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 Com-
merce, for a period to be subsequently determined by the Speaker, in 
each case for consideration of such provisions as fall within the jurisdic-
tion 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 Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Emergency Med-
ical Center Act of 2018’’ or the ‘‘REMC Act of 2018’’. 
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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 Se-
curity Act (42 U.S.C. 1395x) is amended— 
(A) in subsection (e), in the last sentence 
of the matter following paragraph (9), by in-
serting ‘‘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 sub-
section: 
‘‘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 
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being located in a rural area pursuant to sec-
tion 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 mid-
night; 
‘‘(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 trans-
fer of patients who require acute care inpatient serv-
ices or other inpatient services; 
‘‘(E) provides for the transport of patients who 
require acute care inpatient services or other inpa-
tient services from the rural emergency medical cen-
ter to a hospital or critical access hospital, either by 
the rural emergency medical center’s ambulance 
service provider or through another ambulance serv-
ice supplier; 
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‘‘(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 para-
graph (4). 
‘‘(2)(A) The term ‘rural emergency medical center 
services’ means medical and other health services fur-
nished by a rural emergency medical center on an out-
patient 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 meet-
ing the standards established for such licensing. 
‘‘(4) The Secretary shall certify a facility as a rural 
emergency medical center if the facility— 
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‘‘(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
MED-
ICAL 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 emer-
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gency medical center ambulance service provider or 
another ambulance service supplier to transport pa-
tients who require acute care inpatient services or 
other inpatient services from such rural emergency 
medical center to a hospital or critical access hos-
pital, and extended care services furnished by a 
rural emergency medical center, the amounts de-
scribed 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 EMER-
GENCY MEDICAL CENTERS.— 
‘‘(1) PAYMENT FOR RURAL EMERGENCY MED-
ICAL CENTER OUTPATIENT SERVICES.—The amount 
of payment for rural emergency medical center serv-
ices of a rural emergency medical center is deter-
mined as follows: 
‘‘(A) FACILITY FEE.—With respect to fa-
cility 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 
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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 addi-
tional facility payment in an amount deter-
mined 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 re-
spect 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
SERV-
ICES.—The amount of payment for services provided 
by a rural emergency medical center ambulance serv-
ice 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 ac-
cess hospital is equal to 105 percent of the amount 
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otherwise payable for such services in such area 
under section 1834(l). 
‘‘(3) PAYMENT
FOR
EXTENDED
CARE
SERV-
ICES.—The amount of payment for extended care 
services furnished by a rural emergency medical cen-
ter that is licensed and approved to furnish such ex-
tended 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 fol-
lowing 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 
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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 ac-
cess 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 sub-
section (relating to certain payment re-
strictions for inpatient hospital services); 
and 
‘‘(II) paragraph (1)(T) of this sub-
section (relating to data submission re-
quirements for inpatient hospital services 
for purposes of the low-volume adjust-
ment); and 
‘‘(v) such others provisions of law or regu-
lation, including provisions under Part B and 
Part E, as the Secretary may specify.’’. 
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(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 RE-
PLACEMENT CAHS; SUBSEQUENT REDESIGNATION
OF 
RURAL EMERGENCY MEDICAL CENTER AS CAHS.—Sec-
tion 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 sub-
paragraphs: 
‘‘(F) OPTION
TO
WAIVE
DISTANCE
RE-
QUIREMENT.—Beginning on the date of the en-
actment of this subparagraph, for every critical 
access hospital located in a State that is cer-
tified 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 re-
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spect to another facility located in the State 
that is seeking designation as a critical access 
hospital under this paragraph. 
‘‘(G) REDESIGNATION OF A RURAL EMER-
GENCY MEDICAL CENTER AS A CRITICAL AC-
CESS
HOSPITAL.—A rural emergency medical 
center that was previously designated as a crit-
ical access hospital under this paragraph may 
elect to be redesignated as a critical access hos-
pital (in the same manner that the hospital was 
originally designated as a critical access hos-
pital) 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 ‘‘crit-
ical 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 enact-
ment of this Act. 
Æ 
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