,,ii  #aacth ,,congress  #ast ,session  
,s4 #cbh  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,february #ad1 #bjac
 ,mr4 ,thune 7for himself1 ,mr4 ,udall  
of ,new ,mexico1 and ,mr4 ,bennet7      
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,finance  ,a ,,bill  ,to  
amend title ,,xviii of the ,social      
,security ,act to allow certain critical
 access hospitals and sole community    
hospitals to use interactive            
telecommunications systems to satisfy   
requirements with respect to having a   
physician available to stabilize an     
individual with an emergency medical    
condition under the ,medicare program4  
#a4 ,short title ,this ,act may be cited
 as the ,strengthening ,rural ,access to
 ,emergency ,services ,act4  #b4        
,allowing certain critical access       
hospitals and sole community hospitals  
to use interactive telecommunications   
systems to satisfy requirements with    
respect to having a physician available 

to stabilize an individual with an      
emergency medical condition  7a7 ,in    
general ,section #ahff7;a7 of the       
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7a77 is amended--  7#a7 in      
paragraph 7#a77;,i77iii71 by inserting  
7subject to paragraph 7#d77 after on    
call for duty2 and  7#b7 by adding at   
the end the following new paragraph3    
7#d7 7,a7 ,for purposes of paragraph    
7#a77;,i77iii7 of this subsection and   
subsections 7b77#a77;,a7 and            
7d77#a77;,c7 of section #ahfg1 effective
 on the date of enactment of this       
paragraph1 with respect to an applicable
 critical access hospital or applicable 
sole community hospital1 a physician is 
considered on call for duty under such  
paragraph1 available to provide further 
medical examination and treatment       
necessary to stabilize an individual    
with an emergency medical condition     
under such subsection 7b77#a77;,a71 and 
to have appeared under such subsection  
7d77#a77;,c71 if the physician is       

available--  7i7 in person2 or  7ii7    
subject to subparagraph 7,b71 by        
interactive telecommunications system   
7as defined in section #daj4gh7;a77#c7  
of title #db1 ,code of ,federal         
,regulations74  7,b7 ,subparagraph      
7,a77ii7 shall only apply if--  7i7 the 
physician available by such interactive 
telecommunications system is board      
certified in emergency medicine or      
pediatric emergency medicine2 and  7ii7 
a nurse practitioner or physician       
assistant 7as those terms are defined in
 section #ahfa7;aa77#e77 is onsite in   
the emergency department4  7,c7 ,in this
 paragraph3  7i7 ,the term applicable   
critical access hospital means a        
critical access hospital 7as defined in 
section #ahfa7mm77#a77 located--  7,i7  
in an area that is designated as a rural
 health professional shortage area under
 section #ccb7;a77#a77;,a7 of the       
,public ,health ,service ,act2 and      
7,,ii7 in a county that is not included 
in a ,metropolitan ,statistical area4   

7ii7 ,the term applicable sole community
 hospital means a sole community        
hospital 7as defined in section         
#ahhf7;d77#e77;,d77iii77 that--  7,i7   
has less than #ej beds2  7,,ii7 has an  
emergency department2 and  7,,iii7 is   
located--  7aa7 in an area that is      
designated as a rural health            
professional shortage area under section
 #ccb7;a77#a77;,a7 of the ,public       
,health ,service ,act2 and  7bb7 in a   
county that is not included in a        
,metropolitan ,statistical ,area4  4    
7b7 ,conforming amendments ,section     
#ahfg of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acie;dd7 is amended--  7#a7 
in subsection 7b77#a77;,a71 by inserting
 7determined in accordance with section 
#ahff7;a77#d77 after hospital2 and  7#b7
 in subsection 7d77#a77;,c71 in the     
first sentence1 by inserting 7determined
 in accordance with section             
#ahff7;a77#d77 after refuses to appear4