,i #aaeth ,,congress #b;d ,session ,h4 ,r4 #fejb ,,in ,,the ,,house ,,of ,,representatives ,july #be1 #bjah,mr4 ,smith of ,nebraska 7for himself1 ,mrs4 ,black1 ,mr4 ,crowley1 ,mr4 ,griffith1 and ,mr4 ,ben ,ray ,lujn of ,new ,mexico7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 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 hospitalizations1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,reducing ,unnecessary ,senior ,hospitalizations ,act of #bjah or the ,,rush ,act of #bjah4 #b4 ,,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 section3 #ahii;,c4 ,,snf-based provision of preventive acute care and hospitalization reduction program 7a7 ,establishment ,there is established a program to be known as the ,,snf-based ,provision of ,preventive ,acute ,care and ,hospitalization ,reduction ,program 7in this section referred to as the ,program71 to be administered by the ,secretary1 for purposes of reducing unnecessary hospitalizations and emergency department visits by allowing qualified group practices 7as defined in section #ahgg7;h77#d77 on or after ,january #a1 #bjai1 to furnish items and services identified under subsection 7b77#c7 to individuals entitled to benefits under part ,a and enrolled under part ,b residing in qualified skilled nursing facilities4 7b7 ,operation of ,program ,under the ,program1 the ,secretary shall provide for the following3 7#a7 ,certification of skilled nursing facilities as qualified skilled nursing facilities under subsection 7c77#a74 7#b7 ,certification of group practices as qualified group practices under subsection 7c77#b74 7#c7 ,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 ,program4 7#d7 ,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 year4 7#e7 ,establishment of qualifications for nonphysician employees of such qualified group practices who may furnish such items and services at a qualified skilled nursing facility4 ,such qualifications shall include the requirement that such an employee-- 7,a7 be certified in advanced cardiovascular life support by a nationally recognized specialty board of certification or equivalent certification board2 and 7,b7 have at least one year of clinical experience furnishing medical care-- 7i7 in a hospital emergency department setting2 or 7ii7 as an employee of a provider or supplier of ambulance services4 7#f7 ,payment under this title for items and services identified under paragraph 7#c7 or 7#d7 furnished by such qualified group practices at such a facility in amounts determined under subsection 7d74 7c7 ,certifications 7#a7 ,qualified skilled nursing facilities ,for purposes of this section1 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 requirements3 7,a7 ,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 capabilities4 7,b7 ,the facility ensures that residents of such facility1 upon entering such facility1 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 possible4 7,c7 ,the facility ensures that individuals to be furnished such items and services under the ,program at such facility have the opportunity1 at their request1 to instead be transported to a hospital emergency department4 7#b7 ,qualified group practices ,for purposes of this section1 the ,secretary shall certify a group practice as a qualified group practice for a period of #c years if the group practice submits an application in a time and manner specified by the ,secretary and meets the following requirements3 7,a7 ,the group practice offers to furnish all minimum required items and services identified under subsection 7b77#c7 under the ,program4 7,b7 ,the group practice submits a notification to the ,secretary annually specifying which 7if any7 additional items and services identified under subsection 7b77#d7 for a year the group practice will offer to furnish for such year under the ,program4 7,c7 ,the group practice ensures that only individuals who meet the qualifications established under subsection 7b77#d7 or a physician who is part of such group practice may furnish such minimum required items and services and such additional items and services4 7,d7 ,the group practice ensures that at least #a 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 services4 7,e7 ,the group practice ensures that1 in the case where such minimum required items and services or such additional items and services are furnished by such an individual1 such individual furnishes such minimum required items and services or additional items and services under the supervision1 either in-person or through the use of telehealth 7not including store-and-forward technologies71 of-- 7i7 a physician-- 7,i7 who is board certified or board eligible in emergency medicine1 family medicine1 or internal medicine2 or 7,,ii7 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 support2 7ii7 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 support2 or 7iii7 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 support4 7,f7 ,with respect to any year in which the qualified group practice would participate in the ,program1 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 participation4 7d7 ,payments 7#a7 ,in general ,for #bjai and each subsequent year1 the ,secretary shall develop a schedule of payments to apply for items and services identified under paragraph 7#c7 or paragraph 7#d7 of subsection 7b7 furnished during such year by a qualified group practice under the ,program4 ,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 ,program4 7#b7 ,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 participation1 the ,secretary shall-- 7,a7 pay to such qualified group practice an amount equal to #cg4e percent of the estimated amount of such reduction2 and 7,b7 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 #ab4e 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 year4 7e7 ,evaluation 7#a7 ,in general ,with respect to a qualified group practice and a qualified skilled nursing facility1 not later than #f months after such group practice begins furnishing items and services under the ,program 7or1 in the case of a qualified skilled nursing facility1 not less than #f months after a qualified group practice first furnishes such items and services at such facility71 and not less than once every #b years thereafter1 the ,secretary shall evaluate such qualified group practice and such qualified facility using information received under paragraph 7#b7 on such criteria as determined appropriate by the ,secretary4 7#b7 ,reporting of information ,in a time and manner specified by the ,secretary1 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 7as specified by the ,secretary73 7,a7 ,the number of individuals with respect to whom such group practice furnished such items and services in such period 7or1 in the case of a qualified skilled nursing facility1 the number of individuals with respect to whom such a group practice furnished such items and services at such facility in such period74 7,b7 ,the number of such individuals who were admitted to a hospital or treated in the emergency department of a hospital within #bd hours of being furnished such items and services4 7,c7 ,other information determined appropriate by the ,secretary4 7#c7 ,loss of qualified certification 7,a7 ,in general ,not later than #c months after a determination described in this sentence is made1 the ,secretary may revoke the certification of a qualified skilled nursing facility or a qualified group practice made under subsection 7c7 if-- 7i7 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 participation2 or 7ii7 the ,secretary determines that such skilled nursing facility or such group practice has failed to comply with a requirement specified in paragraph 7#a7 or 7#b7 of subsection 7c71 as applicable4 7,b7 ,exclusion from certification for #c-year period ,in the case that the ,secretary revokes the certification of a qualified skilled nursing facility or a qualified group practice under subparagraph 7,a71 such skilled nursing facility or such group practice shall be ineligible for certification as a qualified skilled nursing facility or a qualified group practice 7as applicable7 under subsection 7c7 for a period of #c years beginning on the date of such revocation4 7f7 ,determination of budget neutrality2 termination of program 7#a7 ,determination ,not later than ,july #a1 #bjbd1 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 #a1 #bjai1 and ending on ,december #ca1 #bjbc1 compared to what such expenditures would have been during such period had the ,program not been in operation4 7#b7 ,termination ,if the ,chief ,actuary makes a determination under paragraph 7#a7 that the ,program has resulted in an increase in total expenditures under this title1 the ,secretary shall terminate the ,program as of ,january #a of the first year beginning after such determination4 4