[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7391 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 7391

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 21, 2018

Mr. Arrington 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 access 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 Hospital Freedom and 
Flexibility Act of 2018''.

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

    (a) In General.--
            (1) Rural emergency access 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 access center (as defined in subsection 
                (kkk)(1))'' before the period at the end; and
                    (B) by adding at the end the following subsection:

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

    ``(kkk)(1) The term `rural emergency access center' means a 
facility that--
            ``(A) was a critical access hospital as of 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) 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;
            ``(D) provides for the transport of patients who require 
        acute care inpatient services or other inpatient services from 
        the rural emergency access center to a hospital or critical 
        access hospital, either by the rural emergency access center's 
        ambulance service provider or through another ambulance service 
        supplier;
            ``(E) has elected to be designated as a rural emergency 
        access center;
            ``(F) has been licensed by, or received approval to operate 
        as a qualified emergency medical center from, the State under 
        paragraph (3); and
            ``(G) is certified by the Secretary under paragraph (4).
    ``(2) The term `rural emergency access center services' means 
medical and other health services furnished by a rural emergency access 
center on an outpatient basis.
    ``(3) A facility may not operate as a rural emergency access 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 
access center if the facility--
            ``(A) meets the criteria for rural emergency access center 
        described in subparagraphs (A) through (F) 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 
access center shall be deemed to be a critical access hospital for 
purposes of section 340B of the Public Health Service Act.''.
            (2) Payment for rural emergency access 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 access center 
        services and services provided by a rural emergency access 
        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 
        access center to a hospital or critical access hospital, the 
        amounts described in section 1834(x).''.
                    (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:
    ``(x) Payment Rules Relating to Rural Emergency Access Centers.--
            ``(1) Payment for rural emergency access center outpatient 
        services.--The amount of payment for rural emergency access 
        center services of a rural emergency access 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 takes into 
                        account the low volume of services provided by 
                        such center and the low number of individuals 
                        served 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 payment 
        amount for ambulance services provided by a rural emergency 
        access 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 access center to a hospital or critical access 
        hospital is equal to the sum of--
                    ``(A) the amount that would otherwise be paid for 
                such ambulance services under section 1834(l); and
                    ``(B) an additional amount determined appropriate 
                by the Secretary.''.
    (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 access 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 access 
                                center (as defined in section 
                                1861(kkk)(1)).''.
    (d) Conforming Amendment.--Section 1861(u) of the Social Security 
Act (42 U.S.C. 1395x(u)) is amended by inserting ``rural emergency 
access center,'' after ``critical access hospital,''.
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