SECTION 1. SHORT TITLE. 

    This Act may be cited as the ``Rural Hospital Relief Act of 1999''.

SEC. 2. ELIMINATING UNINTENDED REDUCTION IN CONVERSION FACTOR FOR 
              MEDICARE OPD PPS.

    (a) Calculation of Base Amounts.--Section 1833(t)(3)(A)(ii) of the 
Social Security Act (42 U.S.C. 1395l(t)(3)(A)(ii)) is amended--
            (1) by striking ``copayments estimated to be paid under 
        this subsection'' and inserting ``coinsurance that would be 
        paid under this part'';and
            (2) by striking ``1999,'' and inserting ``1999 if this 
        subsection did not apply and''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the provision of the Balanced Budget Act 
of 1997 to which the amendment relates at the time such provision 
became law.

SEC. 3. LIMITING REDUCTIONS IN FEDERAL PAYMENTS UNDER OPD PPS.

    (a) In General.--Section 4523 of the Balanced Budget Act of 1997 is 
amended by adding at the end the following:
    ``(e) Temporary Limit on Reductions in Federal Payments.--
            ``(1) In general.--Notwithstanding section 1833(t) of the 
        Social Security Act (42 U.S.C. 1395l(t)), as added by 
        subsection (a), the amount that is paid from the Federal 
        Supplementary Medical Insurance Trust Fund for covered OPD 
        Services furnished by a hospital in a rural area during a 
        calendar year (or portion thereof) specified in paragraph 
        (2)(A) may not be less than the applicable percentage of the 
        case mix adjusted average amount that would have been payable 
        to such hospital for such services (including cost-sharing) if 
        the prospective payment system established under such section 
        did not apply. Such average amount may be determined on a 
        prospective basis using the Secretary's best estimate of the 
        reasonable costs incurred in furnishing covered OPD services or 
        on a retrospective basis using cost reports submitted by such a 
        hospital.
            ``(2) Definitions.--For purposes of paragraph (1)--
                    ``(A) subject to paragraph (3), the term 
                `applicable percentage' means--
                            ``(i) with respect to covered OPD services 
                        furnished during the first full calendar year 
                        (and any portion of the immediately preceding 
                        calendar year) for which the prospective 
                        payment system established under section 
                        1833(t) of such Act is in effect--
                                    ``(I) 100 percent for hospitals in 
                                rural areas with less than 50 beds; and
                                    ``(II) 95 percent for hospitals not 
                                described in subclause (I);
                            ``(ii) with respect to the second full 
                        calendar year for which such system is in 
                        effect--
                                    ``(I) 98 percent for hospitals in 
                                rural areas with less than 50 beds; and
                                    ``(II) 90 percent for hospitals not 
                                described in subclause (I);
                            ``(iii) with respect to the third full 
                        calendar year for which such system is in 
                        effect--
                                    ``(I) 95 percent for hospitals in 
                                rural areas with less than 50 beds; and
                                    ``(II) 85 percent for hospitals not 
                                described in subclause (I); and
                    ``(B) the term `covered OPD services' has the 
                meaning given that term in section 1833(t)(1)(B) of 
                such Act.
            ``(3) Application to certain hospitals.--In the case of 
        hospitals described in section 1833(t)(8) of such Act, the 
        `applicable percentage' for a calendar year (or portion 
        thereof) shall be the same applicable percentage that applies 
        to covered OPD services furnished by hospitals that are not 
        described in such section during such calendar year (or portion 
        thereof).
            ``(4) Rule of construction.--Nothing in this subsection 
        shall be construed as affecting the amount of cost-sharing paid 
        by individuals enrolled under part B of title XVIII of the 
        Social Security Act for covered OPD services.''.
    (b) Conforming Amendment.--Section 1833(t)(1)(A) of the Social 
Security Act (42 U.S.C. 1395l(t)(1)(A)) is amended by inserting 
``except as provided in section 4523(e) of the Balanced Budget Act of 
1997,'' after ``1999,''.
    (c) Effective Date.--The amendments made by this section shall 
become effective as if included in the enactment of the Balanced Budget 
Act of 1997.

SEC. 4. EXCLUDING CERTAIN AMBULANCE SERVICES FROM SNF PPS.

    (a) In General.--Section 1888(e)(2)(A)(ii) of the Social Security 
Act (42 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting ``ambulance 
and transport services furnished to patients requiring outpatient 
dialysis services,'' after ``section 1861(s)(2),''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to services furnished on or after January 1, 2000.

SEC. 5. STANDARDS FOR, AND TREATMENT OF, CRITICAL ACCESS HOSPITALS.

    (a) In General.--
            (1) Limitations on beds and los.--Section 
        1820(c)(2)(B)(iii) of the Social Security Act (42 U.S.C. 1395i-
        4(c)(2)(B)(iii)) is amended by striking ``to exceed 96 hours'' 
        and inserting ``to exceed, on average, 96 hours per patient''.
            (2) Payment.--
                    (A) Part a.--Section 1814(l) of the Social Security 
                Act (42 U.S.C. 1395f(l) is amended by adding at the end 
                the following: ``In the case of a critical access 
                hospital that is located in a health professional 
                shortage area, the amount otherwise payable under the 
                preceding sentence shall be increased by 5 percentage 
                points.''.
                    (B) Part b.--Section 1834(g) of the Social Security 
                Act (42 U.S.C. 1395m(g)) is amended by adding at the 
                end the following: ``In the case of a critical access 
                hospital that is located in a health professional 
                shortage area, the amount otherwise payable under the 
                preceding sentence shall be increased by 5 percentage 
                points.''.
            (3) Permitting maintenance of distinct part geriatric 
        psychiatric unit.--Section 1820(f) of the Social Security Act 
        (42 U.S.C. 1395i-4(f)) is amended--
                    (A) by inserting ``and certain distinct part 
                units'' after ``swing beds'';
                    (B) by inserting ``(1)'' after ``beds.--'', and
                    (C) by adding at the end the following:
    ``(2) Nothing in this section shall be construed to prohibit a 
State from designating or the Secretary from certifying a facility as a 
critical access hospital solely because the facility maintains a 
distinct part psychiatric unit for geriatric patients.''.
    (b) Criteria for Designation.--Section 1820(c)(2)(B)(i) of the 
Social Security Act (42 U.S.C. 1395i-4(c)(2)(B)(i)) is amended by 
striking ``is a'' and all that follows through ``hospital and''.
    (c) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after October 1, 1999.

SEC. 6. EXCLUSION OF SWING-BED DAYS FROM SNF PPS.

    (a) Exclusion From SNF PPS.--Section 1888(e)(7) of the Social 
Security Act (42 U.S.C. 1395yy(e)(7)) is amended to read as follows:
            ``(7) Exclusion.--The prospective payment system 
        established under this subsection shall not apply to services 
        provided by a hospital under an agreement described in section 
        1883.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after October 1, 1999.

SEC. 7. RESTORATION OF MEDICARE PAYMENTS FOR BAD DEBT.

    (a) In General.--Section 1861(v)(1)(T)(iii) of the Social Security 
Act (42 U.S.C. 1395x(v)(1)(T)(iii)) is amended by striking ``45'' and 
inserting ``10''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the provision of the Balanced Budget Act 
of 1997 to which the amendment relates at the time such provision 
became law.

SEC. 8. TEMPORARY EXEMPTION OF RURAL HEALTH CLINICS FROM PRODUCTIVITY 
              STANDARDS.

    (a) In General.--Section 1833(f) of the Social Security Act (42 
U.S.C. 1395l(f)) is amended--
            (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively;
            (2) by inserting ``(1)'' after ``(f)''; and
            (3) by adding at the end the following:
    ``(2) The Secretary may not apply productivity guidelines in 
determining the reasonable costs of rural health clinics for services 
furnished in calendar year 1998, 1999, 2000, or 2001.''.

SEC. 9. INFLATION UPDATES FOR RURAL PROVIDERS.

    (a) Hospitals.--
            (1) PPS.--Subclauses (XV) and (XVI) of section 
        1886(b)(3)(B)(i) of the Social Security Act (42 U.S.C. 
        1395ww(b)(3)(B)(i)) are each amended by striking ``all areas'' 
        and inserting ``urban areas, and the market basket percentage 
        increase for hospitals in rural areas''.
            (2) PPS-exempt.--Section 1886(b)(3)
        (B)(ii)(VII) of the Social Security Act (42 U.S.C. 
        1395ww(b)(3)(B)(ii)(VlI)) is amended to read as follows:
            ``(VII) for fiscal years 1999 through 2002, is the market 
        basket percentage increase for hospitals in rural areas, and 
        the applicable update factor specified under clause (vi) for 
        the fiscal year for hospitals in urban areas; and''.
    (b) Skilled Nursing Facilities.--Subclauses (I) and (II) of section 
1888(e)(4)(E)(ii) of the Social Security Act (42 U.S.C. 
1395yy(e)(4)(E)(ii)) are each amended by inserting ``for skilled 
nursing facilities in urban areas, and by the skilled nursing facility 
market basket percentage change for such year for skilled nursing 
facilities in rural areas'' after ``point''.

SEC. 10. EMERGENCY REQUIREMENT.

    The entire amount necessary to carry out this Act and the 
amendments made by this Act shall be available only to the extent that 
an official budget request for the entire amount, that includes 
designation of the entire amount of the request as an emergency 
requirement as defined in the Balanced Budget and Emergency Deficit 
Control Act of 1985, as amended, is transmitted by the President to the 
Congress: Provided, That the entire amount is designated by the 
Congress as an emergency requirement pursuant to section 251(b)(2)(A) 
of such Act.
Amends the Balanced Budget Act of 1997 to establish a temporary limit on reductions in Federal payments for covered OPD services furnished by a hospital in a rural area during a calendar year.
Provides that the entire amount necessary to carry out this Act and the amendments made by it shall be available only to the extent that an official budget request for the entire amount, that includes designation of the entire amount of the request as an emergency requirement under the Balanced Budget and Emergency Deficit Control Act of 1985 (Gramm- Rudman-Hollings Act), as amended, is transmitted by the President to Congress, if that entire amount is designated by Congress as an emergency requirement.
Rural Hospital Relief Act of 1999