; and (B) by adding at the end the following: (iii) Community outpatient hospital (1) The term community outpatient hospital means a facility that— (A) at any time during the period beginning on the date that is 5 years before the date of the enactment of this subsection and ending on December 31, 2016, was a critical access hospital, or is a hospital with not more than 50 beds that is— (i) located in a rural area (as defined in section 1886(d)(2)(D)); or (ii) treated as being located in a rural area under section 1886(d)(8)(E); (B) provides emergency medical care and observation care available on a 24-hour basis; (C) with respect to continuous care for an individual, does not provide care over two or more consecutive midnights; (D) does not provide any acute care inpatient beds and has protocols in place for the timely transfer of patients who require other inpatient services; (E) has the resources required of a level IV or higher trauma center (as verified by the American College of Surgeons or other means specified by the Secretary), or has available for consultation on a 24-hour basis a health care professional who successfully completed the Advanced Trauma Life Support Course offered by the American College of Surgeons (or an equivalent course as determined by the Secretary) within the preceding 4 years; (F) has in effect a transfer agreement with a level I or level II trauma center designated under section 1231(1) of the Public Health Service Act; (G) meets the requirements of subsection (aa)(2)(I); (H) has been approved by the State in which the facility is located for treatment as a community outpatient hospital; (I) notifies the Secretary at such time and in such manner as the Secretary may require of the intent of such facility to be designated as a community outpatient facility