Rural Hospital and Provider Equity (HoPE) Act of 2006 - Amends title XVIII (Medicare) of the Social Security Act with respect to: (1) the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals; (2) extension of the temporary increase in payments to certain rural hospitals (Medicare hold harmless provision) under the prospective payment system for hospital outpatient department services; (3) the definition of low-volume hospital for purposes of the Medicare inpatient hospital payment adjustment; (4) critical access hospitals; (5) extension of the Medicare incentive payment program for physician scarcity areas; (6) extension of the 1.00 floor on Medicare work geographic adjustment to payments for physician services; (7) Medicare home health care planning; (8) rural health clinics; (9) use of medical conditions for coding ambulance services; (10) extension of increased Medicare payments for ground ambulance services in rural areas; and (11) coverage of marriage and family therapist services and mental health counselor services under Medicare part B (Supplementary Medical Insurance).
Amends the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 with respect to the extension of: (1) Medicare wage index reclassifications for certain hospitals; and (2) Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas.
Amends the Public Health Service Act with respect to: (1) a capital infrastructure revolving loan program; and (2) community health center collaborative access.
Directs the Secretary of Health and Human Services to: (1) conduct pilot projects to provide incentives to home health agencies to utilize remote home monitoring and communications technologies; and (2) facilitate the provision of telehealth services across state lines.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 3500 Introduced in Senate (IS)]
109th CONGRESS
2d Session
S. 3500
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, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 13, 2006
Mr. Thomas (for himself, Mr. Conrad, Mr. Harkin, Mr. Roberts, Ms.
Collins, Mr. Dayton, Mr. Salazar, Mr. Domenici, Mr. Burns, Mr. Dorgan,
Mr. Thune, Mr. Johnson, Mr. Nelson of Nebraska, Ms. Murkowski, and Ms.
Snowe) introduced the following bill; which was read twice and referred
to the Committee on Finance
_______________________________________________________________________
A BILL
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, 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 and
Provider Equity (HoPE) Act of 2006''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Fairness in the Medicare disproportionate share hospital (DSH)
adjustment for rural hospitals.
Sec. 3. Extension and Expansion of Medicare hold harmless provision
under the prospective payment system for
hospital outpatient department (HOPD)
services.
Sec. 4. Improvement of definition of low-volume hospital for purposes
of the Medicare inpatient hospital payment
adjustment.
Sec. 5. Extension of Medicare wage index reclassifications for certain
hospitals.
Sec. 6. Extension of Medicare reasonable costs payments for certain
clinical diagnostic laboratory tests
furnished to hospital patients in certain
rural areas.
Sec. 7. Critical access hospital improvements.
Sec. 8. Capital infrastructure revolving loan program.
Sec. 9. Extension of Medicare incentive payment program for physician
scarcity areas.
Sec. 10. Extension of floor on medicare work geographic adjustment.
Sec. 11. Medicare home health care planning improvements.
Sec. 12. Rural health clinic improvements.
Sec. 13. Community health center collaborative access expansion.
Sec. 14. Applying add-on policy for home health services furnished in a
rural area for 2007.
Sec. 15. Use of medical conditions for coding ambulance services.
Sec. 16. Extension of increased Medicare payments for ground ambulance
services in rural areas.
Sec. 17. Improvement in payments to retain emergency and other capacity
for ambulances in rural areas.
Sec. 18. Coverage of marriage and family therapist services and mental
health counselor services under part B of
the Medicare program.
Sec. 19. Medicare remote monitoring pilot projects.
Sec. 20. Facilitating the provision of telehealth services across State
lines.
SEC. 2. 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--
(1) by striking ``or, in the case'' and all that follows
through ``subparagraph (G)(iv)''; and
(2) by inserting 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, 2006.''.
SEC. 3. EXTENSION AND EXPANSION OF MEDICARE HOLD HARMLESS PROVISION
UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL
OUTPATIENT DEPARTMENT (HOPD) SERVICES.
(a) Extension.--
(1) In general.--Section 1833(t)(7)(D)(i) of the Social
Security Act (42 U.S.C. 1395l(t)(7)(D)(i)), as amended by
section 5105 of the Deficit Reduction Act of 2005 (Public Law
109-171), is amended--
(A) in subclause (I)--
(i) by striking ``(I)'';
(ii) by striking ``(iii)) located in a
rural area'' and inserting ``(iii))''; and
(iii) by striking ``before January 1,
2006'' and inserting ``before January 1,
2009''; and
(B) by striking subclause (II).
(2) Effective date.--The amendments made by paragraph (1)
shall apply to covered OPD services furnished on or after
January 1, 2006.
(b) Study and Report.--
(1) Study.--The Secretary of Health and Human Services
shall conduct a study to determine if, under the prospective
payment system for hospital outpatient department services
under section 1833(t) of the Social Security Act (42 U.S.C.
1395l(t)), costs incurred by sole community hospitals (as
defined in section 1886(d)(5)(D)(iii) of such Act (42 U.S.C.
1395ww(d)(5)(D)(iii))) located in urban areas by ambulatory
payment classification groups (APCs) exceed those costs
incurred by other hospitals located in urban areas.
(2) Report.--Not later than January 1, 2008, the Secretary
of Health and Human Services shall submit to Congress a report
on the study conducted under paragraph (1) together with
recommendations for such legislation and administrative action
as the Secretary determines to be appropriate.
SEC. 4. IMPROVEMENT OF DEFINITION OF LOW-VOLUME HOSPITAL FOR PURPOSES
OF THE MEDICARE INPATIENT HOSPITAL PAYMENT ADJUSTMENT.
Section 1886(d)(12)(C)(i) of the Social Security Act (42 U.S.C.
1395ww(d)(12)(C)(i)) is amended by inserting ``(or, beginning with
fiscal year 2007, 2,000 discharges)'' after ``800 discharges''.
SEC. 5. EXTENSION OF MEDICARE WAGE INDEX RECLASSIFICATIONS FOR CERTAIN
HOSPITALS.
(a) MMA Provision.--Section 508 of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (42 U.S.C. 1395ww note) is
amended by adding at the end the following new subsection:
``(g) Three-Year Extension for Certain Hospitals.--
``(1) In general.--In the case of a hospital described in
paragraph (2)--
``(A) subsections (a)(3) and (b) shall be applied
by substituting `6-year period' for `3-year period';
and
``(B) the limitation under subsection (e) shall not
apply after March 31, 2007.
``(2) Hospital described.--A hospital described in this
paragraph is a hospital--
``(A) that is reclassified to an area under this
section as of the day before the date of enactment of
this subsection; and
``(B)(i) that is located in a State with less than
10 people per square mile; or
``(ii)(I) that is located in a rural area; and
``(II) for which the Secretary has determined the
extension under this subsection to be appropriate.''.
(b) Additional Provision.--The Secretary of Health and Human
Services shall extend the special exception reclassification of a sole
community hospital located in a State with less than 10 people per
square mile (made under the authority of section 1886(d)(5)(I)(i) of
the Social Security Act (42 U.S.C. 1395ww(d)(5)(I)(i)) and contained in
the final rule promulgated by the Secretary in the Federal Register on
August 11, 2004 (69 Fed. Reg. 49107)) for 3 years through fiscal year
2010.
SEC. 6. 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 (Public Law 108-173; 117 Stat. 2282; 42
U.S.C. 1395l-4(b)) is amended by striking ``2-year'' and inserting ``4-
year''.
SEC. 7. CRITICAL ACCESS HOSPITAL IMPROVEMENTS.
(a) Clarification of Payment for Clinical Laboratory Tests
Furnished by Critical Access Hospitals.--
(1) In general.--Section 1834(g)(4) of the Social Security
Act (42 U.S.C. 1395m(g)(4)) is amended--
(A) in the heading, by striking ``no beneficiary
cost-sharing'' and inserting ``treatment of''; and
(B) by adding at the end the following new
sentence: ``For purposes of the preceding sentence and
section 1861(mm)(3), clinical diagnostic laboratory
services furnished by a critical access hospital shall
be treated as being furnished as part of outpatient
critical access services without regard to whether--
``(A) the individual with respect to whom such
services are furnished is physically present in the
critical access hospital at the time the specimen is
collected;
``(B) such individual is registered as an
outpatient on the records of, and receives such
services directly from, the critical access hospital;
or
``(C) payment is (or, but for this subsection,
would be) available for such services under the fee
schedule established under section 1833(h).''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply to cost reporting periods beginning on or after
October 1, 2003.
(b) Elimination of Isolation Test for Cost-Based Ambulance
Reimbursement.--
(1) In general.--Section 1834(l)(8) of the Social Security
Act (42 U.S.C. 1395m(l)(8)) is amended--
(A) in subparagraph (B)--
(i) by striking ``owned and''; and
(ii) by inserting ``(including when such
services are provided by the entity under an
arrangement with the hospital)'' after
``hospital''; and
(B) by striking the comma at the end of
subparagraph (B) and all that follows and inserting a
period.
(2) Effective date.--The amendments made by this subsection
shall apply to services furnished on or after January 1, 2007.
SEC. 8. CAPITAL INFRASTRUCTURE REVOLVING LOAN PROGRAM.
(a) In General.--Part A of title XVI of the Public Health Service
Act (42 U.S.C. 300q et seq.) is amended by adding at the end the
following new section:
``capital infrastructure revolving loan program
``Sec. 1603. (a) Authority To Make and Guarantee Loans.--
``(1) Authority to make loans.--The Secretary may make
loans from the fund established under section 1602(d) to any
rural entity for projects for capital improvements, including--
``(A) the acquisition of land necessary for the
capital improvements;
``(B) the renovation or modernization of any
building;
``(C) the acquisition or repair of fixed or major
movable equipment; and
``(D) such other project expenses as the Secretary
determines appropriate.
``(2) Authority to guarantee loans.--
``(A) In general.--The Secretary may guarantee the
payment of principal and interest for loans made to
rural entities for projects for any capital improvement
described in paragraph (1) to any non-Federal lender.
``(B) Interest subsidies.--In the case of a
guarantee of any loan made to a rural entity under
subparagraph (A), the Secretary may pay to the holder
of such loan, for and on behalf of the project for
which the loan was made, amounts sufficient to reduce
(by not more than 3 percent) the net effective interest
rate otherwise payable on such loan.
``(b) Amount of Loan.--The principal amount of a loan directly made
or guaranteed under subsection (a) for a project for capital
improvement may not exceed $5,000,000.
``(c) Funding Limitations.--
``(1) Government credit subsidy exposure.--The total of the
Government credit subsidy exposure under the Credit Reform Act
of 1990 scoring protocol with respect to the loans outstanding
at any time with respect to which guarantees have been issued,
or which have been directly made, under subsection (a) may not
exceed $50,000,000 per year.
``(2) Total amounts.--Subject to paragraph (1), the total
of the principal amount of all loans directly made or
guaranteed under subsection (a) may not exceed $250,000,000 per
year.
``(d) Capital Assessment and Planning Grants.--
``(1) Nonrepayable grants.--Subject to paragraph (2), the
Secretary may make a grant to a rural entity, in an amount not
to exceed $50,000, for purposes of capital assessment and
business planning.
``(2) Limitation.--The cumulative total of grants awarded
under this subsection may not exceed $2,500,000 per year.
``(e) Termination of Authority.--The Secretary may not directly
make or guarantee any loan under subsection (a) or make a grant under
subsection (d) after September 30, 2010.''.
(b) Rural Entity Defined.--Section 1624 of the Public Health
Service Act (42 U.S.C. 300s-3) is amended by adding at the end the
following new paragraph:
``(15)(A) The term `rural entity' includes--
``(i) a rural health clinic, as defined in section
1861(aa)(2) of the Social Security Act;
``(ii) any medical facility with at least 1 bed,
but with less than 50 beds, that is located in--
``(I) a county that is not part of a
metropolitan statistical area; or
``(II) a rural census tract of a
metropolitan statistical area (as determined
under the most recent modification of the
Goldsmith Modification, originally published in
the Federal Register on February 27, 1992 (57
Fed. Reg. 6725));
``(iii) a hospital that is classified as a rural,
regional, or national referral center under section
1886(d)(5)(C) of the Social Security Act; and
``(iv) a hospital that is a sole community hospital
(as defined in section 1886(d)(5)(D)(iii) of the Social
Security Act).
``(B) For purposes of subparagraph (A), the fact that a
clinic, facility, or hospital has been geographically
reclassified under the Medicare program under title XVIII of
the Social Security Act shall not preclude a hospital from
being considered a rural entity under clause (i) or (ii) of
subparagraph (A).''.
(c) Conforming Amendments.--Section 1602 of the Public Health
Service Act (42 U.S.C. 300q-2) is amended--
(1) in subsection (b)(2)(D), by inserting ``or
1603(a)(2)(B)'' after ``1601(a)(2)(B)''; and
(2) in subsection (d)--
(A) in paragraph (1)(C), by striking ``section
1601(a)(2)(B)'' and inserting ``sections 1601(a)(2)(B)
and 1603(a)(2)(B)''; and
(B) in paragraph (2)(A), by inserting ``or
1603(a)(2)(B)'' after ``1601(a)(2)(B)''.
SEC. 9. 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 striking ``before January 1, 2008'' and
inserting ``before January 1, 2009''.
SEC. 10. 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 January 1, 2007'' and
inserting ``before January 1, 2009''.
SEC. 11. MEDICARE HOME HEALTH CARE PLANNING IMPROVEMENTS.
(a) In General.--Section 1814(a)(2) of the Social Security Act (42
U.S.C. 1395f(a)(2)), in the matter preceding subparagraph (A), is
amended--
(1) by striking ``subparagraph (B)'' and inserting
``subparagraphs (B) and (C)'';
(2) by inserting ``(as those terms are defined in section
1861(aa)(5))'' after ``clinical nurse specialist'';
(3) by inserting ``or home health agency (as the case may
be)'' after ``facility''; and
(4) by inserting ``(or in the case of services described in
subparagraph (C), a physician assistant (as defined in
1861(aa)(5)) under the supervision of a physician)'' after
``collaboration with a physician''.
(b) Conforming Amendments.--(1) Section 1814(a) of the Social
Security Act (42 U.S.C. 1395f(a)) is amended--
(A) in paragraph (2)(C), by inserting ``a nurse
practitioner, a clinical nurse specialist, or a physician
assistant (as the case may be)'' after ``physician'' each place
it appears;
(B) in the second sentence, by striking ``or clinical nurse
specialist'' and inserting ``clinical nurse specialist, or
physician assistant'';
(C) in the third sentence--
(i) by striking ``physician certification'' and
inserting ``certification'';
(ii) by inserting ``(or on January 1, 2007, in the
case of regulations to implement the amendments made by
section 11 of the Rural Hospital and Provider Equity
(HoPE) Act of 2006)'' after ``1981''; and
(iii) by striking ``a physician who'' and inserting
``a physician, nurse practitioner, clinical nurse
specialist, or physician assistant who''; and
(D) in the fourth sentence, by inserting ``, nurse
practitioner, clinical nurse specialist, or physician
assistant'' after ``physician''.
(2) Section 1835(a) of the Social Security Act (42 U.S.C. 1395n(a))
is amended--
(A) in paragraph (2)--
(i) in the matter preceding subparagraph (A), by
inserting ``or, in the case of services described in
subparagraph (A), a physician, or a nurse practitioner
or clinical nurse specialist (as those terms are
defined in 1861(aa)(5)), who does not have a direct or
indirect employment relationship with the home health
agency but is working in collaboration with a physician
(or a physician assistant (as defined in 1861(aa)(5))
under the supervision of a physician)'' after ``a
physician''; and
(ii) in subparagraph (A) by inserting ``a nurse
practitioner, a clinical nurse specialist, or a
physician assistant (as the case may be)'' after
``physician'' each place it appears;
(B) in the third sentence, by inserting ``, nurse
practitioner, clinical nurse specialist, or physician assistant
(as the case may be)'' after physician;
(C) in the fourth sentence--
(i) by striking ``physician certification'' and
inserting ``certification'';
(ii) by inserting ``(or on January 1, 2007, in the
case of regulations to implement the amendments made by
section 11 of the Rural Hospital and Provider Equity
(HoPE) Act of 2006)'' after ``1981''; and
(iii) by striking ``a physician who'' and inserting
``a physician, nurse practitioner, clinical nurse
specialist, or physician assistant who''; and
(D) in the fifth sentence, by inserting ``, nurse
practitioner, clinical nurse specialist, or physician
assistant'' after ``physician''.
(3) Section 1861 of the Social Security Act (42 U.S.C. 1395x) is
amended--
(A) in subsection (m)--
(i) in the matter preceding paragraph (1)--
(I) by inserting ``, or a nurse
practitioner, clinical nurse specialist, or
physician assistant (as those terms are defined
in subsection (aa)(5))'' after ``physician''
the first place it appears; and
(II) by inserting ``or a nurse
practitioner, clinical nurse specialist, or
physician assistant'' after ``physician'' the
second place it appears; and
(ii) in paragraph (3), by inserting ``or a nurse
practitioner, clinical nurse specialist, or physician
assistant'' after ``physician''; and
(B) in subsection (o)(2)--
(i) by inserting ``, nurse practitioners, clinical
nurse specialists, or physician assistants (as those
terms are defined in subsection (aa)(5))'' after
``physicians''; and
(ii) by inserting ``, nurse practitioner, clinical
nurse specialist, physician assistant,'' after
``physician''
(4) Section 1895 of the Social Security Act (42 U.S.C. 1395fff) is
amended--
(A) in subsection (c)(1), by inserting ``, or the nurse
practitioner, clinical nurse specialist, or physician assistant
(as those terms are defined in section 1861(aa)(5)),'' after
``physician''; and
(B) in subsection (e)--
(i) in paragraph (1)(A), by inserting ``, or a
nurse practitioner, clinical nurse specialist, or
physician assistant (as those terms are defined in
section 1861(aa)(5)),'' after ``physician''; and
(ii) in paragraph (2)--
(I) in the heading, by striking ``Physician
certification'' and inserting ``Rule of
construction regarding requirement for
certification''; and
(II) by striking ``physician''.
(c) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after January 1, 2007.
SEC. 12. RURAL HEALTH CLINIC IMPROVEMENTS.
Section 1833(f) of the Social Security Act (42 U.S.C. 1395l(f)) is
amended--
(1) in paragraph (1), by striking ``, and'' at the end and
inserting a semicolon;
(2) in paragraph (2)--
(A) by inserting ``(before 2007)'' after ``in a
subsequent year''; and
(B) by striking the period at the end and inserting
a semicolon; and
(3) by adding at the end the following new paragraphs:
``(3) in 2007, at $82 per visit; and
``(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.''
SEC. 13. COMMUNITY HEALTH CENTER COLLABORATIVE ACCESS EXPANSION.
Section 330 of the Public Health Service Act (42 U.S.C. 254b) is
amended by adding at the end the following:
``(s) Miscellaneous Provisions.--
``(1) Rule of construction with respect to rural health
clinics.--
``(A) In general.--Nothing in this section shall be
construed to prevent a community health center from
contracting with a federally certified rural health
clinic (as defined by section 1861(aa)(2) of the Social
Security Act) for the delivery of primary health care
services that are available at the rural health clinic
to individuals who would otherwise be eligible for free
or reduced cost care if that individual were able to
obtain that care at the community health center. Such
services may be limited in scope to those primary
health care services available in that rural health
clinic.
``(B) Assurances.--In order for a rural health
clinic to receive funds under this section through a
contract with a community health center under paragraph
(1), such rural health clinic shall establish policies
to ensure--
``(i) nondiscrimination based upon the
ability of a patient to pay; and
``(ii) the establishment of a sliding fee
scale for low-income patients.''.
SEC. 14. APPLYING ADD-ON POLICY FOR HOME HEALTH SERVICES FURNISHED IN A
RURAL AREA FOR 2007.
Section 421 of 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), is amended--
(1) in the heading, by striking ``one-year'' and inserting
``temporary''; and
(2) in subsection (a), by striking ``before January 1,
2007'' and inserting ``before January 1, 2008''.
SEC. 15. USE OF MEDICAL CONDITIONS FOR CODING AMBULANCE SERVICES.
Section 1834(l)(7) of the Social Security Act (42 U.S.C.
1395m(l)(7)) is amended to read as follows:
``(7) Coding system.--
``(A) In general.--The Secretary shall, in
accordance with section 1173(c)(1)(B) and not later
than January 1, 2007, establish a mandatory system or
systems for the coding of claims for ambulance services
for which payment is made under this subsection,
including a code set specifying the medical condition
of the individual who is transported and the level of
service that is appropriate for the transportation of
an individual with that medical condition.
``(B) Medical conditions.--The code set established
under subparagraph (A) shall take into account the list
of medical conditions developed in the course of the
negotiated rulemaking process conducted under paragraph
(1).''.
SEC. 16. EXTENSION OF INCREASED MEDICARE PAYMENTS FOR GROUND AMBULANCE
SERVICES IN RURAL AREAS.
Section 1834(l)(13) of the Social Security Act (42 U.S.C.
1395m(l)(13)) is amended--
(1) in subparagraph (A), in the matter preceding clause
(i), by striking ``before January 1, 2007'' and inserting
``before January 1, 2008'';
(2) in subparagraph (B), in the heading, by striking
``after 2006'' and inserting ``after 2007''.
SEC. 17. IMPROVEMENT IN PAYMENTS TO RETAIN EMERGENCY AND OTHER CAPACITY
FOR AMBULANCES IN RURAL AREAS.
(a) In General.--Section 1834(l) of the Social Security Act (42
U.S.C. 1395m(l)) is amended by adding at the end the following new
paragraph:
``(15) Additional payments for providers furnishing
ambulance services in rural areas.--
``(A) In general.--In the case of ground ambulance
services furnished on or after January 1, 2007, for
which the transportation originates in a rural area (as
determined under subparagraph (B)), the Secretary shall
provide for a percent increase in the base rate of the
fee schedule for a trip identified under this
subsection.
``(B) Identification of rural areas.--The
Secretary, in consultation with the Office of Rural
Health Policy, shall use the Rural-Urban Commuting
Areas (RUCA) coding system, adopted by that Office, to
designate rural areas for the purposes of this
paragraph. A rural area is any area in RUCA levels 2
through 10 and any unclassified area.
``(C) Tiering of rural areas.--The Secretary shall
designate 4 tiers of rural areas, using a ZIP Code
population-based methodology generated by the RUCA
coding system, as follows:
``(i) Tier 1.--A rural area that is a high
metropolitan commuting area, in which 30
percent or more of the commuting flow is to an
urban area, as designated by the Bureau of the
Census (RUCA level 2).
``(ii) Tier 2.--A rural area that is a low
metropolitan commuting area, in which less than
30 percent of the commuting flow is to an urban
area or to a large town, as designated by the
Bureau of the Census (RUCA levels 3-6).
``(iii) Tier 3.--A rural area that is a
small town core, as designated by the Bureau of
the Census, in which no significant portion of
the commuting flow is to an area of population
greater than 10,000 people (RUCA levels 7-9).
``(iv) Tier 4.--A rural area in which there
is no dominant commuting flow (RUCA level 10)
and any unclassified area.
The Secretary shall consult with the Office of Rural
Health Policy not less often than every 2 years to
update the designation of rural areas in accordance
with any changes that are made to the RUCA system.
``(D) Payment adjustments for trips in rural
areas.--The Secretary shall adjust the payment rate
under this section for ambulance trips that originate
in each of the tiers established in subparagraph (C)
according to the national average cost of full-cost
providers for providing ambulance services in each such
tier.''.
(b) Review of Payments for Rural Ambulance Services and Report to
Congress.--
(1) Review.--Not later than July 1, 2009, the Secretary of
Health and Human Services shall review the system for adjusting
payments for rural ambulance services under section 1834(l)(15)
of the Social Security Act, as added by subsection (a), to
determine the adequacy and appropriateness of such adjustments.
In conducting such review, the Secretary shall consult with
providers and suppliers affected by such adjustments and with
representatives of the ambulance industry generally to
determine--
(A) whether such adjustments adequately cover the
additional costs incurred in serving areas of low
population density; and
(B) whether the tiered structure for making such
adjustments appropriately reflects the difference in
costs of providing services in different types of rural
areas.
(2) Report.--Not later than January 1, 2010, the Secretary
shall submit to Congress a report on the review conducted under
paragraph (1) together with any recommendations for revision to
the systems for adjusting payments for ambulance services in
rural areas that the Secretary of Health and Human Services
determines appropriate.
(c) Conforming Amendments.--(1) Section 1834(l) of the Social
Security Act (42 U.S.C. 1395m(l)), as amended by subsection (a), is
amended by adding at the end the following new paragraph:
``(16) Designation of rural areas for mileage payment
purposes.--In establishing any differential in the amount of
payment for mileage between rural and urban areas in the fee
schedule established under paragraph (1), the Secretary shall,
in the case of ambulance services furnished on or after January
1, 2007, identify rural areas in the same manner as provided in
paragraph (15)(B).''.
(2) Section 1834(l)(12)(A) of the Social Security Act (42 U.S.C.
1395m(l)(12)(A)) is amended by striking ``January 1, 2010'' and
inserting ``January 1, 2007''.
(3) Section 1834(l)(13)(A)(i) of the Social Security Act (42 U.S.C.
1395m(l)(13)(A)(i)) is amended--
(A) by inserting ``(or in the case of such services
furnished in 2007, in a rural area identified by the Secretary
under paragraph (15)(B))'' after ``such paragraph''; and
(B) by striking ``paragraphs (11) and (12)'' and inserting
``paragraphs (11), (12), and (15)''.
SEC. 18. COVERAGE OF MARRIAGE AND FAMILY THERAPIST SERVICES AND MENTAL
HEALTH COUNSELOR SERVICES UNDER PART B OF THE MEDICARE
PROGRAM.
(a) Coverage of Services.--
(1) In general.--Section 1861(s)(2) of the Social Security
Act (42 U.S.C. 1395x(s)(2)), as amended by section 5112 of the
Deficit Reduction Act of 2005 (Public Law 109-171), is
amended--
(A) in subparagraph (Z), by striking ``and'' at the
end;
(B) in subparagraph (AA), by inserting ``and'' at
the end; and
(C) by adding at the end the following new
subparagraph:
``(BB) marriage and family therapist services (as defined
in subsection (ccc)(1)) and mental health counselor services
(as defined in subsection (ccc)(3));''.
(2) Definitions.--Section 1861 of the Social Security Act
(42 U.S.C. 1395x), as amended by section 5112 of the Deficit
Reduction Act of 2005 (Public Law 109-171), is amended by
adding at the end the following new subsection:
``Marriage and Family Therapist Services; Marriage and Family
Therapist; Mental Health Counselor Services; Mental Health Counselor
``(ccc)(1) The term `marriage and family therapist services' means
services performed by a marriage and family therapist (as defined in
paragraph (2)) for the diagnosis and treatment of mental illnesses,
which the marriage and family therapist is legally authorized to
perform under State law (or the State regulatory mechanism provided by
State law) of the State in which such services are performed, as would
otherwise be covered if furnished by a physician or as an incident to a
physician's professional service, but only if no facility or other
provider charges or is paid any amounts with respect to the furnishing
of such services.
``(2) The term `marriage and family therapist' means an individual
who--
``(A) possesses a master's or doctoral degree which
qualifies for licensure or certification as a marriage and
family therapist pursuant to State law;
``(B) after obtaining such degree has performed at least 2
years of clinical supervised experience in marriage and family
therapy; and
``(C) in the case of an individual performing services in a
State that provides for licensure or certification of marriage
and family therapists, is licensed or certified as a marriage
and family therapist in such State.
``(3) The term `mental health counselor services' means services
performed by a mental health counselor (as defined in paragraph (4))
for the diagnosis and treatment of mental illnesses which the mental
health counselor is legally authorized to perform under State law (or
the State regulatory mechanism provided by the State law) of the State
in which such services are performed, as would otherwise be covered if
furnished by a physician or as incident to a physician's professional
service, but only if no facility or other provider charges or is paid
any amounts with respect to the furnishing of such services.
``(4) The term `mental health counselor' means an individual who--
``(A) possesses a master's or doctor's degree in mental
health counseling or a related field;
``(B) after obtaining such a degree has performed at least
2 years of supervised mental health counselor practice; and
``(C) in the case of an individual performing services in a
State that provides for licensure or certification of mental
health counselors or professional counselors, is licensed or
certified as a mental health counselor or professional
counselor in such State.''.
(3) Provision for payment under part b.--Section
1832(a)(2)(B) of the Social Security Act (42 U.S.C.
1395k(a)(2)(B)) is amended by adding at the end the following
new clause:
``(v) marriage and family therapist
services and mental health counselor
services;''.
(4) Amount of payment.--Section 1833(a)(1) of the Social
Security Act (42 U.S.C. 1395l(a)(1)) is amended--
(A) by striking ``and (V)'' and inserting ``(V)'';
and
(B) by inserting before the semicolon at the end
the following: ``, and (W) with respect to marriage and
family therapist services and mental health counselor
services under section 1861(s)(2)(BB), the amounts paid
shall be 80 percent of the lesser of the actual charge
for the services or 75 percent of the amount determined
for payment of a psychologist under subparagraph (L)''.
(5) Exclusion of marriage and family therapist services and
mental health counselor services from skilled nursing facility
prospective payment system.--Section 1888(e)(2)(A)(ii) of the
Social Security Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended
by inserting ``marriage and family therapist services (as
defined in section 1861(ccc)(1)), mental health counselor
services (as defined in section 1861(ccc)(3)),'' after
``qualified psychologist services,''.
(6) Inclusion of marriage and family therapists and mental
health counselors as practitioners for assignment of claims.--
Section 1842(b)(18)(C) of the Social Security Act (42 U.S.C.
1395u(b)(18)(C)) is amended by adding at the end the following
new clauses:
``(vii) A marriage and family therapist (as defined in
section 1861(ccc)(2)).
``(viii) A mental health counselor (as defined in section
1861(ccc)(4)).''.
(b) Coverage of Certain Mental Health Services Provided in Certain
Settings.--
(1) Rural health clinics and federally qualified health
centers.--Section 1861(aa)(1)(B) of the Social Security Act (42
U.S.C. 1395x(aa)(1)(B)) is amended by striking ``or by a
clinical social worker (as defined in subsection (hh)(1)),''
and inserting ``, by a clinical social worker (as defined in
subsection (hh)(1)), by a marriage and family therapist (as
defined in subsection (ccc)(2)), or by a mental health
counselor (as defined in subsection (ccc)(4)),''.
(2) Hospice programs.--Section 1861(dd)(2)(B)(i)(III) of
the Social Security Act (42 U.S.C. 1395x(dd)(2)(B)(i)(III)) is
amended by inserting ``or one marriage and family therapist (as
defined in subsection (ccc)(2))'' after ``social worker''.
(c) Authorization of Marriage and Family Therapists to Develop
Discharge Plans for Post-Hospital Services.--Section 1861(ee)(2)(G) of
the Social Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended by
inserting ``marriage and family therapist (as defined in subsection
(ccc)(2)),'' after ``social worker,''.
(d) Effective Date.--The amendments made by this section shall
apply with respect to services furnished on or after January 1, 2007.
SEC. 19. MEDICARE REMOTE MONITORING PILOT PROJECTS.
(a) Pilot Projects.--
(1) In general.--Not later than 9 months after the date of
enactment of this Act, the Secretary of Health and Human
Services (in this section referred to as the ``Secretary'')
shall conduct pilot projects under title XVIII of the Social
Security Act for the purpose of providing incentives to home
health agencies to utilize home monitoring and communications
technologies that--
(A) enhance health outcomes for Medicare
beneficiaries; and
(B) reduce expenditures under such title.
(2) Site requirements.--
(A) Urban and rural.--The Secretary shall conduct
the pilot projects under this section in both urban and
rural areas.
(B) Site in a small state.--The Secretary shall
conduct at least 3 of the pilot projects in a State
with a population of less than 1,000,000.
(3) Definition of home health agency.--In this section, the
term ``home health agency'' has the meaning given that term in
section 1861(o) of the Social Security Act (42 U.S.C.
1395x(o)).
(b) Medicare Beneficiaries Within the Scope of Projects.--The
Secretary shall specify the criteria for identifying those Medicare
beneficiaries who shall be considered within the scope of the pilot
projects under this section for purposes of the application of
subsection (c) and for the assessment of the effectiveness of the home
health agency in achieving the objectives of this section. Such
criteria may provide for the inclusion in the projects of Medicare
beneficiaries who begin receiving home health services under title
XVIII of the Social Security Act after the date of the implementation
of the projects.
(c) Incentives.--
(1) Performance targets.--The Secretary shall establish for
each home health agency participating in a pilot project under
this section a performance target using one of the following
methodologies, as determined appropriate by the Secretary:
(A) Adjusted historical performance target.--The
Secretary shall establish for the agency--
(i) a base expenditure amount equal to the
average total payments made to the agency under
parts A and B of title XVIII of the Social
Security Act for Medicare beneficiaries
determined to be within the scope of the pilot
project in a base period determined by the
Secretary; and
(ii) an annual per capita expenditure
target for such beneficiaries, reflecting the
base expenditure amount adjusted for risk and
adjusted growth rates.
(B) Comparative performance target.--The Secretary
shall establish for the agency a comparative
performance target equal to the average total payments
under such parts A and B during the pilot project for
comparable individuals in the same geographic area that
are not determined to be within the scope of the pilot
project.
(2) Incentive.--Subject to paragraph (3), the Secretary
shall pay to each participating home care agency an incentive
payment for each year under the pilot project equal to a
portion of the Medicare savings realized for such year relative
to the performance target under paragraph (1).
(3) Limitation on expenditures.--The Secretary shall limit
incentive payments under this section in order to ensure that
the aggregate expenditures under title XVIII of the Social
Security Act (including incentive payments under this
subsection) do not exceed the amount that the Secretary
estimates would have been expended if the pilot projects under
this section had not been implemented.
(d) Waiver Authority.--The Secretary may waive such provisions of
titles XI and XVIII of the Social Security Act as the Secretary
determines to be appropriate for the conduct of the pilot projects
under this section.
(e) Report to Congress.--Not later than 5 years after the date that
the first pilot project under this section is implemented, the
Secretary shall submit to Congress a report on the pilot projects. Such
report shall contain a detailed description of issues related to the
expansion of the projects under subsection (f) and recommendations for
such legislation and administrative actions as the Secretary considers
appropriate.
(f) Expansion.--If the Secretary determines that any of the pilot
projects under this section enhance health outcomes for Medicare
beneficiaries and reduce expenditures under title XVIII of the Social
Security Act, the Secretary may initiate comparable projects in
additional areas.
(g) Incentive Payments Have No Effect on Other Medicare Payments to
Agencies.--An incentive payment under this section--
(1) shall be in addition to the payments that a home health
agency would otherwise receive under title XVIII of the Social
Security Act for the provision of home health services; and
(2) shall have no effect on the amount of such payments.
SEC. 20. 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.
(b) Definitions.--In subsection (a):
(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)).
(2) Physician, practitioner.--The terms ``physician'' and
``practitioner'' have the meaning given those terms in
subparagraphs (D) and (E), respectively, of such section.
(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.).
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S5789-5790)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S5790-5793)
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