,,ii #aafth ,,congress #b;d ,session ,s4 #cddg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #aa1 #bjbj,mr4 ,thune 7for himself and ,mr4 ,cardin7 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 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 #bjbj or the ,,rush ,act of #bjbj4 #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 #bjba1 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 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 basic life support by a nationally recognized specialty board of certification or equivalent certification board2 and 7,b7 have-- 7i7 clinical experience furnishing medical care-- 7,i7 in a skilled nursing facility2 7,,ii7 in a hospital emergency department setting2 or 7,,iii7 as an employee of a provider or supplier of ambulance services2 or 7ii7 a certification in paramedicine4 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 items and services under the ,program and real-time audio and visual capabilities4 7,b7 ,the facility has at least one individual who meets the qualifications described in paragraph 7#e7 or a physician present #bd hours a day and #g days a week to work with the qualified group practice4 ,such individual may be a member of the staff of the qualified skilled nursing facility or of the qualified group practice4 7,c7 ,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,d7 ,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,e7 ,the facility is not part of the ,special ,focus ,facility program of the ,centers for ,medicare ,medicaid ,services 7although the facility may1 at the discretion of the ,secretary1 be a candidate for selection under such program74 ,nothing in this paragraph shall affect the requirements under section #ahai7;b77#d74 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#e7 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 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 geriatrics1 or internal medicine2 or 7,,ii7 who has been certified by a nationally recognized specialty board of certification or equivalent certification board in basic life support2 7ii7 a nurse practitioner who has been certified by a nationally recognized specialty board of certification or equivalent certification board in basic life support2 or 7iii7 a physician assistant who has been certified by a nationally recognized specialty board of certification or equivalent certification board in basic life support4 7,e7 ,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 #bjba 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 under the ,program4 ,such payments shall be in lieu of any other payments that may be made under this title for such items and services4 7#b7 ,shared savings ,in the case of a year for which the ,secretary determines that 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 in the case of each qualified skilled nursing facility where such qualified group practice furnished items and services under the ,program during such year-- 7i7 if the qualified skilled nursing facility has at least a three-star rating under the ,five ,star ,quality ,rating ,system 7or a successor system71 pay to the facility 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 year2 and 7ii7 in the case of a qualified skilled nursing facility that is not described in clause 7i71 retain in the ,federal ,hospital ,insurance ,trust ,fund under section #ahag the amount that the facility would have been paid pursuant to clause 7i7 if the facility were described in such clause until such time as the facility has at least a three-star rating under the ,five ,star ,quality ,rating ,system 7or a successor system71 at which point the ,secretary shall pay such amount to the facility4 7#c7 ,advanced alternative payment models ,paragraph 7#b7 shall not apply to items and services furnished to an individual entitled to benefits under part ,a and enrolled under ,part ,b for whom shared savings would otherwise be attributed through an advanced alternative payment model as authorized under section #aaae;,a or section #ahii4 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 the participation of such skilled nursing facility or such group practice 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 a facility is selected for the ,special ,focus ,facility program or1 if the facility is a candidate for the ,special ,focus ,facility program1 the ,secretary determines that the participation of such facility in the ,program should be terminated4 7,b7 ,exclusion from certification 7i7 ,in general ,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 the applicable period 7as defined under clause 7ii774 7ii7 ,applicable period defined ,in this subparagraph1 the term applicable period means-- 7,i7 if the revocation of a facility or group practice under subparagraph 7,a7 is due to the application of clause 7i7 of such subparagraph1 a #a-year period beginning on the date of such revocation2 and 7,,ii7 in the revocation of a facility under subparagraph 7,a7 is due to the application of clause 7ii7 of such subparagraph1 the period beginning on the date of such revocation and ending on the date on which the facility graduates from the ,special ,focus ,facility program 7or1 in the case of a facility that is a candidate for such program1 the date on which the facility is no longer such a candidate1 as determined by the ,secretary74 7f7 ,determination of budget neutrality2 termination of program 7#a7 ,determination ,not later than ,july #a1 #bjbf1 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 #bjba1 and ending on ,december #ca1 #bjbe1 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