Rural Health Fairness in Competition Act
Bill: H.R.5883 | Sponsor: Rep. Sewell, Terri A. (D-AL)
Policy area: Health

Summary:
Rural Health Fairness in Competition Act
This bill requires the Centers for Medicare & Medicaid Services (CMS) to establish a Medicare Rural Health Clinic Value-Based Care Program that exempts certain rural health clinics (e.g., those participating in Medicare quality programs) from payment limitations if they meet reporting requirements relating to quality measures and performance standards, as set by the CMS.

To establish a value-based care program to exempt eligible rural health 
   clinics from certain payment limitations, and for other purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Health Fairness in Competition 
Act''.

SEC. 2. MEDICARE RURAL HEALTH CLINIC VALUE-BASED CARE PROGRAM.

    (a) Medicare Rural Health Clinic Value-Based Program.--Not later 
than 90 days after the date of the enactment of this Act, the Secretary 
of Health and Human Services (hereinafter referred to as the 
``Secretary'') shall establish a Medicare Rural Health Clinic Value-
Based Care Program under which an eligible clinic (as defined in 
subsection (b)(1)(B)) shall be exempt from any limitation on payment 
established under section 1833(a) of the Social Security Act (42 U.S.C. 
1395l(a)) if such clinic submits reports required under subsection 
(b)(2).
    (b) Program Requirements.--
            (1) Application.--
                    (A) In general.--The Secretary shall establish a 
                process by which an eligible clinic may apply for 
                participation in the program described in subsection 
                (a).
                    (B) Eligible clinic.--For purposes of this section, 
                an eligible clinic is a rural health clinic (as defined 
                in section 1861(aa)(2) of the Social Security Act (42 
                U.S.C. 1395x(aa)(2))) that--
                            (i) is owned or operated by a hospital, 
                        including a critical access hospital, with less 
                        than 50 beds;
                            (ii) is enrolled under section 1866(j) of 
                        such Act (including temporary enrollment during 
                        the emergency period described in section 
                        1135(g)(1)(B) of such Act); and
                            (iii) meets the reporting requirements 
                        established under paragraph (2); or
                            (iv) is participating in a Medicare quality 
                        program, including the National Committee for 
                        Quality Assurance Patient-Centered Medical Home 
                        Recognition Program, or another value-based 
                        care program as determined by the Secretary.
            (2) Reports.--
                    (A) In general.--Not later than the end of the 
                first calendar year in which an eligible clinic 
                participates in the program described under subsection 
                (a), and annually thereafter, each eligible clinic 
                shall submit to the Administrator of the Centers for 
                Medicare & Medicaid Services a report on the quality 
                measures described in subsection (c)(1).
                    (B) Subsequent years.--Not later than the end of 
                the third calendar year in which an eligible clinic has 
                participated in the program described under subsection 
                (a), and annually thereafter, such eligible clinic 
                shall submit to the Administrator a report containing 
                the information required under subparagraph (A), and 
                may submit additional information with respect to 
                performance measures (described in subsection (c)(2)) 
                as the Administrator may require.
                    (C) Publication of reports.--Not later than 90 days 
                after the last day of each calendar year for which an 
                eligible clinic has submitted a report pursuant to this 
                paragraph, the Administrator shall make such report 
                publicly available on the website of the Centers for 
                Medicare & Medicaid Services.
            (3) Duration.--The exemption from payment limitations under 
        section 1833(a) shall apply for as long as an eligible clinic 
        meets the requirements set forth in this subsection.
    (c) Selection of Quality Measures; Performance Standards.--
            (1) Selection of quality measures.--Not later than 90 days 
        after the date of the enactment of this Act, the Secretary 
        shall select quality measures for purposes of the reporting 
        requirements under subsection (b)(2). In selecting quality 
        measures, the Secretary shall select such measure that are--
                    (A) used in existing programs;
                    (B) focused on primary care; or
                    (C) based on input from stakeholders.
            (2) Performance standards.--Not later than 2 years after 
        the date of the enactment of this Act, the Secretary may 
        establish performance measurements standards for purposes of 
        the reporting requirements under subsection (b)(2).
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