II 

113TH CONGRESS 

1ST SESSION S. 328 

To amend title XVIII of the Social Security Act to allow certain critical 

access hospitals and sole community hospitals to use interactive telecommunications systems to satisfy requirements with respect to having 

a physician available to stabilize an individual with an emergency medical 

condition under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 14, 2013 

Mr. THUNE (for himself, Mr. UDALL of New Mexico, and Mr. BENNET) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to allow 

certain critical access hospitals and sole community hospitals to use interactive telecommunications systems to 

satisfy requirements with respect to having a physician 

available to stabilize an individual with an emergency 

medical condition under the Medicare program. 

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 ‘‘Strengthening Rural 

5 Access to Emergency Services Act’’. 


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1 SEC. 2. ALLOWING CERTAIN CRITICAL ACCESS HOSPITALS 

2 AND SOLE COMMUNITY HOSPITALS TO USE 

3 INTERACTIVE TELECOMMUNICATIONS SYS4 TEMS TO SATISFY REQUIREMENTS WITH RE5 SPECT TO HAVING A PHYSICIAN AVAILABLE 

6 TO STABILIZE AN INDIVIDUAL WITH AN 

7 EMERGENCY MEDICAL CONDITION. 

8 (a) IN GENERAL.—Section 1866(a) of the Social Se9 curity Act (42 U.S.C. 1395cc(a)) is amended— 

10 (1) in paragraph (1)(I)(iii), by inserting ‘‘(sub11 ject to paragraph (4))’’ after ‘‘on call for duty’’; and 

12 (2) by adding at the end the following new 

13 paragraph: 

14 ‘‘(4)(A) For purposes of paragraph (1)(I)(iii) of this 

15 subsection and subsections (b)(1)(A) and (d)(1)(C) of sec16 tion 1867, effective on the date of enactment of this para17 graph, with respect to an applicable critical access hospital 

18 or applicable sole community hospital, a physician is con19 sidered on call for duty under such paragraph, available 

20 to provide further medical examination and treatment nec21 essary to stabilize an individual with an emergency med22 ical condition under such subsection (b)(1)(A), and to 

23 have appeared under such subsection (d)(1)(C), if the phy24 sician is available— 

25 ‘‘(i) in person; or 


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1 ‘‘(ii) subject to subparagraph (B), by interactive 

2 telecommunications system (as defined in section 

3 410.78(a)(3) of title 42, Code of Federal Regula4 tions). 

5 ‘‘(B) Subparagraph (A)(ii) shall only apply if— 

6 ‘‘(i) the physician available by such interactive 

7 telecommunications system is board certified in 

8 emergency medicine or pediatric emergency medi9 cine; and 

10 ‘‘(ii) a nurse practitioner or physician assistant 

11 (as those terms are defined in section 1861(aa)(5)) 

12 is onsite in the emergency department. 

13 ‘‘(C) In this paragraph: 

14 ‘‘(i) The term ‘applicable critical access hos15 pital’ means a critical access hospital (as defined in 

16 section 1861(mm)(1)) located— 

17 ‘‘(I) in an area that is designated as a 

18 rural health professional shortage area under 

19 section 332(a)(1)(A) of the Public Health Serv20 ice Act; and 

21 ‘‘(II) in a county that is not included in a 

22 Metropolitan Statistical area. 

23 ‘‘(ii) The term ‘applicable sole community hos24 pital’ means a sole community hospital (as defined 

25 in section 1886(d)(5)(D)(iii)) that— 


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1 ‘‘(I) has less than 50 beds; 

2 ‘‘(II) has an emergency department; and 

3 ‘‘(III) is located— 

4 ‘‘(aa) in an area that is designated as 

5 a rural health professional shortage area 

6 under section 332(a)(1)(A) of the Public 

7 Health Service Act; and 

8 ‘‘(bb) in a county that is not included 

9 in a Metropolitan Statistical Area.’’. 

10 (b) CONFORMING AMENDMENTS.—Section 1867 of 

11 the Social Security Act (42 U.S.C. 1395dd) is amended— 

12 (1) in subsection (b)(1)(A), by inserting ‘‘(de13 termined in accordance with section 1866(a)(4))’’ 

14 after ‘‘hospital’’; and 

15 (2) in subsection (d)(1)(C), in the first sen16 tence, by inserting ‘‘(determined in accordance with 

17 section 1866(a)(4))’’ after ‘‘refuses to appear’’. 

Æ 


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