Rural Emergency Medical Center Act of 2018 or the REMC Act of 2018
This bill establishes several requirements under Medicare regarding certified rural emergency medical centers, including payment, certification, and participation requirements.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5678 Introduced in House (IH)]
<DOC>
115th CONGRESS
2d Session
H. R. 5678
To amend title XVIII of the Social Security Act to provide for coverage
of rural emergency medical center services under the Medicare program,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 7, 2018
Ms. Jenkins of Kansas (for herself, Mr. Kind, and Ms. Sewell of
Alabama) introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently 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 center services under the Medicare program,
and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Rural Emergency Medical Center Act
of 2018'' or the ``REMC Act of 2018''.
SEC. 2. MEDICARE RURAL EMERGENCY MEDICAL CENTERS AND SERVICES.
(a) In General.--
(1) Rural emergency medical center and services defined.--
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 medical center (as defined in
subsection (jjj)(1))'' before the period at the end;
and
(B) by adding at the end the following subsection:
``Rural Emergency Medical Center; Rural Emergency Medical Center
Services
``(jjj)(1) The term `rural emergency medical center' means a
facility that--
``(A)(i) as of the date of the enactment of this
subsection--
``(I) was a critical access hospital; or
``(II) was a hospital 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 hospital with not more than 50
beds that was treated as being located in a rural area
pursuant to section 1886(d)(8)(E); or
``(ii) was a critical access hospital described in clause
(i)(I) or a hospital described in clause (i)(II) that ceased
operations during the period beginning on the date that is 5
years prior to the date of the enactment of this subsection and
ending on the date of the enactment of this subsection;
``(B) provides 24-hour emergency medical care and
observation care that does not exceed an annual per patient
average of 24 hours or more than 1 midnight;
``(C) may include a unit of the facility that is licensed
as a distinct part skilled nursing facility;
``(D) does not provide any acute care inpatient beds and
has protocols in place for the timely transfer of patients who
require acute care inpatient services or other inpatient
services;
``(E) provides for the transport of patients who require
acute care inpatient services or other inpatient services from
the rural emergency medical center to a hospital or critical
access hospital, either by the rural emergency medical center's
ambulance service provider or through another ambulance service
supplier;
``(F) has elected to be designated as a rural emergency
medical center;
``(G) has been licensed by, or received approval to operate
as a qualified emergency medical center from, the State under
paragraph (3); and
``(H) is certified by the Secretary under paragraph (4).
``(2)(A) The term `rural emergency medical center services' means
medical and other health services furnished by a rural emergency
medical center on an outpatient basis.
``(B) Such term shall include extended care services (as defined in
subsection (h)) subject to such requirements as the Secretary may
specify.
``(3) A facility may not operate as a rural emergency medical
center unless the facility--
``(A) is located in a State that provides for the licensing
of emergency medical centers 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.
``(4) The Secretary shall certify a facility as a rural emergency
medical center if the facility--
``(A) meets the criteria for rural emergency medical center
described in subparagraphs (A) through (G) of paragraph (1);
``(B) has in effect a transfer agreement with a level I or
level II trauma center; and
``(C) meets such staff training and certification
requirements as the Secretary may require.
``(5) A facility certified by the Secretary as a rural emergency
medical center shall be deemed to be a critical access hospital for
purposes of section 256b of title 42, United States Code.''.
(2) Payment for rural emergency medical center 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) in the case of rural emergency medical center
services, services provided by a rural emergency medical center
ambulance service provider or another ambulance service
supplier to transport patients who require acute care inpatient
services or other inpatient services from such rural emergency
medical center to a hospital or critical access hospital, and
extended care services furnished by a rural emergency medical
center, the amounts described in section 1834(w).''.
(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:
``(w) Payment Rules Relating to Rural Emergency Medical Centers.--
``(1) Payment for rural emergency medical center outpatient
services.--The amount of payment for rural emergency medical
center services of a rural emergency medical center is
determined as follows:
``(A) Facility fee.--With respect to facility
services (other than services for which payment is made
under subparagraph (B)), the sum of the following:
``(i) OPPS rate.--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)).
``(ii) Additional fee.--An additional
facility payment in an amount determined
appropriate by the Secretary that accounts for
the fixed costs of the rural emergency medical
center in furnishing rural emergency medical
center services and the low volume of services
provided by such center.
``(B) Professional services.--With respect to
professional services, the amount of payment that would
otherwise be made under this part (other than under
section 1833(t)(21)) for such services.
``(2) Payment for transportation services.--The amount of
payment for services provided by a rural emergency medical
center ambulance service provider or another ambulance service
supplier to transport patients who require acute care inpatient
services or other inpatient services from such rural emergency
medical center to a hospital or critical access hospital is
equal to 105 percent of the amount otherwise payable for such
services in such area under section 1834(l).
``(3) Payment for extended care services.--The amount of
payment for extended care services furnished by a rural
emergency medical center that is licensed and approved to
furnish such extended care services is equal to 110 percent of
the amount of payment that would otherwise be made for covered
skilled nursing facility services under section 1888(e) for the
year involved without regard to section 1888(h).''.
(b) Conditions of Participation.--Section 1866(a)(1) of the Social
Security Act (42 U.S.C. 1395cc(a)(1)) is amended--
(1) in subparagraph (X), by striking at the end ``and'';
(2) in the subparagraph (Y), by striking at the end the
period and inserting a comma; and
(3) by inserting after subparagraph (Y) the following new
subparagraph:
``(Z) in the case of a rural emergency medical center, to
meet requirements applicable to critical access hospitals under
this title, other than--
``(i) requirements relating to a Medicare rural
hospital flexibility program under section 1820(c),
including state designation of a facility as a critical
access hospital and criteria for such designation under
paragraph (2) of such section;
``(ii) requirements relating to critical access
hospitals and rural health networks under section
1820(d);
``(iii) certification by the Secretary as a
critical access hospital under section 1820(e);
``(iv) requirements relating to the provision of
inpatient hospital services or acute care beds by a
hospital or critical access hospital under this
section, including under--
``(I) paragraph (1)(G) of this subsection
(relating to certain payment restrictions for
inpatient hospital services); and
``(II) paragraph (1)(T) of this subsection
(relating to data submission requirements for
inpatient hospital services for purposes of the
low-volume adjustment); and
``(v) such others provisions of law or regulation,
including provisions under Part B and Part E, as the
Secretary may specify.''.
(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:
``(IX) A rural emergency medical
center (as defined in section
1861(jjj)(1)).''.
(d) Waiver of Distance Requirement for Replacement CAHs; Subsequent
Redesignation of Rural Emergency Medical Center as CAHs.--Section
1820(c)(2) of the Social Security Act (42 U.S.C. 1395i-4(c)(2)) is
amended--
(1) in subparagraph (B)(i)(I), by inserting ``subject to
subparagraph (F),'' before ``is located''; and
(2) by adding at the end the following new subparagraphs:
``(F) Option to waive distance requirement.--
Beginning on the date of the enactment of this
subparagraph, for every critical access hospital
located in a State that is certified as a rural
emergency medical center under section 1861(jjj)(4),
the State shall have the option of waiving the distance
requirement described in subparagraph (B)(i)(I) with
respect to another facility located in the State that
is seeking designation as a critical access hospital
under this paragraph.
``(G) Redesignation of a rural emergency medical
center as a critical access hospital.--A rural
emergency medical center that was previously designated
as a critical access hospital under this paragraph may
elect to be redesignated as a critical access hospital
(in the same manner that the hospital was originally
designated as a critical access hospital) at any time,
subject to such conditions as the Secretary may
establish.''.
(e) Conforming Amendment.--Section 1861(u) of the Social Security
Act (42 U.S.C. 1395x(u)) is amended by inserting ``rural emergency
medical center,'' after ``critical access hospital,''.
(f) Effective Date.--The amendments made by this section shall
apply to items and services furnished on or after the date that is 1
year after the date of the enactment of this Act.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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