1. Short title This Act may be cited as the Rural Hospital Freedom and Flexibility Act of 2018 . 2. Medicare rural emergency access centers and services (a) In general (1) Rural emergency access center and services defined Section 1861 of the Social Security Act ( 42 U.S.C. 1395x ) is amended— (A) in subsection (e), in the last sentence of the matter following paragraph (9), by inserting or a rural emergency access center (as defined in subsection (kkk)(1)) before the period at the end; and (B) by adding at the end the following subsection: (kkk) Rural Emergency access Center; Rural access Medical Center Services (1) The term rural emergency access center means a facility that— (A) was a critical access hospital as of the date of the enactment of this subsection; (B) provides 24-hour emergency medical care and observation care that does not exceed an annual per patient average of 24 hours or more than 1 midnight; (C) does not provide any acute care inpatient beds and has protocols in place for the timely transfer of patients who require acute care inpatient services or other inpatient services; (D) provides for the transport of patients who require acute care inpatient services or other inpatient services from the rural emergency access center to a hospital or critical access hospital, either by the rural emergency access center’s ambulance service provider or through another ambulance service supplier; (E) has elected to be designated as a rural emergency access center; (F) has been licensed by, or received approval to operate as a qualified emergency medical center from, the State under paragraph (3)