DEMONSTRATION PROJECT ON COMMUNITY HEALTH INTEGRATION MODELS IN CERTAIN RURAL COUNTIES.

SEC. 123. DEMONSTRATION PROJECT ON COMMUNITY HEALTH INTEGRATION MODELS IN CERTAIN RURAL COUNTIES.(a) In General.—The Secretary shall establish a demonstration project to allow eligible entities to develop and test new models for the delivery of health care services in eligible counties for the purpose of improving access to, and better integrating the delivery of, acute care, extended care, and other essential health care services to Medicare beneficiaries.(b) Purpose.—The purpose of the demonstration project under this section is to—(1) explore ways to increase access to, and improve the adequacy of, payments for acute care, extended care, and other essential health care services provided under the Medicare and Medicaid programs in eligible counties; and(2) evaluate regulatory challenges facing such providers and the communities they serve.(c) Requirements.—The following requirements shall apply under the demonstration project:122 STAT. 2515(1) Health care providers in eligible counties selected to participate in the demonstration project under subsection (d)(3) shall (when determined appropriate by the Secretary), instead of the payment rates otherwise applicable under the Medicare program, be reimbursed at a rate that covers at least the reasonable costs of the provider in furnishing acute care, extended care, and other essential health care services to Medicare beneficiaries.(2) Methods to coordinate the survey and certification process under the Medicare program and the Medicaid program across all health service categories included in the demonstration project shall be tested with the goal of assuring quality and safety while reducing administrative burdens, as appropriate, related to completing such survey and certification process.(3) Health care providers in eligible counties selected to participate in the demonstration project under subsection (d)(3) and the Secretary shall work with the State to explore ways to revise reimbursement policies under the Medicaid program to improve access to the range of health care services available in such eligible counties.(4) The Secretary shall identify regulatory requirements that may be revised appropriately to improve access to care in eligible counties.(5) Other essential health care services necessary to ensure access to the range of health care services in eligible counties selected to participate in the demonstration project under subsection (d)(3) shall be identified. Ways to ensure adequate funding for such services shall also be explored.(d) Application Process.—(1) Eligibility.—(A) In general.—Eligibility to participate in the demonstration project under this section shall be limited to eligible entities.(B) Eligible entity defined.—In this section, the term “eligible entity” means an entity that—(i) is a Rural Hospital Flexibility Program grantee under section 1820(g) of the Social Security Act (42 U.S.C. 1395i–4(g)); and(ii) is located in a State in which at least 65 percent of the counties in the State are counties that have 6 or less residents per square mile.(2) Application.—(A) In general.—An eligible entity seeking to participate in the demonstration project under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require.(B) Limitation.—The Secretary shall select eligible entities located in not more than 4 States to participate in the demonstration project under this section.(3) Selection of eligible counties.—An eligible entity selected by the Secretary to participate in the demonstration project under this section shall select not more than 6 eligible counties in the State in which the entity is located in which to conduct the demonstration project.122 STAT. 2516(4) Eligible county defined.—In this section, the term “eligible county” means a county that meets the following requirements:(A) The county has 6 or less residents per square mile.(B) As of the date of the enactment of this Act, a facility designated as a critical access hospital which meets the following requirements was located in the county:(i) As of the date of the enactment of this Act, the critical access hospital furnished 1 or more of the following:(I) Home health services.(II) Hospice care.(III) Rural health clinic services.(ii) As of the date of the enactment of this Act, the critical access hospital has an average daily inpatient census of 5 or less.(C) As of the date of the enactment of this Act, skilled nursing facility services were available in the county in—(i) a critical access hospital using swing beds; or(ii) a local nursing home.(e) Administration.—(1) In general.—The demonstration project under this section shall be administered jointly by the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration and the Administrator of the Centers for Medicare & Medicaid Services, in accordance with paragraphs (2) and (3).(2) HRSA duties.—In administering the demonstration project under this section, the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration shall—(A) award grants to the eligible entities selected to participate in the demonstration project; and(B) work with such entities to provide technical assistance related to the requirements under the project.(3) CMS duties.—In administering the demonstration project under this section, the Administrator of the Centers for Medicare & Medicaid Services shall determine which provisions of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) the Secretary should waive under the waiver authority under subsection (i) that are relevant to the development of alternative reimbursement methodologies, which may include, as appropriate, covering at least the reasonable costs of the provider in furnishing acute care, extended care, and other essential health care services to Medicare beneficiaries and coordinating the survey and certification process under the Medicare and Medicaid programs, as appropriate, across all service categories included in the demonstration project.(f) Duration.—(1) In general.—The demonstration project under this section shall be conducted for a 3-year period beginning on October 1, 2009.(2) Beginning date of demonstration project.—The demonstration project under this section shall be considered to have begun in a State on the date on which the eligible 122 STAT. 2517 counties selected to participate in the demonstration project under subsection (d)(3) begin operations in accordance with the requirements under the demonstration project.(g) Funding.—(1) CMS.—(A) In general.—The Secretary shall provide for the transfer, in appropriate part from the Federal Hospital Insurance Trust Fund established under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund established under section 1841 of such Act (42 U.S.C. 1395t), of such sums as are necessary for the costs to the Centers for Medicare & Medicaid Services of carrying out its duties under the demonstration project under this section.(B) Budget neutrality.—In conducting the demonstration project under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary estimates would have been paid if the demonstration project under this section was not implemented.(2) HRSA.—There are authorized to be appropriated to the Office of Rural Health Policy of the Health Resources and Services Administration $800,000 for each of fiscal years 2010, 2011, and 2012 for the purpose of carrying out the duties of such Office under the demonstration project under this section, to remain available for the duration of the demonstration project.(h) Report.—(1) Interim report.—Not later than the date that is 2 years after the date on which the demonstration project under this section is implemented, the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration, in coordination with the Administrator of the Centers for Medicare & Medicaid Services, shall submit a report to Congress on the status of the demonstration project that includes initial recommendations on ways to improve access to, and the availability of, health care services in eligible counties based on the findings of the demonstration project.(2) Final report.—Not later than 1 year after the completion of the demonstration project, the Administrator of the Office of Rural Health Policy of the Health Resources and Services Administration, in coordination with the Administrator of the Centers for Medicare & Medicaid Services, shall submit a report to Congress on such project, together with recommendations for such legislation and administrative action as the Secretary determines appropriate.(i) Waiver Authority.—The Secretary may waive such requirements of titles XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 et seq.) as may be necessary and appropriate for the purpose of carrying out the demonstration project under this section.(j) Definitions.—In this section:(1) Extended care services.—The term “extended care services” means the following:(A) Home health services.(B) Covered skilled nursing facility services.(C) Hospice care.122 STAT. 2518(2) Covered skilled nursing facility services.—The term “covered skilled nursing facility services” has the meaning given such term in section 1888(e)(2)(A) of the Social Security Act (42 U.S.C. 1395yy(e)(2)(A)).(3) Critical access hospital.—The term “critical access hospital” means a facility designated as a critical access hospital under section 1820(c) of such Act (42 U.S.C. 1395i–4(c)).(4) Home health services.—The term “home health services” has the meaning given such term in section 1861(m) of such Act (42 U.S.C. 1395x(m)).(5) Hospice care.—The term “hospice care” has the meaning given such term in section 1861(dd) of such Act (42 U.S.C. 1395x(dd)).(6) Medicaid program.—The term “Medicaid program” means the program under title XIX of such Act (42 U.S.C. 1396 et seq.).(7) Medicare program.—The term “Medicare program” means the program under title XVIII of such Act (42 U.S.C. 1395 et seq.).(8) Other essential health care services.—The term “other essential health care services” means the following:(A) Ambulance services (as described in section 1861(s)(7) of the Social Security Act (42 U.S.C. 1395x(s)(7))).(B) Rural health clinic services.(C) Public health services (as defined by the Secretary).(D) Other health care services determined appropriate by the Secretary.(9) Rural health clinic services.—The term “rural health clinic services” has the meaning given such term in section 1861(aa)(1) of such Act (42 U.S.C. 1395x(aa)(1)).(10) Secretary.—The term “Secretary” means the Secretary of Health and Human Services.