I 

115TH CONGRESS 

2D SESSION H. R. 7391 

To amend title XVIII of the Social Security Act to provide for coverage 

of rural emergency medical access services under the Medicare program, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 21, 2018 

Mr. ARRINGTON 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 access 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 Hospital Free5 dom and Flexibility Act of 2018’’. 

6 SEC. 2. MEDICARE RURAL EMERGENCY ACCESS CENTERS 

7 AND SERVICES. 

8 (a) IN GENERAL.— 


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1 (1) RURAL EMERGENCY ACCESS CENTER AND

2 SERVICES DEFINED.—Section 1861 of the Social Se3 curity Act (42 U.S.C. 1395x) is amended— 

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

5 of the matter following paragraph (9), by in6 serting ‘‘or a rural emergency access center (as 

7 defined in subsection (kkk)(1))’’ before the pe8 riod at the end; and 

9 (B) by adding at the end the following sub10 section: 

11 ‘‘Rural Emergency Access Center; Rural Access Medical 

12 Center Services 

13 ‘‘(kkk)(1) The term ‘rural emergency access center’ 

14 means a facility that— 

15 ‘‘(A) was a critical access hospital as of the 

16 date of the enactment of this subsection; 

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

18 and observation care that does not exceed an annual 

19 per patient average of 24 hours or more than 1 mid20 night; 

21 ‘‘(C) does not provide any acute care inpatient 

22 beds and has protocols in place for the timely trans23 fer of patients who require acute care inpatient serv24 ices or other inpatient services; 


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1 ‘‘(D) provides for the transport of patients who 

2 require acute care inpatient services or other inpa3 tient services from the rural emergency access center 

4 to a hospital or critical access hospital, either by the 

5 rural emergency access center’s ambulance service 

6 provider or through another ambulance service sup7 plier; 

8 ‘‘(E) has elected to be designated as a rural 

9 emergency access center; 

10 ‘‘(F) has been licensed by, or received approval 

11 to operate as a qualified emergency medical center 

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

13 ‘‘(G) is certified by the Secretary under para14 graph (4). 

15 ‘‘(2) The term ‘rural emergency access center serv16 ices’ means medical and other health services furnished 

17 by a rural emergency access center on an outpatient basis. 

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

19 access center unless the facility— 

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

21 licensing of emergency medical centers under State 

22 or applicable local law; and 

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


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

2 locality responsible for licensing hospitals, as meet3 ing the standards established for such licensing. 

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

5 emergency access center if the facility— 

6 ‘‘(A) meets the criteria for rural emergency ac7 cess center described in subparagraphs (A) through 

8 (F) of paragraph (1); 

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

10 level I or level II trauma center; and 

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

12 requirements as the Secretary may require. 

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

14 emergency access center shall be deemed to be a critical 

15 access hospital for purposes of section 340B of the Public 

16 Health Service Act.’’. 

17 (2) PAYMENT FOR RURAL EMERGENCY ACCESS

18 CENTER SERVICES.— 

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

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

21 amended— 

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

23 ‘‘and’’ at the end; 


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

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

3 and 

4 (iii) by inserting after paragraph (9) 

5 the following new paragraph: 

6 ‘‘(10) in the case of rural emergency access cen7 ter services and services provided by a rural emer8 gency access center ambulance service provider or 

9 another ambulance service supplier to transport pa10 tients who require acute care inpatient services or 

11 other inpatient services from such rural emergency 

12 access center to a hospital or critical access hospital, 

13 the amounts described in section 1834(x).’’. 

14 (B) PAYMENT AMOUNT.—Section 1834 of 

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

16 amended by adding at the end the following 

17 subsection: 

18 ‘‘(x) PAYMENT RULES RELATING TO RURAL EMER19 GENCY ACCESS CENTERS.— 

20 ‘‘(1) PAYMENT FOR RURAL EMERGENCY ACCESS

21 CENTER OUTPATIENT SERVICES.—The amount of 

22 payment for rural emergency access center services 

23 of a rural emergency access center is determined as 

24 follows: 


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1 ‘‘(A) FACILITY FEE.—With respect to fa2 cility services (other than services for which 

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

4 sum of the following: 

5 ‘‘(i) OPPS RATE.—The amount of 

6 payment that would otherwise apply under 

7 section 1833(t) for covered OPD services 

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

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

10 ‘‘(ii) ADDITIONAL FEE.—An addi11 tional facility payment in an amount deter12 mined appropriate by the Secretary that 

13 takes into account the low volume of serv14 ices provided by such center and the low 

15 number of individuals served by such cen16 ter. 

17 ‘‘(B) PROFESSIONAL SERVICES.—With re18 spect to professional services, the amount of 

19 payment that would otherwise be made under 

20 this part (other than under section 

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

22 ‘‘(2) PAYMENT FOR TRANSPORTATION SERV23 ICES.—The payment amount for ambulance services 

24 provided by a rural emergency access center ambu25 lance service provider or another ambulance service 


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1 supplier to transport patients who require acute care 

2 inpatient services or other inpatient services from 

3 such rural emergency access center to a hospital or 

4 critical access hospital is equal to the sum of— 

5 ‘‘(A) the amount that would otherwise be 

6 paid for such ambulance services under section 

7 1834(l); and 

8 ‘‘(B) an additional amount determined ap9 propriate by the Secretary.’’. 

10 (b) CONDITIONS OF PARTICIPATION.—Section 

11 1866(a)(1) of the Social Security Act (42 U.S.C. 

12 1395cc(a)(1)) is amended— 

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

14 ‘‘and’’; 

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

16 end the period and inserting a comma; and 

17 (3) by inserting after subparagraph (Y) the fol18 lowing new subparagraph: 

19 ‘‘(Z) in the case of a rural emergency access 

20 center, to meet requirements applicable to critical 

21 access hospitals under this title, other than— 

22 ‘‘(i) requirements relating to a Medicare 

23 rural hospital flexibility program under section 

24 1820(c), including state designation of a facility 

25 as a critical access hospital and criteria for 


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1 such designation under paragraph (2) of such 

2 section; 

3 ‘‘(ii) requirements relating to critical ac4 cess hospitals and rural health networks under 

5 section 1820(d); 

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

7 critical access hospital under section 1820(e); 

8 ‘‘(iv) requirements relating to the provision 

9 of inpatient hospital services or acute care beds 

10 by a hospital or critical access hospital under 

11 this section, including under— 

12 ‘‘(I) paragraph (1)(G) of this sub13 section (relating to certain payment re14 strictions for inpatient hospital services); 

15 and 

16 ‘‘(II) paragraph (1)(T) of this sub17 section (relating to data submission re18 quirements for inpatient hospital services 

19 for purposes of the low-volume adjust20 ment); and 

21 ‘‘(v) such others provisions of law or regu22 lation, including provisions under Part B and 

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

24 (c) TREATMENT AS TELEHEALTH ORIGINATING

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


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

2 at the end the following new subclause: 

3 ‘‘(IX) A rural emergency access 

4 center (as defined in section 

5 1861(kkk)(1)).’’. 

6 (d) CONFORMING AMENDMENT.—Section 1861(u) of 

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

8 by inserting ‘‘rural emergency access center,’’ after ‘‘crit9 ical access hospital,’’. 

Æ 


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