Expanding the definition of rural emergency hospital under the Medicare program

(a) In general Section 1861(kkk) of the Social Security Act (42 U.S.C. 1395x(kkk)) is amended— (1) in paragraph (2)— (A) in subparagraph (A), by striking the detailed transition plan and all that follows through such paragraph and inserting the detailed transition plan described in clause (i)(I) of such paragraph or the assessment of health care needs described in clause (i)(II) of such paragraph, as applicable,; (B) in subparagraph (D)(vi), by striking the period at the end and inserting; and; and (C) by adding at the end the following new subparagraph: (E) in the case of a facility described in paragraph (3)(B)— (i) submits an application under section 1866(j) to enroll under this title as a rural emergency hospital— (I) in the case that such facility is located in a State that, as of January 1, 2027, provides for the licensing of rural emergency hospitals under State or applicable local law (as described in paragraph (5)(A)), not later than December 31, 2027; and (II) in the case that such facility is located in a State that, as of January 1, 2027, does not provide for the licensing of such rural emergency hospitals under State or applicable local law (as so described), not later than the date that is 1 year after the date on which such State begins to provide for such licensing; and (ii) in the case that such facility is located less than 35 miles away from the nearest hospital, critical access hospital, or rural emergency hospital as of the date on which such facility submits an application under section 1866(j) to enroll under this title as a rural emergency hospital, beginning not later than 1 year after the end of the first full cost reporting period for which the facility is so enrolled, demonstrates annually, in a form and manner determined appropriate by the Secretary, that more than 50 percent of the services furnished for the most recent cost reporting period (as determined by the Secretary) were services described in paragraph (1)(A)(i), as determined based on discharges of individuals entitled to benefits under part A or enrolled under part B during such cost reporting period.; (2) in paragraph (3)— (A) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and adjusting the margins accordingly; (B) by striking A facility and inserting: (A) In general A facility; and (C) by adding at the end the following new subparagraph: (B) Additional facilities Beginning January 1, 2027, a facility described in this paragraph shall also include a facility that— (i) at any time during the period beginning January 1, 2014, and ending December 26, 2020— (I) was a critical access hospital; or (II) was a subsection (d) hospital (as defined in section 1886(d)(1)(B)) 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)); and (ii) as of December 27, 2020, was not enrolled in the program under this title under section 1866(j).; and (3) in paragraph (4)— (A) in subparagraph (A)(i)— (i) in subclause (IV), by striking the period at the end and inserting; and; (ii) by redesignating subclauses (I) through (IV) as items (aa) through (dd), respectively, and adjusting the margins accordingly; (iii) by striking including a detailed and inserting including— (I) except in the case of a facility described in paragraph (3)(B), a detailed; and (iv) by adding at the end the following new subclause: (II) in the case of a facility described in paragraph (3)(B), an assessment of the health care needs of the county (or equivalent unit of local government) in which such facility is located, which shall include— (aa) a description of the services furnished by the facility during the period that such facility was enrolled in the program under this title under section 1866(j); (bb) a description of the reasons that the facility, as of December 27, 2020, was no longer so enrolled; (cc) the population of such county (or equivalent unit); (dd) the percentage of such population who are individuals entitled to benefits under part A or enrolled under part B; and (ee) a description of any lack of access to health care services experienced by such individuals, and an explanation of how reopening the facility as a rural emergency hospital would mitigate such lack of access.. (b) Amendments to payment rules Section 1834(x) of the Social Security Act (42 U.S.C. 1395m(x)) is amended— (1) in paragraph (1), by inserting, except that, in the case of a facility described in section 1861(kkk)(3)(B) that, as of the date on which such facility submits an application under section 1866(j) to enroll under this title as a rural emergency hospital, is located less than 35 miles away from the nearest hospital, critical access hospital, or rural emergency hospital, such increase shall not apply before the period at the end; and (2) in paragraph (2)(A), by inserting (other than a facility described in section 1861(kkk)(3)(B) that, as of the date on which such facility submits an application under section 1866(j) to enroll under this title as a rural emergency hospital, is located less than 10 miles away from the nearest hospital, critical access hospital, or rural emergency hospital) after rural emergency hospital.

(a) In general Section 1861(kkk) of the Social Security Act (42 U.S.C. 1395x(kkk)) is amended— (1) in paragraph (2)— (A) in subparagraph (A), by striking the detailed transition plan and all that follows through such paragraph and inserting the detailed transition plan described in clause (i)(I) of such paragraph or the assessment of health care needs described in clause (i)(II) of such paragraph, as applicable,; (B) in subparagraph (D)(vi), by striking the period at the end and inserting; and; and (C) by adding at the end the following new subparagraph: (E) in the case of a facility described in paragraph (3)(B)— (i) submits an application under section 1866(j) to enroll under this title as a rural emergency hospital— (I) in the case that such facility is located in a State that, as of January 1, 2027, provides for the licensing of rural emergency hospitals under State or applicable local law (as described in paragraph (5)(A)), not later than December 31, 2027; and (II) in the case that such facility is located in a State that, as of January 1, 2027, does not provide for the licensing of such rural emergency hospitals under State or applicable local law (as so described), not later than the date that is 1 year after the date on which such State begins to provide for such licensing; and (ii) in the case that such facility is located less than 35 miles away from the nearest hospital, critical access hospital, or rural emergency hospital as of the date on which such facility submits an application under section 1866(j) to enroll under this title as a rural emergency hospital, beginning not later than 1 year after the end of the first full cost reporting period for which the facility is so enrolled, demonstrates annually, in a form and manner determined appropriate by the Secretary, that more than 50 percent of the services furnished for the most recent cost reporting period (as determined by the Secretary) were services described in paragraph (1)(A)(i), as determined based on discharges of individuals entitled to benefits under part A or enrolled under part B during such cost reporting period.; (2) in paragraph (3)— (A) by redesignating subparagraphs (A) and (B) as clauses (i) and (ii), respectively, and adjusting the margins accordingly; (B) by striking A facility and inserting: (A) In general A facility; and (C) by adding at the end the following new subparagraph: (B) Additional facilities Beginning January 1, 2027, a facility described in this paragraph shall also include a facility that— (i) at any time during the period beginning January 1, 2014, and ending December 26, 2020— (I) was a critical access hospital; or (II) was a subsection (d) hospital (as defined in section 1886(d)(1)(B)) 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)); and (ii) as of December 27, 2020, was not enrolled in the program under this title under section 1866(j).; and (3) in paragraph (4)— (A) in subparagraph (A)(i)— (i) in subclause (IV), by striking the period at the end and inserting; and; (ii) by redesignating subclauses (I) through (IV) as items (aa) through (dd), respectively, and adjusting the margins accordingly; (iii) by striking including a detailed and inserting including— (I) except in the case of a facility described in paragraph (3)(B), a detailed; and (iv) by adding at the end the following new subclause: (II) in the case of a facility described in paragraph (3)(B), an assessment of the health care needs of the county (or equivalent unit of local government) in which such facility is located, which shall include— (aa) a description of the services furnished by the facility during the period that such facility was enrolled in the program under this title under section 1866(j); (bb) a description of the reasons that the facility, as of December 27, 2020, was no longer so enrolled; (cc) the population of such county (or equivalent unit); (dd) the percentage of such population who are individuals entitled to benefits under part A or enrolled under part B; and (ee) a description of any lack of access to health care services experienced by such individuals, and an explanation of how reopening the facility as a rural emergency hospital would mitigate such lack of access.. (b) Amendments to payment rules Section 1834(x) of the Social Security Act (42 U.S.C. 1395m(x)) is amended— (1) in paragraph (1), by inserting, except that, in the case of a facility described in section 1861(kkk)(3)(B) that, as of the date on which such facility submits an application under section 1866(j) to enroll under this title as a rural emergency hospital, is located less than 35 miles away from the nearest hospital, critical access hospital, or rural emergency hospital, such increase shall not apply before the period at the end; and (2) in paragraph (2)(A), by inserting (other than a facility described in section 1861(kkk)(3)(B) that, as of the date on which such facility submits an application under section 1866(j) to enroll under this title as a rural emergency hospital, is located less than 10 miles away from the nearest hospital, critical access hospital, or rural emergency hospital) after rural emergency hospital.