article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Essential Access Community Hospital (EACH) Amendments of 1993''. SEC. 2. ESSENTIAL ACCESS COMMUNITY HOSPITAL (EACH) AMENDMENTS. (a) Increasing Number of Participating States.--Section 1820(a)(1) (42 U.S.C. 1395i-4(a)(1)) is amended by striking ``7'' and inserting ``9''. (b) Treatment of Inpatient Hospital Services Provided in Rural Primary Care Hospitals.-- (1) In general.--Section 1820(f)(1)(F) (42 U.S.C. 1395i- 4(f)(1)(F)) is amended to read as follows: ``(F) subject to paragraph (4), provides not more than 6 inpatient beds (meeting such conditions as the Secretary may establish) for providing inpatient care to patients requiring stabilization before discharge or transfer to a hospital, except that the facility may not provide any inpatient hospital services-- ``(i) to any patient whose attending physician does not certify that the patient may reasonably be expected to be discharged or transferred to a hospital within 72 hours of admission to the facility; or ``(ii) consisting of surgery or any other service requiring the use of general anesthesia (other than surgical procedures specified by the Secretary under section 1833(i)(1)(A)), unless the attending physician certifies that the risk associated with transferring the patient to a hospital for such services outweighs the benefits of transferring the patient to a hospital for such services.''. (2) Limitation on average length of stay.--Section 1820(f) (42 U.S.C. 1395i-4(f)) is amended by adding at the end the following new paragraph: ``(4) Limitation on average length of inpatient stays.--The Secretary may terminate a designation of a rural primary care hospital under paragraph (1) if the Secretary finds that the average length of stay for inpatients at the facility during the previous year in which the designation was in effect exceeded 72 hours. In determining the compliance of a facility with the requirement of the previous sentence, there shall not be taken into account periods of duty of inpatients in excess of 72 hours to the extent such periods exceed 72 hours because transfer to a hospital is precluded because of inclement weather or other emergency conditions.''. (3) Conforming amendment.--Section 1814(a)(8) (42 U.S.C. 1395f(a)(8)) is amended by striking ``such services'' and all that follows and inserting ``the individual may reasonably be expected to be discharged or transferred to a hospital within 72 hours after admission to the rural primary care hospital.''. (4) GAO reports.--Not later than 2 years after the date of the enactment of this Act, the Comptroller General shall submit reports to Congress on-- (A) the application of the requirements under section 1820(f) of the Social Security Act (as amended by this subsection) that rural primary care hospitals provide inpatient care only to those individuals whose attending physicians certify may reasonably be expected to be discharged within 72 hours after admission and maintain an average length of inpatient stay during a year that does not exceed 72 hours; and (B) the extent to which such requirements have resulted in such hospitals providing inpatient care beyond their capabilities or have limited the ability of such hospitals to provide needed services. (c) Designation of Hospitals.-- (1) Permitting designation of hospitals located in urban areas.-- (A) In general.--Section 1820 (42 U.S.C. 1395i-4) is amended-- (i) by striking paragraph (1) of subsection (e) and redesignating paragraphs (2) through (6) as paragraphs (1) through (5); and (ii) in subsection (e)(1)(A) (as redesignated by subparagraph (A))-- (I) by striking ``is located'' and inserting ``except in the case of a hospital located in an urban area, is located'', (II) by striking ``, (ii)'' and inserting ``or (ii)'', (III) by striking ``or (iii)'' and all that follows through ``section,'', and (IV) in subsection (i)(1)(B), by striking ``paragraph (3)'' and inserting ``paragraph (2)''. (B) No change in medicare prospective payment.-- Section 1886(d)(5)(D) (42 U.S.C. 1395ww(d)(5)(D)) is amended-- (i) in clause (iii)(III), by inserting ``located in a rural area and'' after ``that is'', and (ii) in clause (v), by inserting ``located in a rural area and'' after ``in the case of a hospital''. (2) Permitting hospitals located in adjoining states to participate in state program.-- (A) In general.--Section 1820 (42 U.S.C. 1395i-4) is amended-- (i) by redesignating subsection (k) as subsection (l); and (ii) by inserting after subsection (j) the following new subsection: ``(k) Eligibility of Hospitals Not Located in Participating States.--Notwithstanding any other provision of this section-- ``(1) for purposes of including a hospital or facility as a member institution of a rural health network, a State may designate a hospital or facility that is not located in the State as an essential access community hospital or a rural primary care hospital if the hospital or facility is located in an adjoining State and is otherwise eligible for designation as such a hospital; ``(2) the Secretary may designate a hospital or facility that is not located in a State receiving a grant under subsection (a)(1) as an essential access community hospital or a rural primary care hospital if the hospital or facility is a member institution of a rural health network of a State receiving a grant under such subsection; and ``(3) a hospital or facility designated pursuant to this subsection shall be eligible to receive a grant under subsection (a)(2).''. (B) Conforming amendments.--(i) Section 1820(c)(1) (42 U.S.C. 1395i-4(c)(1)) is amended by striking ``paragraph (3)'' and inserting ``paragraph (3) or subsection (k)''. (ii) Paragraphs (1)(A) and (2)(A) of section 1820(i) (42 U.S.C. 1395i-4(i)) are each amended-- (I) in clause (i), by striking ``(a)(1)'' and inserting ``(a)(1) (except as provided in subsection (k))'', and (II) in clause (ii), by striking ``subparagraph (B)'' and inserting ``subparagraph (B) or subsection (k)''. (d) Skilled Nursing Services in Rural Primary Care Hospitals.-- Section 1820(f)(3) (42 U.S.C. 1395i-4(f)(3)) is amended by striking ``because the facility'' and all that follows and inserting the following: ``because, at the time the facility applies to the State for designation as a rural primary care hospital, there is in effect an agreement between the facility and the Secretary under section 1883 under which the facility's inpatient hospital facilities are used for the furnishing of extended care services, except that the number of beds used for the furnishing of such services may not exceed the total number of licensed inpatient beds at the time the facility applies to the State for such designation (minus the number of inpatient beds used for providing inpatient care pursuant to paragraph (1)(F)). For purposes of the previous sentence, the number of beds of the facility used for the furnishing of extended care services shall not include any beds of a unit of the facility that is licensed as a distinct-part skilled nursing facility at the time the facility applies to the State for designation as a rural primary care hospital.''. (e) Payment for Outpatient Rural Primary Care Hospital Services.-- Section 1834(g)(1) (42 U.S.C. 1395m(g)(1)) is amended by adding at the end the following: ``The amount of payment shall be determined under either method without regard to the amount of the customary or other charge.''. (f) Clarification of Physician Staffing Requirement for Rural Primary Care Hospitals.--Section 1820(f)(1)(H) (42 U.S.C. 1395i- 4(f)(1)(H)) is amended by striking the period and inserting the following: ``, except that in determining whether a facility meets the requirements of this subparagraph, subparagraphs (E) and (F) of that paragraph shall be applied as if any reference to a `physician' is a reference to a physician as defined in section 1861(r)(1).''. (g) Technical Amendments Relating to Part A Deductible, Coinsurance, and Spell of Illness.--(1) Section 1812(a)(1) (42 U.S.C. 1395d(a)(1)) is amended-- (A) by striking ``inpatient hospital services'' the first place it appears and inserting ``inpatient hospital services or inpatient rural primary care hospital services''; (B) by striking ``inpatient hospital services'' the second place it appears and inserting ``such services''; and (C) by striking ``and inpatient rural primary care hospital services''. (2) Sections 1813(a) and 1813(b)(3)(A) (42 U.S.C. 1395e(a), 1395e(b)(3)(A)) are each amended by striking ``inpatient hospital services'' each place it appears and inserting ``inpatient hospital services or inpatient rural primary care hospital services''. (3) Section 1813(b)(3)(B) (42 U.S.C. 1395e(b)(3)(B)) is amended by striking ``inpatient hospital services'' and inserting ``inpatient hospital services, inpatient rural primary care hospital services''. (4) Section 1861(a) (42 U.S.C. 1395x(a)) is amended-- (A) in paragraph (1), by striking ``inpatient hospital services'' and inserting ``inpatient hospital services, inpatient rural primary care hospital services''; and (B) in paragraph (2), by striking ``hospital'' and inserting ``hospital or rural primary care hospital''. (h) Authorization of Appropriations.--Section 1820(k) (42 U.S.C. 1395i-4(k)) is amended by striking ``1990, 1991, and 1992'' and inserting ``1990 through 1995''. (i) Effective Date.--The amendments made by this section shall take effect on the date of the enactment of this Act.
summary: Essential Access Community Hospital (EACH) Amendments of 1993 - Amends title XVIII (Medicare) of the Social Security Act to make miscellaneous and technical changes with respect to Medicare's Essential Access Community Hospital Program and other Medicare provisions, including those relating to Medicare part A (Hospital Insurance) deductibles and co-payments. Authorizes appropriations.