MEDICARE PAYMENT FOR RURAL EMERGENCY HOSPITAL SERVICES.

SEC. 125. MEDICARE PAYMENT FOR RURAL EMERGENCY HOSPITAL SERVICES. (a) In General.— (1) Definitions.—Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended— (A) in subsection (e), in the last sentence of the matter following paragraph (9), by inserting “or a rural emergency hospital (as defined in subsection (kkk)(2))” before the period at the end; and (B) by adding at the end the following subsection:“Rural Emergency Hospital Services; Rural Emergency Hospital “(kkk)(1) Rural Emergency Hospital Services.— “(A) In general.—The term ‘rural emergency hospital services ’ means the following services furnished by a rural emergency hospital (as defined in paragraph (2)) that do not exceed an annual per patient average of 24 hours in such rural emergency hospital: “(i) Emergency department services and observation care. “(ii) At the election of the rural emergency hospital, with respect to services furnished on an outpatient basis, other medical and health services as specified by the Secretary through rulemaking. “(B) Staffed emergency department.—For purposes of subparagraph (A)(i), an emergency department of a rural emergency hospital shall be considered a staffed emergency department if it meets the following requirements: “(i) The emergency department is staffed 24 hours a day, 7 days a week. “(ii) A physician (as defined in section 1861(r)(1)), nurse practitioner, clinical nurse specialist, or physician assistant (as those terms are defined in section 1861(aa)(5)) is available to furnish rural emergency hospital services in the facility 24 hours a day. “(iii) Applicable staffing and staffing responsibilities under section 485.631 of title 42, Code of Federal Regulations (or any successor regulation). “(2) Rural Emergency Hospital.—The term ‘rural emergency hospital’ means a facility described in paragraph (3) that— “(A) is enrolled under section 1866(j), submits the additional information described in paragraph (4)(A) for purposes of such enrollment, and makes the detailed transition plan described in clause (i) of such paragraph available to the public, in a form and manner determined appropriate by the Secretary; “(B) does not provide any acute care inpatient services, other than those described in paragraph (6)(A); “(C) has in effect a transfer agreement with a level I or level II trauma center; “(D) meets— “(i) licensure requirements as described in paragraph (5); “(ii) the requirements of a staffed emergency department as described in paragraph (1)(B); “(iii) such staff training and certification requirements as the Secretary may require; “(iv) conditions of participation applicable to— “(I) critical access hospitals, with respect to emergency services under section 485.618 of title 42, Code of Federal Regulations (or any successor regulation); and “(II) hospital emergency departments under this title, as determined applicable by the Secretary; “(v) such other requirements as the Secretary finds necessary in the interest of the health and safety of individuals who are furnished rural emergency hospital services; and “(vi) in the case where the rural emergency hospital includes a distinct part unit of the facility that is licensed as a skilled nursing facility, such distinct part meets the requirements applicable to skilled nursing facilities under this title. “(3) Facility Described.—A facility described in this paragraph is a facility that as of the date of the enactment of this subsection— “(A) was a critical access hospital; or “(B) was a subsection (d) hospital (as defined in section 1886(d)(1)(B)) with not more than 50 beds located in a county (or equivalent unit of local government) in a rural area (as defined in section 1886(d)(2)(D)), or was a subsection (d) hospital (as so defined) with not more than 50 beds that was treated as being located in a rural area pursuant to section 1886(d)(8)(E). “(4) Additional Information.— “(A) Information.—For purposes of paragraph (2)(A), a facility that submits an application for enrollment under section 1866(j) as a rural emergency hospital shall submit the following information at such time and in such form as the Secretary may require: “(i) An action plan for initiating rural emergency hospital services (as defined in paragraph (1)), including a detailed transition plan that lists the specific services that the facility will— “(I) retain; “(II) modify “(III) add; and “(IV) discontinue. “(ii) A description of services that the facility intends to furnish on an outpatient basis pursuant to paragraph (1)(A)(ii). “(iii) Information regarding how the facility intends to use the additional facility payment provided under section 1834(x)(2), including a description of the services covered under this title that the additional facility payment would be supporting, such as furnishing telehealth services and ambulance services, including operating the facility and maintaining the emergency department to provide such services covered under this title. “(iv) Such other information as the Secretary determines appropriate. “(B) Effect of enrollment.—Such enrollment shall remain effective with respect to a facility until such time as— “(i) the facility elects to convert back to its prior designation as a critical access hospital or a subsection (d) hospital (as defined in section 1886(d)(1)(B)), subject to requirements applicable under this title for such designation and in accordance with procedures established by the Secretary; or “(ii) the Secretary determines the facility does not meet the requirements applicable to a rural emergency hospital under this subsection. “(5) Licensure.—A facility may not operate as a rural emergency hospital in a State unless the facility— “(A) is located in a State that provides for the licensing of such hospitals under State or applicable local law; and “(B)(i) is licensed pursuant to such law; or “(ii) is approved by the agency of such State or locality responsible for licensing hospitals, as meeting the standards established for such licensing. “(6) Discretionary Authority.—A rural emergency hospital may— “(A) include a unit of the facility that is a distinct part licensed as a skilled nursing facility to furnish post-hospital extended care services; and “(B) be considered a hospital with less than 50 beds for purposes of the exception to the payment limit for rural health clinics under section 1833(f). “(7) Quality Measurement.— “(A) In general.—The Secretary shall establish quality measurement reporting requirements for rural emergency hospitals, which may include the use of a small number of claims-based outcomes measures or surveys of patients with respect to their experience in the rural emergency hospital, in accordance with the succeeding provisions of this paragraph. “(B) Quality reporting by rural emergency hospitals.— “(i) In general.—With respect to each year beginning with 2023, (or each year beginning on or after the date that is one year after one or more measures are first specified under subparagraph (C)), a rural emergency hospital shall submit data to the Secretary in accordance with clause (ii). “(ii) Submission of quality data.—With respect to each such year, a rural emergency hospital shall submit to the Secretary data on quality measures specified under subparagraph (C). Such data shall be submitted in a form and manner, and at a time, specified by the Secretary for purposes of this subparagraph. “(C) Quality measures.— “(i) In general.—Subject to clause (ii), any measure specified by the Secretary under this subparagraph must have been endorsed by the entity with a contract under section 1890(a). “(ii) Exception.—In the case of a specified area or medical topic determined appropriate by the Secretary for which a feasible and practical measure has not been endorsed by the entity with a contract under section 1890(a), the Secretary may specify a measure that is not so endorsed as long as due consideration is given to measures that have been endorsed or adopted by a consensus organization identified by the Secretary. “(iii) Consideration of low case volume when specifying performance measures.—The Secretary shall, in the selection of measures specified under this subparagraph, take into consideration ways to account for rural emergency hospitals that lack sufficient case volume to ensure that the performance rates for such measures are reliable. “(D) Public availability of data submitted.—The Secretary shall establish procedures for making data submitted under subparagraph (B) available to the public regarding the performance of individual rural emergency hospitals. Such procedures shall ensure that a rural emergency hospital has the opportunity to review, and submit corrections for, the data that is to be made public with respect to the rural emergency hospital prior to such data being made public. Such information shall be posted on the Internet website of the Centers for Medicare & Medicaid Services in an easily understandable format as determined appropriate by the Secretary. “(8) Clarification Regarding Application of Provisions Relating to Off-campus Outpatient Department of a Provider.—Nothing in this subsection, section 1833(a)(10), or section 1834(x) shall affect the application of paragraph (1)(B)(v) of section 1833(t), relating to applicable items and services (as defined in subparagraph (A) of paragraph (21) of such section) that are furnished by an off-campus outpatient department of a provider (as defined in subparagraph (B) of such paragraph). “(9) Implementation.—There shall be no administrative or judicial review under section 1869, 1878, or otherwise of the following: “(A) The determination of whether a rural emergency hospital meets the requirements of this subsection. “(B) The establishment of requirements under this subsection by the Secretary, including requirements described in paragraphs (2)(D), (4), and (7). “(C) The determination of payment amounts under section 1834(x), including the additional facility payment described in paragraph (2) of such section.” . (2) Payment for rural emergency hospital services.— (A) In general.—Section 1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) is amended— (i) in paragraph (8), by striking “and” at the end; (ii) in paragraph (9), by striking the period at the end and inserting “; and”; and (iii) by inserting after paragraph (9) the following new paragraph: “(10) with respect to rural emergency hospital services furnished on or after January 1, 2023, the amounts determined under section 1834(x).” . (B) Payment amount.—Section 1834 of the Social Security Act (42 U.S.C. 1395m) is amended by adding at the end the following subsection: “(x) Payment Rules Relating to Rural Emergency Hospitals.— “(1) Payment for rural emergency hospital services.—In the case of rural emergency hospital services (as defined in section 1861(kkk)(1)), furnished by a rural emergency hospital (as defined in section 1861(kkk)(2)) on or after January 1, 2023, the amount of payment for such services shall be equal to the amount of payment that would otherwise apply under section 1833(t) for covered OPD services (as defined in section 1833(t)(1)(B) (other than clause (ii) of such section)), increased by 5 percent to reflect the higher costs incurred by such hospitals, and shall include the application of any copayment amount determined under section 1833(t)(8) as if such increase had not occurred. “(2) Additional facility payment.— “(A) In general.—The Secretary shall make monthly payments to a rural emergency hospital in an amount that is equal to 1⁄12 of the annual additional facility payment specified in subparagraph (B). “(B) Annual additional facility payment amount.—The annual additional facility payment amount specified in this subparagraph is— “(i) for 2023, a Medicare subsidy amount determined under subparagraph (C); and “(ii) for 2024 and each subsequent year, the amount determined under this subparagraph for the preceding year, increased by the hospital market basket percentage increase. “(C) Determination of medicare subsidy amount.—For purposes of subparagraph (B)(i), the Medicare subsidy amount determined under this subparagraph is an amount equal to— “(i) the excess (if any) of— “(I) the total amount that the Secretary determines was paid under this title to all critical access hospitals in 2019; over “(II) the estimated total amount that the Secretary determines would have been paid under this title to such hospitals in 2019 if payment were made for inpatient hospital, outpatient hospital, and skilled nursing facility services under the applicable prospective payment systems for such services during such year; divided by “(ii) the total number of such hospitals in 2019. “(D) Reporting on use of the additional facility payment.—A rural emergency hospital receiving the additional facility payment under this paragraph shall maintain detailed information as specified by the Secretary as to how the facility has used the additional facility payments. Such information shall be made available to the Secretary upon request. “(3) Payment for ambulance services.—For provisions relating to payment for ambulance services furnished by an entity owned and operated by a rural emergency hospital, see section 1834(l). “(4) Payment for post-hospital extended care services.—For provisions relating to payment for post-hospital extended care services furnished by a rural emergency hospital that has a unit that is a distinct part licensed as a skilled nursing facility, see section 1888(e). “(5) Source of payments.— “(A) In general.—Except as provided in subparagraph (B), payments under this subsection shall be made from the Federal Supplementary Medical Insurance Trust Fund under section 1841. “(B) Additional facility payment and post-hospital extended care services.—Payments under paragraph (2) shall be made from the Federal Hospital Insurance Trust Fund under section 1817.” . (b) Provider Agreements.— (1) Agreement with qio.—Section 1866(a) of the Social Security Act (42 U.S.C. 1395cc(a)) is amended— (A) in paragraph (1)(F)(ii), by inserting “rural emergency hospitals,” after “critical access hospitals,”; and (B) in paragraph (3)— (i) in subparagraph (A), by inserting “rural emergency hospital,” after “critical access hospital,”; (ii) in subparagraph (B), by inserting “rural emergency hospital,” after “critical access hospital,” each place it appears; and (iii) in subparagraph (C)(ii)(II), by inserting “rural emergency hospitals,” after “critical access hospitals,” each place it appears. (2) Emergency medical treatment and labor act.— (A) Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended— (i) in subparagraph (I)— (I) in the matter preceding clause (i), by striking “or critical access hospital” and inserting “, critical access hospital, or rural emergency hospital”; and (II) in clause (ii), by inserting “, critical access hospital, or rural emergency hospital” after “hospital”; and (ii) in subparagraph (N)— (I) in the matter preceding clause (i), by striking “and critical access hospitals” and inserting “, critical access hospitals, and rural emergency hospitals”; (II) in clause (i), by striking “or critical access hospital” and inserting “, critical access hospital, or rural emergency hospital”; and (III) in clause (iv), by inserting “, critical access hospital, or rural emergency hospital” after “hospital”. (B) Section 1867(e)(5) of such Act (42 U.S.C. 1395dd(e)(5)) is amended by inserting “and a rural emergency hospital (as defined in section 1861(kkk)(2))” before the period. (c) Treatment as Telehealth Originating Site.—Section 1834(m)(4)(C)(ii) of the Social Security Act (42 U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the end the following new subclause: “(XI) A rural emergency hospital (as defined in section 1861(kkk)(2)).” . (d) Conforming Amendments.— (1) Section 1861(u) of the Social Security Act (42 U.S.C. 1395x(u)) is amended by inserting “rural emergency hospital,” after “critical access hospital,”. (2) Section 1864 of the Social Security Act (42 U.S.C. 1395aa) is amended by inserting before the period at the end of the first sentence ", or whether a facility is a rural emergency hospital as defined in section 1861(kkk)(2). (e) Studies and Reports.— (1) Studies.—The Secretary of Health and Human Services shall conduct 3 studies to evaluate the impact of rural emergency hospitals on the availability of health care and health outcomes in rural areas (as defined in section 1886(d)(2)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(2)(D))). The Secretary shall conduct a study— (A) 4 years after the date of the enactment of this Act; (B) 7 years after the date of the enactment of this Act; and (C) 10 years after the date of the enactment of this Act. (2) Reports.—Not later than 6 months after each date that the Secretary of Health and Human Services is required to conduct a study under paragraph (1), the Secretary shall submit to Congress a report containing the results of each such study. (3) Funding.—For purposes of carrying out this subsection, the Secretary of Health and Human Services shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in such proportion as the Secretary determines appropriate, to the Centers for Medicare & Medicaid Services Program Management Account, of $9,000,000. Amounts transferred under the preceding sentence shall remain available until expended. (f) [42 U.S.C. 1395b-6 note] MedPAC Review of Payments to Rural Emergency Hospitals.—Each report submitted by the Medicare Payment Advisory Commission under section 1805(b)(1)(C) of the Social Security Act (42 U.S.C. 1395b-6(b)(1)(C)) (beginning with 2024), shall include a review of payments to rural emergency hospitals under section 1834(x), as added by subsection (a). (g) [42 U.S.C. 1395l note] Effective Date.—The amendments made by this section shall apply to items and services furnished on or after January 1, 2023.