StrickenHall languageof wouldthe beHouse deletedof fromRepresentatives and93rd underlinedGeneral languageAssembly would- beRegular addedSession, to2021 presentAmendment law.Form ______________________________________________________________________ Subtitle of Senate Bill No.

State663 ofTO ArkansasMODIFY AsAND Engrossed:DEFER THE AUTHORITY OF THE DEPARTMENT OF HEALTH TO THE CENTERS FOR MEDICARE & MEDICAID SERVICES CONCERNING THE HOSPITALS WITHOUT WALLS PROGRAM;

H4/20/21 93rd General Assembly A Bill Regular Session, 2021 SENATE BILL 663 5 By:

Senator Irvin By:

Representative Boyd 8 For An Act To Be Entitled AN ACT TO MODIFY THE AUTHORITY OF THE DEPARTMENT OF HEALTH;

TO DEFER THE AUTHORITY OF THE DEPARTMENT OF HEALTH TO THE CENTERS FOR MEDICARE & MEDICAID SERVICES CONCERNING THE HOSPITALS WITHOUT WALLS PROGRAM;

TO DECLARE AN EMERGENCY;

AND FOR OTHER PURPOSES.

Subtitle TO MODIFY THE AUTHORITY OF THE DEPARTMENT OF HEALTH DURING A PUBLIC HEALTH EMERGENCY;

BE______________________________________________________________________ ITAmendment ENACTEDNo. BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:

SECTION1 1.to Senate Bill 663 Amend Senate Bill No.

Arkansas663 Code Title 20, Chapter 9, Subchapter 3, is amended to add an additional section to read as follows:originally introduced:

20-9-312.Add Representative Boyd as a cosponsor of the bill AND Delete the subtitle in its entirety and substitute:

Deferral"TO ofMODIFY authorityTHE ofAUTHORITY DepartmentOF ofTHE HealthDEPARTMENT toOF CentersHEALTH forDURING MedicareA &PUBLIC MedicaidHEALTH ServicesEMERGENCY; — Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities — Legislative findings and intent — Authority.

(a)AND TheTO GeneralDECLARE AssemblyAN findsEMERGENCY." that:AND Page 1, delete line 29, and substitute the following:

(1)"Medicare The& Medicaid Services — Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services’Services-certified Hospitalsfacility Withoutflexibilities Walls— initiativeLegislative" AND Page 1, line 33, delete "program allows" and substitute "initiative and other Centers for Medicare & Medicaid Services-Services-certified certified facility flexibilities allow:allow" AND Page 2, line 9, delete "program;

(A)and" Participatingand ambulatorysubstitute surgery"initiative centersand toother convertCenters tofor licensedMedicare hospitals& duringMedicaid theServices-certified periodfacility flexibilities;" AND *.ANS463* ANS463 - 04-19-2021 17:04:13 Page 1 of the3 coronavirusPage 20192, (COVID-19)delete *ANS407*lines 04-20-202113 13:56:41and ANS40714, Asand Engrossed:substitute the following:

H4/20/21"Services' SB663Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities for the purpose of promoting public health emergency;in this state;

and (B) Existing hospitals to provide healthcare services at the patient's home and other selected sites;

(2) In cooperation and in an effort to promote public health, the Department of Health suspended portions of its Rules for Hospitals and Related Institutions according to the Governor's Executive Orders 20-06 and 20-16, and any future executive orders that extend the public health emergency, to allow for the regulatory flexibilities to facilities participating in the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services- certified facility flexibilities;

(3) Legislative clarification is necessary to clarify that the department has the regulatory authority necessary to continue the regulatory flexibilities for the duration of the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities for the purpose of promoting public health in this state;

and (B) Issue temporary blanket waivers or temporary specific waivers if the temporary waivers are intended to help beneficiaries access care.care." AND Page 2, delete lines 17 and 18, and substitute the following:

(b)"(1) ItAllow isall theCenters intentfor ofMedicare & Medicaid Services- certified facilities participating in the GeneralCenters Assembly,for Medicare & Medicaid Services' Hospitals Without Walls initiative and other Centers for theMedicare benefit& ofMedicaid theServices-certified citizensfacility offlexibilities thisto state,continue thatto" theAND departmentPage have2, thedelete authorityline to:22, and substitute the following:

(1)"Walls Allow all Centers for Medicare & Medicaid Services-certified facilities participating in the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services-certifiedServices- certified facility flexibilitiesflexibilities; to continue to do so until:

(A)or" TheAND CentersPage for2, Medicareline &26, Medicaiddelete Services"department terminateshave" theand Centerssubstitute for"department Medicareshall &have" MedicaidAND Services'Page Hospitals2, Withoutline Walls28, initiativedelete "program is" and substitute "initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities;flexibilities are" AND Page 2, delete lines 33 through 36, and substitute the following:

or"Hospitals (B)Without TheWalls nationalinitiative. public health emergency is declared over;

and(d) (2)The Administerdepartment shall exercise the authority granted under subsection (c) of this section.section to suspend portions of its rules for facilities participating in the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities." AND Page 3, delete lines 1 through 11, and substitute the following:

04-20-2021ANS463 13:56:41- ANS40704-19-2021 As17:04Amendment Engrossed:No.

H4/20/21___ to SB663 (c)(1)Page The2 departmentof shall3 have"(e)(1) theThis authoritysection applies to deferany tofuture public health emergency if the Centers for Medicare & Medicaid Services asimplements toan wheninitiative similar to the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative andor other Centers for Medicare & Medicaid Services-certified facility flexibilitiesflexibilities. are terminated.

(2) The authority described in subdivision (c)(1) of this section shall include the ability to suspend portions of its Rules for Hospitals and Related Institutions to allow regulatory flexibilities to facilities participating in the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative.

(d) The department shall exercise the authority granted under subsection (c) of this section to suspend portions of its rules for facilities participating in the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities.

(e)(1) This section applies to any future public health emergency if the Centers for Medicare & Medicaid Services implements an initiative similar to the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative or other Centers for Medicare & Medicaid Services-certified facility flexibilities.

or 04-20-2021(B) 13:56:41The ANS407national Aspublic Engrossed:health emergency is declared over." AND Page 3, line 17, delete "Walls program" and substitute "Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities" AND Page 3, line 22, delete "program can" and substitute "initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities can" AND Page 3, line 25, delete "Walls program" and substitute "Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities" The Amendment was read ________________________________________________________________________________ By:

H4/20/21Representative SB663Boyd (B)ANS/ANS The- national04-19-2021 public17:04:13 health_________________________ emergencyANS463 isChief declaredClerk over.ANS463 - 04-19-2021 17:04Amendment No.

___ to SB663 Page 3 SECTIONof 2.3

EMERGENCY CLAUSE.

It is found and determined by the General Assembly of the State of Arkansas that the coronavirus 2019 (COVID- 19) pandemic has caused great uncertainty and anxiety in the operation of participating ambulatory surgery centers converted to hospitals under the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities;

that by providing legislative clarity concerning the regulatory authority of the Department of Health the uncertainty will resolved and the continued operation of participating ambulatory surgery centers converted to hospitals under the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities can continue;

and that this act is immediately necessary to protect the public health and safety in order to provide legislative clarity for the Department of Health's regulatory authority concerning the Centers for Medicare & Medicaid Services' Hospitals Without Walls initiative and other Centers for Medicare & Medicaid Services-certified facility flexibilities.

Therefore, an emergency is declared to exist, and this act being immediately necessary for the preservation of the public peace, health, and safety shall become effective on: