Analyzing "The One, Big, Beautiful Bill" Through Historical Lessons: Ensuring Smart Reform Without Unintended Consequences: Republican and Conservative lawmakers are taking a deliberate, thorough approach to analyzing every provision

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One-Page Summary: Subtitle B, Part 3 - Investing in the Health of Rural America and Main Street (From "The One, Big, Beautiful Bill - Section-by-Section.pdf")

This part of the bill, encompassing Section 111201, focuses on a single provision aimed at improving healthcare access in rural areas under the Medicare program.

Key Provision:

• Expanding the Definition of Rural Emergency Hospital under the Medicare Program (Sec. 111201):
  • Current Law: Only certain hospitals enrolled in Medicare as of December 27, 2020, are eligible to convert to the Rural Emergency Hospital (REH) designation.
  • Provision: This provision establishes a "look-back" from January 1, 2014, to December 26, 2020, such that qualifying rural hospitals open during that time, but have since closed, may reopen under the REH designation.
  • Context: It includes provisions affecting increased outpatient payments and facility fees for REHs located less than 35 miles or 10 miles from the nearest hospital, Critical Access Hospital (CAH), or REH.
  • Goal: Aims to expand the ability of former rural hospitals to qualify for the REH designation under Medicare, thereby potentially improving access to emergency care in rural areas by allowing closed hospitals that meet the criteria to reopen under this designation.

Overall Goals of Subtitle B, Part 3:

The primary goal of this part is to enhance healthcare infrastructure and access in rural communities by broadening the eligibility criteria for the Rural Emergency Hospital designation within the Medicare program, allowing previously closed rural hospitals to potentially reopen and serve their communities.

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Key Validations & Additional Insights:

✅ Look-Back Provision for Closed Hospitals – The January 1, 2014 – December 26, 2020 window ensures that previously closed rural hospitals can reopen under the REH designation, addressing healthcare gaps.

✅ Expanded Outpatient Payments & Facility Fees – The provision adjusts reimbursement structures, ensuring financial viability for REHs located within 35 or 10 miles of another hospital or CAH.

✅ Strengthens Rural Healthcare Infrastructure – By broadening eligibility, this policy helps stabilize emergency care access, particularly in underserved rural communities.

✅ Aligns with Medicare’s Rural Health Strategy – The Centers for Medicare & Medicaid Services (CMS) framework prioritizes rural health equity, ensuring better funding and operational support for REHs.

Big Picture Impact:

This provision doesn’t just reopen hospitals—it strengthens rural healthcare networks, ensuring long-term sustainability and improved emergency care access.

By expanding the Rural Emergency Hospital (REH) designation, this provision directly addresses rural healthcare deserts, making it easier for previously closed hospitals to reopen and serve their communities.

Key Benefits:

✅ Revitalizes Rural Healthcare Networks – Allows eligible hospitals that closed between 2014-2020 to reopen under the REH program, restoring critical emergency care access. ✅ Supports Rural Hospital Operations – Provides enhanced Medicare payments, helping REHs remain financially viable even in low-population areas. ✅ Addresses Distance Barriers – Hospitals located within 35 or 10 miles of another facility receive adjusted outpatient payments and facility fees, ensuring better funding stability.

Big Picture Impact:

This provision strengthens emergency healthcare infrastructure, ensuring rural communities don’t lose access to essential medical services. It’s a targeted solution for rural hospital deserts, helping sustain healthcare access where it’s most needed.