II 118th CONGRESS 2d Session S. 4322 IN THE SENATE OF THE UNITED STATES May 14, 2024 Mr. Moran (for himself and Ms. Smith ) 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 make improvements relating to the designation of rural emergency hospitals.

1. Short title This Act may be cited as the Rural Emergency Hospital Designation Improvement Act . 2. Eligibility changes (a) In general Section 1861(kkk)(3) of the Social Security Act ( 42 U.S.C. 1395x(kkk)(3) ) is amended, in the matter preceding subparagraph (A), by striking as of and inserting at any point during the period beginning on January 1, 2015, and ending on . (b) Waiver of certain requirements Section 1861(kkk)(3) of the Social Security ( 42 U.S.C. 1395x(kkk)(3) , as amended by subsection (a), is amended— (1) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively; (2) by striking described .—A facility and inserting “ described .— (A) In general Subject to subparagraph (B), a facility ; and (3) by adding at the end the following new subparagraph: (B) Waiver Not later than one year after the date of enactment of this subparagraph, the Secretary shall promulgate regulations to waive subparagraph (A) with respect to facilities that operate similarly to a rural emergency hospital in order for such facilities to be eligible for conversion to a rural emergency hospital under this subsection. . 3. Distinct part units Section 1861(kkk)(6) of the Social Security Act ( 42 U.S.C. 1395x(kkk)(6) ) is amended— (1) in subparagraph (A), by striking and at the end; (2) in subparagraph (B), by striking the period at the end and inserting a semicolon; and (3) by adding at the end the following new subparagraphs: (C) maintain or include a unit of the facility that is a distinct part licensed as an inpatient psychiatric unit for behavioral health patients and allows for inpatient care; (D) maintain or include a unit of the facility that is a distinct part licensed as an inpatient rehabilitation facility and allows for inpatient care; and (E) maintain or include a unit of the facility that is a distinct part unit licensed as an obstetric wing, labor and delivery unit, or obstetric emergency department. . 4. Add-on payment for diagnostic laboratory tests Section 1834(x)(1) of the Social Security Act ( 42 U.S.C. 1395m(x)(1) ) is amended— (1) by striking hospitals .— and all that follows through In the case and inserting “ hospitals .— (1) In general (A) Payment for rural emergency hospital services In the case ; and (2) by adding at the end the following new subparagraph: (B) Payment for diagnostic laboratory tests In the case of clinical diagnostic laboratory tests and other diagnostic laboratory tests that are not covered OPD services (as defined in section 1833(t)(1)(B)) furnished by a rural emergency hospital (as defined in section 1861(kkk)(2)) on or after January 1, 2025, the amount of payment for such tests shall be equal to the amount of payment that would otherwise apply under the applicable fee schedule, increased by 5 percent to reflect the higher costs incurred by such hospitals, and shall include the application of any copayment amount determined under this part as if such increase had not occurred . 5. Swing beds Section 1861(kkk)(6) of the Social Security Act ( 42 U.S.C. 1395x(kkk)(6) ), as amended by section 3, is amended— (1) in subparagraph (B), by striking and at the end; (2) in subparagraph (C), by striking the period at the end and inserting ; and ; and (3) by adding at the end the following new subparagraph: (D) may enter into an agreement described in section 1883. . 6. Necessary provider status for facilities that revert to critical access hospital designation Not later than one year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate regulations to permit a rural emergency hospital (as defined in section 1861(kkk)(2) of the Social Security Act ( 42 U.S.C. 1395x(kkk)(2) )) that reverts back to its previous designation as a critical access hospital (as defined in section 1861(mm)(1) of such Act ( 42 U.S.C. 1395x(m) )) to regain its status as a necessary provider of health care services pursuant to section 1820(c)(2)(B)(i)(II) of such Act ( 42 U.S.C. 1395i–4(c)(2)(B)(i)(II) ), but only if the facility was designated as a necessary provider of health care services pursuant to such section prior to converting to a rural emergency hospital. 7. National Health Service Corps Site Eligibility The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, shall promulgate regulations to deem a rural emergency hospital (as defined in section 1861(kkk)(2) of the Social Security Act ( 42 U.S.C. 1395x(kkk)(2) )) to be a health professional shortage area in accordance with section 332(a)(1)(C) of the Public Health Service Act ( 42 U.S.C. 254e(a)(1)(C) ). 8. Small rural hospital improvement program grants Section 1820(g) of the Social Security Act (42 U.S.C. 42 U.S.C. 1395i–4(g) ) is amended— (1) in paragraph (1)(D), by inserting or rural emergency hospitals (as defined in section 1861(kkk)(2)) after critical access hospitals ; and (2) in paragraph (3)(A), by inserting or rural emergency hospitals (as defined in section 1861(kkk)(2)) after small rural hospitals .