,,ii #aafth ,,congress #ast ,session ,s4 #baeg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #ah1 #bjai,mr4 ,casey introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xi of the ,social ,security ,act to expand the use of global payments to hospitals in rural areas4 #a4 ,short title ,this ,act may be cited as the ,rural ,hospital ,sustainability ,act4 #b4 ,findings ,congress makes the following findings3 7#a7 ,approximately #aj1jjj1jjj individuals age #fe and older live in rural ,america today4 ,in fact1 #a out of every #d older adults lives in a small town or other rural area4 7#b7 ,residents of rural areas are more likely to be poorer1 sicker1 and have lower incomes compared to their urban counterparts4 7#c7 ,according to the ,office of ,rural ,health ,policy1 from #bjje to #bjji1 people living in rural areas had an average life expectancy of #gf4h years1 a full two years less than their urban counterparts who had an average life expectancy of #gh4h years4 7#d7 ,many rural hospitals are located in areas where a majority of the population is age #fe and older and has ,medicare coverage4 7#e7 ,certain ,state-based demonstrations to improve payment models for rural hospitals show promise in improving healthcare1 reducing costs1 and integrating services for patients4 7#f7 ,experts and organizations suggest that transitioning rural hospitals to global payment systems would benefit patients1 providers1 and rural communities4 #c4 ,expanding the use of global payments to hospitals in rural areas ,section #aaae;,a7b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77 is amended-- 7#a7 in subparagraph 7,b71 by adding at the end the following new clause3 7xxviii7 ,national testing of a model for global payments to hospitals in rural areas as described in subparagraph 7,d74 2 and 7#b7 by adding at the end the following new subparagraph3 7,d7 ,national testing of model for global payments to hospitals in rural areas ,in the case where the ,secretary selects the model described in clause 7ii7 of this subparagraph for testing pursuant to clause 7xxviii7 of subparagraph 7,b71 the following shall apply3 7i7 ,national testing 7,i7 ,in general ,subject to subclause 7,,ii71 the ,secretary shall allow each ,state to develop and submit to the ,secretary an application to begin testing such model in accordance with this clause within #a year of the date on which the model is selected for such testing4 7,,ii7 ,state designation of entities ,a ,state may designate an entity or organization for purposes of developing and submitting an application under subclause 7,i7 with respect to the ,state1 which may include the implementation of such model in the ,state4 ,in the case where a ,state makes such a designation1 with respect to any activities covered by the designation1 the entity or organization so designated shall be subject to any requirements applicable to the implementing ,state under this subparagraph in the same manner as such requirements are applicable to the implementing ,state4 7,,iii7 ,no effect on ongoing models or demonstration projects ,nothing in this subparagraph shall effect the testing of any model under this subsection or any demonstration project under this ,act that is implemented prior to the date of the enactment of this subparagraph4 7ii7 ,model described ,the model described in this clause seeks to increase rural ,americans' access to quality care in order to improve health1 while also reducing the growth of hospital expenditures across payers1 including ,medicare1 and increasing the financial viability of rural hospitals to ensure continued access to care4 ,under this model1 participating rural hospitals would-- 7,i7 be paid based on all-payer global budget1 a fixed amount that is set in advance for inpatient and outpatient hospital-based services and paid monthly by ,medicare fee-for-service1 ,state ,medicaid plans1 and all other participating payers2 7,,ii7 deliberately redesign the delivery of care to improve quality of care and meet the needs of their local communities2 7,,iii7 receive an upfront1 fixed payment for infrastructure redesign1 in an amount to be recovered over a period of time as set forth by the ,secretary2 7,,iv7 receive annual global budget payment adjustments based on an amount determined in conjunction with the ,secretary2 and 7,v7 partner with non-hospital providers such as physicians1 behavioral health providers1 schools1 and community based organizations to create a comprehensive care delivery system4 7iii7 ,definitions ,in this subparagraph3 7,i7 ,implementing ,state ,the term implementing ,state means a ,state whose application to begin testing such model is approved by the ,secretary under clause 7i74 7,,ii7 ,rural hospital ,the term rural hospital means the following3 7aa7 ,a critical access hospital 7as defined in section #ahfa7mm77#a774 7bb7 ,a sole community hospital 7as defined in section #ahhf7;d77#e77;,d77iii774 7cc7 ,a medicare-dependent1 small rural hospital 7as defined in section #ahhf7;d77#e77;,g77iv774 7dd7 ,any other hospital that is located in a rural area 7as defined in section #ahhf7;d77#b77;,d77 or is treated as being located in a rural area pursuant to section #ahhf7;d77#h77;,e74 7iv7 ,requirements for participating hospitals 7,i7 ,in general ,in order to participate in the model in an implementing ,state1 a rural hospital must-- 7aa7 subject to subclause 7,,ii71 conduct a community health needs assessment survey to determine the condition and health needs in their community1 including those needs with respect to mental or behavioral health2 and 7bb7 following such assessment survey1 submit and1 subject to clause 7vi71 receive approval of a ,rural ,hospital ,transformation ,plan 7as described in clause 7v77 from the implementing ,state and the ,secretary4 7,,ii7 ,exception ,a rural hospital meets the requirement described in subclause 7,i77aa7 if the rural hospital has conducted a community health needs assessment survey during the preceding year for any purpose4 7v7 ,rural ,hospital ,transformation ,plan described ,a ,rural ,hospital ,transformation ,plan described in this clause1 with respect to a rural hospital1 shall include the following information3 7,i7 ,results of the community health needs assessment survey under clause 7iv77,i77aa7 and an explanation of how the ,transformation ,plan suits the needs of the community4 7,,ii7 ,the population of individuals who will be served by the rural hospital under the model4 7,,iii7 ,the types of services that will be included in the global payment under the model4 7,,iv7 ,how the rural hospital intends to improve quality and health outcomes under the model1 including which population health outcomes the hospital will assess on an annual basis4 7,v7 ,how the rural hospital will achieve patient engagement and involvement in the model4 7,,vi7 ,how the rural hospital will identify1 partner with1 and pay other entities participating in the model4 7,,vii7 ,how private payers will be included in the model4 7,,viii7 ,plans to account for any market share changes under the model4 7,,ix7 ,how access to preventive care will be increased under the model4 7,x7 ,how the rural hospital will sustain the changes made under the model4 7,,xi7 ,how savings under the model will accrue to the ,medicare program under title ,,xviii4 7,,xii7 ,any other information required by the implementing ,state or the ,secretary4 7vi7 ,opportunity for public comment ,in order for the ,secretary or an implementing ,state to approve a ,rural ,hospital ,transformation ,plan under clause 7iv71 the ,secretary in consultation with the implementing ,state1 shall-- 7,i7 provide the public with a meaningful opportunity1 as determined by the ,secretary1 to provide comments on the plan2 and 7,,ii7 make a summary of comments provided available to the public on the ,internet website of the ,centers for ,medicare ,medicaid ,services4 7vii7 ,technical assistance ,the ,secretary shall designate an entity to provide technical assistance to participating rural hospitals as they redesign the care they deliver under the model4 7viii7 ,accounting for uncertainty ,in order for implementing ,states and participating rural hospitals to receive unanticipated additional resources needed to implement the model1 the ,secretary shall establish procedures for implementing ,states and participating rural hospitals to submit to the ,secretary a request for additional resources1 should variations in services outside of normally planned volume occur or should new technologies be developed1 or in such other circumstances as the ,secretary determines appropriate4 7ix7 ,monitoring outcomes ,the ,secretary1 in conjunction with implementing ,states and participating rural hospitals1 shall develop a plan to-- 7,i7 identify1 using a participating rural hospital's approved ,rural ,hospital ,transformation ,plan described in clause 7v71 the relevant local population of patients attributable to the hospital1 the data points the hospital may need to guide care redesign for that population1 and how the hospital may use such data2 7,,ii7 annually monitor outcomes under the model1 which may include financial1 quality1 access1 and utilization outcomes2 7,,iii7 annually monitor the specific population health outcomes listed in the approved ,rural ,hospital ,transformation ,plan of each participating rural hospital pursuant to clause 7v77,,iv72 and 7,,iv7 any other outcomes as determined by the ,secretary4 7x7 ,risk mitigation ,as part of the model1 the ,secretary1 in conjunction with implementing ,states and participating rural hospitals1 shall develop appropriate mechanisms to mitigate risks1 including the use of reinsurance4 7xi7 ,reporting requirements 7,i7 ,report to ,secretary ,an implementing ,state1 as a condition of implementing the model1 shall partner with an independent entity to report to the ,secretary on the ability of a participating rural hospital to carry out the ,rural ,hospital ,transformation ,plan described in clause 7v74 7,,ii7 ,report to ,congress ,not less frequently than every #e years 7for the duration of the implementation of the model under this subparagraph71 the ,secretary shall submit to ,congress a report on the implementation of the model under this subparagraph4 ,the report shall include best practices for future implementation efforts and any other information the ,secretary determines appropriate1 including the information reported under subclause 7,i71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 7xii7 ,funding ,the ,secretary shall allocate funds made available under subsection 7f77#a7 to design1 implement1 evaluate1 and report on the model described in clause 7ii7 in accordance with this subparagraph4 4