SB 553, 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 in Alaska and Hawaii. If the Secretary of Health and Human Services determines that outpatient prospective payment amounts for covered outpatient department services at one of these hospitals are below 94% of the hospital’s reasonable costs, Medicare payments would be increased to make up the difference.
The bill is narrowly targeted to sole community hospitals in Alaska and Hawaii, reflecting the higher operating costs and geographic isolation faced by hospitals in those states. It also directs the Secretary to issue implementing regulations within six months of enactment, with the new payment policy taking effect on the first January 1 after enactment. The bill expressly states that the added payments would not change beneficiary copayments and would not be subject to budget neutrality adjustments.
Impact
The bill would amend Section 1833(t) of the Social Security Act, changing Medicare outpatient payment rules for a small class of hospitals. It would require the Centers for Medicare & Medicaid Services to boost payments when outpatient reimbursement falls below 94% of reasonable costs for sole community hospitals in Alaska and Hawaii, and it would do so outside the normal budget-neutral framework. The practical effect would be higher federal Medicare spending for affected hospitals, with no change to patient copayments, and a likely improvement in financial stability for rural and remote emergency and outpatient services in those states.
Sentiment
The available context suggests generally positive and bipartisan support for the bill. It was introduced by Senators Sullivan, Schatz, and Murkowski, indicating cross-party and cross-state sponsorship, and the bill’s title and purpose frame it as a targeted effort to preserve essential hospital services. No committee transcript or vote record is provided, so there is no evidence of recorded opposition in the materials supplied.
Contention
The main policy issue is the cost and payment design: the bill creates a Medicare payment floor and exempts the added payments from budget neutrality, which could draw concern from budget-focused lawmakers or administrators. Another possible point of debate is the narrow geographic scope, since the relief applies only to sole community hospitals in Alaska and Hawaii, potentially raising questions about whether similarly situated rural hospitals elsewhere should receive comparable treatment. However, no specific objections are documented in the provided materials.