,i #aaf? ,,congress #b;d ,session ,h4 ,r4 #ehjh ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,febru>y #g1 #bjbj,mr4 ,arr+ton 7= himself & ,mr4 ,cuell>7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means1 & 9 addition to ! ,committee on ,en]gy & ,comm]ce1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide = cov]age ( rural em]g5cy m$ical access s]vices "u ! ,m$ic>e program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,save ,rural ,communities ,act ( #bjbj4 #b4 ,m$ic>e rural em]g5cy access c5t]s & s]vices 7a7 ,9 g5]al 7#a7 ,rural em]g5cy access c5t] & s]vices def9$ ,section #ahfa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is am5d$-- 7,a7 9 subsection 7e71 9 ! la/ s5t5ce ( ! matt] foll[+ p>agraph 7#i71 by ins]t+ or a rural em]g5cy access c5t] 7z def9$ 9 subsection 7kkk77#a77 be=e ! p]iod at ! end2 & 7,b7 by add+ at ! end ! foll[+ subsection3 7kkk7 ,rural ,em]g5cy ,access ,c5t]2 ,rural ,access ,m$ical ,c5t] ,s]vices 7#a7 ,! t]m rural em]g5cy access c5t] means a facility t-- 7,a7 01 z ( ! date t is #b ye>s prior to ! date ( ! enactm5t ( ?is subsection-- 7i7 a hospital ) n m ?an #ej b$s locat$ 9 a c\nty 7or equival5t unit ( local gov]nm5t7 9 a rural area 7z def9$ 9 section #ahhf7;d77#b77;,d772 7ii7 a hospital ) n m ?an #ej b$s t 0 treat$ z be+ locat$ 9 a rural area pursuant to section #ahhf7;d77#h77;,e72 or 7iii7 a critical access hospital2 7,b7 provides #bd-;h\r em]g5cy m$ical c>e & obs]vation c>e t does n exce$ an annual p] pati5t av]age ( #bd h\rs or m ?an #a midnight2 7,c7 does n provide any acute c>e inpati5t b$s & has protocols 9 place = ! timely transf] ( pati5ts :o require acute c>e inpati5t s]vices or o!r inpati5t s]vices2 7,d7 provides = ! transport ( pati5ts :o require acute c>e inpati5t s]vices or o!r inpati5t s]vices f ! rural em]g5cy access c5t] to a hospital or critical access hospital1 ei!r by ! rural em]g5cy access c5t]'s ambulance s]vice provid] or ?r\gh ano!r ambulance s]vice suppli]2 7,e7 has elect$ to be designat$ z a rural em]g5cy access c5t]2 7,f7 has be5 lic5s$ by1 or receiv$ approval to op]ate z a qualifi$ em]g5cy m$ical c5t] f1 ! ,/ate "u p>agraph 7#c72 & 7,g7 is c]tifi$ by ! ,secret>y "u p>agraph 7#d74 7#b7 ,! t]m rural em]g5cy access c5t] s]vices means m$ical & o!r heal? s]vices furni%$ by a rural em]g5cy access c5t] on an outpati5t basis4 7#c7 ,a facility may n op]ate z a rural em]g5cy access c5t] unless ! facility-- 7,a7 is locat$ 9 a ,/ate t provides = ! lic5s+ ( em]g5cy m$ical c5t]s "u ,/ate or applicable local law2 & 7,b7 7i7 is lic5s$ pursuant to su* law2 or 7ii7 is approv$ by ! ag5cy ( su* ,/ate or locality responsible = lic5s+ hospitals1 z meet+ ! /&>ds e/abli%$ = su* lic5s+4 7#d7 ,! ,secret>y %all c]tify a facility z a rural em]g5cy access c5t] if ! facility-- 7,a7 meets ! crit]ia = rural em]g5cy access c5t] describ$ 9 subp>agraphs 7,a7 ?r\gh 7,f7 ( p>agraph 7#a72 7,b7 has 9 effect a transf] agreem5t ) a level ,i or level ,,ii trauma c5t]2 & 7,c7 meets su* /aff tra9+ & c]tification requirem5ts z ! ,secret>y may require4 4 7#b7 ,paym5t = rural em]g5cy access c5t] s]vices 7,a7 ,9 g5]al ,section #ahcc7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7a77 is am5d$-- 7i7 9 p>agraph 7#h71 by /rik+ & at ! end2 7ii7 9 p>agraph 7#i71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7iii7 by ins]t+ aft] p>agraph 7#i7 ! foll[+ new p>agraph3 7#aj7 9 ! case ( rural em]g5cy access c5t] s]vices & s]vices provid$ by a rural em]g5cy access c5t] ambulance s]vice provid] or ano!r ambulance s]vice suppli] to transport pati5ts :o require acute c>e inpati5t s]vices or o!r inpati5t s]vices f su* rural em]g5cy access c5t] to a hospital or critical access hospital1 ! am\nts describ$ 9 section #ahcd7x74 4 7,b7 ,paym5t am\nt ,section #ahcd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7 is am5d$ by add+ at ! end ! foll[+ subsection3 7x7 ,paym5t rules relat+ to rural em]g5cy access c5t]s 7#a7 ,paym5t = rural em]g5cy access c5t] outpati5t s]vices ,! am\nt ( paym5t = rural em]g5cy access c5t] s]vices ( a rural em]g5cy access c5t] is det]m9$ z foll[s3 7,a7 ,facility fee ,) respect to facility s]vices 7o!r ?an s]vices = :i* paym5t is made "u subp>agraph 7,b771 ! sum ( ! foll[+3 7i7 ,,opps rate ,! am\nt ( paym5t t w\ld o!rwise apply "u section #ahcc7t7 = cov]$ ,,opd s]vices 7z def9$ 9 section #ahcc7t77#a77;,b7 7o!r ?an clause 7ii7 ( su* section774 7ii7 ,additional fee ,an additional facility paym5t 9 an am\nt det]m9$ appropriate by ! ,secret>y t takes into acc\nt ! l[ volume ( s]vices provid$ by su* c5t] & ! l[ numb] ( individuals s]v$ by su* c5t]4 7,b7 ,pr(essional s]vices ,) respect to pr(essional s]vices1 ! am\nt ( paym5t t w\ld o!rwise be made "u ?is "p 7o!r ?an "u section #ahcc7t77#ba77 = su* s]vices4 7#b7 ,paym5t = transportation s]vices ,! paym5t am\nt = ambulance s]vices provid$ by a rural em]g5cy access c5t] ambulance s]vice provid] or ano!r ambulance s]vice suppli] to transport pati5ts :o require acute c>e inpati5t s]vices or o!r inpati5t s]vices f su* rural em]g5cy access c5t] to a hospital or critical access hospital is equal to ! sum (-- 7,a7 ! am\nt t w\ld o!rwise be paid = su* ambulance s]vices "u section #ahcd7l72 & 7,b7 an additional am\nt det]m9$ appropriate by ! ,secret>y4 4 7b7 ,conditions ( p>ticipation ,section #ahff7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is am5d$-- 7#a7 9 subp>agraph 7,x71 by /rik+ at ! end &2 7#b7 9 subp>agraph 7,y71 by /rik+ at ! end ! p]iod & ins]t+ 1 &2 & 7#c7 by ins]t+ aft] subp>agraph 7,y7 ! foll[+ new subp>agraph3 7,z7 9 ! case ( a rural em]g5cy access c5t]1 to meet requirem5ts applicable to critical access hospitals "u ?is title1 o!r ?an-- 7i7 requirem5ts relat+ to a ,m$ic>e rural hospital flexibility program "u section #ahbj7;c71 includ+ /ate designation ( a facility z a critical access hospital & crit]ia = su* designation "u p>agraph 7#b7 ( su* section2 7ii7 requirem5ts relat+ to critical access hospitals & rural heal? networks "u section #ahbj7;d72 7iii7 c]tification by ! ,secret>y z a critical access hospital "u section #ahbj7;e72 7iv7 requirem5ts relat+ to ! provision ( inpati5t hospital s]vices or acute c>e b$s by a hospital or critical access hospital "u ?is section1 includ+ "u-- 7,i7 p>agraph 7#a77;,g7 ( ?is subsection 7relat+ to c]ta9 paym5t re/rictions = inpati5t hospital s]vices72 & 7,,ii7 p>agraph 7#a77,t7 ( ?is subsection 7relat+ to data submission requirem5ts = inpati5t hospital s]vices = purposes ( ! l[-volume adju/m5t72 & 7v7 su* o!rs provisions ( law or regulation1 includ+ provisions "u ,"p ,b & ,"p ,e1 z ! ,secret>y may specify4 4 7c7 ,treatm5t z teleheal? orig9at+ site ,section #ahcd7m77#d77;,c77ii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciem7m77#d77;,c77ii77 is am5d$ by add+ at ! end ! foll[+ new subclause3 7,,xi7 ,a rural em]g5cy access c5t] 7z def9$ 9 section #ahfa7kkk77#a774 4 7d7 ,con=m+ am5dm5t ,section #ahfa7u7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u77 is am5d$ by ins]t+ rural em]g5cy access c5t]1 aft] critical access hospital14 7e7 #cdj;,b cov]$ entity ,section #cdj;,b7a77#d7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;b7a77#d77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,p7 ,a rural em]g5cy access c5t] 7z def9$ 9 section #ahfa7kkk77#a7 ( ! ,social ,security ,act7 & t meets ! requirem5ts ( subp>agraph 7,l77i74 4