Save Rural Communities Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 5808 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 FEBRUARY 7, 2020 Mr. ARRINGTON (for himself and Mr. CUELLAR) introduced the following bill; which was referred to the Committee on Ways and Means, and in addi- tion to the Committee on Energy and Commerce, for a period to be sub- sequently 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Save Rural Commu- 4 nities Act of 2020’’. 5 SEC. 2. MEDICARE RURAL EMERGENCY ACCESS CENTERS 6 AND SERVICES. 7 (a) IN GENERAL.— 8 VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 5808 IH (1) RURAL EMERGENCY ACCESS CENTER AND 1 SERVICES DEFINED.—Section 1861 of the Social Se- 2 curity Act (42 U.S.C. 1395x) is amended— 3 (A) in subsection (e), in the last sentence 4 of the matter following paragraph (9), by in- 5 serting ‘‘or a rural emergency access center (as 6 defined in subsection (kkk)(1))’’ before the pe- 7 riod at the end; and 8 (B) by adding at the end the following sub- 9 section: 10 ‘‘Rural Emergency Access Center; Rural Access Medical 11 Center Services 12 ‘‘(kkk)(1) The term ‘rural emergency access center’ 13 means a facility that— 14 ‘‘(A) was, as of the date that is 2 years prior 15 to the date of the enactment of this subsection— 16 ‘‘(i) a hospital with not more than 50 beds 17 located in a county (or equivalent unit of local 18 government) in a rural area (as defined in sec- 19 tion 1886(d)(2)(D)); 20 ‘‘(ii) a hospital with not more than 50 beds 21 that was treated as being located in a rural 22 area pursuant to section 1886(d)(8)(E); or 23 ‘‘(iii) a critical access hospital; 24 VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 5808 IH ‘‘(B) provides 24-hour emergency medical care 1 and observation care that does not exceed an annual 2 per patient average of 24 hours or more than 1 mid- 3 night; 4 ‘‘(C) does not provide any acute care inpatient 5 beds and has protocols in place for the timely trans- 6 fer of patients who require acute care inpatient serv- 7 ices or other inpatient services; 8 ‘‘(D) provides for the transport of patients who 9 require acute care inpatient services or other inpa- 10 tient services from the rural emergency access center 11 to a hospital or critical access hospital, either by the 12 rural emergency access center’s ambulance service 13 provider or through another ambulance service sup- 14 plier; 15 ‘‘(E) has elected to be designated as a rural 16 emergency access center; 17 ‘‘(F) has been licensed by, or received approval 18 to operate as a qualified emergency medical center 19 from, the State under paragraph (3); and 20 ‘‘(G) is certified by the Secretary under para- 21 graph (4). 22 ‘‘(2) The term ‘rural emergency access center serv- 23 ices’ means medical and other health services furnished 24 by a rural emergency access center on an outpatient basis. 25 VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 5808 IH ‘‘(3) A facility may not operate as a rural emergency 1 access center unless the facility— 2 ‘‘(A) is located in a State that provides for the 3 licensing of emergency medical centers under State 4 or applicable local law; and 5 ‘‘(B)(i) is licensed pursuant to such law; or 6 ‘‘(ii) is approved by the agency of such State or 7 locality responsible for licensing hospitals, as meet- 8 ing the standards established for such licensing. 9 ‘‘(4) The Secretary shall certify a facility as a rural 10 emergency access center if the facility— 11 ‘‘(A) meets the criteria for rural emergency ac- 12 cess center described in subparagraphs (A) through 13 (F) of paragraph (1); 14 ‘‘(B) has in effect a transfer agreement with a 15 level I or level II trauma center; and 16 ‘‘(C) meets such staff training and certification 17 requirements as the Secretary may require.’’. 18 (2) PAYMENT FOR RURAL EMERGENCY ACCESS 19 CENTER SERVICES.— 20 (A) IN GENERAL.—Section 1833(a) of the 21 Social Security Act (42 U.S.C. 1395l(a)) is 22 amended— 23 (i) in paragraph (8), by striking 24 ‘‘and’’ at the end; 25 VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 5808 IH (ii) in paragraph (9), by striking the 1 period at the end and inserting ‘‘; and’’; 2 and 3 (iii) by inserting after paragraph (9) 4 the following new paragraph: 5 ‘‘(10) in the case of rural emergency access cen- 6 ter services and services provided by a rural emer- 7 gency access center ambulance service provider or 8 another ambulance service supplier to transport pa- 9 tients who require acute care inpatient services or 10 other inpatient services from such rural emergency 11 access center to a hospital or critical access hospital, 12 the amounts described in section 1834(x).’’. 13 (B) PAYMENT AMOUNT.—Section 1834 of 14 the Social Security Act (42 U.S.C. 1395m) is 15 amended by adding at the end the following 16 subsection: 17 ‘‘(x) PAYMENT RULES RELATING TO RURAL EMER- 18 GENCY ACCESS CENTERS.— 19 ‘‘(1) PAYMENT FOR RURAL EMERGENCY ACCESS 20 CENTER OUTPATIENT SERVICES.—The amount of 21 payment for rural emergency access center services 22 of a rural emergency access center is determined as 23 follows: 24 VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 5808 IH ‘‘(A) FACILITY FEE.—With respect to fa- 1 cility services (other than services for which 2 payment is made under subparagraph (B)), the 3 sum of the following: 4 ‘‘(i) OPPS RATE.—The amount of 5 payment that would otherwise apply under 6 section 1833(t) for covered OPD services 7 (as defined in section 1833(t)(1)(B) (other 8 than clause (ii) of such section)). 9 ‘‘(ii) ADDITIONAL FEE.—An addi- 10 tional facility payment in an amount deter- 11 mined appropriate by the Secretary that 12 takes into account the low volume of serv- 13 ices provided by such center and the low 14 number of individuals served by such cen- 15 ter. 16 ‘‘(B) PROFESSIONAL SERVICES.—With re- 17 spect to professional services, the amount of 18 payment that would otherwise be made under 19 this part (other than under section 20 1833(t)(21)) for such services. 21 ‘‘(2) PAYMENT FOR TRANSPORTATION SERV- 22 ICES.—The payment amount for ambulance services 23 provided by a rural emergency access center ambu- 24 lance service provider or another ambulance service 25 VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 5808 IH supplier to transport patients who require acute care 1 inpatient services or other inpatient services from 2 such rural emergency access center to a hospital or 3 critical access hospital is equal to the sum of— 4 ‘‘(A) the amount that would otherwise be 5 paid for such ambulance services under section 6 1834(l); and 7 ‘‘(B) an additional amount determined ap- 8 propriate by the Secretary.’’. 9 (b) CONDITIONS OF PARTICIPATION.—Section 10 1866(a)(1) of the Social Security Act (42 U.S.C. 11 1395cc(a)(1)) is amended— 12 (1) in subparagraph (X), by striking at the end 13 ‘‘and’’; 14 (2) in subparagraph (Y), by striking at the end 15 the period and inserting ‘‘, and’’; and 16 (3) by inserting after subparagraph (Y) the fol- 17 lowing new subparagraph: 18 ‘‘(Z) in the case of a rural emergency access 19 center, to meet requirements applicable to critical 20 access hospitals under this title, other than— 21 ‘‘(i) requirements relating to a Medicare 22 rural hospital flexibility program under section 23 1820(c), including state designation of a facility 24 as a critical access hospital and criteria for 25 VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 5808 IH such designation under paragraph (2) of such 1 section; 2 ‘‘(ii) requirements relating to critical ac- 3 cess hospitals and rural health networks under 4 section 1820(d); 5 ‘‘(iii) certification by the Secretary as a 6 critical access hospital under section 1820(e); 7 ‘‘(iv) requirements relating to the provision 8 of inpatient hospital services or acute care beds 9 by a hospital or critical access hospital under 10 this section, including under— 11 ‘‘(I) paragraph (1)(G) of this sub- 12 section (relating to certain payment re- 13 strictions for inpatient hospital services); 14 and 15 ‘‘(II) paragraph (1)(T) of this sub- 16 section (relating to data submission re- 17 quirements for inpatient hospital services 18 for purposes of the low-volume adjust- 19 ment); and 20 ‘‘(v) such others provisions of law or regu- 21 lation, including provisions under Part B and 22 Part E, as the Secretary may specify.’’. 23 (c) TREATMENT AS TELEHEALTH ORIGINATING 24 SITE.—Section 1834(m)(4)(C)(ii) of the Social Security 25 VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 5808 IH Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding 1 at the end the following new subclause: 2 ‘‘(XI) A rural emergency access 3 center (as defined in section 4 1861(kkk)(1)).’’. 5 (d) CONFORMING AMENDMENT.—Section 1861(u) of 6 the Social Security Act (42 U.S.C. 1395x(u)) is amended 7 by inserting ‘‘rural emergency access center,’’ after ‘‘crit- 8 ical access hospital,’’. 9 (e) 340B COVERED ENTITY.—Section 340B(a)(4) of 10 the Public Health Service Act (42 U.S.C. 256b(a)(4)) is 11 amended by adding at the end the following new subpara- 12 graph: 13 ‘‘(P) A rural emergency access center (as 14 defined in section 1861(kkk)(1) of the Social 15 Security Act) and that meets the requirements 16 of subparagraph (L)(i).’’. 17 Æ VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H5808.IH H5808 kjohnson on DSK79L0C42PROD with BILLS