text: 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.
target: 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.
feat_title: Essential Access Community Hospital (EACH) Amendments of 1993