In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.

Q: SECTION 1. MODIFICATIONS AND INCREASED VOLUME CAP WITH RESPECT TO 
              QUALIFIED MORTGAGE BONDS.

    (a) Use of Qualified Mortgage Bonds Proceeds for Subprime 
Refinancing Loans.--Section 143(k) of the Internal Revenue Code of 1986 
(relating to other definitions and special rules) is amended by adding 
at the end the following new paragraph:
            ``(12) Special rules for subprime refinancings.--
                    ``(A) In general.--In the case of a residence which 
                was originally financed by the mortgagor through a 
                qualified subprime loan, this section shall be applied 
                with the following modifications:
                            ``(i) Subsection (i)(1) (relating to 
                        mortgages must be new mortgages) shall not 
                        apply.
                            ``(ii) Subsection (a)(2)(D)(i) shall be 
                        applied by substituting `12-month period' for 
                        `42-month period' each place it appears.
                            ``(iii) Subsection (d) (relating to 3-year 
                        requirement) shall not apply.
                            ``(iv) Subsection (e) (relating to purchase 
                        price requirement) shall be applied by using 
                        the market value of the residence at the time 
                        of refinancing in lieu of the acquisition cost.
                    ``(B) Qualified subprime loan.--
                            ``(i) In general.--The term `qualified 
                        subprime loan' means an adjustable rate single-
                        family residential mortgage loan originated 
                        after December 31, 2001, and before January 1, 
                        2008, that the bond issuer determines has 
                        characteristics that suggest both a reasonably 
                        foreseeable risk of default and a reasonable 
                        potential to avoid default with the benefit of 
                        a lower cost refinancing.
                            ``(ii) Considerations.--In making the 
                        determination under clause (i), the bond issuer 
                        may consider the following characteristics:
                                    ``(I) Loan payments which are 
                                scheduled to increase by more than 10 
                                percent after December 31, 2007, and 
                                before January 1, 2011.
                                    ``(II) A loan-to-value ratio of 97 
                                percent or greater at the time of the 
                                original mortgage loan or at the time 
                                of the refinancing of such loan after 
                                adjustment for any decline in the fair 
                                market value of the residence.
                                    ``(III) A borrower whose 
                                creditworthiness is relatively low in 
                                comparison to a prime borrower, based 
                                on a lower credit score, such as a Fair 
                                Isaac Credit Organization credit score 
                                at the time of the original subprime 
                                loan of less than 660 and the absence 
                                of an increase in such score by more 
                                than 10 percent since the time of the 
                                original loan.
                                    ``(IV) Whether loan payments on the 
                                original mortgage loan generally have 
                                been made in a current, timely manner, 
                                subject only to isolated late payments.
                    ``(C) Termination.--This paragraph shall not apply 
                to any bonds issued after December 31, 2010.''.
    (b) Increased Volume Cap for Qualified Mortgage Bonds.--
            (1) In general.--Subsection (d) of section 146 of the 
        Internal Revenue Code of 1986 is amended by adding at the end 
        the following new paragraph:
            ``(5) Increase and set aside for qualified mortgage bonds 
        for 2008.--
                    ``(A) In general.--The State ceiling for calendar 
                year 2008 shall be increased by $15,000,000,000.
                    ``(B) Set aside.--
                            ``(i) In general.--Not less than an amount 
                        equal to each State's allocable share of the 
                        increase in the State ceiling under 
                        subparagraph (A) shall be allocated solely for 
                        the purpose of a qualified mortgage issue which 
                        meets the requirement clause (ii).
                            ``(ii) Requirement.--A qualified mortgage 
                        issue meets the requirement of this clause if 
                        such issue meets the requirement of section 
                        143(a)(2)(D)(i) (determined by substituting 
                        `12-month period' for `42-month period' each 
                        place it appears).''.
            (2) Carryforward of unused limitations.--Subsection (f) of 
        section 146 of such Code is amended by adding at the end the 
        following new paragraph:
            ``(6) Special rules for increased volume cap under 
        subsection (d)(5).--No amount which is attributable to the 
        increase under subsection (d)(5) may be used--
                    ``(A) for a carryforward purpose other than issuing 
                qualified mortgage bonds, and
                    ``(B) to issue any bond after calendar year 
                2010.''.
    (c) Alternative Minimum Tax.--
            (1) In general.--Clause (ii) of section 57(a)(5)(C) of the 
        Internal Revenue Code of 1986 is amended by striking ``shall 
        not include'' and all that follows and inserting ``shall not 
        include--
                                    ``(I) any qualified 501(c)(3) bond 
                                (as defined in section 145), or
                                    ``(II) any qualified mortgage bond 
                                (as defined in section 143(a)) or 
                                qualified veterans' mortgage bond (as 
                                defined in section 143(b)) issued after 
                                December 31, 2007, and before January 
                                1, 2011.''.
            (2) Conforming amendment.--The heading for section 
        57(a)(5)(C)(ii) is amended by striking ``qualified 501(c)(3) 
        bonds'' and inserting ``certain bonds''.
    (d) Effective Date.--The amendments made by this section shall 
apply to bonds issued after December 31, 2007.

A: Amends the Internal Revenue Code to: (1) allow proceeds of qualified mortgage bonds to be used to refinance certain residential subprime loans issued between 2002 and 2008; (2) increase in 2008 limitations on issuance amounts for qualified mortgage bonds; and (3) exempt tax-exempt interest on qualified mortgage or veterans' mortgage bonds issued before 2011 from the alternative minimum tax.
****
Q: SECTION 1. KOREA VISA WAIVER PILOT PROGRAM.

    (a) Congressional Findings.--The Congress finds that--
            (1) travel and tourism play a major role in reducing the 
        United States unfavorable balance of trade;
            (2) the characteristics of the Korean travel market do not 
        permit long-term planning for longer trips;
            (3) applications for United States visas cannot now be 
        processed in a reasonable period of time;
            (4) the Secretary of State has attempted to solve the 
        problem by adding additional staff to the consular section at 
        the United States Embassy in Seoul;
            (5) unfortunately, these additions have not resulted in any 
        discernable improvement in reducing visa processing delays;
            (6) further, it is unlikely, given the current fiscal 
        environment, to expect funding to be available for further 
        staff additions in sufficient numbers to effect any significant 
        improvement in the time required to process visa applications;
            (7) most of the nations of the South Pacific, Europe, and 
        Canada do not currently require Koreans entering their 
        countries to have a visa, thus providing them with a serious 
        competitive advantage in the tourism industry;
            (8) the United States territory of Guam has been permitted 
        by the United States Government to eliminate visa requirements 
        for Koreans visiting Guam, with resultant impressive increases 
        in travel and tourism from citizens of the Republic of Korea;
            (9) any application under existing procedures to add the 
        Republic of Korea, or any other nation to the group of favored 
        nations exempted from United States visa regulations, would 
        require many years during which time the United States could 
        well lose its competitive advantages in attracting travel and 
        tourism from the Republic of Korea;
            (10) the Republic of Korea, as a gesture of goodwill, has 
        already unilaterally exempted United States tourists who seek 
        to enter the Republic of Korea from the requirement of 
        obtaining a visa; and
            (11) growth in Korean travel to the United States has not 
        kept pace with growth in travel to non-United States 
        destinations, and cumbersome and time-consuming visa processing 
        procedures are widely recognized as the cause of this loss of 
        market share and competitiveness with alternative destinations.
    (b) Pilot Program.--The Secretary of State and the Attorney General 
jointly shall establish a pilot project (in this section referred to as 
the ``pilot program'') within six months of the date of the enactment 
of this Act under which the requirement of paragraph (7)(B)(i)(II) of 
section 212(a) of the Immigration and Nationality Act (8 U.S.C. 
1182(a)(7)(B)(i)(II)) is waived during the pilot program period in the 
case of any alien who meets the following requirements:
            (1) National of pilot program country.--The alien is a 
        national of, and presents a passport issued by, the Republic of 
        Korea. The Republic of Korea is urged to provide machine 
        readable passports to its citizens in the near future.
            (2) Seeking entry as tourist.--The alien is applying for 
        admission to the United States during the pilot program period 
        as a nonimmigrant visitor for pleasure (as described in section 
        101(a)(15)(B) of the Immigration and Nationality Act (8 U.S.C. 
        1101(a)(15)(B))), as part of a group tour to the United States.
            (3) Period of stay.--The alien seeks to stay in the United 
        States for a period of not more than 15 days.
            (4) Executes immigration forms.--The alien before the time 
        of such admission completes such immigration form as the 
        Attorney General shall establish.
            (5) Entry into the united states.--If arriving by sea or 
        air, the alien arrives at the port of entry into the United 
States on a carrier which has entered into an agreement with the 
Immigration and Naturalization Service to guarantee transport of the 
alien out of the United States if the alien is found inadmissible or 
deportable by an immigration officer.
            (6) Not a safety threat.--The alien has been determined not 
        to represent a threat to the welfare, health, safety, or 
        security of the United States.
            (7) No previous violation.--If the alien previously was 
        admitted without a visa under this section, the alien must not 
        have failed to comply with the conditions of any previous 
        admission as such a nonimmigrant.
            (8) Round-trip ticket.--The alien is in possession of a 
        round-trip transportation ticket (unless this requirement is 
        waived by the Attorney General under regulations).
    (c) Waiver of Rights.--An alien may not be provided a waiver under 
the pilot program unless the alien has waived any right--
            (1) to review or appeal under this Act of an immigration 
        officer's determination as to the admissibility of the alien at 
        the port of entry into the United States, or
            (2) to contest, other than on the basis of an application 
        for asylum, any action for deportation against the alien.
    (d) Termination of Authority.--Notwithstanding any other provision 
of this section, the Attorney General and the Secretary of State, 
acting jointly, may terminate the pilot program under this section on 
or after a date which is one year after the date of the establishment 
of the pilot program if--
            (1) during the preceding fiscal year, the overstay rate for 
        nationals of the Republic of Korea entering the United States 
        under the pilot program exceeds the overstay rate of such 
        nationals entering the United States with valid visas; and
            (2) the Attorney General and the Secretary of State have 
        jointly determined that the pilot program is leading to a 
        significant increase in the number of overstays by such 
        nationals.
    (e) Special Bond and Notification Requirements for Tour 
Operators.--
            (1) In general.--Nationals of the Republic of Korea may not 
        enter the United States under the terms of this section unless 
        they are accompanied for the duration of their authorized 
        admission period by a tour operator who has fulfilled the 
        following requirements:
                    (A) The tour operator has posted a bond of $200,000 
                with the Secretary of State.
                    (B) The Secretary of State, under such regulations 
                as the Secretary may prescribe, has approved an 
                application by the tour operator to escort tour groups 
                to the United States.
                    (C) The tour operator provides the name, address, 
                birthdate, passport number, and citizenship of all 
                prospective tour group members to the Secretary of 
                State no less than one business day prior to the 
                departure date of the group, under such regulations as 
                he may prescribe, in order to determine that the 
                prospective travelers do not represent a threat to the 
                welfare, health, safety, and security of the United 
                States.
                    (D) The tour operator excludes from the tour group 
                any person whom the Secretary of State denies 
                permission to travel to the United States.
                    (E) The tour operator provides written 
                certification or other such evidence prescribed by the 
                Secretary of State and Attorney General which documents 
the return to Korea of each tour group member.
            (2) Forfeiture of bonds.--Bonds posted in accordance with 
        this subsection shall be forfeited in whole or in part and a 
        tour operator's authorization to escort tours to the United 
        States may be suspended or revoked if the Secretary of State 
        finds that the tour operator--
                    (A) has failed to disclose a material fact in 
                connection with the application required under 
                paragraph (1)(B);
                    (B) fails to comply with the advance notification 
                and refusal requirements of paragraphs (1)(C) and 
                (1)(D);
                    (C) has failed to take adequate steps to ensure 
                that visitors who are being escorted to the United 
                States under the terms of an approved application 
                return to their country of residence; or
                    (D) is found at any time to have committed a felony 
                or any offense under the immigration laws of the United 
                States.
    (f) Participation by Tour Agents.--The Secretary of State shall 
periodically review the overstay rate of nationals of the Republic of 
Korea that corresponds to each tour agent participating in the program 
under this section. The Secretary may terminate the participation in 
the program of any tour agent if the Secretary determines that the 
corresponding overstay rate is excessive.
    (g) Definitions.--For purposes of this section--
            (1) Group tour.--The term ``group tour'' means travelers 
        who take advantage of group-purchased hotel or airfare 
        packages, as guided, supervised, and arranged by a tour agent 
        in the Republic of Korea approved or licensed by the Department 
        of State.
            (2) Overstay rate.--The term ``overstay rate'' means, 
        during a specified period of time, the proportion that the 
        number of aliens remaining in the United States after the 
        expiration of their visas bears to the total number of aliens 
        entering the United States during that period of time.
            (3) Pilot program period.--The term ``pilot program 
        period'' means the three-year period immediately following the 
        establishment of the pilot program.

A: Directs the Secretary of State and the Attorney General to jointly establish a visa waiver pilot program for Korean nationals traveling in tour groups to the United States.  Specifies requirements for such waiver.
****
Q: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Emergency Acute Care Hospital 
Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) According to the University of North Carolina's Center 
        for Health Services Research, 55 rural hospitals have closed in 
        the Unites States since January 2010.
            (2) In 2014, iVantage conducted a study for the National 
        Rural Health Association and found 283 hospitals at risk of 
        closure based upon performance indicators that matched those 
        facilities already forced to close in this decade.
            (3) Researchers at the University of North Carolina 
        identified inpatient volume as a substantial contributing 
        factor to the financial performance of rural hospitals, with 
        many of the at-risk hospitals having an average daily bed 
        census of less than 2.
            (4) Adverse impacts to the local economy and the loss of 
        timely access to emergency medical care are 2 major effects of 
        rural hospital closures.
            (5) According to the National Center for Rural Health 
        Works, the typical rural hospital creates over 140 jobs and 
        generates $6,800,000 in compensation while serving an average 
        population of 14,600.
            (6) The 2014 iVantage study estimates that the 283 at-risk 
        hospitals could result in the loss of 36,000 health care jobs, 
        50,000 community jobs, and $10,600,000,000 in gross domestic 
        product.
            (7) Time is the most critical factor for achieving 
        successful outcomes in emergency medicine, and emergency 
        medical clinicians refer to the time-sensitive period during 
        which successful outcomes may be best achieved as the ``golden 
        hour''.
            (8) The National Conference of State Legislatures states 
        that 60 percent of trauma deaths in the United States occur in 
        rural areas, where only 15 percent of the population is 
        represented.
            (9) The disproportionate percentage of trauma deaths in 
        rural areas is likely attributable in large part to a 
        combination of response time to the scene and distance to the 
        nearest emergency room to stabilize trauma victims.
            (10) The percentage of trauma deaths occurring in rural 
        areas could continue to increase as more rural hospitals close, 
        further limiting access to emergency services and requiring 
        patients to travel longer distances to receive emergency 
        medical care.
            (11) The creation of a rural emergency hospital designation 
        under the Medicare program will allow facilities in rural areas 
        to provide emergency medical services without having to 
        maintain inpatient beds.
            (12) In addition to providing emergency care, rural 
        emergency hospitals could convert the space previously used for 
        inpatient services to provide other medical services including, 
        but not limited to, observation care, skilled nursing facility 
        care, infusion services, hemodialysis, home health, hospice, 
        nursing home care, population health, and telemedicine 
        services.

SEC. 3. RURAL EMERGENCY HOSPITAL PROGRAM.

    (a) In General.--
            (1) Rural emergency hospital and services defined.--Section 
        1861 of the Social Security Act (42 U.S.C. 1395x) is amended--
                    (A) in subsection (e), in the last sentence of the 
                matter following paragraph (9), by inserting ``or a 
                rural emergency hospital (as defined in section 
                1861(iii)(1))'' before the period at the end; and
                    (B) by adding at the end the following subsection:

    ``Rural Emergency Hospital; Rural Emergency Hospital Outpatient 
                                Services

    ``(iii)(1) The term `rural emergency hospital' means a facility 
that--
            ``(A)(i) as of December 31, 2014--
                            ``(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 
                        being located in a rural area pursuant to 
                        section 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 December 30, 
                2014;
            ``(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 midnight;
            ``(C) does not provide any acute care inpatient beds and 
        has protocols in place for the timely transfer of patients who 
        require acute care inpatient services or other inpatient 
        services;
            ``(D) has elected to be designated as a rural emergency 
        hospital;
            ``(E) has received approval to operate as a rural emergency 
        hospital from the State under section 1834(r)(3)(A); and
            ``(F) is certified by the Secretary under section 
        1834(r)(3)(B).
    ``(2) The term `rural emergency hospital outpatient services' means 
medical and other health services furnished by a rural emergency 
hospital on an outpatient basis.
    ``(3) Nothing in this subsection or section 1834(r)(3) shall be 
construed to prohibit a rural emergency hospital from providing 
extended care services.''.
            (2) Payment for rural emergency hospital 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 hospital emergency 
        services and services provided by a rural emergency hospital or 
        other provider of ambulance services to transport patients who 
        require acute care inpatient services or other inpatient 
        services from such rural emergency hospital to a hospital or 
        critical access hospital, the amounts described in section 
        1834(r).''.
                    (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:
    ``(r) Payment Rules Relating to Rural Emergency Hospitals.--
            ``(1) Payment for rural emergency hospital outpatient 
        services.--
                    ``(A) In general.--The amount of payment for rural 
                emergency hospital outpatient services of a rural 
                emergency hospital is equal to 110 percent of the 
                reasonable costs of providing such services.
                    ``(B) Telehealth services.--For purposes of this 
                paragraph, in determining the reasonable costs of 
                providing rural emergency hospital outpatient services, 
                costs associated with having a backup physician 
                available via a telecommunications system shall be 
                considered reasonable costs.
            ``(2) Payment for transportation services.--The amount of 
        payment for services provided by a rural emergency hospital or 
        other provider of ambulance services to transport patients who 
        require acute care inpatient services or other inpatient 
        services from such rural emergency hospital to a hospital or 
        critical access hospital is equal to 110 percent of the 
        reasonable costs of providing such services.
            ``(3) Requirements for rural emergency hospitals.--
                    ``(A) State approval to operate as a rural 
                emergency hospital.--No payment shall be made under 
                this subsection to a facility, or to a provider of 
                ambulance services providing transportation services 
                from such facility, unless the State in which the 
                facility is located has approved the facility's 
                designation as a rural emergency hospital.
                    ``(B) Certification of rural emergency hospital.--
                            ``(i) In general.--No payment shall be made 
                        under this subsection to a facility, or to a 
                        provider of ambulance services providing 
                        transportation services from such facility, 
                        unless the facility has been certified by the 
                        Secretary as a rural emergency hospital.
                            ``(ii) Certification requirements.--The 
                        Secretary shall certify a facility as a rural 
                        emergency hospital if the facility--
                                    ``(I) meets the criteria for rural 
                                emergency hospitals described in 
                                subparagraphs (A) through (E) of 
                                section 1861(iii)(1);
                                    ``(II) either--
                                            ``(aa) is verified by the 
                                        American College of Surgeons as 
                                        having the resources required 
                                        of a level IV trauma center or 
                                        higher; or
                                            ``(bb) employs healthcare 
                                        professionals that successfully 
                                        completed the Advanced Trauma 
                                        Life Support Course offered by 
                                        the American College of 
                                        Surgeons within the preceding 4 
                                        years;
                                    ``(III) has in effect a transfer 
                                agreement with a level I or level II 
                                trauma center; and
                                    ``(IV) meets such staff training 
                                and certification requirements as the 
                                Secretary may require.
            ``(4) Coinsurance.--
                    ``(A) In general.--The amount of payment for rural 
                emergency hospital services or transportation services 
                made to a rural emergency hospital or other provider of 
                ambulance services under this subsection shall be 
                reduced by the coinsurance amount described in 
                subparagraph (B).
                    ``(B) Coinsurance amount.--The coinsurance amount 
                described in this subparagraph, with respect to an item 
                or service provided by a rural emergency hospital or 
                provider of ambulance services, shall be calculated in 
                the same manner as the coinsurance amount for an 
                outpatient critical access hospital service is 
                calculated under section 1866(a)(2).''.
    (b) Waiver of Distance Requirement for Replacement CAHs; Subsequent 
Redesignation of Rural Emergency Hospitals as CAHs.--Section 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 subparagraphs:
                    ``(F) Option to waive distance requirement.--
                Beginning on the date of the enactment of this 
                subparagraph, for every critical access hospital 
                located in a State that is certified as a rural 
                emergency hospital under section 1834(r)(3)(B), the 
                State shall have the option of waiving the distance 
                requirement described in subparagraph (B)(i)(I) with 
                respect to another facility located in the State that 
                is seeking designation as a critical access hospital 
                under this paragraph.
                    ``(G) Redesignation of a rural emergency hospital 
                as a critical access hospital.--A rural emergency 
                hospital that was previously designated as a critical 
                access hospital under this paragraph may elect to be 
                redesignated as a critical access hospital (in the same 
                manner that the hospital was originally designated as a 
                critical access hospital) at any time, subject to such 
                conditions as the Secretary may establish.''.
    (c) Studies and Reports.--
            (1) Studies.--The Secretary of Health & Human Services 
        shall conduct 3 studies to evaluate the impact of rural 
        emergency hospitals on the availability of health care and 
        health outcomes in rural areas (as defined in section 
        1886(d)(2)(D) of the Social Security Act (42 U.S.C. 1395ww)). 
        The Secretary shall conduct a study--
                    (A) 2 years after the date of the enactment of this 
                Act;
                    (B) 5 years after the date of the enactment of this 
                Act; and
                    (C) 10 years after the date of the enactment of 
                this Act.
            (2) Reports.--Not later than 6 months after each date that 
        the Secretary of Health & Human Services is required to conduct 
        a study under paragraph (1), the Secretary shall submit a 
        report to Congress containing the results of each such study.
    (d) 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 enactment of this Act.

SEC. 4. INCLUSION OF EMERGENCY MEDICINE AS HEALTH SERVICES UNDER THE 
              NATIONAL HEALTH SERVICE CORPS.

    Section 331(a)(3)(D) of the Public Health Service Act (42 U.S.C. 
254d(a)(3)(D)) is amended by inserting ``, and includes emergency 
medicine provided by physicians in a rural emergency hospital (as 
defined in section 1861(iii) of the Social Security Act)'' before the 
period.

SEC. 5. PERMITTING HOSPITALS WITH APPROVED RESIDENCY PROGRAMS IN 
              EMERGENCY MEDICINE TO INCLUDE TIME SPENT BY INTERNS AND 
              RESIDENTS IN THE EMERGENCY DEPARTMENT OF A RURAL HOSPITAL 
              IN FULL-TIME EQUIVALENT COUNT.

    (a) Indirect Medical Education.--Section 1886(d)(5)(B)(iv) of the 
Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is amended by 
adding at the end the following new subclause:
            ``(III) Effective for discharges occurring on or after 
        October 1, 2015, all of the time spent in patient care 
        activities in the emergency department of a rural hospital by 
        interns and residents in emergency medicine from a hospital 
        with an approved medical residency training program (as defined 
        in subsection (h)(5)(A)) in such specialty shall be included in 
        determining the number of full-time equivalent interns and 
        residents in such program if the hospital with such program 
        incurs the costs of the stipends and fringe benefits of the 
        interns or residents during the time the interns or residents 
        spend in that rural hospital in accordance with subclause (II). 
        In this subclause, the term `rural hospital' means a hospital 
        that is located in a rural area (as defined for purposes of 
        paragraph (2)(D)).''.
    (b) Direct Medical Education.--Section 1886(h)(4)(E) of the Social 
Security Act (42 U.S.C. 1395(h)(4)) is amended--
            (1) in clause (ii), by striking the period at the end and 
        inserting ``; and'';
            (2) by inserting after clause (ii) the following new 
        clause:
                            ``(iii) effective for cost reporting 
                        periods beginning on or after July 1, 2015, all 
                        of the time so spent in the emergency 
                        department of a rural hospital by residents in 
                        emergency medicine from a hospital with an 
                        approved medical residency training program in 
                        such specialty shall be counted towards the 
                        determination of full-time equivalency in such 
                        program if the hospital with such program bears 
                        all, or substantially all, of the costs of 
                        training such residents in the rural hospital. 
                        In this subparagraph, the term `rural hospital' 
                        means a hospital that is located in a rural 
                        area (as defined for purposes of subsection 
                        (d)(2)(D)).''; and
            (3) by adding at the end the following new sentence: ``For 
        purposes of this subparagraph, the emergency department of a 
        rural hospital described in clause (iii) is a nonprovider 
        setting.''.

A:
Rural Emergency Acute Care Hospital Act  This bill amends title XVIII (Medicare) of the Social Security Act to designate as a rural emergency hospital any facility that as of December 31, 2014, was:   a critical access hospital (CAH) or a hospital with at most 50 beds located in a county in a rural area or treated as located in a rural area, or one of such hospitals that ceased operations during the period beginning five years before enactment of this Act and ending on December 30, 2014.  A rural emergency hospital:  must provide 24-hour emergency medical care and observation care not exceeding an annual per patient average of 24 hours or more than 1 midnight, does not provide any acute care inpatient beds and has protocols in place for the timely transfer of patients who require acute care inpatient services or other inpatient services, has elected to be designated as a rural emergency hospital, has received approval to operate as one from the state, and is certified by the Department of Health and Human Services (HHS).  Medicare part B (Supplementary Medical Insurance Benefits) shall cover rural emergency hospital emergency services as well as ambulance services provided by a rural emergency hospital or other provider to transport patients who require acute care inpatient services or other inpatient services from the rural emergency hospital to a hospital or a CAH. Payment for rural emergency hospital outpatient services of a rural emergency hospital, including telehealth and ambulance services, shall be 110% percent of their reasonable costs. Rural emergency hospitals must be approved by the state and certified by HHS. States shall have the option of waiving a specified distance requirement between a CAH certified as a rural emergency hospital and another facility located in the state that is seeking designation as a CAH. Primary health services which the National Health Service Corps may provide under the Public Health Service Act shall include emergency medicine provided by physicians in a rural emergency hospital. Hospitals with approved residency programs in emergency medicine shall include time spent by interns and residents in the emergency department of a rural hospital in the full-time equivalent count with respect to reimbursement for the indirect (stipend, fringe benefit) and direct (all or substantially all training) costs of medical education in subsection (d) hospitals. (Generally, a subsection [d] hospital is an acute care hospital, particularly one that receives payments under Medicare's inpatient prospective payment system [IPPS] when providing covered inpatient services to eligible beneficiaries.)
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