Sec. 401. Community outpatient hospital program
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Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— in the last sentence of subsection (e), by inserting before the period at the end or a community outpatient hospital (as defined in subsection (iii)(1)) ; and by adding at the end the following: The term community outpatient hospital means a facility that— at any time during the period beginning on the date that is 5 years before the date of the enactment of this subsection and ending on December 31, 2016, was a critical access hospital, or is a hospital with not more than 50 beds that is— located in a rural area (as defined in section 1886(d)(2)(D)); or treated as being located in a rural area under section 1886(d)(8)(E); provides emergency medical care and observation care available on a 24-hour basis; with respect to continuous care for an individual, does not provide care over two or more consecutive midnights; does not provide any acute care inpatient beds and has protocols in place for the timely transfer of patients who require other inpatient services; has the resources required of a level IV or higher trauma center (as verified by the American College of Surgeons or other means specified by the Secretary), or has available for consultation on a 24-hour basis a health care professional who successfully completed the Advanced Trauma Life Support Course offered by the American College of Surgeons (or an equivalent course as determined by the Secretary) within the preceding 4 years; has in effect a transfer agreement with a level I or level II trauma center designated under section 1231(1) of the Public Health Service Act; meets the requirements of subsection (aa)(2)(I); has been approved by the State in which the facility is located for treatment as a community outpatient hospital; notifies the Secretary at such time and in such manner as the Secretary may require of the intent of such facility to be designated as a community outpatient facility; and meets such staff training and certification requirements as the Secretary may require.
Nothing in this subsection or section 1834(r) shall be construed to prohibit a community outpatient hospital from having an agreement under section 1883 for the provision of extended care services. Unless the context otherwise requires, a reference to a community outpatient hospital in this title shall be deemed to also be a reference to a critical access hospital. The term qualified outpatient services means medical and other health services furnished on an outpatient basis by a community outpatient hospital, rural health clinic (as defined in section 1861(aa)(2)), federally qualified health center (as defined in section 1861(aa)(4)), or an entity certified by the Health Resources and Services Administration as a federally qualified health center look-alike, including, for individuals who require services from a hospital or critical access hospital, transportation services from such community outpatient hospital to a hospital or critical access hospital. .
Section 1834 of the Social Security Act ( 42 U.S.C. 1395m ) is amended by adding at the end the following: The amount of payment for qualified outpatient services is equal to 105 percent of the reasonable costs of providing such services. For purposes of this subsection, with respect to qualified outpatient services, costs reasonably associated with having a backup physician available via a telecommunications system shall be considered reasonable costs. . Section 1820(c)(2) of the Social Security Act ( 42 U.S.C. 1395i–4(c)(2) ) is amended— in subparagraph (B)(i)(I), by inserting , subject to subparagraph (F), before is located ; and by adding at the end the following:
The State may waive the distance requirement described in subparagraph (B)(i)(I) with respect to a facility located in the State that is seeking designation as a critical access hospital under this paragraph if the total number of waivers for such facilities does not exceed the number of facilities that are critical access hospitals without such a waiver. A community outpatient hospital may elect to be redesignated as a community outpatient hospital by notifying the Secretary at the same time and in the same manner as notifications under section 1861(iii)(1)(I) if such community outpatient hospital— meets the requirements in paragraphs
(1)and
(3)of section 1820(e); and was designated as a critical access hospital under this paragraph on the date that the Secretary first considered such community outpatient hospital to be a community outpatient hospital. . Section 1861(v)(7) of the Social Security Act ( 42 U.S.C. 1395x(v)(7) ) is amended by adding at the end the following: For additional items included in reasonable cost for community outpatient hospitals and for determination of payment amounts for qualified outpatient services, see section 1834(r). . OH s as covered services Section 1832(a)(2)(H) of the Social Security Act ( 42 U.S.C. 1395k(a)(2)(H) ) is amended by inserting and qualified outpatient services (as defined in section 1861(iii)(2)) before the semicolon. Section 1833(a) of the Social Security Act ( 42 U.S.C. 1395l(a) ) is amended— in paragraph (8), by striking ; and ; in paragraph (9), by striking the period at the end and inserting ; and ; and by inserting after paragraph
(9)the following: in the case of qualified outpatient services, the amounts described in section 1834(r). . The amendments made by this subsection shall apply to items and services furnished on or after the first day of the first calendar year beginning more than 1 year after the date of the enactment of this Act. The Secretary of Health and Human Services shall submit to Congress three reports on the impact of community outpatient 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(d)(2)(D) )) as follows: An initial report approximately 2 years after the date of the enactment of this Act. An interim report approximately 5 years after the date of the enactment of this Act. A final report approximately 10 years after the date of the enactment of this Act.
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- 42 USC 1395i–4(c)(2)
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Sec. 401
Community outpatient hospital program
Cite42 USC 1395i–4(c)(2)
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