population of 600,000 or less; and'.CommentsClose CommentsPermalink





(b) Inapplicability of Competitively Bid Prices to Rural and Small MSAs- Section 1834(a)(1)(F)(ii) of the Social Security Act (42 U.S.C. 1395m(a)(1)(F)(ii)) is amended by striking `the Secretary' and inserting `except in the case of any area that is exempt from the programs under section 1847 pursuant to subsection (a)(3)(A) of such section, the Secretary'.CommentsClose CommentsPermalink





(c) Effective Date; Exception-CommentsClose CommentsPermalink





(1) EFFECTIVE DATE- Subject to paragraph (2), the amendments made by this section shall take effect as if included in the enactment of section 302 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2223).CommentsClose CommentsPermalink





(2) EXCEPTION- The amendments made by this section shall not apply to contracts entered into under section 1847 of the Social Security Act (42 U.S.C. 1395w-3) prior to September 1, 2008, pursuant to the implementation of subsection (a)(1)(B)(i)(I) of such section 1847.CommentsClose CommentsPermalink

SEC. 214. PERMITTING PHYSICIAN ASSISTANTS TO ORDER POST-HOSPITAL EXTENDED CARE SERVICES AND TO PROVIDE FOR RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS.

(a) Ordering Post-Hospital Extended Care Services-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1814(a)(2) of the Social Security Act (42 U.S.C. 1395f(a)(2)), in the matter preceding subparagraph (A), is amended by striking `nurse practitioner or clinical nurse specialist' and inserting `nurse practitioner, a clinical nurse specialist, or a physician assistant (as those terms are defined in section 1861(aa)(5))'.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENT- Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) is amended, in the second sentence, by striking `or clinical nurse specialist' and inserting `clinical nurse specialist, or physician assistant'.CommentsClose CommentsPermalink





(b) Recognition of Attending Physician Assistants as Attending Physicians To Serve Hospice Patients-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1861(dd)(3)(B) of the Social Security Act (42 U.S.C. 1395x(dd)(3)(B)) is amended--CommentsClose CommentsPermalink





(A) by striking `or nurse' and inserting `, the nurse'; andCommentsClose CommentsPermalink





(B) by inserting `, or the physician assistant (as defined in such subsection)' after `subsection (aa)(5))'.CommentsClose CommentsPermalink





(2) CLARIFICATION OF HOSPICE ROLE OF PHYSICIAN ASSISTANTS- Section 1814(a)(7)(A)(i)(I) of the Social Security Act (42 U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by inserting `or a physician assistant' after `a nurse practitioner'.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2009.CommentsClose CommentsPermalink