,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #cbbd  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #ac1 #bjag,mr4  
,h>p] 7= himself1 ,mr4 ,loebsack1 ,mr4  
,k9d1 ,mr4 ,kelly ( ,mississippi1 ,mr4  
,?ompson ( ,mississippi1 ,mr4 ,palazzo1 
& ,mr4 ,pet]son7 introduc$ ! foll[+     
bill2 :i* 0 ref]r$ to ! ,committee on   
,ways & ,means1 & 9 addition to !       
,committee on ,en]gy & ,comm]ce1 = 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 am5d 
title ,,xviii ( ! ,social ,security ,act
 to cl>ify reasonable co/s = critical   
access hospital paym5ts "u ! ,m$ic>e    
program1 & = o!r purposes4  #a4 ,%ort   
title ,?is ,act may be cit$ z !         
,critical ,access & ,rural ,equity ,act 
( #bjag or ! ,,c>e ,act ( #bjag4  #b4   
,cl>ify+ reasonable co/s = critical     
access hospital ,m$ic>e paym5ts  7a7    
,inclusion ( c]ta9 co/s z reasonable    
co/s  7#a7 ,inpati5t critical access    

hospital s]vices ,section #ahad7l7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;f7l77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#f7 ,9 det]m9+   
paym5t & reasonable co/s "u p>agraph    
7#a7 = inpati5t critical access s]vices1
 ! ,secret>y %all recognize z all[able  
co/s ( ! critical access hospital at    
lea/ ! foll[+3  7,a7 ,co/s ( s]vices t  
w\ld be consid]$ bona fide em]g5cy      
s]vices 7z def9$ 9 section              
#ahfa7v77#a77,k77ii77 if provid$ 9 a    
hospital em]g5cy room1 includ+          
pr(essional s]vices & any associat$     
surgical on-call & /&by co/s4  7,b7     
,co/s ( a te/ or proc$ure p]=m$ at a    
critical access hospital or an entity   
own$ by ! critical access hospital1     
includ+ a cl9ical diagno/ic laboratory  
te/1 mammogram 7z def9$ 9 section       
#ced7;a77#e7 ( ! ,public ,heal? ,s]vice 
,act71 colonoscopy1 c>diac /ress te/1   
pulmon>y function te/1 e*oc>diogram1 &  
bone d5sity /udy4  7,c7 ,/&by & on-call 
co/s = c]tifi$ regi/]$ nurse ane/heti/  

s]vices1 reg>dless ( ! numb] ( surgical 
proc$ures requir+ ane/hesia s]vices &   
reg>dless ( ! numb] ( full-"t equival5t 
physicians4  7,d7 ,co/s ( s]vices       
provid$ by ! critical access hospital or
 satellite facility ( ! critical access 
hospital t improve ! total heal? (      
communities1 includ+ immunization       
programs1 heal? cl9ics1 & m$ical homes4 
7,e7 ,co/s ( s]vices provid$ by an      
(f-campus provid]-bas$ cl9ic describ$ 9 
section #ahbj7;c77#b77;,f7 ( ! critical 
access hospital1 reg>dless ( di/ance (  
su* cl9ic f a hospital or ano!r critical
 access hospital4  4  7#b7 ,outpati5t   
critical access hospital s]vices        
,section #ahcd7;g7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciem7g77 is am5d$
 by add+ at ! end ! foll[+ new p>agraph3
  7#f7 ,cov]age ( c]ta9 additional co/s 
z reasonable co/s ,9 det]m9+ !          
reasonable co/s ( outpati5t critical    
access hospital s]vices "u p>agraphs    
7#a7 & 7#b77;,a71 ! ,secret>y %all      
recognize z all[able ! co/s describ$ 9  

p>agraph 7#f7 ( section #ahad7l74  4    
7#c7 ,con=m+ am5dm5t ,section           
#ahfa7v77#g7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #aciex7v77#g77 is am5d$  
by add+ at ! end ! foll[+ new           
subp>agraph3  7,e7 ,= provisions fur!r  
describ+ co/s recogniz$ z reasonable    
co/s = inpati5t & outpati5t critical    
access hospital s]vices1 see sections   
#ahad7l77#f7 & #ahcd7;g77#f74  4  7b7   
,treatm5t ( provid]-,bas$ cl9ics (      
critical access hospitals ,section      
#ahbj7;c77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;i-#d7;c77#b77 is  
am5d$-- 7#a7 9 subp>agraph 7,b77i77,i71 
by /rik+ is locat$ & ins]t+ subject to  
subp>agraph 7,e71 is locat$2 &  7#b7 by 
add+ at ! end ! foll[+ new subp>agraph3 
7,f7 ,treatm5t ( (f-campus provid]-bas$ 
cl9ics ,subp>agraph 7,b77i77,i7 %all n  
apply to an (f-campus provid]-bas$ cl9ic
 7z describ$ 9 section #dhe4faj ( title 
#de ( ! ,code ( ,f$]al ,regulations7 ( a
 facility designat$ z a critical access 
hospital4  4  7c7 ,all[+ coord9ation =  

provision ( em]g5cy s]vices ,section    
#ahbj7;c77#b7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;i-#d7;c77#b771 z  
am5d$ by subsection 7b71 is fur!r       
am5d$--  7#a7 9 subp>agraph 7,b77ii71 by
 /rik+ makes & ins]t+ subject to        
subp>agraph 7,g71 makes2 &  7#b7 by add+
 at ! end ! foll[+ new subp>agraph3     
7,g7 ,all[+ coord9ation = provision (   
em]g5cy s]vices ,! ,secret>y may waive !
 requirem5ts "u subp>agraph 7,b77ii71 ) 
respect to a facility1 if su* facility--
  7i7 is locat$ n m ?an #ae miles (     
ano!r facility or hospital t has an     
em]g5cy dep>tm5t t satisfies !          
requirem5t ( subp>agraph 7,b77ii72 &    
7ii7 coord9ates ) su* o!r facility or   
hospital ) respect to furni%+ #bd-;h\r  
em]g5cy c>e s]vices describ$ 9 su*      
subp>agraph to ! area s]v$ by su*       
facility4  4  7d7 ,treatm5t ( ,m$icaid  
provid] taxes = critical access hospital
 reasonable co/s  7#a7 ,inpati5t        
critical access hospital s]vices        
,section #ahad7l7 ( ! ,social ,security 

,act 7#db ,u4,s4,c4 #acie;f7l771 z am5d$
 by subsection 7a77#a71 is fur!r am5d$  
by add+ at ! end ! foll[+ new p>agraph3 
7#g7  7,a7 ,9 det]m9+ paym5t &          
reasonable co/s "u p>agraph 7#a7 =      
inpati5t critical access s]vices--  7i7 
) respect to a curr5t p]missible heal?  
c>e relat$ tax impos$ & paid by !       
critical access hospital = a co/ report+
 p]iod beg9n+ be=e ! date ( enactm5t (  
?is p>agraph1 ! ,secret>y %all n1 ?r\gh 
rec\pm5t or o!rwise1 disall[ paym5t to !
 critical access hospital "u ?is        
subsection on ! basis t paym5ts to !    
critical access hospital "u ?is         
subsection (fset "s or all ( ! co/s (   
su* tax2 &  7ii7 ) respect to a curr5t  
p]missible heal? c>e relat$ tax impos$ &
 paid by ! critical access hospital = a 
co/ report+ p]iod beg9n+ on or aft] !   
date ( enactm5t ( ?is p>agraph1 !       
,secret>y %all--  7,i7 assess ! p]c5tage
 ( individuals entitl$ to b5efits "u ?is
 "p :o are furni%$ inpati5t critical    
access hospital s]vices at su* critical 

access hospital dur+ su* co/ report+    
p]iod & :o are also receiv+ m$ical      
assi/ance "u ! ,m$icaid program "u title
 ,,xix dur+ su* p]iod2 &  7,,ii7 adju/  
paym5ts "u ?is subsection ) respect to  
su* s]vices furni%$ dur+ su* p]iod 9 a  
mann] specifi$ by ! ,secret>y bas$ on   
su* p]c5tage to take into acc\nt su*    
tax4  7,b7 ,= purposes ( ?is p>agraph & 
section #ahcd7;g77#g71 ! t]m curr5t     
p]missible heal? c>e relat$ tax means a 
broad-bas$ heal? c>e relat$ tax 7z def9$
 9 p>agraph 7#c77;,b7 ( su* section7 t  
is 9 effect prior to enactm5t ( ?is     
p>agraph & = :i* !re is n 9 effect a    
hold h>mless provision describ$ 9       
p>agraph 7#d7 ( su* section4  4  7#b7   
,outpati5t critical access hospital     
s]vices ,section #ahcd7;g7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciem7g771 z am5d$ by subsection       
7a77#b71 is fur!r am5d$ by add+ at ! end
 ! foll[+ new p>agraph3  7#g7 ,treatm5t 
( ,m$icaid provid] taxes ,9 det]m9+     
paym5t = outpati5t critical access      

hospital s]vices "u p>agraphs 7#a7 &    
7#b71 ! provisions ( p>agraph 7#g7 (    
section #ahad7l7 %all apply to paym5t = 
su* s]vices "u ?is subsection 9 ! same  
mann] z su* provisions apply to paym5t =
 inpati5t critical access hospital      
s]vices "u section #ahad7l71 except t 9 
apply+ subp>agraph 7,b7 ( su* p>agraph  
7#g71 ! ref]5ce to individuals entitl$  
to b5efits "u ?is "p %all be deem$ a    
ref]5ce to individuals enroll$ "u "p ,b4
  4