Selected Provisions of the House and Senate Bills

by Sheldon Weisgrau
Senior Consultant, Rural Health Consultants

Part of the Summer 1999 Newsletter article
Overview of H.R.1244 and S.980 Health Care Legislation.

Issue	H.R. 1344	revenue effect	integration effect	access effect	S.980	revenue effect	integration effect	access effect
Hospital Related Provisions
Medicare Hospital Outpatient Prospective Payment System(PPS)	Exempts certain hospitals that are considered critical for access to care from the proposed Medicare hospital outpatient PPS.	increases	diminishes	neutral	Same as H.R. 1344, if hospital requests exemption within a certain time.	increases	diminishes	neutral
Critical Access Hospitals (CAH)	Allows closed hospitals or hospitals that downsized to clinics to reopen as CAHs.	increases	neutral	promotes	Allows closed hospitals or hospitals that downsized to state licensed health clinics or health centers to reopen as CAHs.	increases	neutral	promotes
	Provides choice in the method of outpatient payment for CAHs.	increases	neutral	promotes	Changes the 96 hour length of stay limit to a 96 hour average.	increases	neutral	promotes
	Requires Medicaid programs to reimburse for services in CAHs.	increases	neutral	promotes	Provides choice in the method of outpatient payment for CAHs.	increases	neutral	promotes
					Exempts CAH swing beds from PPS for skilled nursing facilities.	increases	neutral	promotes
Issue	H.R. 1344	revenue effect	integration effect	access effect	S.980	revenue effect	integration effect	access effect
Medicare + Choice
Payments to Medicare+Choice Organizations	Makes technical changes to the payment methodology for Medicare risk plans, likely resulting in higher payments to plans that serve low cost rural areas.	increases	promotes	promotes	Same as H.R. 1344	increases	promotes	promotes
Other Payment Provisions
Medicare Payment for Physician Assistants (PAs), Nurse Practitioners (NPs), and Clinical Nurse Specialists (CNS)	Increases payment to PAs, NPs, and CNS in underserved rural areas and permits direct Medicare payment to these providers.	increases	neutral	promotes access to health plans	No Provision	n/a	n/a	n/a
PAs and NPs — Medicaid Coverage	Requires Medicaid to cover the services of PAs and NPs (consistent with state law and regulation).	increases	promotes	promotes	No Provision	n/a	n/a	n/a
Issue	H.R. 1344	revenue effect	integration effect	access effect	S.980	revenue effect	integration effect	access effect
Medicare Waivers for Designation of Areas as "Rural"	Establishes a waiver process to allow some providers located in an "urban" area for payment purposes (i.e., a Metropolitan Statistical Area) to be classified as "rural" if they meet certain criteria.	increases	neutral	promotes	Same as H.R. 1344	increase	diminishes	promotes
Medicare Waivers for Designation of Areas as "Rural"	No Provision	n/a	n/a	n/a	Requires the U.S. Department of Health and Human Services (DHHS) to establish a program under which Indian tribes, tribal organizations, and Alaska Native health organizations may directly bill for and receive Medicare, Medicaid, and other third-party payment.	may increase	promotes	promotes
					Increases the federal match for Medicaid payment.	increases	diminishes	promotes
					Allows hospitals and clinics participating in this program to be reimbursed directly by Medicare and Medicaid.	may increase	promotes	diminishes
Issue	H.R. 1344	revenue effect	integration effect	access effect	S.980	revenue effect	integration effect	access effect
Federally Qualified Health Centers (FQHCs) — Medicaid Payment	Eliminates the phase-out of cost-based Medicaid reimbursement to FQHCs.	increases	diminishes	promotes	Requires current cost-based Medicaid payment to FQHCs and increases this amount for inflation in subsequent years.	increase	diminishes	promotes
	Adds conforming language to the requirement that Medicaid managed care organizations pay FQHCs at the same rate as other providers for the same services.	increases	diminishes	promotes	Requires states to provide supplemental payments to FQHCs that furnish services under managed care contracts to make up the difference in payment between that provided by the managed care organization and the amount that the facility would have received under the payment methodology described above.	increase	diminishes	promotes
					Allows states to pay for services at rates above those determined by the above methodologies.	increases	diminishes	promotes
Issue	H.R. 1344	revenue effect	integration effect	access effect	S.980	revenue effect	integration effect	access effect
Rural Health Clinics (RHCs) — Medicaid Payment	Adds conforming language to the requirement that Medicaid managed care organizations pay RHCs at the same rate as other providers for the same services.	increases	diminishes	promotes	Same as FQHC provisions above.	increase	diminishes	promotes
Rural Health Clinics (RHCs) — Medicaid Payment	No Provisions	n/a	n/a	n/a	Requires DHHS to determine a cost-related payment rate for RHCs and increases this amount for inflation in subsequent years.	increase	diminishes	promotes
					Allows DHHS to establish a Medicare PPS for RHCs and exempts RHCs located in hospitals with less than 50 beds from this payment system.	decreases	diminishes	promotes
Issue	H.R. 1344	revenue effect	integration effect	access effect	S.980	revenue effect	integration effect	access effect
Provisions to Address Shortages of Health Professionals
Health Professional Shortage Areas (HPSAs)	Eases the requirements for an area to be designated as a HPSA.	increases	neutral	promotes	Same as H.R. 1344	increases	neutral	promotes
	Requires DHHS to engage in an expedited negotiated rulemaking process for developing HPSA regulations.	neutral	neutral	may promote	Prohibits any new methodology for HPSA designation that results in provision of fewer services or is otherwise detrimental to rural or frontier communities.	increases	diminishes	promotes
HPSAs — Payment	Requires payment for services delivered by licensed practitioners in a HPSA for all conditions for which coverage is included under federal employee health insurance contracts.	increases	neutral	promotes	Same as H.R. 1344	increases	neutral	promotes
					Allows NPs to receive bonus payments for delivering services in a HPSA.	increases	neutral	promotes
Issue	H.R. 1344	revenue effect	integration effect	access effect	S.980	revenue effect	integration effect	access effect
Provisions to Address Shortages of Health Professionals
Financial Assistance to Telehealth Networks	Requires DHHS to provide grants and loans to community-based health care networks for development of telehealth services.	increases	promotes	promotes	Same as H.R. 1344, except authorizes $40 million for FY 2000.	increases	promotes	promotes
	Authorizes appropriation of $25 million for FY 2000 and "necessary" sums for FYs 2001-2006 to carry out this financial assistance program.	increases	promotes	promotes
Issue	H.R. 1344	revenue effect	integration effect	access effect	S.980	revenue effect	integration effect	access effect
Medicare Coverage of Telehealth Services	Expands payment to Physical Therapists, Occupational Therapists, and Speech Therapists	increases	promotes	promotes	Expands payment to PAs, NPs, CNS, Certified Registered Nurse Anesthetists (CRNAs), Certified Nurse-Midwives, Clinical Social Workers, Clinical Psychologists, Physical Therapists, Occupational Therapists, and Speech Therapists.	increases	promotes	promotes
	Requires payment for services using certain technology.	increases	promotes	promotes
	Allows any state licensed practitioner to present Medicare patient to the consulting practitioner.	increases	promotes	promotes	Requires payment for services using certain technology.	increases	promotes	promotes
	Extends payment for telehealth services to all rural areas, not just HPSAs.	increases	promotes	promotes	Allows any state licensed practitioner to present Medicare patient to the consulting practitioner.	increases	promotes	promotes
	Requires development of a fee schedule for payment of telehealth services and mandates that certain factors be considered in payment.	increases	promotes	promotes	Extends payment for telehealth services to all rural areas, not just HPSAs.	increases	promotes	promotes
	Limits beneficiary co-pay for telehealth services.	may decrease	neutral	promotes	Requires payment for all services covered under the Medicare program.	increases	promotes	promotes

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