RUSH Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 6209 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 MARCH 11, 2020 Ms. KUSTER of New Hampshire (for herself and Mr. SMITH of Nebraska) in- troduced 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 pur- poses. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 6209 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Reducing Unnecessary 2 Senior Hospitalizations Act of 2020’’ or the ‘‘RUSH Act 3 of 2020’’. 4 SEC. 2. SNF-BASED PROVISION OF PREVENTIVE ACUTE 5 CARE AND HOSPITALIZATION REDUCTION 6 PROGRAM. 7 Title XVIII of the Social Security Act is amended by 8 adding at the end the following new section: 9 ‘‘SEC. 1899C. SNF-BASED PROVISION OF PREVENTIVE 10 ACUTE CARE AND HOSPITALIZATION REDUC- 11 TION PROGRAM. 12 ‘‘(a) ESTABLISHMENT.—There is established a pro- 13 gram to be known as the ‘SNF-based Provision of Preven- 14 tive Acute Care and Hospitalization Reduction Program’ 15 (in this section referred to as the ‘Program’), to be admin- 16 istered by the Secretary, for purposes of reducing unneces- 17 sary hospitalizations and emergency department visits by 18 allowing qualified group practices (as defined in section 19 1877(h)(4)) on or after January 1, 2021, to furnish items 20 and services identified under subsection (b)(3) to individ- 21 uals entitled to benefits under part A and enrolled under 22 part B residing in qualified skilled nursing facilities. 23 ‘‘(b) OPERATION OF PROGRAM.—Under the Pro- 24 gram, the Secretary shall provide for the following: 25 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 6209 IH ‘‘(1) Certification of skilled nursing facilities as 1 qualified skilled nursing facilities under subsection 2 (c)(1). 3 ‘‘(2) Certification of group practices as quali- 4 fied group practices under subsection (c)(2). 5 ‘‘(3) Identification of minimum required non- 6 surgical items and services furnished at a hospital 7 emergency department that may be safely furnished 8 by a qualified group practice at a qualified skilled 9 nursing facility under the Program and that such 10 qualified group practice shall offer to furnish under 11 the Program. 12 ‘‘(4) Annual identification of additional items 13 and services furnished at a hospital emergency de- 14 partment that may be safely furnished by a qualified 15 group practice at a qualified skilled nursing facility 16 under the Program during a year and that such 17 qualified group practice may offer to furnish under 18 the Program during such year. 19 ‘‘(5) Establishment of qualifications for non- 20 physician employees who may furnish such items 21 and services at a qualified skilled nursing facility. 22 Such qualifications shall include the requirement 23 that such an employee— 24 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 6209 IH ‘‘(A) be certified in basic life support by a 1 nationally recognized specialty board of certifi- 2 cation or equivalent certification board; and 3 ‘‘(B) have— 4 ‘‘(i) clinical experience furnishing 5 medical care— 6 ‘‘(I) in a skilled nursing facility; 7 ‘‘(II) in a hospital emergency de- 8 partment setting; or 9 ‘‘(III) as an employee of a pro- 10 vider or supplier of ambulance serv- 11 ices; or 12 ‘‘(ii) a certification in paramedicine. 13 ‘‘(6) Payment under this title for items and 14 services identified under paragraph (3) or (4) fur- 15 nished by such qualified group practices at such a 16 facility in amounts determined under subsection (d). 17 ‘‘(c) CERTIFICATIONS.— 18 ‘‘(1) QUALIFIED SKILLED NURSING FACILI- 19 TIES.—For purposes of this section, the Secretary 20 shall certify a skilled nursing facility as a qualified 21 skilled nursing facility if the facility submits an ap- 22 plication in a time and manner specified by the Sec- 23 retary and meets the following requirements: 24 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 6209 IH ‘‘(A) The facility has on-site diagnostic 1 equipment necessary for a qualified group prac- 2 tice to furnish items and services under the 3 Program and real-time audio and visual capa- 4 bilities. 5 ‘‘(B) The facility has at least one indi- 6 vidual who meets the qualifications described in 7 paragraph (5) or a physician present 24 hours 8 a day and 7 days a week to work with the 9 qualified group practice. Such individual may 10 be a member of the staff of the qualified skilled 11 nursing facility or of the qualified group prac- 12 tice. 13 ‘‘(C) The facility ensures that residents of 14 such facility, upon entering such facility, are al- 15 lowed to specify in an advanced care directive 16 whether the resident wishes to receive items 17 and services furnished at the facility under the 18 Program in a case where communication with 19 the resident is not possible. 20 ‘‘(D) The facility ensures that individuals 21 to be furnished such items and services under 22 the Program at such facility have the oppor- 23 tunity, at their request, to instead be trans- 24 ported to a hospital emergency department. 25 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 6209 IH ‘‘(E) The facility is not part of the Special 1 Focus Facility program of the Centers for 2 Medicare & Medicaid Services (although the fa- 3 cility may, at the discretion of the Secretary, be 4 a candidate for selection under such program). 5 Nothing in this paragraph shall affect the require- 6 ments under section 1819(b)(4). 7 ‘‘(2) QUALIFIED GROUP PRACTICES.—For pur- 8 poses of this section, the Secretary shall certify a 9 group practice as a qualified group practice for a pe- 10 riod of 3 years if the group practice submits an ap- 11 plication in a time and manner specified by the Sec- 12 retary and meets the following requirements: 13 ‘‘(A) The group practice offers to furnish 14 all minimum required items and services identi- 15 fied under subsection (b)(3) under the Pro- 16 gram. 17 ‘‘(B) The group practice submits a notifi- 18 cation to the Secretary annually specifying 19 which (if any) additional items and services 20 identified under subsection (b)(4) for a year the 21 group practice will offer to furnish for such 22 year under the Program. 23 ‘‘(C) The group practice ensures that only 24 individuals who meet the qualifications estab- 25 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 6209 IH lished under subsection (b)(5) or a physician 1 who is part of such group practice may furnish 2 such minimum required items and services and 3 such additional items and services. 4 ‘‘(D) The group practice ensures that, in 5 the case where such minimum required items 6 and services or such additional items and serv- 7 ices are furnished by such an individual, such 8 individual furnishes such minimum required 9 items and services or additional items and serv- 10 ices under the supervision, either in-person or 11 through the use of telehealth (not including 12 store-and-forward technologies), of— 13 ‘‘(i) a physician— 14 ‘‘(I) who is board certified or 15 board eligible in emergency medicine, 16 family medicine, geriatrics, or internal 17 medicine; or 18 ‘‘(II) who has been certified by a 19 nationally recognized specialty board 20 of certification or equivalent certifi- 21 cation board in basic life support; 22 ‘‘(ii) a nurse practitioner who has 23 been certified by a nationally recognized 24 specialty board of certification or equiva- 25 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 6209 IH lent certification board in basic life sup- 1 port; or 2 ‘‘(iii) a physician assistant who has 3 been certified by a nationally recognized 4 specialty board of certification or equiva- 5 lent certification board in basic life sup- 6 port. 7 ‘‘(E) With respect to any year in which the 8 qualified group practice would participate in the 9 Program, the Chief Actuary for the Centers for 10 Medicare & Medicaid Services determines that 11 such participation during such year will not re- 12 sult in total estimated expenditures under this 13 title for such year being greater than total esti- 14 mated expenditures under such title for such 15 year without such participation. 16 ‘‘(d) PAYMENTS.— 17 ‘‘(1) IN GENERAL.—For 2021 and each subse- 18 quent year, the Secretary shall develop a schedule of 19 payments to apply for items and services identified 20 under paragraph (3) or paragraph (4) of subsection 21 (b) furnished during such year under the Program. 22 Such payments shall be in lieu of any other pay- 23 ments that may be made under this title for such 24 items and services. 25 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 6209 IH ‘‘(2) SHARED SAVINGS.—In the case of a year 1 for which the Secretary determines that participa- 2 tion in the Program resulted in a reduction in ex- 3 penditures under this title compared to what such 4 expenditures would have been without such partici- 5 pation, the Secretary shall— 6 ‘‘(A) pay to such qualified group practice 7 an amount equal to 37.5 percent of the esti- 8 mated amount of such reduction; and 9 ‘‘(B) in the case of each qualified skilled 10 nursing facility where such qualified group 11 practice furnished items and services under the 12 Program during such year— 13 ‘‘(i) if the qualified skilled nursing fa- 14 cility has at least a three-star rating under 15 the Five Star Quality Rating System (or a 16 successor system), pay to the facility an 17 amount that bears the same ratio to 12.5 18 percent of the estimated amount of such 19 reduction as the amount of expenditures 20 under the Program for such items and 21 services furnished with respect to individ- 22 uals at such facility by such qualified 23 group practice during such year bears to 24 the total amount of expenditures under the 25 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 10 •HR 6209 IH Program for such items and services fur- 1 nished with respect to all individuals by 2 such qualified group practice during such 3 year; and 4 ‘‘(ii) in the case of a qualified skilled 5 nursing facility that is not described in 6 clause (i), retain in the Federal Hospital 7 Insurance Trust Fund under section 1817 8 the amount that the facility would have 9 been paid pursuant to clause (i) if the fa- 10 cility were described in such clause until 11 such time as the facility has at least a 12 three-star rating under the Five Star Qual- 13 ity Rating System (or a successor system), 14 at which point the Secretary shall pay such 15 amount to the facility. 16 ‘‘(3) ADVANCED ALTERNATIVE PAYMENT MOD- 17 ELS.—Paragraph (2) shall not apply to items and 18 services furnished to an individual entitled to bene- 19 fits under part A and enrolled under Part B for 20 whom shared savings would otherwise be attributed 21 through an advanced alternative payment model as 22 authorized under section 1115A or section 1899. 23 ‘‘(e) EVALUATION.— 24 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 11 •HR 6209 IH ‘‘(1) IN GENERAL.—With respect to a qualified 1 group practice and a qualified skilled nursing facil- 2 ity, not later than 6 months after such group prac- 3 tice begins furnishing items and services under the 4 Program (or, in the case of a qualified skilled nurs- 5 ing facility, not less than 6 months after a qualified 6 group practice first furnishes such items and serv- 7 ices at such facility), and not less than once every 8 2 years thereafter, the Secretary shall evaluate such 9 qualified group practice and such qualified facility 10 using information received under paragraph (2) on 11 such criteria as determined appropriate by the Sec- 12 retary. 13 ‘‘(2) REPORTING OF INFORMATION.—In a time 14 and manner specified by the Secretary, a qualified 15 group practice and a qualified skilled nursing facility 16 shall submit to the Secretary a report containing the 17 following information with respect to items and serv- 18 ices furnished under the Program during a reporting 19 period (as specified by the Secretary): 20 ‘‘(A) The number of individuals with re- 21 spect to whom such group practice furnished 22 such items and services in such period (or, in 23 the case of a qualified skilled nursing facility, 24 the number of individuals with respect to whom 25 VerDate Sep 11 2014 02:21 Mar 25, 2020 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H6209.IH H6209 pamtmann on DSKBC07HB2PROD with BILLS 12 •HR 6209 IH such a group practice furnished such items and 1 services at such facility in such period). 2 ‘‘(B) The number of such individuals who 3 were admitted to a hospital or treated in the 4 emergency department of a hospital within 24 5 hours of being furnished such items and serv- 6 ices. 7 ‘‘(C) Other information determined appro- 8 priate by the Secretary. 9 ‘‘(3) LOSS OF QUALIFIED CERTIFICATION.— 10 ‘ [Text truncated for display. 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