[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 2157 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 2157
To amend title XI of the Social Security Act to expand the use of
global payments to hospitals in rural areas.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 18, 2019
Mr. Casey introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XI of the Social Security Act to expand the use of
global payments to hospitals in rural areas.
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 ``Rural Hospital Sustainability Act''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Approximately 10,000,000 individuals age 65 and older
live in rural America today. In fact, 1 out of every 4 older
adults lives in a small town or other rural area.
(2) Residents of rural areas are more likely to be poorer,
sicker, and have lower incomes compared to their urban
counterparts.
(3) According to the Office of Rural Health Policy, from
2005 to 2009, people living in rural areas had an average life
expectancy of 76.8 years, a full two years less than their
urban counterparts who had an average life expectancy of 78.8
years.
(4) Many rural hospitals are located in areas where a
majority of the population is age 65 and older and has Medicare
coverage.
(5) Certain State-based demonstrations to improve payment
models for rural hospitals show promise in improving
healthcare, reducing costs, and integrating services for
patients.
(6) Experts and organizations suggest that transitioning
rural hospitals to global payment systems would benefit
patients, providers, and rural communities.
SEC. 3. EXPANDING THE USE OF GLOBAL PAYMENTS TO HOSPITALS IN RURAL
AREAS.
Section 1115A(b)(2) of the Social Security Act (42 U.S.C.
1315a(b)(2)) is amended--
(1) in subparagraph (B), by adding at the end the following
new clause:
``(xxviii) National testing of a model for
global payments to hospitals in rural areas as
described in subparagraph (D).''; and
(2) by adding at the end the following new subparagraph:
``(D) National testing of model for global payments
to hospitals in rural areas.--In the case where the
Secretary selects the model described in clause (ii) of
this subparagraph for testing pursuant to clause
(xxviii) of subparagraph (B), the following shall
apply:
``(i) National testing.--
``(I) In general.--Subject to
subclause (II), the Secretary shall
allow each State to develop and submit
to the Secretary an application to
begin testing such model in accordance
with this clause within 1 year of the
date on which the model is selected for
such testing.
``(II) State designation of
entities.--A State may designate an
entity or organization for purposes of
developing and submitting an
application under subclause (I) with
respect to the State, which may include
the implementation of such model in the
State. In the case where a State makes
such a designation, with respect to any
activities covered by the designation,
the entity or organization so
designated shall be subject to any
requirements applicable to the
implementing State under this
subparagraph in the same manner as such
requirements are applicable to the
implementing State.
``(III) No effect on ongoing models
or demonstration projects.--Nothing in
this subparagraph shall effect the
testing of any model under this
subsection or any demonstration project
under this Act that is implemented
prior to the date of the enactment of
this subparagraph.
``(ii) Model described.--The model
described in this clause seeks to increase
rural Americans' access to quality care in
order to improve health, while also reducing
the growth of hospital expenditures across
payers, including Medicare, and increasing the
financial viability of rural hospitals to
ensure continued access to care. Under this
model, participating rural hospitals would--
``(I) be paid based on all-payer
global budget, a fixed amount that is
set in advance for inpatient and
outpatient hospital-based services and
paid monthly by Medicare fee-for-
service, State Medicaid plans, and all
other participating payers;
``(II) deliberately redesign the
delivery of care to improve quality of
care and meet the needs of their local
communities;
``(III) receive an upfront, fixed
payment for infrastructure redesign, in
an amount to be recovered over a period
of time as set forth by the Secretary;
``(IV) receive annual global budget
payment adjustments based on an amount
determined in conjunction with the
Secretary; and
``(V) partner with non-hospital
providers such as physicians,
behavioral health providers, schools,
and community based organizations to
create a comprehensive care delivery
system.
``(iii) Definitions.--In this subparagraph:
``(I) Implementing state.--The term
`implementing State' means a State
whose application to begin testing such
model is approved by the Secretary
under clause (i).
``(II) Rural hospital.--The term
`rural hospital' means the following:
``(aa) A critical access
hospital (as defined in section
1861(mm)(1)).
``(bb) A sole community
hospital (as defined in section
1886(d)(5)(D)(iii)).
``(cc) A medicare-
dependent, small rural hospital
(as defined in section
1886(d)(5)(G)(iv)).
``(dd) Any other hospital
that is located in a rural area
(as defined in section
1886(d)(2)(D)) or is treated as
being located in a rural area
pursuant to section
1886(d)(8)(E).
``(iv) Requirements for participating
hospitals.--
``(I) In general.--In order to
participate in the model in an
implementing State, a rural hospital
must--
``(aa) subject to subclause
(II), conduct a community
health needs assessment survey
to determine the condition and
health needs in their
community, including those
needs with respect to mental or
behavioral health; and
``(bb) following such
assessment survey, submit and,
subject to clause (vi), receive
approval of a Rural Hospital
Transformation Plan (as
described in clause (v)) from
the implementing State and the
Secretary.
``(II) Exception.--A rural hospital
meets the requirement described in
subclause (I)(aa) if the rural hospital
has conducted a community health needs
assessment survey during the preceding
year for any purpose.
``(v) Rural hospital transformation plan
described.--A Rural Hospital Transformation
Plan described in this clause, with respect to
a rural hospital, shall include the following
information:
``(I) Results of the community
health needs assessment survey under
clause (iv)(I)(aa) and an explanation
of how the Transformation Plan suits
the needs of the community.
``(II) The population of
individuals who will be served by the
rural hospital under the model.
``(III) The types of services that
will be included in the global payment
under the model.
``(IV) How the rural hospital
intends to improve quality and health
outcomes under the model, including
which population health outcomes the
hospital will assess on an annual
basis.
``(V) How the rural hospital will
achieve patient engagement and
involvement in the model.
``(VI) How the rural hospital will
identify, partner with, and pay other
entities participating in the model.
``(VII) How private payers will be
included in the model.
``(VIII) Plans to account for any
market share changes under the model.
``(IX) How access to preventive
care will be increased under the model.
``(X) How the rural hospital will
sustain the changes made under the
model.
``(XI) How savings under the model
will accrue to the Medicare program
under title XVIII.
``(XII) Any other information
required by the implementing State or
the Secretary.
``(vi) Opportunity for public comment.--In
order for the Secretary or an implementing
State to approve a Rural Hospital
Transformation Plan under clause (iv), the
Secretary in consultation with the implementing
State, shall--
``(I) provide the public with a
meaningful opportunity, as determined
by the Secretary, to provide comments
on the plan; and
``(II) make a summary of comments
provided available to the public on the
Internet website of the Centers for
Medicare & Medicaid Services.
``(vii) Technical assistance.--The
Secretary shall designate an entity to provide
technical assistance to participating rural
hospitals as they redesign the care they
deliver under the model.
``(viii) Accounting for uncertainty.--In
order for implementing States and participating
rural hospitals to receive unanticipated
additional resources needed to implement the
model, the Secretary shall establish procedures
for implementing States and participating rural
hospitals to submit to the Secretary a request
for additional resources, should variations in
services outside of normally planned volume
occur or should new technologies be developed,
or in such other circumstances as the Secretary
determines appropriate.
``(ix) Monitoring outcomes.--The Secretary,
in conjunction with implementing States and
participating rural hospitals, shall develop a
plan to--
``(I) identify, using a
participating rural hospital's approved
Rural Hospital Transformation Plan
described in clause (v), the relevant
local population of patients
attributable to the hospital, the data
points the hospital may need to guide
care redesign for that population, and
how the hospital may use such data;
``(II) annually monitor outcomes
under the model, which may include
financial, quality, access, and
utilization outcomes;
``(III) annually monitor the
specific population health outcomes
listed in the approved Rural Hospital
Transformation Plan of each
participating rural hospital pursuant
to clause (v)(IV); and
``(IV) any other outcomes as
determined by the Secretary.
``(x) Risk mitigation.--As part of the
model, the Secretary, in conjunction with
implementing States and participating rural
hospitals, shall develop appropriate mechanisms
to mitigate risks, including the use of
reinsurance.
``(xi) Reporting requirements.--
``(I) Report to secretary.--An
implementing State, as a condition of
implementing the model, shall partner
with an independent entity to report to
the Secretary on the ability of a
participating rural hospital to carry
out the Rural Hospital Transformation
Plan described in clause (v).
``(II) Report to congress.--Not
less frequently than every 5 years (for
the duration of the implementation of
the model under this subparagraph), the
Secretary shall submit to Congress a
report on the implementation of the
model under this subparagraph. The
report shall include best practices for
future implementation efforts and any
other information the Secretary
determines appropriate, including the
information reported under subclause
(I), together with recommendations for
such legislation and administrative
action as the Secretary determines
appropriate.
``(xii) Funding.--The Secretary shall
allocate funds made available under subsection
(f)(1) to design, implement, evaluate, and
report on the model described in clause (ii) in
accordance with this subparagraph.''.
<all>
Rural Hospital Sustainability Act
#2157 | S Congress #116
Policy Area: Health
Last Action: Read twice and referred to the Committee on Finance. (7/18/2019)
Bill Text Source: Congress.gov
Summary and Impacts
Original Text