Sending Office: Honorable Lynn Jenkins
Sent By:

Cosponsor the Rural Emergency Medical Center (REMC) Act of 2018

Dear Colleague,

We write to request your support for bipartisan legislation, the Rural Emergency Medical Center (REMC) Act, which would establish a new rural designation under the Medicare Program to allow existing critical access hospitals (CAHs) and those with 50 or fewer
beds to convert to a 24/7 emergency medical center.

The REMC Act would enable certain rural hospitals to protect access to essential health care services in the community. In addition to emergency services, REMCs would provide the type of services a hospital provides on an outpatient basis to Medicare beneficiaries,
including observation, diagnostic and telehealth services. REMCs could also provide post-acute care in a separately licensed skilled nursing facility unit.

MedPAC recently unanimously voted to recommend allowing “isolated, rural stand-alone emergency departments” that would bill at the outpatient prospective payment system (OPPS) rate and provide annual payments that would assist with fixed costs.
Our legislation creates such a designation — the rural emergency medical center (REMC), which would reimburse at the outpatient prospective payment rate for services and also provide a fixed facility fee payment.

As you know, rural hospitals have always faced a challenging set of circumstances, patient population; payer mix, workforce shortages; regulatory burden; remote location, etc. In the past Congress created special rural payment programs and designations to
help account for these challenges, however many have either expired or not kept pace with changes in rural communities or health care delivery. For example, many services that used to require inpatient care are now provided in the outpatient setting; yet federal
payment continues to incentivize inpatient, fee-for-service care.

The American Hospital Association (AHA) supports the REMC Act and calls it “an important step in ‘right-sizing’ the health care infrastructure in certain vulnerable communities and protecting access to patient care.” In 2016, the AHA’s Task
Force on Ensuring Access in Vulnerable Communities issued recommendations Congress could take to helps stabilize access to care, including the creation of a 24/7 emergency center with enhance reimbursement. 

According to the University of North Carolina Rural Health Research Program, 83 rural hospitals have closed since 2010 due to “likely multiple contributing factors, including failure to recover from the recession, population demographic trends, market trends,
decreased demand for inpatient services, and new models of care.” The REMC Act would allow certain hospitals which closed within 5 years prior to the date of enactment to apply for REMC designation.

Please consider adding your name as a cosponsor to this important legislation to protect access to patient care in rural communities.  If you have any questions or would like to add your name as a cosponsor, please contact Baruch Humble (
with Rep. Jenkins’ office or Alex Eveland ( with Rep. Kind’s office.


Lynn Jenkins, CPA                     Ron Kind                                 Terri Sewell

                                         Member of Congress                  Member of Congress                Member of Congress

Related Legislative Issues

Selected legislative information: HealthCare

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