H.R.5808

            I 

116TH CONGRESS 
2D SESSION H. R. 5808 

To amend title XVIII of the Social Security Act to provide for coverage 
of rural emergency medical access services under the Medicare program, 
and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 7, 2020 
Mr. ARRINGTON (for himself and Mr. CUELLAR) introduced the following bill; 

which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined by the Speaker, 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 program, and for other purposes. 

Be it enacted by the Senate and House of Representa-1

tives of the United States of America in Congress assembled, 2

SECTION 1. SHORT TITLE. 3

This Act may be cited as the ‘‘Save Rural Commu-4

nities Act of 2020’’. 5

SEC. 2. MEDICARE RURAL EMERGENCY ACCESS CENTERS 6

AND SERVICES. 7

(a) IN GENERAL.— 8

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2 

•HR 5808 IH

(1) RURAL EMERGENCY ACCESS CENTER AND 1

SERVICES DEFINED.—Section 1861 of the Social Se-2

curity Act (42 U.S.C. 1395x) is amended— 3

(A) in subsection (e), in the last sentence 4

of the matter following paragraph (9), by in-5

serting ‘‘or a rural emergency access center (as 6

defined in subsection (kkk)(1))’’ before the pe-7

riod at the end; and 8

(B) by adding at the end the following sub-9

section: 10

‘‘Rural Emergency Access Center; Rural Access Medical 11

Center Services 12

‘‘(kkk)(1) The term ‘rural emergency access center’ 13

means a facility that— 14

‘‘(A) was, as of the date that is 2 years prior 15

to the date of the enactment of this subsection— 16

‘‘(i) a hospital with not more than 50 beds 17

located in a county (or equivalent unit of local 18

government) in a rural area (as defined in sec-19

tion 1886(d)(2)(D)); 20

‘‘(ii) a hospital with not more than 50 beds 21

that was treated as being located in a rural 22

area pursuant to section 1886(d)(8)(E); or 23

‘‘(iii) a critical access hospital; 24

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3 

•HR 5808 IH

‘‘(B) provides 24-hour emergency medical care 1

and observation care that does not exceed an annual 2

per patient average of 24 hours or more than 1 mid-3

night; 4

‘‘(C) does not provide any acute care inpatient 5

beds and has protocols in place for the timely trans-6

fer of patients who require acute care inpatient serv-7

ices or other inpatient services; 8

‘‘(D) provides for the transport of patients who 9

require acute care inpatient services or other inpa-10

tient services from the rural emergency access center 11

to a hospital or critical access hospital, either by the 12

rural emergency access center’s ambulance service 13

provider or through another ambulance service sup-14

plier; 15

‘‘(E) has elected to be designated as a rural 16

emergency access center; 17

‘‘(F) has been licensed by, or received approval 18

to operate as a qualified emergency medical center 19

from, the State under paragraph (3); and 20

‘‘(G) is certified by the Secretary under para-21

graph (4). 22

‘‘(2) The term ‘rural emergency access center serv-23

ices’ means medical and other health services furnished 24

by a rural emergency access center on an outpatient basis. 25

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4 

•HR 5808 IH

‘‘(3) A facility may not operate as a rural emergency 1

access center unless the facility— 2

‘‘(A) is located in a State that provides for the 3

licensing of emergency medical centers under State 4

or applicable local law; and 5

‘‘(B)(i) is licensed pursuant to such law; or 6

‘‘(ii) is approved by the agency of such State or 7

locality responsible for licensing hospitals, as meet-8

ing the standards established for such licensing. 9

‘‘(4) The Secretary shall certify a facility as a rural 10

emergency access center if the facility— 11

‘‘(A) meets the criteria for rural emergency ac-12

cess center described in subparagraphs (A) through 13

(F) of paragraph (1); 14

‘‘(B) has in effect a transfer agreement with a 15

level I or level II trauma center; and 16

‘‘(C) meets such staff training and certification 17

requirements as the Secretary may require.’’. 18

(2) PAYMENT FOR RURAL EMERGENCY ACCESS 19

CENTER SERVICES.— 20

(A) IN GENERAL.—Section 1833(a) of the 21

Social Security Act (42 U.S.C. 1395l(a)) is 22

amended— 23

(i) in paragraph (8), by striking 24

‘‘and’’ at the end; 25

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5 

•HR 5808 IH

(ii) in paragraph (9), by striking the 1

period at the end and inserting ‘‘; and’’; 2

and 3

(iii) by inserting after paragraph (9) 4

the following new paragraph: 5

‘‘(10) in the case of rural emergency access cen-6

ter services and services provided by a rural emer-7

gency access center ambulance service provider or 8

another ambulance service supplier to transport pa-9

tients who require acute care inpatient services or 10

other inpatient services from such rural emergency 11

access center to a hospital or critical access hospital, 12

the amounts described in section 1834(x).’’. 13

(B) PAYMENT AMOUNT.—Section 1834 of 14

the Social Security Act (42 U.S.C. 1395m) is 15

amended by adding at the end the following 16

subsection: 17

‘‘(x) PAYMENT RULES RELATING TO RURAL EMER-18

GENCY ACCESS CENTERS.— 19

‘‘(1) PAYMENT FOR RURAL EMERGENCY ACCESS 20

CENTER OUTPATIENT SERVICES.—The amount of 21

payment for rural emergency access center services 22

of a rural emergency access center is determined as 23

follows: 24

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6 

•HR 5808 IH

‘‘(A) FACILITY FEE.—With respect to fa-1

cility services (other than services for which 2

payment is made under subparagraph (B)), the 3

sum of the following: 4

‘‘(i) OPPS RATE.—The amount of 5

payment that would otherwise apply under 6

section 1833(t) for covered OPD services 7

(as defined in section 1833(t)(1)(B) (other 8

than clause (ii) of such section)). 9

‘‘(ii) ADDITIONAL FEE.—An addi-10

tional facility payment in an amount deter-11

mined appropriate by the Secretary that 12

takes into account the low volume of serv-13

ices provided by such center and the low 14

number of individuals served by such cen-15

ter. 16

‘‘(B) PROFESSIONAL SERVICES.—With re-17

spect to professional services, the amount of 18

payment that would otherwise be made under 19

this part (other than under section 20

1833(t)(21)) for such services. 21

‘‘(2) PAYMENT FOR TRANSPORTATION SERV-22

ICES.—The payment amount for ambulance services 23

provided by a rural emergency access center ambu-24

lance service provider or another ambulance service 25

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7 

•HR 5808 IH

supplier to transport patients who require acute care 1

inpatient services or other inpatient services from 2

such rural emergency access center to a hospital or 3

critical access hospital is equal to the sum of— 4

‘‘(A) the amount that would otherwise be 5

paid for such ambulance services under section 6

1834(l); and 7

‘‘(B) an additional amount determined ap-8

propriate by the Secretary.’’. 9

(b) CONDITIONS OF PARTICIPATION.—Section 10

1866(a)(1) of the Social Security Act (42 U.S.C. 11

1395cc(a)(1)) is amended— 12

(1) in subparagraph (X), by striking at the end 13

‘‘and’’; 14

(2) in subparagraph (Y), by striking at the end 15

the period and inserting ‘‘, and’’; and 16

(3) by inserting after subparagraph (Y) the fol-17

lowing new subparagraph: 18

‘‘(Z) in the case of a rural emergency access 19

center, to meet requirements applicable to critical 20

access hospitals under this title, other than— 21

‘‘(i) requirements relating to a Medicare 22

rural hospital flexibility program under section 23

1820(c), including state designation of a facility 24

as a critical access hospital and criteria for 25

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8 

•HR 5808 IH

such designation under paragraph (2) of such 1

section; 2

‘‘(ii) requirements relating to critical ac-3

cess hospitals and rural health networks under 4

section 1820(d); 5

‘‘(iii) certification by the Secretary as a 6

critical access hospital under section 1820(e); 7

‘‘(iv) requirements relating to the provision 8

of inpatient hospital services or acute care beds 9

by a hospital or critical access hospital under 10

this section, including under— 11

‘‘(I) paragraph (1)(G) of this sub-12

section (relating to certain payment re-13

strictions for inpatient hospital services); 14

and 15

‘‘(II) paragraph (1)(T) of this sub-16

section (relating to data submission re-17

quirements for inpatient hospital services 18

for purposes of the low-volume adjust-19

ment); and 20

‘‘(v) such others provisions of law or regu-21

lation, including provisions under Part B and 22

Part E, as the Secretary may specify.’’. 23

(c) TREATMENT AS TELEHEALTH ORIGINATING 24

SITE.—Section 1834(m)(4)(C)(ii) of the Social Security 25

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9 

•HR 5808 IH

Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding 1

at the end the following new subclause: 2

‘‘(XI) A rural emergency access 3

center (as defined in section 4

1861(kkk)(1)).’’. 5

(d) CONFORMING AMENDMENT.—Section 1861(u) of 6

the Social Security Act (42 U.S.C. 1395x(u)) is amended 7

by inserting ‘‘rural emergency access center,’’ after ‘‘crit-8

ical access hospital,’’. 9

(e) 340B COVERED ENTITY.—Section 340B(a)(4) of 10

the Public Health Service Act (42 U.S.C. 256b(a)(4)) is 11

amended by adding at the end the following new subpara-12

graph: 13

‘‘(P) A rural emergency access center (as 14

defined in section 1861(kkk)(1) of the Social 15

Security Act) and that meets the requirements 16

of subparagraph (L)(i).’’. 17

Æ 

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