I 
116TH CONGRESS 
2D SESSION 
H. R. 6209 
To amend title XVIII of the Social Security Act to establish a program 
to allow qualified group practices to furnish certain items and services 
at qualified skilled nursing facilities to individuals entitled to benefits 
under part A and enrolled under part B of the Medicare program 
to reduce unnecessary hospitalizations, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 11, 2020 
Ms. KUSTER of New Hampshire (for herself and Mr. SMITH of Nebraska) in-
troduced 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 establish 
a program to allow qualified group practices to furnish 
certain items and services at qualified skilled nursing 
facilities to individuals entitled to benefits under part 
A and enrolled under part B of the Medicare program 
to reduce unnecessary hospitalizations, and for other pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
02:21 Mar 25, 2020
Jkt 099200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H6209.IH
H6209
pamtmann on DSKBC07HB2PROD with BILLS
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Reducing Unnecessary 
Senior Hospitalizations Act of 2020’’ or the ‘‘RUSH Act 
of 2020’’. 
SEC. 2. SNF-BASED PROVISION OF PREVENTIVE ACUTE 
CARE AND HOSPITALIZATION REDUCTION 
PROGRAM. 
Title XVIII of the Social Security Act is amended by 
adding at the end the following new section: 
‘‘SEC. 
1899C. 
SNF-BASED 
PROVISION 
OF 
PREVENTIVE 
ACUTE CARE AND HOSPITALIZATION REDUC-
TION PROGRAM. 
‘‘(a) ESTABLISHMENT.—There is established a pro-
gram to be known as the ‘SNF-based Provision of Preven-
tive Acute Care and Hospitalization Reduction Program’ 
(in this section referred to as the ‘Program’), to be admin-
istered by the Secretary, for purposes of reducing unneces-
sary hospitalizations and emergency department visits by 
allowing qualified group practices (as defined in section 
1877(h)(4)) on or after January 1, 2021, to furnish items 
and services identified under subsection (b)(3) to individ-
uals entitled to benefits under part A and enrolled under 
part B residing in qualified skilled nursing facilities. 
‘‘(b) OPERATION
OF PROGRAM.—Under the Pro-
gram, the Secretary shall provide for the following: 
VerDate Sep 11 2014 
02:21 Mar 25, 2020
Jkt 099200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H6209.IH
H6209
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(1) Certification of skilled nursing facilities as 
qualified skilled nursing facilities under subsection 
(c)(1). 
‘‘(2) Certification of group practices as quali-
fied group practices under subsection (c)(2). 
‘‘(3) Identification of minimum required non-
surgical items and services furnished at a hospital 
emergency department that may be safely furnished 
by a qualified group practice at a qualified skilled 
nursing facility under the Program and that such 
qualified group practice shall offer to furnish under 
the Program. 
‘‘(4) Annual identification of additional items 
and services furnished at a hospital emergency de-
partment that may be safely furnished by a qualified 
group practice at a qualified skilled nursing facility 
under the Program during a year and that such 
qualified group practice may offer to furnish under 
the Program during such year. 
‘‘(5) Establishment of qualifications for non-
physician employees who may furnish such items 
and services at a qualified skilled nursing facility. 
Such qualifications shall include the requirement 
that such an employee— 
VerDate Sep 11 2014 
02:21 Mar 25, 2020
Jkt 099200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H6209.IH
H6209
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(A) be certified in basic life support by a 
nationally recognized specialty board of certifi-
cation or equivalent certification board; and 
‘‘(B) have— 
‘‘(i) 
clinical 
experience 
furnishing 
medical care— 
‘‘(I) in a skilled nursing facility; 
‘‘(II) in a hospital emergency de-
partment setting; or 
‘‘(III) as an employee of a pro-
vider or supplier of ambulance serv-
ices; or 
‘‘(ii) a certification in paramedicine. 
‘‘(6) Payment under this title for items and 
services identified under paragraph (3) or (4) fur-
nished by such qualified group practices at such a 
facility in amounts determined under subsection (d). 
‘‘(c) CERTIFICATIONS.— 
‘‘(1) QUALIFIED
SKILLED
NURSING
FACILI-
TIES.—For purposes of this section, the Secretary 
shall certify a skilled nursing facility as a qualified 
skilled nursing facility if the facility submits an ap-
plication in a time and manner specified by the Sec-
retary and meets the following requirements: 
VerDate Sep 11 2014 
02:21 Mar 25, 2020
Jkt 099200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H6209.IH
H6209
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(A) The facility has on-site diagnostic 
equipment necessary for a qualified group prac-
tice to furnish items and services under the 
Program and real-time audio and visual capa-
bilities. 
‘‘(B) The facility has at least one indi-
vidual who meets the qualifications described in 
paragraph (5) or a physician present 24 hours 
a day and 7 days a week to work with the 
qualified group practice. Such individual may 
be a member of the staff of the qualified skilled 
nursing facility or of the qualified group prac-
tice. 
‘‘(C) The facility ensures that residents of 
such facility, upon entering such facility, are al-
lowed to specify in an advanced care directive 
whether the resident wishes to receive items 
and services furnished at the facility under the 
Program in a case where communication with 
the resident is not possible. 
‘‘(D) The facility ensures that individuals 
to be furnished such items and services under 
the Program at such facility have the oppor-
tunity, at their request, to instead be trans-
ported to a hospital emergency department. 
VerDate Sep 11 2014 
02:21 Mar 25, 2020
Jkt 099200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H6209.IH
H6209
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(E) The facility is not part of the Special 
Focus Facility program of the Centers for 
Medicare & Medicaid Services (although the fa-
cility may, at the discretion of the Secretary, be 
a candidate for selection under such program). 
Nothing in this paragraph shall affect the require-
ments under section 1819(b)(4). 
‘‘(2) QUALIFIED GROUP PRACTICES.—For pur-
poses of this section, the Secretary shall certify a 
group practice as a qualified group practice for a pe-
riod of 3 years if the group practice submits an ap-
plication in a time and manner specified by the Sec-
retary and meets the following requirements: 
‘‘(A) The group practice offers to furnish 
all minimum required items and services identi-
fied under subsection (b)(3) under the Pro-
gram. 
‘‘(B) The group practice submits a notifi-
cation to the Secretary annually specifying 
which (if any) additional items and services 
identified under subsection (b)(4) for a year the 
group practice will offer to furnish for such 
year under the Program. 
‘‘(C) The group practice ensures that only 
individuals who meet the qualifications estab-
VerDate Sep 11 2014 
02:21 Mar 25, 2020
Jkt 099200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H6209.IH
H6209
pamtmann on DSKBC07HB2PROD with BILLS
lished under subsection (b)(5) or a physician 
who is part of such group practice may furnish 
such minimum required items and services and 
such additional items and services. 
‘‘(D) The group practice ensures that, in 
the case where such minimum required items 
and services or such additional items and serv-
ices are furnished by such an individual, such 
individual furnishes such minimum required 
items and services or additional items and serv-
ices under the supervision, either in-person or 
through the use of telehealth (not including 
store-and-forward technologies), of— 
‘‘(i) a physician— 
‘‘(I) who is board certified or 
board eligible in emergency medicine, 
family medicine, geriatrics, or internal 
medicine; or 
‘‘(II) who has been certified by a 
nationally recognized specialty board 
of certification or equivalent certifi-
cation board in basic life support; 
‘‘(ii) a nurse practitioner who has 
been certified by a nationally recognized 
specialty board of certification or equiva-
VerDate Sep 11 2014 
02:21 Mar 25, 2020
Jkt 099200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H6209.IH
H6209
pamtmann on DSKBC07HB2PROD with BILLS
lent certification board in basic life sup-
port; or 
‘‘(iii) a physician assistant who has 
been certified by a nationally recognized 
specialty board of certification or equiva-
lent certification board in basic life sup-
port. 
‘‘(E) With respect to any year in which the 
qualified group practice would participate in the 
Program, the Chief Actuary for the Centers for 
Medicare & Medicaid Services determines that 
such participation during such year will not re-
sult in total estimated expenditures under this 
title for such year being greater than total esti-
mated expenditures under such title for such 
year without such participation. 
‘‘(d) PAYMENTS.— 
‘‘(1) IN GENERAL.—For 2021 and each subse-
quent year, the Secretary shall develop a schedule of 
payments to apply for items and services identified 
under paragraph (3) or paragraph (4) of subsection 
(b) furnished during such year under the Program. 
Such payments shall be in lieu of any other pay-
ments that may be made under this title for such 
items and services. 
VerDate Sep 11 2014 
02:21 Mar 25, 2020
Jkt 099200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H6209.IH
H6209
pamtmann on DSKBC07HB2PROD with BILLS
‘‘(2) SHARED SAVINGS.—In the case of a year 
for which the Secretary determines that participa-
tion in the Program resulted in a reduction in ex-
penditures under this title compared to what such 
expenditures would have been without such partici-
pation, the Secretary shall— 
‘‘(A) pay to such qualified group practice 
an amount equal to 37.5 percent of the esti-
mated amount of such reduction; and 
‘‘(B) in the case of each qualified skilled 
nursing facility where such qualified group 
practice furnished items and services under the 
Program during such year— 
‘‘(i) if the qualified skilled nursing fa-
cility has at least a three-star rating under 
the Five Star Quality Rating System (or a 
successor system), pay to the facility an 
amount that bears the same ratio to 12.5 
percent of the estimated amount of such 
reduction as the amount of expenditures 
under the Program for such items and 
services furnished with respect to individ-
uals at such facility by such qualified 
group practice during such year bears to 
the total amount of expenditures under the 
VerDate Sep 11 2014 
02:21 Mar 25, 2020
Jkt 099200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H6209.IH
H6209
pamtmann on DSKBC07HB2PROD with BILLS