[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4378 Introduced in House (IH)]
103d CONGRESS
2d Session
H. R. 4378
To amend the Social Security Act to require the Secretary of Health and
Human Services to equalize the labor and non-labor portions of the
standardized amounts used to determine the amount of payment made to
rural and urban hospitals under part A of the medicare program for the
operating costs of inpatient hospital services, to amend the Public
Health Service Act to improve the capacity of rural hospitals to
provide health services, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 10, 1994
Mr. Clinger (for himself, Mr. McHugh, Mr. Parker and Mr. Oberstar)
introduced the following bill; which was referred jointly to the
Committees on Ways and Means, Energy and Commerce, the Judiciary, and
Government Operations
_______________________________________________________________________
A BILL
To amend the Social Security Act to require the Secretary of Health and
Human Services to equalize the labor and non-labor portions of the
standardized amounts used to determine the amount of payment made to
rural and urban hospitals under part A of the medicare program for the
operating costs of inpatient hospital services, to amend the Public
Health Service Act to improve the capacity of rural hospitals to
provide health services, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Rural Hospital
Survival Act of 1994''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
TITLE I--PROGRAMS OF HEALTH CARE FINANCING ADMINISTRATION
Subtitle A--Medicare Program
Sec. 101. Equalization of labor and non-labor portions of standardized
amounts for hospitals in rural and other
urban areas.
Sec. 102. Sense of Congress regarding disproportionate impact of
reductions in medicare reimbursements on
rural providers.
Subtitle B--Other Programs
Sec. 111. Extension of authorization of appropriations for rural health
transition grants.
TITLE II--PROGRAMS OF PUBLIC HEALTH SERVICE
Sec. 201. Demonstration grants for telecommunications to improve health
care in rural areas.
Sec. 202. Rural health outreach grant program.
TITLE III--ANTITRUST PROVISIONS
Sec. 301. Antitrust exemption applicable to hospitals.
TITLE IV--COMMISSION ON REDUCING THE BURDEN OF REGULATIONS AND
PAPERWORK ON SMALL RURAL HOSPITALS.
Sec. 401. Establishment.
Sec. 402. Duties of commission.
Sec. 403. Membership.
Sec. 404. Director and staff of commission; experts and consultants.
Sec. 405. Powers of commission.
Sec. 406. Termination.
Sec. 407. Authorization of appropriations.
SEC. 2. FINDINGS.
The Congress finds as follows:
(1) For the 27 percent of Americans living in rural areas,
certain geographic, demographic, and epidemiologic
characteristics can reduce the availability and quality of
medical care.
(2) Rough terrain, bad weather conditions, deteriorating
transportation infrastructure, long distances between medical
facilities, and the lack of public transportation systems all
serve as geographic barriers to adequate health care.
(3) Rural populations tend to be older and have lower
average per capita incomes, resulting in higher concentrations
of medicare, medicaid, and uninsured patients.
(4) In rural regions, hospitals are the primary sources of
medical care and serve as hubs of the local health care
delivery systems.
(5) Rural hospitals generally have fewer beds, fewer
admissions, lower occupancy rates, and higher per patient, per
day expenses than urban hospitals.
(6) The medicare program continues to reimburse rural
hospitals at lower rates than urban hospitals.
(7) Because of the high proportion of medicare, medicaid,
and uninsured individuals in rural areas, rural hospitals rely
heavily on Federal funds in the form of medicare and medicaid
reimbursements for their survival.
(8) When the Congress cuts or freezes medicare
reimbursement, it reduces the primary source of revenues for
rural hospitals.
(9) The volume of uncompensated care that rural hospitals
provide continues to rise and places serious financial burdens
on the hospitals.
(10) Almost one third of all rural hospitals have negative
operating expenses.
(11) Almost 400 rural hospitals have been closed since
1980.
(12) Besides providing medical care, rural hospitals are
integral parts of local economies because they are usually one
of the largest employers in the area and play an important role
in attracting new businesses and residents to the area.
(13) Any health care reform package adopted by the Congress
must include provisions that improve the financial condition
and ensure the survival of our small, rural hospitals.
TITLE I--PROGRAMS OF HEALTH CARE FINANCING ADMINISTRATION
Subtitle A--Medicare Program
SEC. 101. EQUALIZATION OF LABOR AND NON-LABOR PORTIONS OF STANDARDIZED
AMOUNTS FOR HOSPITALS IN RURAL AND OTHER URBAN AREAS.
(a) In General.--Section 1886(d)(3)(A)(iii) of the Social Security
Act (42 U.S.C. 1395ww(d)(3)(A)(iii)) is amended by striking ``average
standardized amount'' the first place it appears and all that follows
and inserting the following: ``portion of the average standardized
amount attributable to wages and wage-related costs and the portion of
such amount not attributable to wages and wage-related costs for
hospitals located in a rural area shall be equal to such portions of
such amount for hospitals located in an other urban area.''.
(b) Limitation on Scope of Costs Considered Attributable to Wages
and Wage-Related Costs.--The first sentence of section 1886(d)(3)(E) of
such Act (42 U.S.C. 1395ww(d)(3)(E)) by striking ``costs,'' and
inserting ``costs (taking into account only costs attributable to wages
and salaries, employee benefits, and professional fees),''.
(c) Effective Date.--The amendments made by this section shall
apply to discharges occurring on or after October 1, 1994.
SEC. 102. SENSE OF CONGRESS REGARDING DISPROPORTIONATE IMPACT OF
REDUCTIONS IN MEDICARE REIMBURSEMENTS ON RURAL PROVIDERS.
(a) Finding.--Congress finds the following:
(1) The proportion of the revenues of rural hospitals,
physicians, and other providers of health care services
providers that is attributable to payments under the medicare
program is significantly higher than the proportion of the
revenues of urban hospitals, physicians, and other providers
that is attributable to such payments, because a higher
proportion of the residents of rural areas are age 65 or older.
(2) As a result, any reductions in the payments made to
hospitals, physicians, and other providers under the medicare
program disproportionately affects providers in rural areas.
(b) Sense of Congress.--It is the sense of Congress that any
reductions in payments made to providers under the medicare program
should be adjusted so as to reduce the disproportionate impact such
reductions have on providers in rural areas.
Subtitle B--Other Programs
SEC. 111. EXTENSION OF AUTHORIZATION OF APPROPRIATIONS FOR RURAL HEALTH
TRANSITION GRANTS.
Section 4005(e)(9) of the Omnibus Budget Reconciliation Act of 1987
is amended--
(1) by striking ``1989 and'' and inserting ``1989,''; and
(2) by striking ``1992'' and inserting ``1992 and
$50,000,000 for each of fiscal years 1993 through 1997''.
TITLE II--PROGRAMS OF PUBLIC HEALTH SERVICE
SEC. 201. DEMONSTRATION GRANTS FOR TELECOMMUNICATIONS TO IMPROVE HEALTH
CARE IN RURAL AREAS.
Part D of title III of the Public Health Service Act (42 U.S.C.
254b et seq.) is amended by adding at the end the following section:
``use of telecommunications for improving health of rural populations
``Sec. 340D. (a) In General.--The Secretary may make grants to
public and nonprofit private entities to carry out demonstration
projects for the purpose of improving health services in rural areas
through using telecommunications to make available to the health
professionals of such areas medical advice and knowledge, and the use
of medical technologies, that otherwise are not significantly available
to the professionals.
``(b) Preferences in Making Grants.--In making grants under
subsection (a), the Secretary shall give preference to an otherwise
qualified applicant if, in the demonstration project under such
subsection, the number of health facilities and health professionals
with respect to which the purpose described in such subsection is to be
carried out constitutes a significant number of the health facilities
and health professionals of the rural area involved.
``(c) Agreements Among Participating Health Professionals.--The
Secretary may make a grant under subsection (a) only if the health
professionals with respect to which the purpose described in such
subsection is to be carried out have entered into an agreement
governing the use by the professionals of the telecommunications
involved.
``(d) Application for Grant.--The Secretary may make a grant under
subsection (a) only if an application for the grant is submitted to the
Secretary and the application is in such form, is made in such manner,
and contains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out this section.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1995 through 1997.''.
SEC. 202. RURAL HEALTH OUTREACH GRANT PROGRAM.
Part D of title III of the Public Health Service Act, as amended by
section 201 of this Act, is amended by adding at the end the following
section:
``access of rural populations to primary health services
``Sec. 340E. (a) In General.--The Secretary, acting through the
Director of the Office of Rural Health Policy, may make grants to
public and nonprofit private health care entities to carry out
demonstration projects for the purposes of--
``(1) increasing the capacity of the residents of rural
areas to utilize primary health services (and related health
and social services) available under Federal, State, and local
programs through--
``(A) informing the residents of the existence of
such programs;
``(B) assisting the residents in establishing
eligibility under the programs;
``(C) providing transportation services for the
residents; and
``(D) such other services as the Secretary
determines to be appropriate; and
``(2) providing primary health services to such residents,
with priority given to the provision of preventive health
services.
``(b) Preferences in Making Grants.--In making grants under
subsection (a), the Secretary shall give preference to an otherwise
qualified applicant if the applicant has, with 2 or more other health
care entities, entered into an agreement under which--
``(1) the participants in the agreement collaborate to
carry out the demonstration project involved; and
``(2) the participants will make significant efforts to
coordinate the delivery of primary health services in the rural
area involved, and to coordinate the provision of such services
with related health and social services in the area.
``(c) Identification of Need for Services.--The Secretary may make
a grant under subsection (a) only if the applicant for the grant has
identified the need in the rural area involved for the services to be
provided under the grant.
``(d) Application for Grant.--The Secretary may make a grant under
subsection (a) only if an application for the grant is submitted to the
Secretary and the application is in such form, is made in such manner,
and contains such agreements, assurances, and information as the
Secretary determines to be necessary to carry out this section.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there is authorized to be appropriated $50,000,000
for each of the fiscal years 1995 through 1997.''.
TITLE III--ANTITRUST PROVISIONS
SEC. 301. ANTITRUST EXEMPTION APPLICABLE TO HOSPITALS.
(a) Exemption.--The antitrust laws shall not apply with respect
to--
(1) the combination of, or the attempt to combine, 2 or
more hospitals,
(2) a contract entered into solely by 2 or more hospitals
to allocate hospital services, or
(3) the attempt by only 2 or more hospitals to enter into a
contract to allocate hospital services,
if each of such hospitals satisfies all of the requirements of
subsection (b) at the time such hospitals engage in the conduct
described in paragraph (1), (2), or (3), as the case may be.
(b) Requirements.--The requirements referred to in subsection (a)
are as follows:
(1) The hospital is located outside of a city, or in a city
that has less than 25,000 inhabitants, as determined in
accordance with the most recent data available from the Bureau
of the Census.
(2) In the most recently concluded calendar year, the
hospital received more than 40 percent of its gross revenue
from payments made under Federal programs.
(3) There is in effect with respect to the hospital a
certificate issued by the Health Care Financing Administration
specifying that such Administration has determined that Federal
expenditures would be reduced, and consumer costs would not
increase, if the 2 or more hospitals that request such
certificate merge, or allocate the hospital services specified
in such request, as the case may be.
(c) Definition.--For purposes of this section, the term ``antitrust
laws'' has the meaning given such term in subsection (a) of the first
section of the Clayton Act (15 U.S.C. 12), except that such term
includes section 5 of the Federal Trade Commission Act (15 U.S.C. 45)
to the extent that such section 5 applies with respect to unfair
methods of competition.
TITLE IV--COMMISSION ON REDUCING THE BURDEN OF REGULATIONS AND
PAPERWORK ON SMALL RURAL HOSPITALS.
SEC. 401. ESTABLISHMENT.
There is hereby established the Advisory Commission on Reducing the
Burden of Regulations and Paperwork on Small Rural Hospitals (hereafter
referred to as the ``Commission'').
SEC. 402. DUTIES OF COMMISSION.
(a) Analysis of Impact of Regulations and Paperwork.--The
Commission shall analyze the impact of Federal, State, and local
government regulations and paperwork requirements on small rural
hospitals.
(b) Reports and Recommendations.--
(1) Interim reports.--During the first 2 years after the
initial appointment of its members, the Commission shall--
(A) submit reports to the Secretary of Health and
Human Services (hereafter referred to as the
``Secretary'') on its activities under subsection (a)
at such times as the Secretary may require; and
(B) submit to the Secretary and Congress
recommendations for regulatory and legislative
proposals to reduce the burden of government
regulations and paperwork requirements on small rural
hospitals.
(2) Final report.--Not later than January 1, 1998, the
Commission shall submit a final report to the Secretary and
Congress on its activities under this title, and shall include
in the report its final recommendations for proposals described
in paragraph (1)(B).
SEC. 403. MEMBERSHIP.
(a) Number and Appointment.--
(1) In general.--The Commission shall be composed of 8
members appointed by the Secretary from individuals who possess
extensive leadership experience in and knowledge of State and
local government, intergovernmental relations, and the
administration and operation of small rural hospitals.
(2) Limitation.--An individual who is a Member or employee
of the Congress may not be appointed or serve as a member of
the Commission.
(b) Waiver of Limitation on Executive Schedule Positions.--
Appointments may be made under this section without regard to section
5311(b) of title 5, United States Code.
(c) Political Affiliation.--Not more than 4 members of the
Commission may be of the same political party.
(d) Terms.--
(1) In general.--Each member of the Commission shall be
appointed for the life of the Commission.
(2) Vacancies.--A vacancy in the Commission shall be filled
in the manner in which the original appointment was made.
(e) Basic Pay.--
(1) Rates of pay.--Members of the Commission shall serve
without pay.
(2) Prohibition of compensation of federal employees.--
Members of the Commission who are full-time officers or
employees of the United States may not receive additional pay,
allowances, or benefits by reason of their service on the
Commission.
(f) Travel Expenses.--Each member of the Commission shall receive
travel expenses, including per diem in lieu of subsistence, in
accordance with sections 5702 and 5703 of title 5, United States Code.
(g) Chairperson.--The President shall designate a member of the
Commission as Chairperson at the time of the appointment of that
member.
(h) Meetings.--
(1) In general.--Subject to paragraph (2), the Commission
shall meet at the call of the Chairperson or a majority of its
members.
(2) First meeting.--The Commission shall convene its first
meeting by not later than 45 days after the date of the
completion of appointment of the member of the Commission.
(3) Quorum.--A majority of members of the Commission shall
constitute a quorum but a lesser number may hold hearings.
SEC. 404. DIRECTOR AND STAFF OF COMMISSION; EXPERTS AND CONSULTANTS.
(a) Director.--The Commission shall, without regard to section
5311(b) of title 5, United States Code, have a Director who shall be
appointed by the Commission. The Director shall be paid at the rate of
basic pay payable for level IV of the Executive Schedule.
(b) Staff.--With the approval of the Commission, and without regard
to section 5311(b) of title 5, United States Code, the Director may
appoint and fix the pay of such staff as is sufficient to enable the
Commission to carry out its duties.
(c) Applicability of Certain Civil Service Laws.--The Director and
staff of the Commission may be appointed without regard to the
provisions of title 5, United States Code, governing appointments in
the competitive service, and may be paid without regard to the
provisions of chapter 51 and subchapter III of chapter 53 of that title
relating to classification and General Schedule pay rates, except that
an individual so appointed may not receive pay in excess of the annual
rate of basic pay payable for GS-18 of the General Schedule.
(d) Experts and Consultants.--The Commission may procure temporary
and intermittent services of experts or consultants under section
3109(b) of title 5, United States Code.
(e) Staff of Federal Agencies.--Upon request of the Director, the
head of any Federal department or agency may detail, on a reimbursable
basis, any of the personnel of that department or agency to the
Commission to assist it in carrying out its duties under this title.
SEC. 405. POWERS OF COMMISSION.
(a) Hearings and Sessions.--The Commission may, for the purpose of
carrying out this title, hold hearings, sit and act at times and
places, take testimony, and receive evidence as the Commission
considers appropriate.
(b) Powers of Members and Agents.--Any member or agent of the
Commission may, if authorized by the Commission, take any action which
the Commission is authorized to take by this section.
(c) Obtaining Official Data.--The Commission may secure directly
from any department or agency of the United States information
necessary to enable it to carry out this title. Upon request of the
Chairperson of the Commission, the head of that department or agency
shall furnish that information to the Commission.
(d) Mails.--The Commission may use the United States mails in the
same manner and under the same conditions as other departments and
agencies of the United States.
(e) Administrative Support Services.--Upon the request of the
Commission, the Administrator of General Services shall provide to the
Commission, on a reimbursable basis, the administrative support
services necessary for the Commission to carry out its duties under
this title.
(f) Contract Authority.--The Commission may, subject to
appropriations, contract with and compensate government and private
agencies or persons for property and services used to carry out its
duties under this title.
SEC. 406. TERMINATION.
The Commission shall terminate 90 days after submitting its final
report pursuant to section 402(b)(2).
SEC. 407. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated to the Commission such sums
as may be necessary for the Commission to carry out its duties under
this title.
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HR 4378 IH----2