| Committee/Subcommittee: | Activity: | |
| Senate Finance | Referral | |
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TABLE OF CONTENTS:
Promoting Health in Rural Areas Act of 1999 - Title I: Promoting Access to Health Care Services in Rural Areas Under the Medicare Program - Subtitle A: Hospital-Related Provisions - Amends title XVIII (Medicare) of the Social Security Act (SSA) with regard to hospital-related provisions to: (1) revise payment and geographic reclassification requirements for sole community hospitals; (2) modify the criteria for designation of a critical access hospital; (3) make certain technical amendments with regard to adjustments for graduate medical education, both indirect and direct; (4) make permanent the payment provision for the Medicare-dependent, small rural hospital program, and provide an option to base program eligibility on discharges during any of the three most recent audited cost reporting periods; and (5) provide for an all-inclusive payment rate option for outpatient critical access hospital services.
(Sec. 106) Provides for: (1) exclusion of swing beds in critical access hospitals from the prospective payment system (PPS) for skilled nursing facilities; (2) exclusion of small rural providers from the PPS for hospital outpatient department services; (3) modification of disproportionate share hospital (DSH) payment adjustment requirements; (4) application of hospital geographic reclassification for inpatient services (labor costs) to all PPS-reimbursed items and services; and (5) mandatory standardization of wage levels for hospitals with respect to occupational mix before adjusting payment rates.
Directs the Secretary of Labor to study and report to Congress on the feasibility and costs of having the Bureau of Labor Statistics collect data on wages that would assist the Secretary of Health and Human Services (Secretary) in determining average wage levels, at the metropolitan statistical area, statewide, and rural level by sector and the proportion of the workforce in each occupational category within each sector.
Subtitle B: General Provisions - Amends Medicare part C (Medicare+Choice) to make certain adjustments to the calculation of annual capitation rates used in determining payments to Medicare+Choice organizations.
(Sec. 122) Amends the Indian Health Care Improvement Act to convert into a permanently authorized program the current demonstration program for direct billing of Medicare, Medicaid (SSA title XIX), and other third party payors by Indian tribes, tribal organizations, and Alaska Native health organizations.
(Sec. 123) Amends SSA title XVIII (Medicare) to: (1) provide for rural representation on the Medicare Payment Advisory Commission (MEDPAC) as well as additional specified duties for MEDPAC; (2) require MEDPAC to review the impact of PPS's for skilled nursing facility services, home health services, and hospital outpatient department services on access to services in rural areas, as well as review the operating margins for hospitals in rural or frontier areas; and (3) provide for Medicare coverage of qualified mental health professional services.
(Sec. 125) Directs the Secretary to study and report to Congress on the barriers that Medicare beneficiaries residing in rural areas face in obtaining quality mental health services, and on ways to reduce or eliminate such barriers.
(Sec. 126) Directs the Secretary to establish a waiver process in which entities and individuals under Medicare that are located in an urban or large urban area for purposes of Medicare reimbursement may apply to be considered as located in a rural area for such purposes if the entity or individual is located in a rural area: (1) within a metropolitan county; or (2) as determined by using a census tract definition adopted by the Office of Rural Health Policy in awarding grants.
(Sec. 127) Revises per-visit payment limits for rural health clinic services under Medicare part B (Supplementary Medical Insurance).
(Sec. 128) Amends Medicare part B to: (1) extend to physician assistant or nurse practitioner services additional payments for services furnished in health professional shortage areas; (2) provide authority for the Secretary to establish a PPS for rural health clinic (RHC) services in a rural hospital with 50 beds or more; (3) establish separate wage indexes for making adjustments to payments under the PPS's for skilled nursing facilities and home health agencies; and (4) require consideration of rural issues in establishing an ambulance service fee schedule.
Title II: Additional Provisions to Address Shortages of Health Professionals in Rural Areas - Amends the Public Health Service Act (PHSA) to direct the Secretary to define "frontier area" for inclusion among health professional shortage areas. Requires the Secretary to consider any pending retirements or resignations of available physicians when determining whether to designate an area as a health professional shortage area.
Prohibits the Secretary from implementing any regulation establishing a new methodology for designating a health professional shortage area unless such methodology: (1) is not detrimental to underserved rural or frontier communities, including that the methodology does not result in the provision of fewer services in such communities; and (2) includes consideration of the percentage of the population over age 65 residing in an area.
(Sec. 202) Amends the Internal Revenue Code (IRC) to exclude from an individual's gross income certain amounts received under the National Health Service Corps Scholarship Program under PHSA.
(Sec. 203) Amends Federal civil service law to provide for the designation of underserved areas under health care contracts administered by the Office of Personnel Management.
(Sec. 204) Amends SSA title XIX (Medicaid) to mandate a new PPS for federally-qualified health centers and rural health clinics under the Medicaid program.
(Sec. 205) Amends the Balanced Budget Act of 1997 to revise requirements for Medicare reimbursement of telehealth services, including store-and-forward technologies among the telecommunications systems used in providing telehealth services.
(Sec. 206) Directs the Secretary to conduct a specified study on telehealth licensure for a report to the Congress.
(Sec. 207) Redesignates the Joint Working Group on Telemedicine as the Joint Working Group on Telehealth, with the chairperson being designated by the Director of the Office for the Advancement on Telehealth. Establishes the mission of the Joint Working Group, among other things, as identifying, monitoring, and coordinating Federal telehealth projects and programs. Authorizes appropriations.
Title III: Development of Telehealth Networks - Subtitle A: Development of Telehealth Networks - Directs the Secretary to provide specified financial assistance to eligible telehealth networks for the purpose of expanding access to health care services for individuals in rural and frontier areas through the use of such networks. Authorizes appropriations.
Subtitle B: Rural Health Outreach and Network Development Grant Program - Amends PHSA to rename the Rural Health Outreach, Network Development, and Telemedicine Grant Program as the Rural Health Outreach and Network Development Grant Program, and to modify the renamed program.
Title IV: Miscellaneous Provisions - Amends the IRC with regard to the non-deductible interest expense of financial institutions allocable to tax-exempt income, and the limited exception from such non-deductibility for interest expense on certain tax-exempt small issuer obligations. Allows a small issuer, the proceeds of whose obligations are to be used to make or finance eligible loans for health care or educational purposes, to elect to apply specified current limitations on the amount of obligations by treating each borrower as the issuer of a separate issue.
(Sec. 402) Requires the heads of the National Center for Health Statistics, the Centers for Disease Control and Prevention, the Agency for Health Care Policy and Research, and the Bureau of the Census to negotiate and enter into interagency agreements with HHS agencies and offices under which they will be provided access to data sets for the intramural and extramural research they conduct or support.