,i  #aad? ,,congress  #b;d ,session  ,h4
 ,r4 #eacc  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,april #bi1 #bjaf ,mr4
 ,h>dy 7= himself & ,ms4 ,sewell (      
,alabama7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce1 & 9 addition to ! ,committee  
on ,agriculture1 = a p]iod to be        
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to improve rural   
heal? s]vices1 includ+ by requir+ !     
,dep>tm5t ( ,heal? & ,human ,s]vices to 
conduct an annual /udy on su* s]vices1 &
 = o!r purposes4  #a4 ,%ort title ,?is  
,act may be cit$ z ! ,rural ,hospital   
,enhancem5t & ,long ,t]m ,heal? ,act (  
#bjaf4  #b4 ,great] availability (      
community facilities grants = rural     
hospitals  7a7 ,9 g5]al ,section        
#cjf7;a77#ai7 ( ! ,consolidat$ ,f>m &   
,rural ,developm5t ,act 7#g ,u4,s4,c4   
#aibf7;a77#ai77 is am5d$ by add+ at !   
end ! foll[+3  7,c7 ,special rules      

applicable to grants = hospitals ,9 !   
case ( a grant "u ?is p>agraph = a      
hospital3 7i7 ,maximum grant ,! maximum 
am\nt ( su* a grant %all be #ajj1jjj4   
7ii7 ,no f9anc+ requirem5t ,! ,secret>y 
may n condition ! provision ( su* a     
grant on ! inability ( ! applicant to   
f9ance ! propos$ project1 9 :ole or 9   
"p1 f ! res\rces ( ! applicant1 ?r\gh   
comm]cial cr$it at reasonable rates &   
t]ms1 or f any o!r fund+ s\rce4  7iii7  
,f$]al %>e ,! am\nt ( su* a grant %all n
 exce$ #ej p]c5t ( ! co/ ( develop+ !   
hospital4  4  7b7 ,effective date ,!    
am5dm5t made by subsection 7a7 %all take
 effect on ! date t is #ij days aft] !  
date ( ! enactm5t ( ?is ,act4  #c4      
,reau?orization ( program ( grants to   
,/ate ,(fices ( ,rural ,heal? ,section  
#cch;,j ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #bedr7 is am5d$ to read z
 foll[s3  #cch;,j4 ,grants to ,/ate     
,(fices ( ,rural ,heal?  7a7 ,9 g5]al ,!
 ,secret>y1 act+ ?r\gh ! ,director ( !  
,(fice ( ,rural ,heal? ,policy 7e/abli%$

 9 section #gaa ( ! ,social ,security   
,act71 %all make grants to ea* ,/ate    
,(fice ( ,rural ,heal? = ! purpose (    
improv+ heal? c>e 9 rural areas4  7b7   
,requirem5t ( mat*+ funds  7#a7 ,9 g5]al
 ,subject to p>agraph 7#b71 ! ,secret>y 
may n make a grant "u subsection 7a7    
unless ! ,/ate ,(fice ( ,rural ,heal?   
involv$ agrees1 ) respect to ! co/s to  
be incurr$ 9 c>ry+ out ! purpose        
describ$ 9 su* subsection1 to provide   
non-,f$]al contributions t[>d su* co/s 9
 an am\nt equal to #c = ea* #a ( ,f$]al 
funds provid$ 9 ! grant4  7#b7 ,waiv] or
 r$uction ,! ,secret>y may waive or     
r$uce ! non-,f$]al contribution if !    
,/ate ,(fice ( ,rural ,heal? c          
demon/rate t requir+ mat*+ funds w\ld   
limit its ability to c>ry out ! purpose 
describ$ 9 subsection 7a74  7#c7        
,det]m9ation ( am\nt ( non-,f$]al       
contribution ,non-,f$]al contributions  
requir$ 9 p>agraph 7#a7 may be 9 ca% or 
9 k9d1 fairly evaluat$1 includ+ plant1  
equipm5t1 or s]vices4 ,am\nts provid$ by

 ! ,f$]al ,gov]nm5t1 or s]vices assi/$  
or subsidiz$ to any significant ext5t by
 ! ,f$]al ,gov]nm5t1 may n be includ$ 9 
det]m9+ ! am\nt ( su* non-,f$]al        
contributions4  7c7 ,c]ta9 requir$      
activities ,activities = :i* grant      
doll>s %all be aw>d$ "u subsection 7a7  
include-- 7#a7 ma9ta9+ )9 ! ,/ate ,(fice
 ( ,rural ,heal? a cle>+h\se = collect+ 
& dissem9at+ in=mation on--  7,a7 rural 
heal? c>e issues2  7,b7 rese>* f9d+s    
relat+ to rural heal? c>e2 &  7,c7      
innovative approa*es to ! deliv]y (     
heal? c>e 9 rural areas2  7#b7 coord9at+
 ! activities c>ri$ out 9 ! ,/ate t     
relate to rural heal? c>e1 includ+      
provid+ coord9ation = ! purpose ( avoid+
 r$undancy 9 su* activities2 &  7#c7    
id5tify+ ,f$]al & ,/ate programs reg>d+ 
rural heal?1 & provid+ te*nical         
assi/ance to public & nonpr(it private  
entities reg>d+ p>ticipation 9 su*      
programs4  7d7 ,requirem5t reg>d+ annual
 budget = (fice ,! ,secret>y may n make 
a grant "u subsection 7a7 unless ! ,/ate

 ,(fice ( ,rural ,heal? involv$ agrees  
t1 = any fiscal ye> = :i* ! ,/ate ,(fice
 ( ,rural ,heal? receives su* a grant1 !
 (fice op]at$ pursuant to subsection 7a7
 w be provid$ ) an annual budget ( n    
less ?an #ej1jjj4  7e7 ,c]ta9 uses (    
funds  7#a7 ,re/rictions ,! ,secret>y   
may n make a grant "u subsection 7a7    
unless ! ,/ate ,(fice ( ,rural ,heal?   
involv$ agrees t ! grant w n be exp5d$--
  7,a7 to provide heal? c>e 7includ+    
provid+ ca% paym5ts reg>d+ su* c>e72    
7,b7 to conduct activities = :i* ,f$]al 
funds are exp5d$--  7i7 )9 ! ,/ate to   
provide te*nical & o!r nonf9ancial      
assi/ance "u subsection 7f7 ( section   
#ccj2  7ii7 "u a memor&um ( agreem5t    
ent]$ into ) ! ,/ate ,(fice ( ,rural    
,heal? "u subsection 7h7 ( su* section2 
or  7iii7 "u a grant "u section #cch;,i2
  7,c7 to pur*ase m$ical equipm5t1 to   
pur*ase ambulances1 aircraft1 or o!r    
vehicles1 or to pur*ase major           
communications equipm5t2  7,d7 to       
pur*ase or improve real prop]ty2 or     

7,e7 to c>ry out any activity reg>d+ a  
c]tificate ( ne$4  7#b7 ,au?orities     
,activities = :i* a ,/ate ,(fice (      
,rural ,heal? may exp5d a grant "u      
subsection 7a7 include--  7,a7 pay+ !   
co/s ( ma9ta9+ su* ,(fice = ! purpose   
describ$ 9 subsection 7a72  7,b7 subject
 to p>agraph 7#a77;,b77iii71 pay+ ! co/s
 ( any activity c>ri$ out ) respect to  
recruit+ & reta9+ heal? pr(essionals to 
s]ve 9 rural areas ( ! ,/ate2 &  7,c7   
provid+ grants & contracts to public &  
nonpr(it private entities to c>ry out   
activities au?oriz$ 9 ?is section4  7f7 
,reports ,! ,secret>y may n make a grant
 "u subsection 7a7 unless ! ,/ate ,(fice
 ( ,rural ,heal? involv$ agrees--  7#a7 
to submit to ! ,secret>y reports or     
p]=mance data conta9+ su* in=mation z ! 
,secret>y may require reg>d+ activities 
c>ri$ out "u ?is section2 &  7#b7 to    
submit su* a report or p]=mance data n  
lat] ?an ! close ( ! fiscal ye>         
imm$iately foll[+ any fiscal ye> = :i* !
 ,/ate ,(fice ( ,rural ,heal? has       

receiv$ su* a grant4  7g7 ,requirem5t ( 
application ,! ,secret>y may n make a   
grant "u subsection 7a7 unless an       
application = ! grant is submitt$ to !  
,secret>y & ! application is 9 su* =m1  
is made 9 su* mann]1 & conta9s su*      
agreem5ts1 assurances1 & in=mation z !  
,secret>y det]m9es to be necess>y to    
c>ry out su* subsection4  7h7           
,noncompliance ,! ,secret>y may n make  
paym5ts "u subsection 7a7 to a ,/ate    
,(fice ( ,rural ,heal? = any fiscal ye> 
subsequ5t to ! fir/ fiscal ye> ( su*    
paym5ts unless ! ,secret>y det]m9es t1 =
 ! imm$iately prec$+ fiscal ye>1 ! ,/ate
 ,(fice ( ,rural ,heal? has compli$ )   
ea* ( ! agreem5ts made by ! ,/ate ,(fice
 ( ,rural ,heal? "u ?is section4  7i7   
,def9itions ,9 ?is section3 7#a7 ,! t]m 
,/ate means ea* ( ! sev]al ,/ates4  7#b7
 ,! t]m ,/ate ,(fice ( ,rural ,heal?    
means1 ) respect to a ,/ate1 ! ag5cy or 
(fice t is prim>ily responsible =       
improv+ heal? c>e 9 rural areas4  7j7   
,au?orization ( appropriations  7#a7 ,9 

g5]al ,= ! purpose ( mak+ grants "u     
subsection 7a71 !re are au?oriz$ to be  
appropriat$1 #ae1jjj1jjj = fiscal ye>   
#bjag & su* sums z may be necess>y =    
fiscal ye>s #bjah ?r\gh #bjba4  7#b7    
,availability ,am\nts appropriat$ "u    
p>agraph 7#a7 %all rema9 available until
 exp5d$4  4  #d4 ,annual /udy & report  
on rural hospitals  7a7 ,/udy ,!        
,secret>y ( ,heal? & ,human ,s]vices    
%all1 ) respect to ! fir/ fiscal ye>    
beg9n+ aft] ! date ( ! enactm5t ( ?is   
,act & ea* fiscal ye> !reaft]1 conduct  
an annual /udy on ! foll[+3  7#a7 ,!    
numb] ( rural hospitals t clos$ 9 su*   
fiscal ye>4  7#b7 ,) respect to ! rural 
hospitals t s clos$ 9 su* fiscal ye>1 ! 
reasons = su* closures4  7#c7 ,) respect
 to ! rural hospitals t s clos$ 9 su*   
fiscal ye>1 ! effect su* closure _h on  
pati5t access to c>e = ! giv5 area4     
7#d7 ,) respect to ea* category ( rural 
hospitals describ$ 9 subsection 7b71 !  
f9ancial well-be+ ( ! rural hospitals 9 
su* category dur+ su* fiscal ye>4  7b7  

,categories describ$ ,! categories (    
rural hospitals describ$ 9 ?is          
subsection are ! foll[+3 7#a7 ,rural    
hospitals t are critical access         
hospitals 7z def9$ 9 section            
#ahfa7mm77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciex7mm77#a7774  7#b7 
,rural hospitals t are sole community   
hospitals 7z def9$ 9 section            
#ahhf7;d77#e77;,d77iii7 ( su* ,act 7#db 
,u4,s4,c4 #acieww7d77#e77;,d77iii7774   
7#c7 ,rural hospitals t are a           
m$ic>e-dep5d5t1 small rural hospital 7z 
def9$ 9 section #ahhf7;d77#e77;,g7 ( su*
 ,act 7#db ,u4,s4,c4                    
#acieww7d77#e77;,g7774  7#d7 ,any o!r   
su* category ( rural hospitals t !      
,secret>y ( ,heal? & ,human ,s]vices    
det]m9es appropriate4  7c7 ,def9ition ( 
rural hospital ,= purposes ( ?is        
section1 ! t]m rural hospital means a   
hospital locat$ 9 a rural area 7z def9$ 
9 section #ahhf7;d77#b77;,d7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acieww7d77#b77;,d7774  7d7 ,report ,)  

respect to ea* /udy conduct$ pursuant to
 subsection 7a7 ) respect to a fiscal   
ye>1 ! ,secret>y ( ,heal? & ,human      
,s]vices %all1 n lat] ?an ,decemb] #ca (
 ! foll[+ fiscal ye>1 submit to         
,congress & to ea* ,/ate (fice ( rural  
heal? 7z describ$ 9 section #cch;,j7a7 (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #bedr7a777 a report on su*    
/udy4