[House Report 107-540]
[From the U.S. Government Publishing Office]
107th Congress Rept. 107-540
HOUSE OF REPRESENTATIVES
2d Session Part 1
======================================================================
MEDICARE MODERNIZATION AND PRESCRIPTION DRUG ACT OF 2002 (TITLE III:
RURAL HEALTH CARE IMPROVEMENTS)
_______
June 26, 2002.--Ordered to be printed
_______
Mr. Tauzin, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 4962]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 4962) to amend title XVIII of the Social
Security Act to make rural health care improvements under the
medicare program, having considered the same, report favorably
thereon without amendment and recommend that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 1
Background and Need for Legislation.............................. 2
Hearings......................................................... 2
Committee Consideration.......................................... 2
Committee Votes.................................................. 2
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 4
Advisory Committee Statement..................................... 4
Constitutional Authority Statement............................... 4
Applicability to Legislative Branch.............................. 5
Section-by-Section Analysis of the Legislation................... 5
Changes in Existing Law Made by the Bill, as Reported............ 8
Purpose and Summary
The purpose of H.R. 4962 is to increase incentives for
providers to serve beneficiaries in rural areas and communities
to ensure that beneficiaries have continued access to the best
medical care possible.
Background and Need for Legislation
The geographic isolation, low population density, and poor
economic conditions associated with rural areas often serve as
impediments to Medicare beneficiaries getting the medical care
they want and need. These barriers also impose financial
hardships on providers and make it difficult to recruit
physicians and other health professionals into rural areas.
Concerned that Medicare beneficiaries living in rural areas may
not receive the care they need while many rural providers
continue to experience financial hardship, the Committee worked
in collaboration with the Committee on Ways and Means to
develop the provisions included in H.R. 4962.
The financial status of rural hospitals and home health
agencies continues to be a source of concern for the Committee.
Rural hospitals rely more on Medicare and on outpatient
services as sources of revenue than do urban hospitals. The
home health prospective payment system may not adequately
account for the unique conditions facing home health agencies
that operate in rural areas.
There are also differences in payment amounts under the
physician fee schedule for physicians' services furnished in
different geographical areas. Physician fees are made up of
three components: work, practice expense, and malpractice.
About 14% of the average physician fee is adjusted based on the
value of their wages in the area of the country where they
practice. While economists support this geographic adjustment
of payment, many physicians feel they practice in a national
market and therefore deserve a more level playing field for
payment.
Hearings
The Committee on Energy and Commerce has not held hearings
on the legislation.
Committee Consideration
On Wednesday, June 19, 2002, the Full Committee met in open
markup session and favorably ordered reported a Committee Print
on Rural Health Care Improvements. Chairman Tauzin then
introduced H.R. 4962 to reflect the Committee's action.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto. The
following are the recorded votes taken on the amendments
offered to the measure, including the names of those members
voting for and against. A motion by Mr. Tauzin to order H.R.
4962 reported to the House, without amendment, was agreed to by
a voice vote.
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee has not held oversight
or legislative hearings on this legislation.
Statement of General Performance Goals and Objectives
The objective of H.R. 4962 is to increase incentives for
providers to serve beneficiaries in rural areas and communities
to ensure that these beneficiaries continue to have access to
the best hospital, home health, hospice, physician, and health
center services possible.
New Budget Authority, Entitlement Authority, and Tax Expenditures
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
4962, to amend title XVIII of the Social Security Act to make
rural health care improvements under the Medicare Program,
would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974, which is
included in the report to accompany H.R. 4984.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the cost estimate provided by the
Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974 is included in the report to
accompany H.R. 4984.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act. The estimate is included in the report to accompany H.R.
4984.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for this legislation is provided in
Article I, section 8, clause 3, which grants Congress the power
to regulate commerce with foreign nations, among the several
States, and with the Indian tribes.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
Section 301. Reference to Full Market Basket Increase for Sole
Community Hospitals
Section 301 will eliminate the reduction from the market
based index (MBI) update specified in Section 401(a) for sole
community hospitals (SCHs) for FY 2003 (see section 401).
This section is effective upon enactment.
Section 302. Enhanced Disproportionate Share Hospital (DSH) Treatment
for Rural and Urban Hospitals with Fewer than 100 Beds
Section 302 states that starting for discharges on or after
October 1, 2002, the DSH adjustment that rural and small urban
hospitals receive is based on a blend of their current DSH
adjustment and the current DSH adjustment for large urban
hospitals. However, the new DSH adjustment would not exceed 10%
for any hospital that was not classified as a rural referral
center. A hospital's new DSH adjustment will be calculated
using 80% of the existing DSH adjustment in FY 2003; 60% in FY
2004; 20% in FY 2006; and 0% in FY 2007 and subsequently.
Section 303. 2-Year Phased-In Increase in the Standardized Amount in
Rural and Small Urban Areas to Achieve a Single, Uniform
Standardized Amount
Section 303 provides for discharges occurring in FY 2003,
the average standardized amount for rural and small urban
hospitals would be increased by half the difference between the
current amount and the larger standardized amount paid to the
hospitals in large urban areas. For discharges occurring in FY
2004, the Secretary will compute one standardized amount for
hospitals located in any area equal to the average standardized
amount for hospitals in large urban areas computed for the
previous year and increased by the applicable update. For
discharges occurring in FY 2005, the Secretary will compute one
standardized amount for hospitals located in any area equal to
the average standardized amount computed for the previous year
for all hospitals increased by the applicable update.
This section is effective upon enactment.
Section 304. More Frequent Update in Weights Used in Hospital Market
Basket.
Section 304 directs the Secretary to revise the MBI cost
weights to reflect the most current data available and to
establish a schedule for revising the cost weights with the
most current data available more often than once every 5 years.
The Secretary is required to submit a report to Congress by
October 1, 2003 on the reasons for and the options considered
in establishing such a schedule.
This section is effective upon enactment.
Section 305. Improvement to Critical Access Hospital Program
Section 305(a) states that starting with payments made on
or after January 1, 2003, eligible critical access hospitals
(CAHs) will be able to receive payments made on a PIP basis for
inpatient services.
This provision is effective starting with payments made on
or after January 1, 2003.
Section 305(b) precludes the Secretary from requiring that
all physicians providing services in a CAH assign their billing
right to the CAH in order for it to be able to be paid at 115%
of the fee schedule for the professional services provided by
the physicians. A CAH cannot receive payment based on 115% of
the fee schedule for any individual physician who did not
assign billing rights to the CAH.
This provision is effective as if included in the Balanced
Budget Refinement Act of 1999 (BBRA), P.L. 106-113.
Section 305(c) requires the Secretary to specify standards
for determining whether a CAH has seasonal variations in
patient admissions that would justify a 5-bed increase in the
number of beds it can maintain (and still retain its
classification as a CAH).
This provision applies to designations made on or after
January 1, 2003, but would not apply to CAHs that were
designated as of that date.
Section 305(d) extends the grant program that permits
annual appropriations from Medicare's Federal Hospital
Insurance Trust Fund of $25 million through FY 2007.
This section is effective upon enactment.
Section 306. Extension of Temporary Increase for Home Health Services
Furnished in a Rural Area
Section 306 extends the 10% additional payment for home
health services furnished in rural areas through the end of
calendar year 2004.
This section is effective upon enactment.
Section 307. Reference to 10 Percent Increase in Payment for Hospice
Care Furnished in a Frontier Area and Rural Hospice
Demonstration Project
Section 307 increases by 10% the Medicare daily payment
rate for hospice care furnished in a frontier area on or after
January 1, 2003, and before January 1, 2008. A frontier area is
defined as a county in which the population density is less
than 7 persons per square mile. The GAO is required to submit a
report to Congress, not later than January 1, 2007, on the
costs of furnishing hospice care in frontier areas. The report
must include recommendations regarding the appropriateness of
extending, and modifying, the payment increase provided under
this section (see section 422).
This section requires the Secretary to conduct a
demonstration project for the delivery of hospice care for
beneficiaries in rural areas. Under the project, beneficiaries
who are unable to receive hospice care at home because they
lack an appropriate caregiver will be provided such care in a
facility of 20 or fewer beds, which offers within its walls the
full range of covered hospice benefits. The project is limited
to three hospice programs over a period of 3 years for each.
The hospice programs participating in the project will comply
with requirements otherwise applicable to hospice care, except
that they will not be required to offer services outside the
home nor be subject to the limitation on inpatient days.
Payments will be at the same rates. The Secretary may require
the participating programs to comply with additional quality
assurance standards for provisions of services in their
facilities. The Secretary is required to submit a report to
Congress, including recommendations regarding extension of such
project to all programs serving rural areas upon completion of
the project (see section 423).
This section is effective upon enactment.
Section 308. Reference to Priority for Hospitals Located in Rural or
Small Urban Areas in Redistribution of Unused Graduate Medical
Education Residencies
Section 308 redistributes unused resident positions.
Starting on July 1, 2003, hospitals can apply to receive these
unfilled positions and applications will be accepted through
December 31, 2004. The Secretary will consider the need for an
increase by specialty and location, first distributing an
increase to programs or hospitals located in rural or small
urban areas on a first-come, first-served basis, based on a
demonstration that the hospital will fill the positions made
available under this clause. No hospital can receive more than
an increase of 25 full-time equivalent positions during this
redistribution process. Hospitals will be reimbursed for direct
graduate medical education costs for the new positions they
receive at 100% of the adjusted national average per resident
amount. Those hospitals that have unfilled positions (they have
not reached their cap on the number of residents for which
Medicare will pay direct graduate medical education costs) and
have not met their cap over the past 3 cost reporting periods
will have their cap adjusted. Starting January 1, 2003, their
cap will be reduced by 75% of the difference between the cap
and the highest number of filled positions over the past 3 cost
reporting periods. In other words, their cap will be adjusted
to reflect the highest number of filled positions over the past
3 cost reporting periods, plus 25% of the remaining unfilled
positions. Those hospitals that fill positions during the cost
reporting period that includes July 1, 2002 can apply to the
Secretary for an adjustment to reflect a greater number of
filled positions than would otherwise be demonstrated based on
their past 3 cost reporting periods.
Reductions in resident counts would affect a hospital's
indirect medical education (IME) adjustment. Any resulting
increase in resident counts would not affect a hospital's IME
adjustment.
This section requires the Secretary to submit a report to
Congress by July 1, 2004, which recommends whether to extend
the application deadline for increases in resident limits.
This section is effective upon enactment.
Section 309. GAO Study of Geographic Differences in Payments for
Physician Services
Section 309 requires the Comptroller General to conduct a
study of differences in payment amounts under the physician fee
schedule for physicians' services furnished in different
geographical areas. This study will include an assessment of
the validity of the geographic adjustment factors used for each
component of the fee schedule, an evaluation of the measures
used for such adjustment (including the frequency of
revisions), and an evaluation of the methods used to determine
professional liability costs used in computing the malpractice
component. Within 1 year of enactment, the Comptroller General
will submit to Congress a report detailing the results of this
study with recommendations regarding the use of more current
data in computing geographic cost of practice indices and the
use of data directly representative of physicians' costs
(rather than proxy measures of such costs).
This section is effective upon enactment.
Section 310. Providing Safe Harbor for Certain Collaborative Efforts
that Benefit Medically Underserved Populations
Section 310 creates a safe harbor for certain health center
arrangements that contribute to the ability of such centers to
maintain or increase the availability, or enhance the quality,
of services provided to medically underserved populations
served by the health center. Coverage under the safe harbor is
limited to agreements between a health center receiving grant
money under section 330 of the Public Health Service Act and
any individual or entity providing goods, items, services,
donations, or loans to the health center. As Section 330
grantees, these health centers serve medically underserved
areas or medically underserved populations and are obligated to
provide primary care services to patients regardless of their
ability to pay.
The Committee is aware that health centers are required, as
a condition of their grant, to establish and maintain
collaborative agreements with other health care providers in
their catchment area. To comply with this requirement and to
assure access to a broad range of services for the increasing
number of uninsured patients in their service area, some health
centers seek out (and/or are offered) opportunities to enter
into arrangements with hospitals or other providers, which
promise to enhance service access or quality for their
uninsured patients.
It is the Committee's understanding that both health
centers and the providers with whom they might contract have
been reluctant to enter into these arrangements since they
might be viewed as violating the federal anti-kickback law if
there is any intent on the part of either of the parties to
induce referrals or the purchase of goods or services in which
federal health care program funds (such as Medicaid or
Medicare) may be expended. The safe harbor provides that the
agreement to provide such goods, items, services, donations, or
loans will not be considered unlawful remuneration under the
anti-kickback statute if the agreement satisfies standards
established by the Secretary. The Committee expects the
Secretary to establish a safe harbor under this section that
contains protections necessary to minimize the possibility of
abuse by the parties. The Secretary is required to publish an
interim final rule, which would be effective immediately,
within 180 days of enactment to establish these standards.
This section is effective upon enactment.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
SOCIAL SECURITY ACT
* * * * * * *
TITLE XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE
SIMPLIFICATION
* * * * * * *
Part A--General Provisions
* * * * * * *
CRIMINAL PENALTIES FOR ACTS INVOLVING FEDERAL HEALTH CARE PROGRAMS
Sec. 1128B. (a) * * *
(b)(1) * * *
* * * * * * *
(3) Paragraphs (1) and (2) shall not apply to--
(A) * * *
* * * * * * *
(E) any payment practice specified by the Secretary
in regulations promulgated pursuant to section 14(a) of
the Medicare and Medicaid Patient and Program
Protection Act of 1987; [and]
(F) any remuneration between an organization and an
individual or entity providing items or services, or a
combination thereof, pursuant to a written agreement
between the organization and the individual or entity
if the organization is an eligible organization under
section 1876 or if the written agreement, through a
risk-sharing arrangement, places the individual or
entity at substantial financial risk for the cost or
utilization of the items or services, or a combination
thereof, which the individual or entity is obligated to
provide[.];
(G) any remuneration between a public or
nonprofit private health center entity
described under clause (i) or (ii) of section
1905(l)(2)(B) and any individual or entity
providing goods, items, services, donations or
loans, or a combination thereof, to such health
center entity pursuant to a contract, lease,
grant, loan, or other agreement, if such
agreement contributes to the ability of the
health center entity to maintain or increase
the availability, or enhance the quality, of
services provided to a medically underserved
population served by the health center entity.
* * * * * * *
TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED
* * * * * * *
Part A--Hospital Insurance Benefits for the Aged and Disabled
* * * * * * *
PAYMENT TO PROVIDERS OF SERVICES
Sec. 1815. (a) * * *
* * * * * * *
(e)(1) * * *
(2) The Secretary shall provide (or continue to provide) for
payment on a periodic interim payment basis (under the
standards established under section 405.454(j) of title 42,
Code of Federal Regulations, as in effect on October 1, 1986)
with respect to--
(A) * * *
* * * * * * *
(C) extended care services; [and]
(D) hospice care; and
(E) inpatient critical access hospital services;
if the provider of such services elects to receive, and
qualifies for, such payments.
* * * * * * *
MEDICARE RURAL HOSPITAL FLEXIBILITY PROGRAM
Sec. 1820. (a) * * *
* * * * * * *
(c) Medicare Rural Hospital Flexibility Program Described.--
(1) * * *
(2) State designation of facilities.--
(A) * * *
(B) Criteria for designation as critical
access hospital.--A State may designate a
facility as a critical access hospital if the
facility--
(i) * * *
* * * * * * *
(iii) provides subject to paragraph
(3) not more than 15 (or, in the case
of a facility under an agreement
described in subsection (f), 25) acute
care inpatient beds (meeting such
standards as the Secretary may
establish) for providing inpatient care
for a period that does not exceed, as
determined on an annual, average basis,
96 hours per patient;
* * * * * * *
(3) Increase in maximum number of beds for hospitals
with strong seasonal census fluctuations.--
(A) In general.--In the case of a hospital
that demonstrates that it meets the standards
established under subparagraph (B), the bed
limitations otherwise applicable under
paragraph (2)(B)(iii) and subsection (f) shall
be increased by 5 beds.
(B) Standards.--The Secretary shall specify
standards for determining whether a critical
access hospital has sufficiently strong
seasonal variations in patient admissions to
justify the increase in bed limitation provided
under subparagraph (A).
* * * * * * *
(j) Authorization of Appropriations.--There are authorized to
be appropriated from the Federal Hospital Insurance Trust Fund
for making grants to all States under subsection (g),
$25,000,000 in each of the fiscal years 1998 through [2002]
2007.
* * * * * * *
Part B--Supplementary Medical Insurance Benefits for the Aged and
Disabled
* * * * * * *
SPECIAL PAYMENT RULES FOR PARTICULAR ITEMS AND SERVICES
Sec. 1834. (a) * * *
* * * * * * *
(g) Payment for Outpatient Critical Access Hospital
Services.--
(1) * * *
(2) Election of cost-based hospital outpatient
service payment plus fee schedule for professional
services.--A critical access hospital may elect to be
paid for outpatient critical access hospital services
amounts equal to the sum of the following, less the
amount that such hospital may charge as described in
section 1866(a)(2)(A):
(A) * * *
(B) Fee schedule for professional services.--
With respect to professional services otherwise
included within outpatient critical access
hospital services, 115 percent of such amounts
as would otherwise be paid under this part if
such services were not included in outpatient
critical access hospital services.
The Secretary may not require, as a condition for
applying subparagraph (B) with respect to a critical
access hospital, that each physician providing
professional services in the hospital must assign
billing rights with respect to such services, except
that such subparagraph shall not apply to those
physicians who have not assigned such billing rights.
* * * * * * *
Part D--Miscellaneous Provisions
* * * * * * *
PAYMENT TO HOSPITALS FOR INPATIENT HOSPITAL SERVICES
Sec. 1886. (a) * * *
(b)(1) * * *
* * * * * * *
(3)(A) * * *
(B)(i) For purposes of subsection (d) and subsection (j) for
discharges occurring during a fiscal year, the ``applicable
percentage increase'' shall be--
(I) * * *
* * * * * * *
[(XVIII) for fiscal year 2003, the market basket
percentage increase minus 0.55 percentage points for
hospitals in all areas, and]
(XVIII) for fiscal year 2003, the market basket
percentage increase for sole community hospitals and
such increase minus 0.25 percentage points for other
hospitals, and
* * * * * * *
(d)(1) * * *
* * * * * * *
(3) The Secretary shall determine a national adjusted DRG
prospective payment rate, for each inpatient hospital discharge
in a fiscal year after fiscal year 1984 involving inpatient
hospital services of a subsection (d) hospital in the United
States, and shall determine a regional adjusted DRG prospective
payment rate for such discharges in each region for which
payment may be made under part A of this title. Each such rate
shall be determined for hospitals located in large urban, other
urban, or rural areas within the United States and within each
such region, respectively, as follows:
(A) Updating previous standardized amounts.--(i) * *
*
* * * * * * *
[(iv) For discharges] (iv)(I) Subject to the
succeeding provisions of this clause, for discharges
occurring in a fiscal year beginning on or after
October 1, 1995, the Secretary shall compute an average
standardized amount for hospitals located in a large
urban area and for hospitals located in other areas
within the United States and within each region equal
to the respective average standardized amount computed
for the previous fiscal year under this subparagraph
increased by the applicable percentage increase under
subsection (b)(3)(B)(i) with respect to hospitals
located in the respective areas for the fiscal year
involved.
(II) For discharges occurring during fiscal year
2003, the average standardized amount for hospitals
located other than in a large urban area shall be
increased by \1/2\ of the difference between the
average standardized amount determined under subclause
(I) for hospitals located in large urban areas for such
fiscal year and such amount determined (without regard
to this subclause) for other hospitals for such fiscal
year.
(III) For discharges occurring in a fiscal year
beginning with fiscal year 2004, the Secretary shall
compute an average standardized amount for hospitals
located in any area within the United States and within
each region equal to the average standardized amount
computed for the previous fiscal year under this
subparagraph for hospitals located in a large urban
area (or, beginning with fiscal year 2005, for
hospitals located in any area) increased by the
applicable percentage increase under subsection
(b)(3)(B)(i).
* * * * * * *
(F)(i) * * *
* * * * * * *
(iv) The disproportionate share adjustment percentage for a
cost reporting period for a hospital that is not described in
clause (i)(II) and that--
(I) * * *
(II) is located in an urban area and has less than
100 beds, is equal to 5 percent or, subject to clause
(xiv) and for discharges occurring on or after April 1,
2001, is equal to the percent determined in accordance
with clause (xiii);
(III) is located in a rural area and is not described
in subclause (IV) or (V) or in the second sentence of
clause (v), is equal to 4 percent or, subject to clause
(xiv) and for discharges occurring on or after April 1,
2001, is equal to the percent determined in accordance
with clause (xii);
(IV) is located in a rural area, is classified as a
rural referral center under subparagraph (C), and is
classified as a sole community hospital under
subparagraph (D), is equal to 10 percent or, if
greater, the percent determined in accordance with the
applicable formula described in clause (viii) or,
subject to clause (xiv) and for discharges occurring on
or after April 1, 2001, the greater of the percentages
determined under clause (x) or (xi);
(V) is located in a rural area, is classified as a
rural referral center under subparagraph (C), and is
not classified as a sole community hospital under
subparagraph (D), is equal to the percent determined in
accordance with the applicable formula described in
clause (viii) or, subject to clause (xiv) and for
discharges occurring on or after April 1, 2001, is
equal to the percent determined in accordance with
clause (xi); or
(VI) is located in a rural area, is classified as a
sole community hospital under subparagraph (D), and is
not classified as a rural referral center under
subparagraph (C), is 10 percent or, subject to clause
(xiv) and for discharges occurring on or after April 1,
2001, is equal to the percent determined in accordance
with clause (x).
* * * * * * *
(viii) [The formula] Subject to clause (xiv), the formula
used to determine the disproportionate share adjustment
percentage for a cost reporting period for a hospital described
in clause (iv)(IV) or (iv)(V) is the percentage determined in
accordance with the following formula:(P-30)(.6) + 4.0, where
``P'' is the hospital's disproportionate patient percentage (as
defined in clause (vi)).
* * * * * * *
(x) [For purposes] Subject to clause (xiv), for purposes of
clause (iv)(VI) (relating to sole community hospitals), in the
case of a hospital for a cost reporting period with a
disproportionate patient percentage (as defined in clause (vi))
that--
(I) * * *
* * * * * * *
(xi) [For purposes] Subject to clause (xiv), for purposes of
clause (iv)(V) (relating to rural referral centers), in the
case of a hospital for a cost reporting period with a
disproportionate patient percentage (as defined in clause (vi))
that--
(I) * * *
* * * * * * *
(xii) [For purposes] Subject to clause (xiv), for purposes of
clause (iv)(III) (relating to small rural hospitals generally),
in the case of a hospital for a cost reporting period with a
disproportionate patient percentage (as defined in clause (vi))
that--
(I) * * *
* * * * * * *
(xiii) [For purposes] Subject to clause (xiv), for purposes
of clause (iv)(II) (relating to urban hospitals with less than
100 beds), in the case of a hospital for a cost reporting
period with a disproportionate patient percentage (as defined
in clause (vi)) that--
(I) * * *
* * * * * * *
(xiv)(I) In the case of discharges in a fiscal year beginning
on or after October 1, 2002, subject to subclause (II), there
shall be substituted for the disproportionate share adjustment
percentage otherwise determined under clause (iv) (other than
subclause (I)) or under clause (viii), (x), (xi), (xii), or
(xiii), the old blend proportion (specified under subclause
(III)) of the disproportionate share adjustment percentage
otherwise determined under the respective clause and 100
percent minus such old blend proportion of the disproportionate
share adjustment percentage determined under clause (vii)
(relating to large, urban hospitals).
(II) Under subclause (I), the disproportionate share
adjustment percentage shall not exceed 10 percent for a
hospital that is not classified as a rural referral center
under subparagraph (C).
(III) For purposes of subclause (I), the old blend proportion
for fiscal year 2003 is 80 percent, for each subsequent year
(through 2006) is the old blend proportion under this subclause
for the previous year minus 20 percentage points, and for each
year beginning with 2007 is 0 percent.
* * * * * * *
----------
MEDICARE, MEDICAID, AND SCHIP BENEFITS IMPROVEMENT AND PROTECTION ACT
OF 2000 (BIPA)
* * * * * * *
TITLE V--PROVISIONS RELATING TO PARTS A AND B
Subtitle A--Home Health Services
* * * * * * *
SEC. 508. TEMPORARY INCREASE FOR HOME HEALTH SERVICES FURNISHED IN A
RURAL AREA.
(a) [24-Month Increase Beginning April 1, 2001] In General.--
In the case of home health services furnished in a rural area
(as defined in section 1886(d)(2)(D) of the Social Security Act
(42 U.S.C. 1395ww(d)(2)(D))) on or after April 1, 2001, and
before [April 1, 2003] January 1, 2005, the Secretary of Health
and Human Services shall increase the payment amount otherwise
made under section 1895 of such Act (42 U.S.C. 1395fff ) for
such services by 10 percent.
* * * * * * *
Subtitle E--Other Provisions
* * * * * * *
SEC. 547. CLARIFICATION OF APPLICATION OF TEMPORARY PAYMENT INCREASES
FOR 2001.
(a) * * *
* * * * * * *
(c) Home Health Services.--
(1) * * *
(2) Temporary increase for rural home health
services.--The payment increase provided under section
508(a) for [the period beginning on April 1, 2001, and
ending on September 30, 2002,] a period under such
section shall not apply to episodes and visits ending
after such period, and shall not be taken into account
in calculating the payment amounts applicable for
episodes and visits occurring after such period.
* * * * * * *
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