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
VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808kjo
hn
so
n
on
D
S
K
79
L0
C
42
P
R
O
D
w
ith
B
IL
LS
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
VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808kjo
hn
so
n
on
D
S
K
79
L0
C
42
P
R
O
D
w
ith
B
IL
LS
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
VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808kjo
hn
so
n
on
D
S
K
79
L0
C
42
P
R
O
D
w
ith
B
IL
LS
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
VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808kjo
hn
so
n
on
D
S
K
79
L0
C
42
P
R
O
D
w
ith
B
IL
LS
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
VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808kjo
hn
so
n
on
D
S
K
79
L0
C
42
P
R
O
D
w
ith
B
IL
LS
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
VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808kjo
hn
so
n
on
D
S
K
79
L0
C
42
P
R
O
D
w
ith
B
IL
LS
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
VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808kjo
hn
so
n
on
D
S
K
79
L0
C
42
P
R
O
D
w
ith
B
IL
LS
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
VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H5808.IH H5808kjo
hn
so
n
on
D
S
K
79
L0
C
42
P
R
O
D
w
ith
B
IL
LS
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
VerDate Sep 11 2014 04:03 Feb 11, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H5808.IH H5808kjo
hn
so
n
on
D
S
K
79
L0
C
42
P
R
O
D
w
ith
B
IL
LS
<<
/ASCII85EncodePages false
/AllowTransparency false
/AutoPositionEPSFiles true
/AutoRotatePages /None
/Binding /Left
/CalGrayProfile (Dot Gain 20%)
/CalRGBProfile (sRGB IEC61966-2.1)
/CalCMYKProfile (U.S. Web Coated \050SWOP\051 v2)
/sRGBProfile (sRGB IEC61966-2.1)
/CannotEmbedFontPolicy /Error
/CompatibilityLevel 1.4
/CompressObjects /Off
/CompressPages true
/ConvertImagesToIndexed true
/PassThroughJPEGImages true
/CreateJobTicket false
/DefaultRenderingIntent /Default
/DetectBlends true
/DetectCurves 0.0000
/ColorConversionStrategy /LeaveColorUnchanged
/DoThumbnails false
/EmbedAllFonts true
/EmbedOpenType false
/ParseICCProfilesInComments true
/EmbedJobOptions true
/DSCReportingLevel 0
/EmitDSCWarnings false
/EndPage -1
/ImageMemory 1048576
/LockDistillerParams true
/MaxSubsetPct 100
/Optimize false
/OPM 1
/ParseDSCComments true
/ParseDSCCommentsForDocInfo true
/PreserveCopyPage true
/PreserveDICMYKValues true
/PreserveEPSInfo true
/PreserveFlatness true
/PreserveHalftoneInfo false
/PreserveOPIComments true
/PreserveOverprintSettings true
/StartPage 1
/SubsetFonts false
/TransferFunctionInfo /Preserve
/UCRandBGInfo /Preserve
/UsePrologue true
/ColorSettingsFile ()
/AlwaysEmbed [ true
]
/NeverEmbed [ true
]
/AntiAliasColorImages false
/CropColorImages true
/ColorImageMinResolution 300
/ColorImageMinResolutionPolicy /OK
/DownsampleColorImages false
/ColorImageDownsampleType /Bicubic
/ColorImageResolution 300
/ColorImageDepth 8
/ColorImageMinDownsampleDepth 1
/ColorImageDownsampleThreshold 1.50000
/EncodeColorImages true
/ColorImageFilter /FlateEncode
/AutoFilterColorImages false
/ColorImageAutoFilterStrategy /JPEG
/ColorACSImageDict <<
/QFactor 0.15
/HSamples [1 1 1 1] /VSamples [1 1 1 1]
>>
/ColorImageDict <<
/QFactor 0.15
/HSamples [1 1 1 1] /VSamples [1 1 1 1]
>>
/JPEG2000ColorACSImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/JPEG2000ColorImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/AntiAliasGrayImages false
/CropGrayImages true
/GrayImageMinResolution 300
/GrayImageMinResolutionPolicy /OK
/DownsampleGrayImages false
/GrayImageDownsampleType /Bicubic
/GrayImageResolution 300
/GrayImageDepth 8
/GrayImageMinDownsampleDepth 2
/GrayImageDownsampleThreshold 1.50000
/EncodeGrayImages true
/GrayImageFilter /FlateEncode
/AutoFilterGrayImages false
/GrayImageAutoFilterStrategy /JPEG
/GrayACSImageDict <<
/QFactor 0.15
/HSamples [1 1 1 1] /VSamples [1 1 1 1]
>>
/GrayImageDict <<
/QFactor 0.15
/HSamples [1 1 1 1] /VSamples [1 1 1 1]
>>
/JPEG2000GrayACSImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/JPEG2000GrayImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/AntiAliasMonoImages false
/CropMonoImages true
/MonoImageMinResolution 1200
/MonoImageMinResolutionPolicy /OK
/DownsampleMonoImages false
/MonoImageDownsampleType /Bicubic
/MonoImageResolution 1200
/MonoImageDepth -1
/MonoImageDownsampleThreshold 1.50000
/EncodeMonoImages true
/MonoImageFilter /CCITTFaxEncode
/MonoImageDict <<
/K -1
>>
/AllowPSXObjects false
/CheckCompliance [
/None
]
/PDFX1aCheck true
/PDFX3Check false
/PDFXCompliantPDFOnly true
/PDFXNoTrimBoxError false
/PDFXTrimBoxToMediaBoxOffset [
0.00000
0.00000
0.00000
0.00000
]
/PDFXSetBleedBoxToMediaBox true
/PDFXBleedBoxToTrimBoxOffset [
0.00000
0.00000
0.00000
0.00000
]
/PDFXOutputIntentProfile (U.S. Web Coated \050SWOP\051 v2)
/PDFXOutputConditionIdentifier (CGATS TR 001)
/PDFXOutputCondition ()
/PDFXRegistryName (http://www.color.org)
/PDFXTrapped /False
/CreateJDFFile false
/Description <<
/ARA
/BGR
/CHS
/CHT
/CZE
/DAN
/DEU
/ESP
/ETI
/FRA
/GRE
/HEB
/HRV
/HUN
/ITA (Utilizzare queste impostazioni per creare documenti Adobe PDF che devono essere conformi o verificati in base a PDF/X-1a:2001, uno standard ISO per lo scambio di contenuto grafico. Per ulteriori informazioni sulla creazione di documenti PDF compatibili con PDF/X-1a, consultare la Guida dell'utente di Acrobat. I documenti PDF creati possono essere aperti con Acrobat e Adobe Reader 4.0 e versioni successive.)
/JPN
/KOR
/LTH
/LVI
/NLD (Gebruik deze instellingen om Adobe PDF-documenten te maken die moeten worden gecontroleerd of moeten voldoen aan PDF/X-1a:2001, een ISO-standaard voor het uitwisselen van grafische gegevens. Raadpleeg de gebruikershandleiding van Acrobat voor meer informatie over het maken van PDF-documenten die compatibel zijn met PDF/X-1a. De gemaakte PDF-documenten kunnen worden geopend met Acrobat en Adobe Reader 4.0 en hoger.)
/NOR
/POL
/PTB
/RUM
/RUS
/SKY
/SLV
/SUO
/SVE
/TUR
/UKR
/ENU (Use these settings to create Adobe PDF documents that are to be checked or must conform to PDF/X-1a:2001, an ISO standard for graphic content exchange. For more information on creating PDF/X-1a compliant PDF documents, please refer to the Acrobat User Guide. Created PDF documents can be opened with Acrobat and Adobe Reader 4.0 and later.)
>>
/Namespace [
(Adobe)
(Common)
(1.0)
]
/OtherNamespaces [
<<
/AsReaderSpreads false
/CropImagesToFrames true
/ErrorControl /WarnAndContinue
/FlattenerIgnoreSpreadOverrides false
/IncludeGuidesGrids false
/IncludeNonPrinting false
/IncludeSlug false
/Namespace [
(Adobe)
(InDesign)
(4.0)
]
/OmitPlacedBitmaps false
/OmitPlacedEPS false
/OmitPlacedPDF false
/SimulateOverprint /Legacy
>>
<<
/AddBleedMarks false
/AddColorBars false
/AddCropMarks false
/AddPageInfo false
/AddRegMarks false
/ConvertColors /ConvertToCMYK
/DestinationProfileName ()
/DestinationProfileSelector /DocumentCMYK
/Downsample16BitImages true
/FlattenerPreset <<
/PresetSelector /HighResolution
>>
/FormElements false
/GenerateStructure false
/IncludeBookmarks false
/IncludeHyperlinks false
/IncludeInteractive false
/IncludeLayers false
/IncludeProfiles false
/MultimediaHandling /UseObjectSettings
/Namespace [
(Adobe)
(CreativeSuite)
(2.0)
]
/PDFXOutputIntentProfileSelector /DocumentCMYK
/PreserveEditing true
/UntaggedCMYKHandling /LeaveUntagged
/UntaggedRGBHandling /UseDocumentProfile
/UseDocumentBleed false
>>
]
>> setdistillerparams
<<
/HWResolution [2400 2400]
/PageSize [612.000 792.000]
>> setpagedevice
Superintendent of Documents
2020-02-13T01:02:41-0500
US GPO, Washington, DC 20401
Superintendent of Documents
GPO attests that this document has not been altered since it was disseminated by GPO