HR 5624 IHCommentsClose CommentsPermalink

112th CONGRESSCommentsClose CommentsPermalink

2d SessionCommentsClose CommentsPermalink

H. R. 5624CommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program, to amend title III of the Public Health Service Act to extend discounts under the 340B program, and for other purposes.CommentsClose CommentsPermalink

IN THE HOUSE OF REPRESENTATIVESCommentsClose CommentsPermalink

May 8, 2012CommentsClose CommentsPermalink

Mrs. MCMORRIS RODGERS introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedCommentsClose CommentsPermalink

A BILLCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to protect and preserve access of Medicare beneficiaries in rural areas to health care providers under the Medicare program, to amend title III of the Public Health Service Act to extend discounts under the 340B program, and for other purposes.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 ‘Rural Hospital and Provider Equity and 340B Improvement Act of 2012’.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--RURAL HOSPITAL AND PROVIDER EQUITY

Sec. 101. Sense of the Congress.CommentsClose CommentsPermalink





Sec. 102. Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals.CommentsClose CommentsPermalink





Sec. 103. 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. 104. Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals.CommentsClose CommentsPermalink





Sec. 105. Extension of Medicare wage index reclassifications for certain hospitals.CommentsClose CommentsPermalink





Sec. 106. Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas.CommentsClose CommentsPermalink





Sec. 107. Elimination of isolation test for cost-based ambulance reimbursement for critical access hospitals.CommentsClose CommentsPermalink





Sec. 108. Extension of Medicare incentive payment program for physician scarcity areas.CommentsClose CommentsPermalink





Sec. 109. Extension of floor on Medicare work geographic adjustment.CommentsClose CommentsPermalink





Sec. 110. Improving care planning for Medicare home health services.CommentsClose CommentsPermalink





Sec. 111. Rural health clinic improvements.CommentsClose CommentsPermalink





Sec. 112. Temporary Medicare payment increase for home health services furnished in a rural area.CommentsClose CommentsPermalink





Sec. 113. Extension of increased Medicare payments for rural ground ambulance services.CommentsClose CommentsPermalink





Sec. 114. Extension of payment for technical component of certain physician pathology services.CommentsClose CommentsPermalink





Sec. 115. Facilitating the provision of telehealth services across State lines.CommentsClose CommentsPermalink





Sec. 116. Medicare Part A payment for anesthesiologist services in certain rural hospitals based on CRNA pass-through rules.CommentsClose CommentsPermalink





Sec. 117. Temporary floor on the practice expense geographic index for services furnished in rural areas outside of frontier States under the Medicare physician fee schedule.CommentsClose CommentsPermalink





Sec. 118. Revisions to standard for designation of sole community hospitals.CommentsClose CommentsPermalink





Sec. 119. State offices of rural health.CommentsClose CommentsPermalink





Sec. 120. Ensuring proportional representation of interests of rural areas on MEDPAC.CommentsClose CommentsPermalink

TITLE II--340B PROGRAM IMPROVEMENT

Sec. 201. Extension of discounts to inpatient drugs.CommentsClose CommentsPermalink





Sec. 202. Prohibition against duplicate discounts for physician administered drugs.CommentsClose CommentsPermalink





Sec. 203. Continued inclusion of orphan drugs in definition of covered outpatient drugs; technical amendment.CommentsClose CommentsPermalink





Sec. 204. Application of rules for determining provider-based status for certain entities.CommentsClose CommentsPermalink

TITLE I--RURAL HOSPITAL AND PROVIDER EQUITYCommentsClose CommentsPermalink

SEC. 101. SENSE OF THE CONGRESS.

It is the sense of the Congress that--CommentsClose CommentsPermalink





(1) residents of rural and frontier communities should have access to affordable, quality health care;CommentsClose CommentsPermalink





(2) rural and frontier communities face unique challenges in health care delivery and financing;CommentsClose CommentsPermalink





(3) Federal health policy must reflect the unique needs of residents of rural and frontier communities and such communities in an equitable and sustainable manner; andCommentsClose CommentsPermalink





(4) stakeholders should work collectively to identify innovative policies that address the availability, delivery, and affordability of health care services in rural and frontier communities.CommentsClose CommentsPermalink

SEC. 102. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE HOSPITAL (DSH) ADJUSTMENT FOR RURAL HOSPITALS.

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 with respect to discharges occurring on or after October 1, 2011, and before October 1, 2012.’.CommentsClose CommentsPermalink

SEC. 103. 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 ‘March 1, 2012’ and inserting ‘January 1, 2013’; andCommentsClose CommentsPermalink





(B) in the second sentence--CommentsClose CommentsPermalink





(i) by striking ‘and 85’ and inserting ‘85’; andCommentsClose CommentsPermalink





(ii) by inserting the following before the period at the end: ‘, and 100 percent with respect to such services furnished in the last 10 months of 2012’; andCommentsClose CommentsPermalink





(2) in subclause (III)--CommentsClose CommentsPermalink





(A) in the first sentence--CommentsClose CommentsPermalink





(i) by striking ‘2009, and before March 1, 2012, for which’ and inserting ‘2009, and before January 1, 2013, for which’; andCommentsClose CommentsPermalink





(ii) by striking ‘85 percent’ and inserting ‘the applicable percentage (as determined under the second sentence of subclause (II) for the year)’; andCommentsClose CommentsPermalink





(B) in the second sentence, by striking ‘2010, and before March 1, 2012, the preceding’ and inserting ‘2010, and before January 1, 2013, the preceding’.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 (C)(i), by inserting ‘and 2,000 discharges, respectively,’ after ‘1,600 discharges’; andCommentsClose CommentsPermalink





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





(A) by striking ‘1,600’ and inserting ‘the applicable number of’; andCommentsClose CommentsPermalink





(B) by adding at the end the following new sentence: ‘For purposes of the preceding sentence, the term ‘applicable number of discharges’ means 1,600 discharges with respect to discharges occurring in fiscal year 2011 and 2,000 discharges with respect to discharges occurring in fiscal year 2012’.CommentsClose CommentsPermalink

SEC. 105. EXTENSION OF MEDICARE WAGE INDEX RECLASSIFICATIONS FOR CERTAIN HOSPITALS.

(a) Extension of Correction of Mid-Year Reclassification Expiration for Certain Hospitals-CommentsClose CommentsPermalink





(1) IN GENERAL- In the case of a hospital described in paragraph (2), the Secretary of Health and Human Services shall apply subsection (a) of section 106 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395ww note), as amended by section 117 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), section 124 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275), sections 3137(a) and 10317 of the Patient Protection and Affordable Care Act (Public Law 111-148), and section 102 of the Medicare and Medicaid Extenders Act of 2010 (Public Law 111-309), by substituting ‘September 30, 2012’ for ‘November 30, 2011’.CommentsClose CommentsPermalink





(2) HOSPITAL DESCRIBED- A hospital described in this paragraph is--CommentsClose CommentsPermalink





(A) a hospital--CommentsClose CommentsPermalink





(i) that is described in subsection (a) of such section 106; andCommentsClose CommentsPermalink





(ii)(I) that is located in a rural area; andCommentsClose CommentsPermalink





(II) for which the Secretary of Health and Human Services has determined the extension under this subsection to be appropriate; orCommentsClose CommentsPermalink





(B) a sole community hospital located in a State with less than 10 people per square mile that was provided with a special exception reclassification extension under section 117(a)(2) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173).CommentsClose CommentsPermalink





(b) Not Budget Neutral- The provisions of this section shall not be effected in a budget-neutral manner.CommentsClose CommentsPermalink

SEC. 106. EXTENSION OF MEDICARE REASONABLE COSTS PAYMENTS FOR CERTAIN CLINICAL DIAGNOSTIC LABORATORY TESTS FURNISHED TO HOSPITAL PATIENTS IN CERTAIN RURAL AREAS.

Section 416(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (42 U.S.C. 1395l-4), as amended by section 105 of division B of the Tax Relief and Health Care Act of 2006 (42 U.S.C. 1395l note), section 107 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395l note), section 3122 of the Patient Protection and Affordable Care Act (Public Law 111-148), and section 109 of the Medicare and Medicaid Extenders Act of 2010 (Public Law 111-309), is amended by striking ‘the 2-year period beginning on July 1, 2010’ and inserting ‘the 30-month period beginning on July 1, 2010’.CommentsClose CommentsPermalink

SEC. 107. ELIMINATION OF ISOLATION TEST FOR COST-BASED AMBULANCE REIMBURSEMENT FOR CRITICAL ACCESS HOSPITALS.

(a) In General- Section 1834(l)(8) of the Social Security Act (42 U.S.C. 1395m(l)(8)) is amended--CommentsClose CommentsPermalink





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





(A) by striking ‘owned and’; andCommentsClose CommentsPermalink





(B) by inserting ‘(including when such services are provided by the entity under an arrangement with the hospital)’ after ‘hospital’; andCommentsClose CommentsPermalink





(2) by striking the comma at the end of subparagraph (B) and all that follows and inserting a period.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by this section shall apply to services furnished on or after January 1, 2012.CommentsClose CommentsPermalink

SEC. 108. EXTENSION OF MEDICARE INCENTIVE PAYMENT PROGRAM FOR PHYSICIAN SCARCITY AREAS.

Section 1833(u)(1) of the Social Security Act (42 U.S.C. 1395l(u)(1)) is amended by inserting ‘, and such services furnished on or after January 1, 2012, and before January 1, 2013’ after ‘2008’.CommentsClose CommentsPermalink

SEC. 109. EXTENSION OF FLOOR ON MEDICARE WORK GEOGRAPHIC ADJUSTMENT.

Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-4(e)(1)(E)) is amended by striking ‘before March 1, 2012’ and inserting ‘before January 1, 2013’.CommentsClose CommentsPermalink

SEC. 110. IMPROVING CARE PLANNING FOR MEDICARE HOME HEALTH SERVICES.

(a) Part A Provisions- Section 1814(a) of the Social Security Act (42 U.S.C. 1395f(a)) is amended--CommentsClose CommentsPermalink





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





(A) in the matter preceding subparagraph (A), by inserting ‘, a nurse practitioner or clinical nurse specialist who is working in collaboration with a physician in accordance with State law, a certified nurse-midwife (as defined in section 1861(gg)) as authorized by State law, or a physician assistant (as defined in section 1861(aa)(5)) under the supervision of a physician’ after ‘1866(j)’; andCommentsClose CommentsPermalink





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





(i) by inserting ‘, a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant (as the case may be)’ after ‘physician’ the first 2 times it appears; andCommentsClose CommentsPermalink





(ii) by striking ‘, and, in the case of a certification made by a physician’ and all that follows through ‘face-to-face encounter’ and inserting ‘, and, in the case of a certification made by a physician after January 1, 2010, or by a nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant (as the case may be) after January 1, 2012, prior to making such certification the physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant must document that the physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant has had a face-to-face encounter’;CommentsClose CommentsPermalink





(2) in the second sentence, by inserting ‘certified nurse-midwife,’ after ‘clinical nurse specialist,’;CommentsClose CommentsPermalink





(3) in the third sentence--CommentsClose CommentsPermalink





(A) by striking ‘physician certification’ and inserting ‘certification’;CommentsClose CommentsPermalink





(B) by inserting ‘(or on January 1, 2012, in the case of regulations to implement the amendments made by section 11 of the Rural Hospital and Provider Equity and 340B Improvement Act of 2012)’ after ‘1981’; andCommentsClose CommentsPermalink





(C) by striking ‘a physician who’ and inserting ‘a physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant who’; andCommentsClose CommentsPermalink





(4) in the fourth sentence, by inserting ‘, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant’ after ‘physician’.CommentsClose CommentsPermalink





(b) Part B Provisions- Section 1835(a) of the Social Security Act (42 U.S.C. 1395n(a)) is amended--CommentsClose CommentsPermalink





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





(A) in the matter preceding subparagraph (A), by inserting ‘, a nurse practitioner or clinical nurse specialist (as those terms are defined in section 1861(aa)(5)) who is working in collaboration with a physician in accordance with State law, a certified nurse-midwife (as defined in section 1861(gg)) as authorized by State law, or a physician assistant (as defined in section 1861(aa)(5)) under the supervision of a physician’ after ‘1866(j)’; andCommentsClose CommentsPermalink





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





(i) in each of clauses (ii) and (iii) of subparagraph (A) by inserting ‘, a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant (as the case may be)’ after ‘physician’; andCommentsClose CommentsPermalink





(ii) in clause (iv), by striking ‘after January 1, 2010’ and all that follows through ‘face-to-face encounter’ and inserting ‘made by a physician after January 1, 2010, or by a nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant (as the case may be) after January 1, 2012, prior to making such certification the physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant must document that the physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant has had a face-to-face encounter’;CommentsClose CommentsPermalink





(2) in the third sentence, by inserting ‘, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant (as the case may be)’ after ‘physician’;CommentsClose CommentsPermalink





(3) in the fourth sentence--CommentsClose CommentsPermalink





(A) by striking ‘physician certification’ and inserting ‘certification’;CommentsClose CommentsPermalink





(B) by inserting ‘(or on January 1, 2012, in the case of regulations to implement the amendments made by section 11 of the Rural Hospital and Provider Equity and 340B Improvement Act of 2012)’ after ‘1981’; andCommentsClose CommentsPermalink





(C) by striking ‘a physician who’ and inserting ‘a physician, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant who’; andCommentsClose CommentsPermalink





(4) in the fifth sentence, by inserting ‘, nurse practitioner, clinical nurse specialist, certified nurse-midwife, or physician assistant’ after ‘physician’.CommentsClose CommentsPermalink





(c) Definition Provisions-CommentsClose CommentsPermalink





(1) HOME HEALTH SERVICES- Section 1861(m) of the Social Security Act (42 U.S.C. 1395x(m)) is amended--CommentsClose CommentsPermalink





(A) in the matter preceding paragraph (1)--CommentsClose CommentsPermalink





(i) by inserting ‘, a nurse practitioner or a clinical nurse specialist (as those terms are defined in subsection (aa)(5)), a certified nurse-midwife (as defined in section 1861(gg)), or a physician assistant (as defined in subsection (aa)(5))’ after ‘physician’ the first place it appears; andCommentsClose CommentsPermalink





(ii) by inserting ‘, a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant’ after ‘physician’ the second place it appears; andCommentsClose CommentsPermalink





(B) in paragraph (3), by inserting ‘, a nurse practitioner, a clinical nurse specialist, a certified nurse-midwife, or a physician assistant’ after ‘physician’.CommentsClose CommentsPermalink





(2) HOME HEALTH AGENCY- Section 1861(o)(2) of the Social Security Act (42 U.S.C. 1395x(o)(2)) is amended--CommentsClose CommentsPermalink





(A) by inserting ‘, nurse practitioners or clinical nurse specialists (as those terms are defined in subsection (aa)(5)), certified nurse-midwives (as defined in section 1861(gg)), or physician assistants (as defined in subsection (aa)(5))’ after ‘physicians’; andCommentsClose CommentsPermalink





(B) by inserting ‘, nurse practitioner, clinical nurse specialist, certified nurse-midwife, physician assistant,’ after ‘physician’.CommentsClose CommentsPermalink





(d) Home Health Prospective Payment System Provisions- Section 1895 of the Social Security Act (42 U.S.C. 1395fff) is amended--CommentsClose CommentsPermalink





(1) in subsection (c)(1), by inserting ‘, the nurse practitioner or clinical nurse specialist (as those terms are defined in section 1861(aa)(5)), the certified nurse-midwife (as defined in section 1861(gg)), or the physician assistant (as defined in section 1861(aa)(5)),’ after ‘physician’; andCommentsClose CommentsPermalink





(2) in subsection (e)--CommentsClose CommentsPermalink





(A) in paragraph (1)(A), by inserting ‘, a nurse practitioner or clinical nurse specialist (as those terms are defined in section 1861(aa)(5)), a certified nurse-midwife (as defined in section 1861(gg)), or a physician assistant (as defined in section 1861(aa)(5))’ after ‘physician’; andCommentsClose CommentsPermalink





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





(i) in the heading, by striking ‘PHYSICIAN CERTIFICATION’ and inserting ‘RULE OF CONSTRUCTION REGARDING REQUIREMENT FOR CERTIFICATION’; andCommentsClose CommentsPermalink





(ii) by striking ‘physician’.CommentsClose CommentsPermalink





(e) Effective Date- The amendments made by this section shall apply to items and services furnished on or after January 1, 2012.CommentsClose CommentsPermalink

SEC. 111. 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 2012)’ 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 2012, at $101 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) applicable to primary care services (as so defined) furnished as of the first day of that year.’.CommentsClose CommentsPermalink

SEC. 112. TEMPORARY MEDICARE PAYMENT INCREASE FOR HOME HEALTH SERVICES FURNISHED IN A RURAL AREA.

Section 421(a) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2283), as amended by section 5201(b) of the Deficit Reduction Act of 2005 (Public Law 109-171; 120 Stat. 46) and section 3131(c) of the Patient Protection and Affordable Care Act (Public Law 111-148; 124 Stat. 428), is amended by striking ‘2016, 3 percent’ and inserting ‘2011, and episodes and visits ending on or after January 1, 2013, and before January 1, 2016, 3 percent’.CommentsClose CommentsPermalink

SEC. 113. EXTENSION OF INCREASED MEDICARE PAYMENTS FOR RURAL GROUND AMBULANCE SERVICES.

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





(1) in the matter preceding clause (i)--CommentsClose CommentsPermalink





(A) by striking ‘2007, and for’ and inserting ‘2007, for’; andCommentsClose CommentsPermalink





(B) by inserting ‘, and for such services described in clause (i) furnished on or after March 1, 2012, and before January 1, 2013’ after ‘2012’; andCommentsClose CommentsPermalink





(2) in clause (i), by inserting ‘, or 5 percent if such service is furnished on or after March 1, 2012, and before January 1, 2013’ after ‘2012’.CommentsClose CommentsPermalink





(b) Super Rural Ambulance- Section 1834(l)(12)(A) of the Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended by striking ‘March 1, 2012’ and inserting ‘January 1, 2013’.CommentsClose CommentsPermalink

SEC. 114. EXTENSION OF PAYMENT FOR TECHNICAL COMPONENT OF CERTAIN PHYSICIAN PATHOLOGY SERVICES.

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), section 104 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 110-173), section 136 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275), section 3104 of the Patient Protection and Affordable Care Act (Public Law 111-148), section 105 of the Medicare and Medicaid Extenders Act of 2010 (Public Law 111-309), and section 305 of the Temporary Payroll Tax Cut Continuation Act of 2011 (Public Law 112-78) is amended by striking ‘the first two months of’.CommentsClose CommentsPermalink

SEC. 115. FACILITATING THE PROVISION OF TELEHEALTH SERVICES ACROSS STATE LINES.

(a) In General- For purposes of expediting the provision of telehealth services, for which payment is made under the Medicare program, across State lines, the Secretary of Health and Human Services shall, in consultation with representatives of States, physicians, health care practitioners, and patient advocates, encourage and facilitate the adoption of provisions allowing for multistate practitioner practice across State lines.CommentsClose CommentsPermalink





(b) Definitions- In subsection (a):CommentsClose CommentsPermalink





(1) TELEHEALTH SERVICE- The term ‘telehealth service’ has the meaning given that term in subparagraph (F) of section 1834(m)(4) of the Social Security Act (42 U.S.C. 1395m(m)(4)).CommentsClose CommentsPermalink





(2) PHYSICIAN, PRACTITIONER- The terms ‘physician’ and ‘practitioner’ have the meaning given those terms in subparagraphs (D) and (E), respectively, of such section.CommentsClose CommentsPermalink





(3) MEDICARE PROGRAM- The term ‘Medicare program’ means the program of health insurance administered by the Secretary of Health and Human Services under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).CommentsClose CommentsPermalink

SEC. 116. 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:CommentsClose CommentsPermalink

‘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 added by section 608(c)(2) of the Family Support Act of 1988 and amended by section 6132 of the Omnibus Budget Reconciliation Act of 1989, (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 9320(k).CommentsClose CommentsPermalink





‘(2) No payment shall be made under any other provision of this title for physicians’ services for which payment is made under this subsection.CommentsClose CommentsPermalink





‘(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 added and amended, except that--CommentsClose CommentsPermalink





‘(A) any reference in such section to a ‘certified registered nurse anesthetist’ or an ‘anesthetist’ is deemed a reference to a ‘physician who is an anesthesiologist’ or an ‘anesthesiologist’, respectively; andCommentsClose CommentsPermalink





‘(B) any reference to ‘January 1, 1988’ or ‘1987’ is deemed a reference to such date and year as the Secretary shall specify.’.CommentsClose CommentsPermalink





(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.CommentsClose CommentsPermalink

SEC. 117. TEMPORARY FLOOR ON THE PRACTICE EXPENSE GEOGRAPHIC INDEX FOR SERVICES FURNISHED IN RURAL AREAS OUTSIDE OF FRONTIER STATES UNDER THE MEDICARE PHYSICIAN FEE SCHEDULE.

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), by striking ‘and (I)’ and inserting ‘(I), and (J)’; andCommentsClose CommentsPermalink





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





‘(J) FLOOR AT 1.0 ON PRACTICE EXPENSE GEOGRAPHIC INDEX FOR SERVICES FURNISHED IN RURAL AREAS OUTSIDE OF FRONTIER STATES- For purposes of payment for services furnished in a rural area (other than a rural area located in a State to which subparagraph (I) applies) on or after January 1, 2012, and before January 1, 2013, after calculating the practice expense index under subparagraph (A)(i), the Secretary shall increase any such index to 1.0 if such index would otherwise be less than 1.0. The preceding sentence shall not be applied in a budget neutral manner.’.CommentsClose CommentsPermalink

SEC. 118. REVISIONS TO STANDARD FOR DESIGNATION OF SOLE COMMUNITY HOSPITALS.

Section 1886(d)(5)(D)(iv) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(D)(iv)) is amended by adding at the end the following new sentence: ‘Under such standard, the time required for an individual to travel to the nearest alternative source of care shall be measured over improved roads maintained by a local, State, or Federal Government entity for use by the general public which is the most expeditious and accessible route as designated by law enforcement for emergency vehicle travel.’.CommentsClose CommentsPermalink

SEC. 119. STATE OFFICES OF RURAL HEALTH.

Section 338J(j)(1) of the Public Health Service Act (42 U.S.C. 254r(j)(1)) is amended by inserting ‘and 2012 through 2013’ before the period.CommentsClose CommentsPermalink

SEC. 120. ENSURING PROPORTIONAL REPRESENTATION OF INTERESTS OF RURAL AREAS ON MEDPAC.

(a) In General- Section 1805(c)(2) of the Social Security Act (42 U.S.C. 1395b-6(c)(2)) is amended--CommentsClose CommentsPermalink





(1) in subparagraph (A), by inserting ‘(consistent with the requirements of subparagraph (E))’ after ‘rural representatives’; andCommentsClose CommentsPermalink





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





‘(E) PROPORTIONAL REPRESENTATION OF INTERESTS OF RURAL AREAS- In order to provide a balance between urban and rural representatives under subparagraph (A), the proportion of members who represent the interests of health care providers and Medicare beneficiaries located in rural areas shall be no less than the proportion of the total number of Medicare beneficiaries who reside in rural areas.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by subsection (a) shall apply to appointments made to the Medicare Payment Advisory Commission after the date of the enactment of this Act.CommentsClose CommentsPermalink

TITLE II--340B PROGRAM IMPROVEMENTCommentsClose CommentsPermalink

SEC. 201. EXTENSION OF DISCOUNTS TO INPATIENT DRUGS.

(a) In General- Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended--CommentsClose CommentsPermalink





(1) in subsection (a)--CommentsClose CommentsPermalink





(A) in paragraphs (1), (2), and (5), by striking ‘covered outpatient drug’ each place such term appears and inserting ‘covered drug’; andCommentsClose CommentsPermalink





(B) in paragraphs (1), (7), and (9), by striking ‘covered outpatient drugs’ each place such term appears and inserting ‘covered drugs’;CommentsClose CommentsPermalink





(2) in subsection (b)(2)(B) by striking ‘paragraph (3)(A)’ and inserting ‘paragraph (3)’; andCommentsClose CommentsPermalink





(3) in subsection (d), by striking ‘covered outpatient drugs’ each place such term appears and inserting ‘covered drugs’.CommentsClose CommentsPermalink





(b) Medicaid Credits on Inpatient Drugs- Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended by inserting after subsection (b) the following new subsection:CommentsClose CommentsPermalink





‘(c) Medicaid Credits on Inpatient Drugs-CommentsClose CommentsPermalink





‘(1) IN GENERAL- For each cost reporting period, based on the most recently filed Medicare cost report under title XVIII of the Social Security Act and subject to paragraph (5), a hospital described in subparagraph (L), (M), (N), or (O) of subsection (a)(4) and enrolled to participate in the drug discount program under this section shall provide to each State that has a plan for medical assistance under title XIX of such Act and that makes payment to such hospital for covered drugs provided to Medicaid recipients for inpatient use, a credit on the estimated annual purchases by such hospital of such covered drugs provided to such Medicaid recipients.CommentsClose CommentsPermalink





‘(2) AMOUNT OF CREDIT-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The credit described in paragraph (1), with respect to a hospital and cost reporting period described in such paragraph shall be equal to--CommentsClose CommentsPermalink





‘(i) the product of--CommentsClose CommentsPermalink





‘(I) the sum of the annual credit amounts (described in subparagraph (B)) calculated under subparagraph (B)(i) for each dosage form and strength of each covered drug purchased by the hospital during the cost reporting period; andCommentsClose CommentsPermalink





‘(II) the estimated percentage of the purchases of covered drugs by the hospital during such period attributable to Medicaid recipients for inpatient use, as determined in accordance with subparagraph (D); andCommentsClose CommentsPermalink





‘(ii) subject to paragraph (3)(D), reduced by the amount by which the Medicaid inpatient reimbursement (as defined in subparagraph (E)(ii)) of the hospital for such period was reduced as a result of participation in the drug discount program under this section during such period by the hospital, as determined in accordance with subparagraph (E).CommentsClose CommentsPermalink





‘(B) ANNUAL CREDIT AMOUNTS- For purposes of subparagraph (A)(i)(I), an annual credit amount, with respect to a covered drug purchased by a hospital described in paragraph (1) during a cost reporting period of the hospital--CommentsClose CommentsPermalink





‘(i) is equal to the sum of the quarterly credit amounts calculated under subparagraph (C)(i), for each of the 4 quarters of the cost reporting period for such covered drug; andCommentsClose CommentsPermalink





‘(ii) shall be calculated for each dosage form and strength of such covered drug.CommentsClose CommentsPermalink





‘(C) QUARTERLY CREDIT AMOUNTS- For purposes of subparagraph (B)(ii), a quarterly credit amount, with respect to a covered drug purchased by a hospital described in paragraph (1) during a quarter of the cost reporting period of the hospital--CommentsClose CommentsPermalink





‘(i) is equal to the product of--CommentsClose CommentsPermalink





‘(I) the total number of units of each dosage form and strength of such covered drug purchased by the hospital during such quarter;CommentsClose CommentsPermalink





‘(II) the average manufacturer price of the covered drug (for the unit of the dosage form and strength involved) during such quarter; andCommentsClose CommentsPermalink





‘(III) half of the rebate percentage for the covered drug, as defined in subsection (a)(2); andCommentsClose CommentsPermalink





‘(ii) shall be calculated for--CommentsClose CommentsPermalink





‘(I) each dosage form and strength of the covered drug purchased by the hospital; andCommentsClose CommentsPermalink





‘(II) each of the 4 quarters of such cost reporting period.CommentsClose CommentsPermalink





‘(D) PERCENTAGE OF DRUG PURCHASES ATTRIBUTABLE TO MEDICAID RECIPIENTS FOR IMPATIENT USE- For purposes of subparagraph (A)(i)(II), the estimated percentage of the drug purchases of the hospital attributable to Medicaid recipients for inpatient use shall be equal to the Medicaid inpatient drug charges as reported on the most recently filed Medicare cost report of the hospital, divided by the total drug charges reported on the cost report.CommentsClose CommentsPermalink





‘(E) CREDIT OFFSET-CommentsClose CommentsPermalink





‘(i) IN GENERAL- For purposes of subparagraph (A)(ii), the amount by which the Medicaid inpatient reimbursement of a hospital, with respect to a cost reporting period, is reduced as a result of the participation in the drug discount program under this section by the hospital shall be computed as the difference between--CommentsClose CommentsPermalink





‘(I) the Medicaid inpatient reimbursement that would have otherwise been payable to the hospital for the cost reporting period if the hospital did not participate in such drug discount program; andCommentsClose CommentsPermalink





‘(II) the actual Medicaid inpatient reimbursement payable to the hospital for the cost reporting period.CommentsClose CommentsPermalink





‘(ii) MEDICAID INPATIENT REIMBURSEMENT DEFINED- For purposes of this subsection, the term ‘Medicaid inpatient reimbursement’ means the total payments received by the hospital under the State plan under title XIX of the Social Security Act for providing inpatient services to Medicaid recipients.CommentsClose CommentsPermalink





‘(3) REQUIREMENTS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- A hospital shall not be required to provide a credit under paragraph (1) to a State unless, not later than 30 days after receiving the information described in subparagraph (B), the State calculates in accordance with paragraph (2) the amount of the credit owed by the hospital under paragraph (1) and provides the hospital with both the amount of such credit so owed and an explanation of how the State calculated such credit.CommentsClose CommentsPermalink





‘(B) HOSPITAL PROVISION OF INFORMATION- Not later than 30 days after the date of the filing of the most recently filed Medicare cost report of a hospital described in paragraph (1), the hospital shall provide the State involved with the information described in subparagraphs (C)(i)(I) and (D) of paragraph (2). With respect to each covered drug purchased during the cost reporting period, the hospital shall provide the National Drug Code, date of purchase, and the number of units purchased. Submission of such information shall not be required if a covered drug has not been assigned a National Drug Code at the time of purchase.CommentsClose CommentsPermalink





‘(C) ACCESS TO AMP AND REBATE DATA- The Secretary shall establish a system for giving States access to the information necessary for them to calculate credits under paragraph (2), with respect to covered drugs, including the average manufacturer price and rebate percentage for such covered drugs.CommentsClose CommentsPermalink





‘(D) CREDIT OFFSET- Paragraph (2)(A)(ii) shall be applied, with respect to a credit owed by a hospital under paragraph (1), only if, not later than 30 days after filing the most recent Medicare cost report, the hospital submits to the State involved--CommentsClose CommentsPermalink





‘(i) a request for the State to apply such paragraph and to calculate the amount described in such paragraph in accordance with paragraph (2)(E); andCommentsClose CommentsPermalink





‘(ii) the data needed by the State to determine the amount of the Medicaid inpatient reimbursement described in paragraph (2)(E)(i)(I) for such hospital.CommentsClose CommentsPermalink





‘(E) DISPUTES- A State and hospital described in paragraph (1) shall have access to the same State dispute resolution procedures and system applicable to Medicaid reimbursement matters under title XIX of the Social Security Act.CommentsClose CommentsPermalink





‘(4) PAYMENT DEADLINE- A hospital shall provide to a State the credits owed by such hospital under paragraph (1) not later than 60 days after the hospital receives the information described in paragraph (3)(A).CommentsClose CommentsPermalink





‘(5) OPT OUT- A hospital shall not be required to provide a credit under paragraph (1) to a State if the hospital and State agree to an alternative arrangement.CommentsClose CommentsPermalink





‘(6) OFFSET AGAINST MEDICAL ASSISTANCE- Amounts received by a State under this subsection shall be considered to be a reduction in the amount expended under the State plan for medical assistance for purposes of section 1903(a)(1) of the Social Security Act.CommentsClose CommentsPermalink





‘(7) MEDICAID RECIPIENT DEFINED- For purposes of this subsection, the term ‘Medicaid recipient’ means, with respect to a State, an individual who receives benefits under the State plan under title XIX of the Social Security Act.’.CommentsClose CommentsPermalink





(c) Conforming Amendments- Section 1927 of the Social Security Act (42 U.S.C. 1396r-8) is amended--CommentsClose CommentsPermalink





(1) in subsection (a)(5)--CommentsClose CommentsPermalink





(A) in subparagraph (A), by striking ‘covered outpatient drugs’ and inserting ‘covered drugs (as defined in section 340B(b)(2) of the Public Health Service Act)’; andCommentsClose CommentsPermalink





(B) by striking subparagraphs (D) and (E); andCommentsClose CommentsPermalink





(2) in subsection (c)(1)(C)(i)--CommentsClose CommentsPermalink





(A) by redesignating subclauses (II) through (VI) as subclauses (III) through (VII), respectively; andCommentsClose CommentsPermalink





(B) by inserting after subclause (I) the following:CommentsClose CommentsPermalink





‘(II) any prices charged for a covered drug, as defined in section 340B(b)(2) of the Public Health Service Act;’.CommentsClose CommentsPermalink

SEC. 202. PROHIBITION AGAINST DUPLICATE DISCOUNTS FOR PHYSICIAN ADMINISTERED DRUGS.

Section 340B(a)(5)(A) of the Public Health Service Act (42 U.S.C. 256b) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(iii) PHYSICIAN ADMINISTERED DRUGS- A hospital described in subparagraph (L), (M), (N), or (O) of paragraph (4) shall not be required under section 1927(a)(7) of the Social Security Act to report National Drug Code numbers for drugs administered by a physician (or under a physician’s supervision) if the State is precluded from seeking a rebate on such drugs because such drugs were purchased at a discount under this section. Nothing in this clause shall relieve a hospital of its obligation to submit National Drug Codes in accordance with subsection (c)(3)(B).’.CommentsClose CommentsPermalink

SEC. 203. CONTINUED INCLUSION OF ORPHAN DRUGS IN DEFINITION OF COVERED OUTPATIENT DRUGS; TECHNICAL AMENDMENT.

(a) In General- Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended by striking subsection (e).CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by subsection (a) shall apply to drugs purchased on or after March 30, 2010.CommentsClose CommentsPermalink

SEC. 204. APPLICATION OF RULES FOR DETERMINING PROVIDER-BASED STATUS FOR CERTAIN ENTITIES.

Notwithstanding any other provision of law, in making determinations of provider-based status under title XVIII of the Social Security Act, the facility or organization shall be treated as satisfying any requirements and standards for geographic location in relation to a hospital or a critical access hospital if the facility or organization is described in subparagraph (L), (M), (N), or (O) of section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 256b(a)(4)).CommentsClose CommentsPermalink