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Introduced in House (03/25/1999)

Triple-A Health Improvement Act of 1999 - Title I: Promoting Access to Health Care Services in Rural Areas Under the Medicare Program - Subtitle A: Hospital-Related Payment Provisions - Amends title XVIII (Medicare) of the Social Security Act (SSA) to revise hospital-related payment provisions concerned with: (1) the prospective payment system for hospital outpatient department services; (2) repeal of a certain restriction on Medicare payment to hospitals for inpatient hospital services with regard to certain hospital discharges to post-acute care; (3) geographic reclassification of sole community hospitals and the conversion of certain hospitals to critical access hospitals; (4) graduate medical education (GME); (5) Medicare- dependent small rural hospitals with regard to rebasing for discharges during the most current audited fiscal year; (6) geographic reclassification for purposes of disproportionate share hospital (DSH) payments; (7) guidelines for such reclassification by wage index; and (8) hospital geographic reclassification for labor costs for all items and services reimbursed under prospective payment systems.

Subtitle B: Medicare+Choice - Amends part C (Medicare+Choice) of SSA title XVIII to make certain adjustments to the calculation of annual capitation rates used in determining payments to Medicare+Choice organizations.

(Sec. 112) Repeals the phase-out of certain Medicare reasonable cost reimbursement contracts with respect to health maintenance organizations and competitive medical plans.

(Sec. 113) Directs the Secretary of Health and Human Services (HHS) to conduct demonstration projects to establish provider-sponsored organizations and other managed care entities based in rural and frontier areas.

Subtitle C: General Payment Provisions - Outlines general payment provisions, including those for: (1) direct Medicare payment for physician assistants, nurse practitioners, and clinical nurse specialists practicing in underserved rural areas; (2) coverage of and payment rules for qualified mental health professional services; and (3) creation of a safe harbor under anti-kickback provisions of SSA title XI part A (General Provisions) for any remuneration from a hospital to an ambulance provider under specified conditions.

(Sec. 123) Directs the Secretary to establish a waiver process under which Medicare program entities and individuals treated for reimbursement purposes as located in an urban or large urban area may apply to be considered as located in a rural area if such entity or individual is in fact located in a rural area (according to a specified definition), outside of an urbanized area, or in an area designated by a State as a rural area.

Title II: Promoting Access to Health Care Services in Rural Areas under the Medicaid Program - Amends SSA title XIX (Medicaid) to provide for continuation of certain Medicaid reimbursement rules (in existence before the Balanced Budget Act of 1997) for Federally-qualified health centers and rural health clinics, and to cover services of physicians' assistants and nurse practitioners under certain circumstances.

Title III: Promoting Access to Health Care Services in Rural Areas under the Internal Revenue Code - Amends the Internal Revenue Code: (1) to exclude from an individual's gross income certain amounts received under the National Health Service Corps Scholarship Program; (2) to revise certain requirements with respect to tax-exempt bonds of certain volunteer fire departments; and (3) allow banks to elect to apply the limitation on the amount of obligations which may be designated deductible small, tax-exempt debts by treating each borrower as the issuer of a separate item.

Title IV: Additional Provisions to Address Shortages of Health Professionals in Rural Areas - Requires that, whenever the Secretary promulgates a regulation relating to a health care program, there must be included with the promulgation an analysis of its likely impact on rural areas.

(Sec. 402) Amends the Public Health Service Act (PHSA) to include among health professional shortage areas frontier areas with six or fewer residents per square mile. 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.

(Sec. 403) Requires the heads of the National Health Service Corps, 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.

(Sec. 404) 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. 405) Mandates and outlines the process for revision of standards for designation of health professional shortage areas under PHSA.

Directs the Secretary to develop a definition for the term "frontier" for certain PHSA- and Medicare-related purposes.

(Sec. 406) Expresses the sense of Congress that the Secretary should establish within the Public Health Service an Office of Reserve Corps Coordination for the Commissioned Corps to oversee Reserve Corps management and provide for its effective utilization in improving rural health care.

Title V: Telemedicine - Subtitle A: Improvements to the Medicare Program - Amends the Balanced Budget Act of 1997 with regard to telehealth services, among other changes to: (1) extend Medicare reimbursement for such services to all Medicare services in all rural areas, including services by physical, occupational, and speech therapists; (2) revise related payment methodology; and (3) add congressional reporting requirements pertaining to the telehealth services program.

(Sec. 502) Redesignates the Joint Working Group on Telemedicine as the Joint Working Group on Telehealth, with the chairperson being designated by the Office for the Advancement on Telehealth. Directs the Joint Working Group to ensure that individuals representing the interests of rural areas are members of the Group. Establishes the mission of the Joint Working Group, among other things, as identifying, monitoring, and coordinating Federal telehealth projects and programs. Authorizes appropriations.

Subtitle B: Development of Telehealth Networks - Directs the Secretary to provide specified financial assistance for the purpose of expanding access to health care services for individuals in rural frontier areas through the use of telehealth. Authorizes appropriations.