HB4250, the “Save our Lone Emergency Services Act” or “SOLES Act,” would amend Medicare’s hospital outpatient prospective payment system to create a payment floor for sole community hospitals located in Alaska and Hawaii. If the Secretary of Health and Human Services determines that outpatient payments for covered services at one of these hospitals are below 94% of the hospital’s reasonable costs, Medicare would increase the payment to make up the difference. The bill applies only to sole community hospitals in those two states and is aimed at hospitals that serve as the primary or only local inpatient/outpatient care option in remote or geographically isolated areas.
The bill also specifies that these supplemental payments would not change beneficiary copayments and would not be subject to budget neutrality offsets, meaning the added Medicare spending would not be recouped by reducing other payments in the system. The Secretary would be required to issue implementing regulations within six months of enactment, and the policy would take effect for covered outpatient department services beginning on the first January 1 after enactment.
Impact
If enacted, the bill would amend section 1833(t) of the Social Security Act and directly affect Medicare reimbursement rules for outpatient hospital services. It would create a statutory floor for payments to qualifying sole community hospitals in Alaska and Hawaii, potentially increasing federal Medicare spending for those facilities and improving their financial stability. The measure would not alter patient copayments, but it would change how the Centers for Medicare & Medicaid Services calculates and pays outpatient claims for the affected hospitals.
Sentiment
The available record shows the bill was introduced and referred to committee, with no recorded votes or committee transcript excerpts provided. Based on the text and sponsor framing, the bill appears to have been presented as a targeted support measure for hospitals in underserved, high-cost, and geographically isolated areas. The overall sentiment inferred from the bill’s introduction is favorable toward preserving access to emergency and outpatient services in Alaska and Hawaii.
Contention
The main policy issue is cost and precedent: the bill would require Medicare to pay above current outpatient prospective payment amounts without applying budget neutrality, which could increase federal outlays. Supporters are likely to emphasize access to care, hospital solvency, and the unique challenges faced by sole community hospitals in Alaska and Hawaii. Potential critics may focus on the exemption from budget neutrality, the narrow geographic scope of the benefit, and whether a special payment floor for only two states is the appropriate way to address rural hospital financing.