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[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6502 Introduced in House (IH)]
115th CONGRESS
2d Session
H. R. 6502
To amend title XVIII of the Social Security Act to establish a program
to allow qualified group practices to furnish certain items and
services at qualified skilled nursing facilities to individuals
entitled to benefits under part A and enrolled under part B of the
Medicare program to reduce unnecessary hospitalizations, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 25, 2018
Mr. Smith of Nebraska (for himself, Mrs. Black, Mr. Crowley, Mr.
Griffith, and Mr. Ben Ray Lujan of New Mexico) introduced the following
bill; which was referred to the Committee on Ways and Means, and in
addition to the Committee on Energy and Commerce, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish a program
to allow qualified group practices to furnish certain items and
services at qualified skilled nursing facilities to individuals
entitled to benefits under part A and enrolled under part B of the
Medicare program to reduce unnecessary hospitalizations, 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 ``Reducing Unnecessary Senior
Hospitalizations Act of 2018'' or the ``RUSH Act of 2018''.
SEC. 2. SNF-BASED PROVISION OF PREVENTIVE ACUTE CARE AND
HOSPITALIZATION REDUCTION PROGRAM.
Title XVIII of the Social Security Act is amended by adding at the
end the following new section:
``SEC. 1899C. SNF-BASED PROVISION OF PREVENTIVE ACUTE CARE AND
HOSPITALIZATION REDUCTION PROGRAM.
``(a) Establishment.--There is established a program to be known as
the `SNF-based Provision of Preventive Acute Care and Hospitalization
Reduction Program' (in this section referred to as the `Program'), to
be administered by the Secretary, for purposes of reducing unnecessary
hospitalizations and emergency department visits by allowing qualified
group practices (as defined in section 1877(h)(4)) on or after January
1, 2019, to furnish items and services identified under subsection
(b)(3) to individuals entitled to benefits under part A and enrolled
under part B residing in qualified skilled nursing facilities.
``(b) Operation of Program.--Under the Program, the Secretary shall
provide for the following:
``(1) Certification of skilled nursing facilities as
qualified skilled nursing facilities under subsection (c)(1).
``(2) Certification of group practices as qualified group
practices under subsection (c)(2).
``(3) Identification of minimum required nonsurgical items
and services furnished at a hospital emergency department that
may be safely furnished by a qualified group practice at a
qualified skilled nursing facility under the Program and that
such qualified group practice shall offer to furnish under the
Program.
``(4) Annual identification of additional items and
services furnished at a hospital emergency department that may
be safely furnished by a qualified group practice at a
qualified skilled nursing facility under the Program during a
year and that such qualified group practice may offer to
furnish under the Program during such year.
``(5) Establishment of qualifications for nonphysician
employees of such qualified group practices who may furnish
such items and services at a qualified skilled nursing
facility. Such qualifications shall include the requirement
that such an employee--
``(A) be certified in advanced cardiovascular life
support by a nationally recognized specialty board of
certification or equivalent certification board; and
``(B) have at least one year of clinical experience
furnishing medical care--
``(i) in a hospital emergency department
setting; or
``(ii) as an employee of a provider or
supplier of ambulance services.
``(6) Payment under this title for items and services
identified under paragraph (3) or (4) furnished by such
qualified group practices at such a facility in amounts
determined under subsection (d).
``(c) Certifications.--
``(1) Qualified skilled nursing facilities.--For purposes
of this section, the Secretary shall certify a skilled nursing
facility as a qualified skilled nursing facility if the
facility submits an application in a time and manner specified
by the Secretary and meets the following requirements:
``(A) The facility has on-site diagnostic equipment
necessary for a qualified group practice to furnish on-
site items and services under the Program and real-time
audio and visual capabilities.
``(B) The facility ensures that residents of such
facility, upon entering such facility, are allowed to
specify in an advanced care directive whether the
resident wishes to receive items and services furnished
at the facility under the Program in a case where
communication with the resident is not possible.
``(C) The facility ensures that individuals to be
furnished such items and services under the Program at
such facility have the opportunity, at their request,
to instead be transported to a hospital emergency
department.
``(2) Qualified group practices.--For purposes of this
section, the Secretary shall certify a group practice as a
qualified group practice for a period of 3 years if the group
practice submits an application in a time and manner specified
by the Secretary and meets the following requirements:
``(A) The group practice offers to furnish all
minimum required items and services identified under
subsection (b)(3) under the Program.
``(B) The group practice submits a notification to
the Secretary annually specifying which (if any)
additional items and services identified under
subsection (b)(4) for a year the group practice will
offer to furnish for such year under the Program.
``(C) The group practice ensures that only
individuals who meet the qualifications established
under subsection (b)(4) or a physician who is part of
such group practice may furnish such minimum required
items and services and such additional items and
services.
``(D) The group practice ensures that at least 1
such individual or such physician is present at all
times at each qualified skilled nursing facility where
the group practice may furnish such minimum required
items and services and such additional items and
services.
``(E) The group practice ensures that, in the case
where such minimum required items and services or such
additional items and services are furnished by such an
individual, such individual furnishes such minimum
required items and services or additional items and
services under the supervision, either in-person or
through the use of telehealth (not including store-and-
forward technologies), of--
``(i) a physician--
``(I) who is board certified or
board eligible in emergency medicine,
family medicine, or internal medicine;
or
``(II) who has been certified by a
nationally recognized specialty board
of certification or equivalent
certification board in advanced cardiac
life support and advanced trauma life
support;
``(ii) a nurse practitioner who has been
certified by a nationally recognized specialty
board of certification or equivalent
certification board in advanced cardiac life
support and advanced trauma life support; or
``(iii) a physician assistant who has been
certified by a nationally recognized specialty
board of certification or equivalent
certification board in advanced cardiac life
support and advanced trauma life support.
``(F) With respect to any year in which the
qualified group practice would participate in the
Program, the Chief Actuary for the Centers for Medicare
& Medicaid Services determines that such participation
during such year will not result in total estimated
expenditures under this title for such year being
greater than total estimated expenditures under such
title for such year without such participation.
``(d) Payments.--
``(1) In general.--For 2019 and each subsequent year, the
Secretary shall develop a schedule of payments to apply for
items and services identified under paragraph (3) or paragraph
(4) of subsection (b) furnished during such year by a qualified
group practice under the Program. Such payments shall be in
lieu of any other payments that may be made under this title
for such items and services furnished under the Program.
``(2) Shared savings.--In the case of a year for which the
Secretary determines that a qualified group practice's
participation in the Program resulted in a reduction in
expenditures under this title compared to what such
expenditures would have been without such participation, the
Secretary shall--
``(A) pay to such qualified group practice an
amount equal to 37.5 percent of the estimated amount of
such reduction; and
``(B) pay to each qualified skilled nursing
facility where such qualified group practice furnished
items and services under the Program during such year
an amount that bears the same ratio to 12.5 percent of
the estimated amount of such reduction as the amount of
expenditures under the Program for such items and
services furnished with respect to individuals at such
facility by such qualified group practice during such
year bears to the total amount of expenditures under
the Program for such items and services furnished with
respect to all individuals by such qualified group
practice during such year.
``(e) Evaluation.--
``(1) In general.--With respect to a qualified group
practice and a qualified skilled nursing facility, not later
than 6 months after such group practice begins furnishing items
and services under the Program (or, in the case of a qualified
skilled nursing facility, not less than 6 months after a
qualified group practice first furnishes such items and
services at such facility), and not less than once every 2
years thereafter, the Secretary shall evaluate such qualified
group practice and such qualified facility using information
received under paragraph (2) on such criteria as determined
appropriate by the Secretary.
``(2) Reporting of information.--In a time and manner
specified by the Secretary, a qualified group practice and a
qualified skilled nursing facility shall submit to the
Secretary a report containing the following information with
respect to items and services furnished under the Program
during a reporting period (as specified by the Secretary):
``(A) The number of individuals with respect to
whom such group practice furnished such items and
services in such period (or, in the case of a qualified
skilled nursing facility, the number of individuals
with respect to whom such a group practice furnished
such items and services at such facility in such
period).
``(B) The number of such individuals who were
admitted to a hospital or treated in the emergency
department of a hospital within 24 hours of being
furnished such items and services.
``(C) Other information determined appropriate by
the Secretary.
``(3) Loss of qualified certification.--
``(A) In general.--Not later than 3 months after a
determination described in this sentence is made, the
Secretary may revoke the certification of a qualified
skilled nursing facility or a qualified group practice
made under subsection (c) if--
``(i) the Chief Actuary of the Centers for
Medicare & Medicaid Services determines that
such skilled nursing facility's or such group
practice's participation in the Program during
a year resulted in total expenditures under
this title for such period being greater than
total expenditures under such title would have
been during such period without such
participation; or
``(ii) the Secretary determines that such
skilled nursing facility or such group practice
has failed to comply with a requirement
specified in paragraph (1) or (2) of subsection
(c), as applicable.
``(B) Exclusion from certification for 3-year
period.--In the case that the Secretary revokes the
certification of a qualified skilled nursing facility
or a qualified group practice under subparagraph (A),
such skilled nursing facility or such group practice
shall be ineligible for certification as a qualified
skilled nursing facility or a qualified group practice
(as applicable) under subsection (c) for a period of 3
years beginning on the date of such revocation.
``(f) Determination of Budget Neutrality; Termination of Program.--
``(1) Determination.--Not later than July 1, 2024, the
Chief Actuary of the Centers for Medicare & Medicaid Services
shall determine whether the Program has resulted in an increase
in total expenditures under this title with respect to the
period beginning on January 1, 2019, and ending on December 31,
2023, compared to what such expenditures would have been during
such period had the Program not been in operation.
``(2) Termination.--If the Chief Actuary makes a
determination under paragraph (1) that the Program has resulted
in an increase in total expenditures under this title, the
Secretary shall terminate the Program as of January 1 of the
first year beginning after such determination.''.
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