[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6502 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 6502

To amend title XVIII of the Social Security Act to establish a program 
    to allow qualified group practices to furnish certain items and 
    services at qualified skilled nursing facilities to individuals 
  entitled to benefits under part A and enrolled under part B of the 
Medicare program to reduce unnecessary hospitalizations, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 25, 2018

   Mr. Smith of Nebraska (for himself, Mrs. Black, Mr. Crowley, Mr. 
Griffith, and Mr. Ben Ray Lujan of New Mexico) 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 establish a program 
    to allow qualified group practices to furnish certain items and 
    services at qualified skilled nursing facilities to individuals 
  entitled to benefits under part A and enrolled under part B of the 
Medicare program to reduce unnecessary hospitalizations, 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 ``Reducing Unnecessary Senior 
Hospitalizations Act of 2018'' or the ``RUSH Act of 2018''.

SEC. 2. SNF-BASED PROVISION OF PREVENTIVE ACUTE CARE AND 
              HOSPITALIZATION REDUCTION PROGRAM.

    Title XVIII of the Social Security Act is amended by adding at the 
end the following new section:

``SEC. 1899C. SNF-BASED PROVISION OF PREVENTIVE ACUTE CARE AND 
              HOSPITALIZATION REDUCTION PROGRAM.

    ``(a) Establishment.--There is established a program to be known as 
the `SNF-based Provision of Preventive Acute Care and Hospitalization 
Reduction Program' (in this section referred to as the `Program'), to 
be administered by the Secretary, for purposes of reducing unnecessary 
hospitalizations and emergency department visits by allowing qualified 
group practices (as defined in section 1877(h)(4)) on or after January 
1, 2019, to furnish items and services identified under subsection 
(b)(3) to individuals entitled to benefits under part A and enrolled 
under part B residing in qualified skilled nursing facilities.
    ``(b) Operation of Program.--Under the Program, the Secretary shall 
provide for the following:
            ``(1) Certification of skilled nursing facilities as 
        qualified skilled nursing facilities under subsection (c)(1).
            ``(2) Certification of group practices as qualified group 
        practices under subsection (c)(2).
            ``(3) Identification of minimum required nonsurgical items 
        and services furnished at a hospital emergency department that 
        may be safely furnished by a qualified group practice at a 
        qualified skilled nursing facility under the Program and that 
        such qualified group practice shall offer to furnish under the 
        Program.
            ``(4) Annual identification of additional items and 
        services furnished at a hospital emergency department that may 
        be safely furnished by a qualified group practice at a 
        qualified skilled nursing facility under the Program during a 
        year and that such qualified group practice may offer to 
        furnish under the Program during such year.
            ``(5) Establishment of qualifications for nonphysician 
        employees of such qualified group practices who may furnish 
        such items and services at a qualified skilled nursing 
        facility. Such qualifications shall include the requirement 
        that such an employee--
                    ``(A) be certified in advanced cardiovascular life 
                support by a nationally recognized specialty board of 
                certification or equivalent certification board; and
                    ``(B) have at least one year of clinical experience 
                furnishing medical care--
                            ``(i) in a hospital emergency department 
                        setting; or
                            ``(ii) as an employee of a provider or 
                        supplier of ambulance services.
            ``(6) Payment under this title for items and services 
        identified under paragraph (3) or (4) furnished by such 
        qualified group practices at such a facility in amounts 
        determined under subsection (d).
    ``(c) Certifications.--
            ``(1) Qualified skilled nursing facilities.--For purposes 
        of this section, the Secretary shall certify a skilled nursing 
        facility as a qualified skilled nursing facility if the 
        facility submits an application in a time and manner specified 
        by the Secretary and meets the following requirements:
                    ``(A) The facility has on-site diagnostic equipment 
                necessary for a qualified group practice to furnish on-
                site items and services under the Program and real-time 
                audio and visual capabilities.
                    ``(B) The facility ensures that residents of such 
                facility, upon entering such facility, are allowed to 
                specify in an advanced care directive whether the 
                resident wishes to receive items and services furnished 
                at the facility under the Program in a case where 
                communication with the resident is not possible.
                    ``(C) The facility ensures that individuals to be 
                furnished such items and services under the Program at 
                such facility have the opportunity, at their request, 
                to instead be transported to a hospital emergency 
                department.
            ``(2) Qualified group practices.--For purposes of this 
        section, the Secretary shall certify a group practice as a 
        qualified group practice for a period of 3 years if the group 
        practice submits an application in a time and manner specified 
        by the Secretary and meets the following requirements:
                    ``(A) The group practice offers to furnish all 
                minimum required items and services identified under 
                subsection (b)(3) under the Program.
                    ``(B) The group practice submits a notification to 
                the Secretary annually specifying which (if any) 
                additional items and services identified under 
                subsection (b)(4) for a year the group practice will 
                offer to furnish for such year under the Program.
                    ``(C) The group practice ensures that only 
                individuals who meet the qualifications established 
                under subsection (b)(4) or a physician who is part of 
                such group practice may furnish such minimum required 
                items and services and such additional items and 
                services.
                    ``(D) The group practice ensures that at least 1 
                such individual or such physician is present at all 
                times at each qualified skilled nursing facility where 
                the group practice may furnish such minimum required 
                items and services and such additional items and 
                services.
                    ``(E) The group practice ensures that, in the case 
                where such minimum required items and services or such 
                additional items and services are furnished by such an 
                individual, such individual furnishes such minimum 
                required items and services or additional items and 
                services under the supervision, either in-person or 
                through the use of telehealth (not including store-and-
                forward technologies), of--
                            ``(i) a physician--
                                    ``(I) who is board certified or 
                                board eligible in emergency medicine, 
                                family medicine, or internal medicine; 
                                or
                                    ``(II) who has been certified by a 
                                nationally recognized specialty board 
                                of certification or equivalent 
                                certification board in advanced cardiac 
                                life support and advanced trauma life 
                                support;
                            ``(ii) a nurse practitioner who has been 
                        certified by a nationally recognized specialty 
                        board of certification or equivalent 
                        certification board in advanced cardiac life 
                        support and advanced trauma life support; or
                            ``(iii) a physician assistant who has been 
                        certified by a nationally recognized specialty 
                        board of certification or equivalent 
                        certification board in advanced cardiac life 
                        support and advanced trauma life support.
                    ``(F) With respect to any year in which the 
                qualified group practice would participate in the 
                Program, the Chief Actuary for the Centers for Medicare 
                & Medicaid Services determines that such participation 
                during such year will not result in total estimated 
                expenditures under this title for such year being 
                greater than total estimated expenditures under such 
                title for such year without such participation.
    ``(d) Payments.--
            ``(1) In general.--For 2019 and each subsequent year, the 
        Secretary shall develop a schedule of payments to apply for 
        items and services identified under paragraph (3) or paragraph 
        (4) of subsection (b) furnished during such year by a qualified 
        group practice under the Program. Such payments shall be in 
        lieu of any other payments that may be made under this title 
        for such items and services furnished under the Program.
            ``(2) Shared savings.--In the case of a year for which the 
        Secretary determines that a qualified group practice's 
        participation in the Program resulted in a reduction in 
        expenditures under this title compared to what such 
        expenditures would have been without such participation, the 
        Secretary shall--
                    ``(A) pay to such qualified group practice an 
                amount equal to 37.5 percent of the estimated amount of 
                such reduction; and
                    ``(B) pay to each qualified skilled nursing 
                facility where such qualified group practice furnished 
                items and services under the Program during such year 
                an amount that bears the same ratio to 12.5 percent of 
                the estimated amount of such reduction as the amount of 
                expenditures under the Program for such items and 
                services furnished with respect to individuals at such 
                facility by such qualified group practice during such 
                year bears to the total amount of expenditures under 
                the Program for such items and services furnished with 
                respect to all individuals by such qualified group 
                practice during such year.
    ``(e) Evaluation.--
            ``(1) In general.--With respect to a qualified group 
        practice and a qualified skilled nursing facility, not later 
        than 6 months after such group practice begins furnishing items 
        and services under the Program (or, in the case of a qualified 
        skilled nursing facility, not less than 6 months after a 
        qualified group practice first furnishes such items and 
        services at such facility), and not less than once every 2 
        years thereafter, the Secretary shall evaluate such qualified 
        group practice and such qualified facility using information 
        received under paragraph (2) on such criteria as determined 
        appropriate by the Secretary.
            ``(2) Reporting of information.--In a time and manner 
        specified by the Secretary, a qualified group practice and a 
        qualified skilled nursing facility shall submit to the 
        Secretary a report containing the following information with 
        respect to items and services furnished under the Program 
        during a reporting period (as specified by the Secretary):
                    ``(A) The number of individuals with respect to 
                whom such group practice furnished such items and 
                services in such period (or, in the case of a qualified 
                skilled nursing facility, the number of individuals 
                with respect to whom such a group practice furnished 
                such items and services at such facility in such 
                period).
                    ``(B) The number of such individuals who were 
                admitted to a hospital or treated in the emergency 
                department of a hospital within 24 hours of being 
                furnished such items and services.
                    ``(C) Other information determined appropriate by 
                the Secretary.
            ``(3) Loss of qualified certification.--
                    ``(A) In general.--Not later than 3 months after a 
                determination described in this sentence is made, the 
                Secretary may revoke the certification of a qualified 
                skilled nursing facility or a qualified group practice 
                made under subsection (c) if--
                            ``(i) the Chief Actuary of the Centers for 
                        Medicare & Medicaid Services determines that 
                        such skilled nursing facility's or such group 
                        practice's participation in the Program during 
                        a year resulted in total expenditures under 
                        this title for such period being greater than 
                        total expenditures under such title would have 
                        been during such period without such 
                        participation; or
                            ``(ii) the Secretary determines that such 
                        skilled nursing facility or such group practice 
                        has failed to comply with a requirement 
                        specified in paragraph (1) or (2) of subsection 
                        (c), as applicable.
                    ``(B) Exclusion from certification for 3-year 
                period.--In the case that the Secretary revokes the 
                certification of a qualified skilled nursing facility 
                or a qualified group practice under subparagraph (A), 
                such skilled nursing facility or such group practice 
                shall be ineligible for certification as a qualified 
                skilled nursing facility or a qualified group practice 
                (as applicable) under subsection (c) for a period of 3 
                years beginning on the date of such revocation.
    ``(f) Determination of Budget Neutrality; Termination of Program.--
            ``(1) Determination.--Not later than July 1, 2024, the 
        Chief Actuary of the Centers for Medicare & Medicaid Services 
        shall determine whether the Program has resulted in an increase 
        in total expenditures under this title with respect to the 
        period beginning on January 1, 2019, and ending on December 31, 
        2023, compared to what such expenditures would have been during 
        such period had the Program not been in operation.
            ``(2) Termination.--If the Chief Actuary makes a 
        determination under paragraph (1) that the Program has resulted 
        in an increase in total expenditures under this title, the 
        Secretary shall terminate the Program as of January 1 of the 
        first year beginning after such determination.''.
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