,,ii #aaith ,,congress #b;d ,session ,s4 #dibg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #bd1 #bjbf,mr4 ,hawley 7for himself and ,ms4 ,hassan7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to establish a guaranteed funding stream to keep existing emergency rooms at ,america's rural hospitals open1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,rural ,hospital ,emergency ,room ,guarantee ,act4 #b4 ,rural ,hospital ,emergency ,room ,guarantee ,fund ,part ,p of title ,,iii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g et seq47 is amended by adding at the end the following3 #cii,v-#h4 ,rural ,hospital ,emergency ,room ,guarantee ,fund 7a7 ,establishment ,there is established in the ,treasury of the ,united ,states a fund1 to be known as the ,rural ,hospital ,emergency ,room ,guarantee ,fund 7referred to in this section as the ,fund71 consisting of-- 7#a7 such amounts as are appropriated to the fund pursuant to subsection 7i72 and 7#b7 any amounts collected as civil monetary penalties under subsection 7g77#b77;,a74 7b7 ,administration ,the ,fund shall be administered by the ,secretary1 acting through the ,administrator of the ,health ,resources and ,services ,administration 7referred to in this section as the ,secretary74 7c7 ,use of funds 7#a7 ,in general ,amounts in the ,fund shall be available1 without further appropriation or fiscal year limitation1 to the ,secretary to make payments under the program established under paragraph 7#b74 7#b7 ,program 7,a7 ,in general ,not later than #ij days after the date of enactment of the ,rural ,hospital ,emergency ,room ,guarantee ,act1 the ,secretary shall establish1 and solicit applications for1 a #aj-year program 7referred to in this section as the program7 to make payments to eligible entities for the authorized uses described in subsection 7e74 7,b7 ,payments ,each year of the program1 the ,secretary shall-- 7i7 make a payment-- 7,i7 in the first year of the program1 in the amount of #a1jjj1jjj 7to be distributed in equal payments on a quarterly basis7 to each eligible entity with an approved application under subsection 7d77#b72 and 7,,ii7 in each subsequent year of the program1 in an amount equal to the amount of the payment for the preceding year1 as adjusted to reflect changes for the #ab-month period ending the preceding ,november #cj in the ,consumer ,price ,index for ,medical ,care ,services published by the ,bureau of ,labor ,statistics of the ,department of ,labor2 and 7ii7 make an additional payment to each such eligible entity in an amount not greater than #ej percent of the amount of the payment made to such eligible entity under clause 7i7 for that year1 to be determined by the ,secretary with respect to each such eligible entity pursuant to a formula established by the ,secretary by rulemaking based on1 with respect to an eligible entity-- 7,i7 the payor mix of the eligible entity2 7,,ii7 the injury need of patients within the immediate geographical area in which the eligible entity is located2 7,,iii7 the economic conditions in the geographic area in which such eligible entity is located2 and 7,,iv7 past financial history of such eligible entity4 7,c7 ,emergency payments ,the ,secretary may make an additional payment1 in an amount not to exceed #bej1jjj1 to an eligible entity with an approved application under subsection 7d77#b7 in any year of the program if the ,secretary determines that the emergency department of such eligible entity is in danger of closing in the next #ad days1 on the condition that no eligible entity may receive more than #a such payment in any year of the program4 7d7 ,applications2 approval2 eligibility 7#a7 ,in general ,each entity desiring to receive payments under the program shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may require4 7#b7 ,approval 7,a7 ,in general ,not later than #cj days after receiving an application under paragraph 7#a71 the ,secretary shall approve such application if the ,secretary determines that such entity meets the eligibility criteria described in paragraph 7#c74 ,such approval shall apply with respect to such an entity for the duration of the program1 except as provided in paragraph 7#d74 7,b7 ,requirement ,if the ,secretary does not approve an application under subparagraph 7,a71 as soon as practicable after such disapproval1 the ,secretary shall provide to the applicant-- 7i7 an explanation of the reason for the disapproval2 and 7ii7 an expedited process for curing any deficiencies in the application and reapplying4 7#c7 ,eligibility ,to be eligible to receive a payment under the program1 an entity-- 7,a7 shall be a rural health facility 7as defined in section #baje7;h77#c77;,d7 of the ,social ,security ,act71 other than an entity described in clause 7i77,,ii7 of such section2 7,b7 shall participate in a ,federal health care program 7as defined in section #aabh;,b7f7 of such ,act72 and 7,c7 shall operate a #bd-;hour emergency department of a hospital 7as defined in section #bgii;,a-#a7;a77#c77 or a #bd-;hour independent freestanding emergency department 7as so defined74 7#d7 ,condition of participation ,after the date on which the application of an eligible entity is approved under paragraph 7#b77;,a71 if such eligible entity is acquired1 in whole or in part1 by a private-equity1 venture-capital1 or similarly purposed ownership fund1 such eligible entity may not continue to participate in the program4 7e7 ,authorized uses ,an eligible entity receiving payments under the program-- 7#a7 may only use the funds to pay for the normal operating expenses1 including for staffing1 of the emergency department of such eligible entity2 and 7#b7 may not-- 7,a7 use the funds-- 7i7 to develop projects that do not directly impact the existing operations of such eligible entity2 or 7ii7 to make payments to executives1 executive staff1 or members of the board of directors of such eligible entity2 or 7,b7 transfer the funds to other facilities1 including other facilities of such eligible entity4 7f7 ,reporting ,each eligible entity receiving payments under the program shall submit to the ,secretary an annual report describing the financial condition and continued need of such eligible entity and the impact of such payments received during the preceding year on such eligible entity4 ,the ,secretary may not use such reported information to disqualify such eligible entity from participation in the program4 7g7 ,compliance 7#a7 ,in general ,the ,secretary shall conduct random audits of eligible entities receiving payments under the program to ensure the compliance of such eligible entities with the requirements of the program4 7#b7 ,violations ,if the ,secretary determines that an eligible entity has violated a requirement of the program1 the ,secretary may-- 7,a7 impose civil penalties1 including civil monetary penalties1 against such eligible entity2 or 7,b7 remove such eligible entity from participation in the program4 7h7 ,regulations for reporting ,not later than #ij days after the date of enactment of the ,rural ,hospital ,emergency ,room ,guarantee ,act1 the ,secretary1 acting through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall promulgate regulations-- 7#a7 establishing a reporting methodology for eligible entities enrolled in the ,medicare program under title ,,xviii of the ,social ,security ,act under section #ahff7;j7 of such ,act to disclose for informational purposes on any required cost reports under such title ,,xviii all payments received under the program2 and 7#b7 allowing an eligible entity to exclude all payments received under the program from cost settlement calculations and expense offsets4 7i7 ,mandatory funding ,out of any money in the ,treasury not otherwise appropriated1 there is authorized to be appropriated1 and there is appropriated1 to the ,fund such sums as are necessary for each of fiscal years #bjbf through #bjcf4 7j7 ,effect ,participation in the program shall not be taken into account in determining eligibility of an eligible entity under any other ,federal health care program 7as defined in section #aabh;,b7f7 of the ,social ,security ,act7 and any payment under the program shall be in addition to any payment such eligible entity is eligible to receive under any other ,federal health care program 7as so defined74 4