Relief for Rural Providers During Emergencies Act

II 116TH CONGRESS 2D SESSION S. 3631 To provide relief for rural providers during the national emergency with respect to the Coronavirus Disease 2019 (COVID–19). IN THE SENATE OF THE UNITED STATES MAY 6, 2020 Mr. SASSE introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To provide relief for rural providers during the national emergency with respect to the Coronavirus Disease 2019 (COVID–19). 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 ‘‘Relief for Rural Pro- 4 viders During Emergencies Act’’. 5 SEC. 2. PAUSING ELIGIBILITY DETERMINATIONS UNDER 6 THE 340B DRUG PRICING PROGRAM. 7 (a) IN GENERAL.—The Secretary of Health and 8 Human Services shall, for any cost reporting period end- 9 ing in 2020 or 2021, for any other cost reporting period 10 VerDate Sep 11 2014 01:59 May 08, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S3631.IS S3631 pamtmann on DSKBC07HB2PROD with BILLS 2 •S 3631 IS in which the COVID–19 public health emergency is in ef- 1 fect during all or part of such period, and for any extended 2 period under subsection (b)— 3 (1) pause the process of making any determina- 4 tion as to whether an entity, that was a covered en- 5 tity for the most recent cost reporting period prior 6 to the first date on which the COVID–19 public 7 health emergency went into effect, continues to be 8 such a covered entity; and 9 (2) deem any entity, that was a covered entity 10 for the most recent cost reporting period prior to the 11 first date on which the COVID–19 public health 12 emergency went into effect, as continuing to meet all 13 requirements for being such a covered entity. 14 (b) EXTENSION.—The Secretary shall extend the ap- 15 plication of paragraphs (1) and (2) of subsection (a) to 16 any cost reporting period that is not described in such sub- 17 section if necessary to ensure that no entity loses eligibility 18 status as a covered entity for any reason related to the 19 COVID–19 public health emergency. 20 (c) DEFINITIONS.—In this section: 21 (1) COVERED ENTITY.—The term ‘‘covered en- 22 tity’’ has the meaning given such term in section 23 340B(a)(4) of the Public Health Service Act (42 24 U.S.C. 256b(a)(4)). 25 VerDate Sep 11 2014 01:59 May 08, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S3631.IS S3631 pamtmann on DSKBC07HB2PROD with BILLS 3 •S 3631 IS (2) COVID–19 PUBLIC HEALTH EMERGENCY.— 1 The term ‘‘COVID–19 public health emergency’’ 2 means the public health emergency declared by the 3 Secretary of Health and Human Services under sec- 4 tion 319 of the Public Health Service Act (42 5 U.S.C. 247d) on January 31, 2020, with respect to 6 COVID–19. 7 SEC. 3. WAIVER OF CERTAIN REQUIREMENTS DURING NA- 8 TIONAL EMERGENCY. 9 Notwithstanding any other provision of law, during 10 any portion of the national emergency declared by the 11 President under the National Emergencies Act (50 U.S.C. 12 1601 et seq.) with respect to the Coronavirus Disease 13 2019 (COVID–19) beginning on or after the date of the 14 enactment of this Act and ending on the earlier of the 15 date on which such emergency declaration terminates or 16 the date that is 180 days after such date of enactment, 17 the Secretary shall— 18 (1) waive any prior authorization requirements 19 otherwise applicable under titles XVIII and XIX of 20 the Social Security Act (42 U.S.C. 1395 et seq., 21 1396 et seq.) with respect to treatment and testing 22 for COVID–19; 23 VerDate Sep 11 2014 01:59 May 08, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3631.IS S3631 pamtmann on DSKBC07HB2PROD with BILLS 4 •S 3631 IS (2) with respect to inpatient hospital services 1 (as defined in section 1861(b) of such Act (42 2 U.S.C. 1395x(b))— 3 (A) waive any requirements otherwise ap- 4 plicable under title XVIII that would otherwise 5 prevent the Secretary from providing reim- 6 bursement for inpatient hospital services that 7 are furnished off-site at an unlicensed facility; 8 and 9 (B) provide reimbursement for such serv- 10 ices furnished at such facility at an amount 11 equal to the payment amount determined under 12 the hospital inpatient prospective payment sys- 13 tem under section 1886(d) of such Act (42 14 U.S.C. 1395ww(d)) if the facility were a sub- 15 section (d) hospital (as defined in paragraph 16 (1)(B) of such section); and 17 (3) waive the provisions of section 1867(d) of 18 the Social Security Act (42 U.S.C. 1395dd(d)), re- 19 lating to enforcement of requirements with respect 20 to examination and treatment for emergency medical 21 conditions and women in labor, for transfers or redi- 22 rections of patients away from hospital emergency 23 departments. 24 VerDate Sep 11 2014 01:59 May 08, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S3631.IS S3631 pamtmann on DSKBC07HB2PROD with BILLS 5 •S 3631 IS SEC. 4. RELIEF FOR CRITICAL ACCESS HOSPITALS. 1 Notwithstanding any other provision of law, during 2 the 60-day period beginning on the date of the enactment 3 of this Act, the Secretary shall waive the following provi- 4 sions of title XVIII of the Social Security Act: 5 (1) With respect to certification of critical ac- 6 cess hospitals (as defined in section 1861(mm)(1)) 7 of such Act (42 U.S.C. 1395x(mm)(1)), the limita- 8 tion on the number of acute care inpatient beds oth- 9 erwise applicable under section 1820(c)(2)(B)(iii) of 10 such Act (42 U.S.C. 1395i–4(c)(2)(B)(iii)). 11 (2) With respect to inpatient critical access hos- 12 pital services (as defined in section 1861(mm)(2)) of 13 such Act (42 U.S.C. 1395x(mm)(2)), the physician 14 certification requirement under section 1814(a)(8) of 15 such Act (42 U.S.C. 1395f(a)(8)). 16 SEC. 5. RELIEF FOR SKILLED NURSING FACILITIES. 17 (a) TEMPORARY WAIVER OF 3-DAY HOSPITALIZA- 18 TION REQUIREMENT FOR COVERAGE OF POST-HOSPITAL 19 EXTENDED CARE SERVICES.—Notwithstanding any other 20 provision of law, with respect to post-hospital extended 21 care services (as defined in section 1861(i)) of the Social 22 Security Act (42 U.S.C. 1395x(i)) furnished during any 23 portion of the national emergency declared by the Presi- 24 dent under the National Emergencies Act (50 U.S.C. 25 1601 et seq.) with respect to the Coronavirus Disease 26 VerDate Sep 11 2014 01:59 May 08, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S3631.IS S3631 pamtmann on DSKBC07HB2PROD with BILLS 6 •S 3631 IS 2019 (COVID–19) beginning on or after the date of the 1 enactment of this Act and ending on the earlier of the 2 date on which such emergency declaration terminates or 3 the date that is 180 days after such date of enactment, 4 the Secretary shall waive the 3-day hospitalization require- 5 ment for coverage of such services under such section 6 1861(i). 7 (b) MEDICARE SKILLED NURSING FACILITY PRO- 8 SPECTIVE PAYMENT SYSTEM ADJUSTMENT FOR COVID– 9 19 RESIDENTS DURING NATIONAL EMERGENCY.— 10 (1) IN GENERAL.—Section 1888(e) of the So- 11 cial Security Act (42 U.S.C. 1395yy(e)) is amend- 12 ed— 13 (A) in paragraph (1), by striking ‘‘and 14 (12)’’ and inserting ‘‘(12), and (13)’’; and 15 (B) by inserting after paragraph (12) the 16 following new paragraph: 17 ‘‘(13) ADJUSTMENT FOR RESIDENTS WITH 18 COVID–19.—During any portion of the national 19 emergency declared by the President under the Na- 20 tional Emergencies Act (50 U.S.C. 1601 et seq.) 21 with respect to the Coronavirus Disease 2019 22 (COVID–19) beginning on or after the date of the 23 enactment of this paragraph and ending on the ear- 24 lier of the date on which such emergency declaration 25 VerDate Sep 11 2014 01:59 May 08, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S3631.IS S3631 pamtmann on DSKBC07HB2PROD with BILLS 7 •S 3631 IS terminates or the date that is 180 days after such 1 date of enactment, in the case of a resident who has 2 a principal or secondary diagnosis of COVID–19, 3 the per diem amount of payment otherwise applica- 4 ble shall be increased by 15 percent to reflect in- 5 creased costs associated with such residents.’’. 6 (2) IMPLEMENTATION.—Notwithstanding any 7 other provision of law, the Secretary may implement 8 the amendments made by this subsection by pro- 9 gram instruction or otherwise. 10 SEC. 6. ENSURING RURAL PROVIDERS ARE INCLUDED IN 11 CARES. 12 (a) IN GENERAL.—The third paragraph in the mat- 13 ter under the heading ‘‘PUBLIC HEALTH AND SOCIAL 14 SERVICES EMERGENCY FUND (INCLUDING TRANSFER OF 15 FUNDS)’’ under the heading OFFICE OF THE SECRETARY 16 under the heading ‘‘DEPARTMENT OF HEALTH AND 17 HUMAN SERVICES’’ of division B of the CARES Act 18 (Public Law 116–136) is amended— 19 (1) in the third proviso, by inserting ‘‘, and in- 20 cludes skilled nursing facilities, nursing facilities, as- 21 sisted living residences, and other types of facilities 22 that provide housing and care for seniors’’ after ‘‘as 23 the Secretary may specify’’; and 24 VerDate Sep 11 2014 01:59 May 08, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S3631.IS S3631 pamtmann on DSKBC07HB2PROD with BILLS 8 •S 3631 IS (2) by inserting after the second proviso the fol- 1 lowing: ‘‘Provided further, That the Secretary shall 2 use at least 20 percent of the funds appropriated 3 under this paragraph in this Act to make payments 4 under this paragraph to eligible health care pro- 5 viders located in rural areas, as defined by the Sec- 6 retary:’’. 7 (b) EFFECTIVE DATE.—The amendments made by 8 this section shall take effect as if included in the enact- 9 ment of the CARES Act (Public Law 116–136). 10 Æ VerDate Sep 11 2014 01:59 May 08, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\S3631.IS S3631 pamtmann on DSKBC07HB2PROD with BILLS