I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Emergency Med5 ical Center Act of 2018’’ or the ‘‘REMC Act of 2018’’. 


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1 SEC. 2. MEDICARE RURAL EMERGENCY MEDICAL CENTERS 

2 AND SERVICES. 

3 (a) IN GENERAL.— 

4 (1) RURAL EMERGENCY MEDICAL CENTER AND

5 SERVICES DEFINED.—Section 1861 of the Social Se6 curity Act (42 U.S.C. 1395x) is amended— 

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

8 of the matter following paragraph (9), by in9 serting ‘‘or a rural emergency medical center 

10 (as defined in subsection (jjj)(1))’’ before the 

11 period at the end; and 

12 (B) by adding at the end the following sub13 section: 

14 ‘‘Rural Emergency Medical Center; Rural Emergency 

15 Medical Center Services 

16 ‘‘(jjj)(1) The term ‘rural emergency medical center’ 

17 means a facility that— 

18 ‘‘(A)(i) as of the date of the enactment of this 

19 subsection— 

20 ‘‘(I) was a critical access hospital; or 

21 ‘‘(II) was a hospital with not more than 50 

22 beds located in a county (or equivalent unit of 

23 local government) in a rural area (as defined in 

24 section 1886(d)(2)(D)), or was a hospital with 

25 not more than 50 beds that was treated as 


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1 being located in a rural area pursuant to sec2 tion 1886(d)(8)(E); or 

3 ‘‘(ii) was a critical access hospital described in 

4 clause (i)(I) or a hospital described in clause (i)(II) 

5 that ceased operations during the period beginning 

6 on the date that is 5 years prior to the date of the 

7 enactment of this subsection and ending on the date 

8 of the enactment of this subsection; 

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

10 and observation care that does not exceed an annual 

11 per patient average of 24 hours or more than 1 mid12 night; 

13 ‘‘(C) may include a unit of the facility that is 

14 licensed as a distinct part skilled nursing facility; 

15 ‘‘(D) does not provide any acute care inpatient 

16 beds and has protocols in place for the timely trans17 fer of patients who require acute care inpatient serv18 ices or other inpatient services; 

19 ‘‘(E) provides for the transport of patients who 

20 require acute care inpatient services or other inpa21 tient services from the rural emergency medical cen22 ter to a hospital or critical access hospital, either by 

23 the rural emergency medical center’s ambulance 

24 service provider or through another ambulance serv25 ice supplier; 


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1 ‘‘(F) has elected to be designated as a rural 

2 emergency medical center; 

3 ‘‘(G) has been licensed by, or received approval 

4 to operate as a qualified emergency medical center 

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

6 ‘‘(H) is certified by the Secretary under para7 graph (4). 

8 ‘‘(2)(A) The term ‘rural emergency medical center 

9 services’ means medical and other health services fur10 nished by a rural emergency medical center on an out11 patient basis. 

12 ‘‘(B) Such term shall include extended care services 

13 (as defined in subsection (h)) subject to such requirements 

14 as the Secretary may specify. 

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

16 medical center unless the facility— 

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

18 licensing of emergency medical centers under State 

19 or applicable local law; and 

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

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

22 locality responsible for licensing hospitals, as meet23 ing the standards established for such licensing. 

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

25 emergency medical center if the facility— 


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1 ‘‘(A) meets the criteria for rural emergency 

2 medical center described in subparagraphs (A) 

3 through (G) of paragraph (1); 

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

5 level I or level II trauma center; and 

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

7 requirements as the Secretary may require. 

8 ‘‘(5) A facility certified by the Secretary as a rural 

9 emergency medical center shall be deemed to be a critical 

10 access hospital for purposes of section 256b of title 42, 

11 United States Code.’’. 

12 (2) PAYMENT FOR RURAL EMERGENCY MED13 ICAL CENTER SERVICES.— 

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

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

16 amended— 

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

18 ‘‘and’’ at the end; 

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

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

21 and 

22 (iii) by inserting after paragraph (9) 

23 the following new paragraph: 

24 ‘‘(10) in the case of rural emergency medical 

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1 gency medical center ambulance service provider or 

2 another ambulance service supplier to transport pa3 tients who require acute care inpatient services or 

4 other inpatient services from such rural emergency 

5 medical center to a hospital or critical access hos6 pital, and extended care services furnished by a 

7 rural emergency medical center, the amounts de8 scribed in section 1834(w).’’. 

9 (B) PAYMENT AMOUNT.—Section 1834 of 

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

11 amended by adding at the end the following 

12 subsection: 

13 ‘‘(w) PAYMENT RULES RELATING TO RURAL EMER14 GENCY MEDICAL CENTERS.— 

15 ‘‘(1) PAYMENT FOR RURAL EMERGENCY MED16 ICAL CENTER OUTPATIENT SERVICES.—The amount 

17 of payment for rural emergency medical center serv18 ices of a rural emergency medical center is deter19 mined as follows: 

20 ‘‘(A) FACILITY FEE.—With respect to fa21 cility services (other than services for which 

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

23 sum of the following: 

24 ‘‘(i) OPPS RATE.—The amount of 

25 payment that would otherwise apply under 


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1 section 1833(t) for covered OPD services 

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

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

4 ‘‘(ii) ADDITIONAL FEE.—An addi5 tional facility payment in an amount deter6 mined appropriate by the Secretary that 

7 accounts for the fixed costs of the rural 

8 emergency medical center in furnishing 

9 rural emergency medical center services 

10 and the low volume of services provided by 

11 such center. 

12 ‘‘(B) PROFESSIONAL SERVICES.—With re13 spect to professional services, the amount of 

14 payment that would otherwise be made under 

15 this part (other than under section 

16 1833(t)(21)) for such services. 

17 ‘‘(2) PAYMENT FOR TRANSPORTATION SERV18 ICES.—The amount of payment for services provided 

19 by a rural emergency medical center ambulance serv20 ice provider or another ambulance service supplier to 

21 transport patients who require acute care inpatient 

22 services or other inpatient services from such rural 

23 emergency medical center to a hospital or critical ac24 cess hospital is equal to 105 percent of the amount 


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1 otherwise payable for such services in such area 

2 under section 1834(l). 

3 ‘‘(3) PAYMENT FOR EXTENDED CARE SERV4 ICES.—The amount of payment for extended care 

5 services furnished by a rural emergency medical cen6 ter that is licensed and approved to furnish such ex7 tended care services is equal to 110 percent of the 

8 amount of payment that would otherwise be made 

9 for covered skilled nursing facility services under 

10 section 1888(e) for the year involved without regard 

11 to section 1888(h).’’. 

12 (b) CONDITIONS OF PARTICIPATION.—Section 

13 1866(a)(1) of the Social Security Act (42 U.S.C. 

14 1395cc(a)(1)) is amended— 

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

16 ‘‘and’’; 

17 (2) in the subparagraph (Y), by striking at the 

18 end the period and inserting a comma; and 

19 (3) by inserting after subparagraph (Y) the fol20 lowing new subparagraph: 

21 ‘‘(Z) in the case of a rural emergency medical 

22 center, to meet requirements applicable to critical 

23 access hospitals under this title, other than— 

24 ‘‘(i) requirements relating to a Medicare 

25 rural hospital flexibility program under section 


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1 1820(c), including state designation of a facility 

2 as a critical access hospital and criteria for 

3 such designation under paragraph (2) of such 

4 section; 

5 ‘‘(ii) requirements relating to critical ac6 cess hospitals and rural health networks under 

7 section 1820(d); 

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

9 critical access hospital under section 1820(e); 

10 ‘‘(iv) requirements relating to the provision 

11 of inpatient hospital services or acute care beds 

12 by a hospital or critical access hospital under 

13 this section, including under— 

14 ‘‘(I) paragraph (1)(G) of this sub15 section (relating to certain payment re16 strictions for inpatient hospital services); 

17 and 

18 ‘‘(II) paragraph (1)(T) of this sub19 section (relating to data submission re20 quirements for inpatient hospital services 

21 for purposes of the low-volume adjust22 ment); and 

23 ‘‘(v) such others provisions of law or regu24 lation, including provisions under Part B and 

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


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1 (c) TREATMENT AS TELEHEALTH ORIGINATING

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

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

4 at the end the following new subclause: 

5 ‘‘(IX) A rural emergency medical 

6 center (as defined in section 

7 1861(jjj)(1)).’’. 

8 (d) WAIVER OF DISTANCE REQUIREMENT FOR RE9 PLACEMENT CAHS; SUBSEQUENT REDESIGNATION OF

10 RURAL EMERGENCY MEDICAL CENTER AS CAHS.—Sec11 tion 1820(c)(2) of the Social Security Act (42 U.S.C. 

12 1395i–4(c)(2)) is amended— 

13 (1) in subparagraph (B)(i)(I), by inserting 

14 ‘‘subject to subparagraph (F),’’ before ‘‘is located’’; 

15 and 

16 (2) by adding at the end the following new sub17 paragraphs: 

18 ‘‘(F) OPTION TO WAIVE DISTANCE RE19 QUIREMENT.—Beginning on the date of the en20 actment of this subparagraph, for every critical 

21 access hospital located in a State that is cer22 tified as a rural emergency medical center 

23 under section 1861(jjj)(4), the State shall have 

24 the option of waiving the distance requirement 

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1 spect to another facility located in the State 

2 that is seeking designation as a critical access 

3 hospital under this paragraph. 

4 ‘‘(G) REDESIGNATION OF A RURAL EMER5 GENCY MEDICAL CENTER AS A CRITICAL AC6 CESS HOSPITAL.—A rural emergency medical 

7 center that was previously designated as a crit8 ical access hospital under this paragraph may 

9 elect to be redesignated as a critical access hos10 pital (in the same manner that the hospital was 

11 originally designated as a critical access hos12 pital) at any time, subject to such conditions as 

13 the Secretary may establish.’’. 

14 (e) CONFORMING AMENDMENT.—Section 1861(u) of 

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

16 by inserting ‘‘rural emergency medical center,’’ after ‘‘crit17 ical access hospital,’’. 

18 (f) EFFECTIVE DATE.—The amendments made by 

19 this section shall apply to items and services furnished on 

20 or after the date that is 1 year after the date of the enact21 ment of this Act. 

Æ 


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