H.R. 9642: Medicare Access to Rural Anesthesiology Act

This bill would change how Medicare pays for certain anesthesia services in rural hospitals and critical access hospitals.

What it would do

• It would require Medicare to pay on a reasonable-cost basis for anesthesia services provided by an anesthesiologist in certain qualifying rural hospitals and critical access hospitals.
• It would apply only to hospitals that meet specific conditions, including:
  • being located in a rural area,
  • having employed or contracted with no more than one full-time equivalent anesthesiologist when the law is enacted,
  • having had no more than 800 surgical procedures requiring anesthesia in the relevant year, and
  • having anesthesiologists agree not to bill Medicare Part B separately for those services at the hospital.
• The hospital would have to keep meeting the procedure-volume limit in later years to remain eligible.

How it would affect Medicare payment rules

• The bill would treat these anesthesia services as part of hospital services rather than separate physician services for Medicare payment purposes.
• It would also direct the Department of Health and Human Services to revise regulations so these services are excluded from certain definitions that otherwise govern physician billing.

Timing

• The changes would generally take effect one year after enactment.
• Different eligibility rules would begin in 2026 and 2027 for some of the hospital categories described in the bill.

Practical effect

• For the hospitals that qualify, the bill would shift Medicare payment for anesthesiology from separate physician billing toward hospital-based reimbursement.
• This could affect how rural hospitals structure anesthesia coverage and how anesthesiologists working there are paid.

Relevant Companies

None found