,i #aafth ,,congress #b;d ,session ,h4 ,r4 #ehjh ,,in ,,the ,,house ,,of ,,representatives ,february #g1 #bjbj,mr4 ,arrington 7for himself and ,mr4 ,cuellar7 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 provide for coverage of rural emergency medical access services under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,save ,rural ,communities ,act of #bjbj4 #b4 ,medicare rural emergency access centers and services 7a7 ,in general 7#a7 ,rural emergency access center and services defined ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7,a7 in subsection 7e71 in the last sentence of the matter following paragraph 7#i71 by inserting or a rural emergency access center 7as defined in subsection 7kkk77#a77 before the period at the end2 and 7,b7 by adding at the end the following subsection3 7kkk7 ,rural ,emergency ,access ,center2 ,rural ,access ,medical ,center ,services 7#a7 ,the term rural emergency access center means a facility that-- 7,a7 was1 as of the date that is #b years prior to the date of the enactment of this subsection-- 7i7 a hospital with not more than #ej beds located in a county 7or equivalent unit of local government7 in a rural area 7as defined in section #ahhf7;d77#b77;,d772 7ii7 a hospital with not more than #ej beds that was treated as being located in a rural area pursuant to section #ahhf7;d77#h77;,e72 or 7iii7 a critical access hospital2 7,b7 provides #bd-;hour emergency medical care and observation care that does not exceed an annual per patient average of #bd hours or more than #a midnight2 7,c7 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 services2 7,d7 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 hospital1 either by the rural emergency access center's ambulance service provider or through another ambulance service supplier2 7,e7 has elected to be designated as a rural emergency access center2 7,f7 has been licensed by1 or received approval to operate as a qualified emergency medical center from1 the ,state under paragraph 7#c72 and 7,g7 is certified by the ,secretary under paragraph 7#d74 7#b7 ,the term rural emergency access center services means medical and other health services furnished by a rural emergency access center on an outpatient basis4 7#c7 ,a facility may not operate as a rural emergency access center unless the facility-- 7,a7 is located in a ,state that provides for the licensing of emergency medical centers under ,state or applicable local law2 and 7,b7 7i7 is licensed pursuant to such law2 or 7ii7 is approved by the agency of such ,state or locality responsible for licensing hospitals1 as meeting the standards established for such licensing4 7#d7 ,the ,secretary shall certify a facility as a rural emergency access center if the facility-- 7,a7 meets the criteria for rural emergency access center described in subparagraphs 7,a7 through 7,f7 of paragraph 7#a72 7,b7 has in effect a transfer agreement with a level ,i or level ,,ii trauma center2 and 7,c7 meets such staff training and certification requirements as the ,secretary may require4 4 7#b7 ,payment for rural emergency access center services 7,a7 ,in general ,section #ahcc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is amended-- 7i7 in paragraph 7#h71 by striking and at the end2 7ii7 in paragraph 7#i71 by striking the period at the end and inserting 2 and2 and 7iii7 by inserting after paragraph 7#i7 the following new paragraph3 7#aj7 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 hospital1 the amounts described in section #ahcd7x74 4 7,b7 ,payment amount ,section #ahcd of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is amended by adding at the end the following subsection3 7x7 ,payment rules relating to rural emergency access centers 7#a7 ,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 follows3 7,a7 ,facility fee ,with respect to facility services 7other than services for which payment is made under subparagraph 7,b771 the sum of the following3 7i7 ,,opps rate ,the amount of payment that would otherwise apply under section #ahcc7t7 for covered ,,opd services 7as defined in section #ahcc7t77#a77;,b7 7other than clause 7ii7 of such section774 7ii7 ,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 center4 7,b7 ,professional services ,with respect to professional services1 the amount of payment that would otherwise be made under this part 7other than under section #ahcc7t77#ba77 for such services4 7#b7 ,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-- 7,a7 the amount that would otherwise be paid for such ambulance services under section #ahcd7l72 and 7,b7 an additional amount determined appropriate by the ,secretary4 4 7b7 ,conditions of participation ,section #ahff7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is amended-- 7#a7 in subparagraph 7,x71 by striking at the end and2 7#b7 in subparagraph 7,y71 by striking at the end the period and inserting 1 and2 and 7#c7 by inserting after subparagraph 7,y7 the following new subparagraph3 7,z7 in the case of a rural emergency access center1 to meet requirements applicable to critical access hospitals under this title1 other than-- 7i7 requirements relating to a ,medicare rural hospital flexibility program under section #ahbj7;c71 including state designation of a facility as a critical access hospital and criteria for such designation under paragraph 7#b7 of such section2 7ii7 requirements relating to critical access hospitals and rural health networks under section #ahbj7;d72 7iii7 certification by the ,secretary as a critical access hospital under section #ahbj7;e72 7iv7 requirements relating to the provision of inpatient hospital services or acute care beds by a hospital or critical access hospital under this section1 including under-- 7,i7 paragraph 7#a77;,g7 of this subsection 7relating to certain payment restrictions for inpatient hospital services72 and 7,,ii7 paragraph 7#a77,t7 of this subsection 7relating to data submission requirements for inpatient hospital services for purposes of the low-volume adjustment72 and 7v7 such others provisions of law or regulation1 including provisions under ,part ,b and ,part ,e1 as the ,secretary may specify4 4 7c7 ,treatment as telehealth originating site ,section #ahcd7m77#d77;,c77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77ii77 is amended by adding at the end the following new subclause3 7,,xi7 ,a rural emergency access center 7as defined in section #ahfa7kkk77#a774 4 7d7 ,conforming amendment ,section #ahfa7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u77 is amended by inserting rural emergency access center1 after critical access hospital14 7e7 #cdj;,b covered entity ,section #cdj;,b7a77#d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bef;b7a77#d77 is amended by adding at the end the following new subparagraph3 7,p7 ,a rural emergency access center 7as defined in section #ahfa7kkk77#a7 of the ,social ,security ,act7 and that meets the requirements of subparagraph 7,l77i74 4