[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5678 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5678

To amend title XVIII of the Social Security Act to provide for coverage 
of rural emergency medical center services under the Medicare program, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 7, 2018

    Ms. Jenkins of Kansas (for herself, Mr. Kind, and Ms. Sewell of 
   Alabama) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide for coverage 
of rural emergency medical center services under the Medicare program, 
                        and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Emergency Medical Center Act 
of 2018'' or the ``REMC Act of 2018''.

SEC. 2. MEDICARE RURAL EMERGENCY MEDICAL CENTERS AND SERVICES.

    (a) In General.--
            (1) Rural emergency medical center and services defined.--
        Section 1861 of the Social Security Act (42 U.S.C. 1395x) is 
        amended--
                    (A) in subsection (e), in the last sentence of the 
                matter following paragraph (9), by inserting ``or a 
                rural emergency medical center (as defined in 
                subsection (jjj)(1))'' before the period at the end; 
                and
                    (B) by adding at the end the following subsection:

   ``Rural Emergency Medical Center; Rural Emergency Medical Center 
                                Services

    ``(jjj)(1) The term `rural emergency medical center' means a 
facility that--
            ``(A)(i) as of the date of the enactment of this 
        subsection--
                    ``(I) was a critical access hospital; or
                    ``(II) was a hospital with not more than 50 beds 
                located in a county (or equivalent unit of local 
                government) in a rural area (as defined in section 
                1886(d)(2)(D)), or was a hospital with not more than 50 
                beds that was treated as being located in a rural area 
                pursuant to section 1886(d)(8)(E); or
            ``(ii) was a critical access hospital described in clause 
        (i)(I) or a hospital described in clause (i)(II) that ceased 
        operations during the period beginning on the date that is 5 
        years prior to the date of the enactment of this subsection and 
        ending on the date of the enactment of this subsection;
            ``(B) provides 24-hour emergency medical care and 
        observation care that does not exceed an annual per patient 
        average of 24 hours or more than 1 midnight;
            ``(C) may include a unit of the facility that is licensed 
        as a distinct part skilled nursing facility;
            ``(D) does not provide any acute care inpatient beds and 
        has protocols in place for the timely transfer of patients who 
        require acute care inpatient services or other inpatient 
        services;
            ``(E) provides for the transport of patients who require 
        acute care inpatient services or other inpatient services from 
        the rural emergency medical center to a hospital or critical 
        access hospital, either by the rural emergency medical center's 
        ambulance service provider or through another ambulance service 
        supplier;
            ``(F) has elected to be designated as a rural emergency 
        medical center;
            ``(G) has been licensed by, or received approval to operate 
        as a qualified emergency medical center from, the State under 
        paragraph (3); and
            ``(H) is certified by the Secretary under paragraph (4).
    ``(2)(A) The term `rural emergency medical center services' means 
medical and other health services furnished by a rural emergency 
medical center on an outpatient basis.
    ``(B) Such term shall include extended care services (as defined in 
subsection (h)) subject to such requirements as the Secretary may 
specify.
    ``(3) A facility may not operate as a rural emergency medical 
center unless the facility--
            ``(A) is located in a State that provides for the licensing 
        of emergency medical centers under State or applicable local 
        law; and
            ``(B)(i) is licensed pursuant to such law; or
            ``(ii) is approved by the agency of such State or locality 
        responsible for licensing hospitals, as meeting the standards 
        established for such licensing.
    ``(4) The Secretary shall certify a facility as a rural emergency 
medical center if the facility--
            ``(A) meets the criteria for rural emergency medical center 
        described in subparagraphs (A) through (G) of paragraph (1);
            ``(B) has in effect a transfer agreement with a level I or 
        level II trauma center; and
            ``(C) meets such staff training and certification 
        requirements as the Secretary may require.
    ``(5) A facility certified by the Secretary as a rural emergency 
medical center shall be deemed to be a critical access hospital for 
purposes of section 256b of title 42, United States Code.''.
            (2) Payment for rural emergency medical center services.--
                    (A) In general.--Section 1833(a) of the Social 
                Security Act (42 U.S.C. 1395l(a)) is amended--
                            (i) in paragraph (8), by striking ``and'' 
                        at the end;
                            (ii) in paragraph (9), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by inserting after paragraph (9) the 
                        following new paragraph:
            ``(10) in the case of rural emergency medical center 
        services, services provided by a rural emergency medical center 
        ambulance service provider or another ambulance service 
        supplier to transport patients who require acute care inpatient 
        services or other inpatient services from such rural emergency 
        medical center to a hospital or critical access hospital, and 
        extended care services furnished by a rural emergency medical 
        center, the amounts described in section 1834(w).''.
                    (B) Payment amount.--Section 1834 of the Social 
                Security Act (42 U.S.C. 1395m) is amended by adding at 
                the end the following subsection:
    ``(w) Payment Rules Relating to Rural Emergency Medical Centers.--
            ``(1) Payment for rural emergency medical center outpatient 
        services.--The amount of payment for rural emergency medical 
        center services of a rural emergency medical center is 
        determined as follows:
                    ``(A) Facility fee.--With respect to facility 
                services (other than services for which payment is made 
                under subparagraph (B)), the sum of the following:
                            ``(i) OPPS rate.--The amount of payment 
                        that would otherwise apply under section 
                        1833(t) for covered OPD services (as defined in 
                        section 1833(t)(1)(B) (other than clause (ii) 
                        of such section)).
                            ``(ii) Additional fee.--An additional 
                        facility payment in an amount determined 
                        appropriate by the Secretary that accounts for 
                        the fixed costs of the rural emergency medical 
                        center in furnishing rural emergency medical 
                        center services and the low volume of services 
                        provided by such center.
                    ``(B) Professional services.--With respect to 
                professional services, the amount of payment that would 
                otherwise be made under this part (other than under 
                section 1833(t)(21)) for such services.
            ``(2) Payment for transportation services.--The amount of 
        payment for services provided by a rural emergency medical 
        center ambulance service provider or another ambulance service 
        supplier to transport patients who require acute care inpatient 
        services or other inpatient services from such rural emergency 
        medical center to a hospital or critical access hospital is 
        equal to 105 percent of the amount otherwise payable for such 
        services in such area under section 1834(l).
            ``(3) Payment for extended care services.--The amount of 
        payment for extended care services furnished by a rural 
        emergency medical center that is licensed and approved to 
        furnish such extended care services is equal to 110 percent of 
        the amount of payment that would otherwise be made for covered 
        skilled nursing facility services under section 1888(e) for the 
        year involved without regard to section 1888(h).''.
    (b) Conditions of Participation.--Section 1866(a)(1) of the Social 
Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
            (1) in subparagraph (X), by striking at the end ``and'';
            (2) in the subparagraph (Y), by striking at the end the 
        period and inserting a comma; and
            (3) by inserting after subparagraph (Y) the following new 
        subparagraph:
            ``(Z) in the case of a rural emergency medical center, to 
        meet requirements applicable to critical access hospitals under 
        this title, other than--
                    ``(i) requirements relating to a Medicare rural 
                hospital flexibility program under section 1820(c), 
                including state designation of a facility as a critical 
                access hospital and criteria for such designation under 
                paragraph (2) of such section;
                    ``(ii) requirements relating to critical access 
                hospitals and rural health networks under section 
                1820(d);
                    ``(iii) certification by the Secretary as a 
                critical access hospital under section 1820(e);
                    ``(iv) requirements relating to the provision of 
                inpatient hospital services or acute care beds by a 
                hospital or critical access hospital under this 
                section, including under--
                            ``(I) paragraph (1)(G) of this subsection 
                        (relating to certain payment restrictions for 
                        inpatient hospital services); and
                            ``(II) paragraph (1)(T) of this subsection 
                        (relating to data submission requirements for 
                        inpatient hospital services for purposes of the 
                        low-volume adjustment); and
                    ``(v) such others provisions of law or regulation, 
                including provisions under Part B and Part E, as the 
                Secretary may specify.''.
    (c) Treatment as Telehealth Originating Site.--Section 
1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 
1395m(m)(4)(C)(ii)) is amended by adding at the end the following new 
subclause:
                                    ``(IX) A rural emergency medical 
                                center (as defined in section 
                                1861(jjj)(1)).''.
    (d) Waiver of Distance Requirement for Replacement CAHs; Subsequent 
Redesignation of Rural Emergency Medical Center as CAHs.--Section 
1820(c)(2) of the Social Security Act (42 U.S.C. 1395i-4(c)(2)) is 
amended--
            (1) in subparagraph (B)(i)(I), by inserting ``subject to 
        subparagraph (F),'' before ``is located''; and
            (2) by adding at the end the following new subparagraphs:
                    ``(F) Option to waive distance requirement.--
                Beginning on the date of the enactment of this 
                subparagraph, for every critical access hospital 
                located in a State that is certified as a rural 
                emergency medical center under section 1861(jjj)(4), 
                the State shall have the option of waiving the distance 
                requirement described in subparagraph (B)(i)(I) with 
                respect to another facility located in the State that 
                is seeking designation as a critical access hospital 
                under this paragraph.
                    ``(G) Redesignation of a rural emergency medical 
                center as a critical access hospital.--A rural 
                emergency medical center that was previously designated 
                as a critical access hospital under this paragraph may 
                elect to be redesignated as a critical access hospital 
                (in the same manner that the hospital was originally 
                designated as a critical access hospital) at any time, 
                subject to such conditions as the Secretary may 
                establish.''.
    (e) Conforming Amendment.--Section 1861(u) of the Social Security 
Act (42 U.S.C. 1395x(u)) is amended by inserting ``rural emergency 
medical center,'' after ``critical access hospital,''.
    (f) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after the date that is 1 
year after the date of the enactment of this Act.
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