; (D) 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; (E) provides for the transport of patients who require acute care inpatient services or other inpatient services from the rural emergency medical center to a hospital or critical access hospital, either by the rural emergency medical center’s ambulance service provider or through another ambulance service supplier; (F) has elected to be designated as a rural emergency medical center; (G) has been licensed by, or received approval to operate as a qualified emergency medical center from, the State under paragraph (3); and (H) is certified by the Secretary under paragraph (4). (2) (A) The term rural emergency medical center services means medical and other health services furnished by a rural emergency medical center on an outpatient basis. (B) Such term shall include extended care services (as defined in subsection (h)) subject to such requirements as the Secretary may specify. (3) A facility may not operate as a rural emergency medical center unless the facility— (A) is located in a State that provides for the licensing of emergency medical centers under State or applicable local law; and (B) (i) is licensed pursuant to such law; or (ii) is approved by the agency of such State or locality responsible for licensing hospitals, as meeting the standards established for such licensing. (4) The Secretary shall certify a facility as a rural emergency medical center if the facility— (A) meets the criteria for rural emergency medical center described in subparagraphs (A) through (G) of paragraph (1); (B) has in effect a transfer agreement with a level I or level II trauma center