,i  #aafth ,,congress  #ast ,session    
,h4 ,r4 #cfgb  ,,in ,,the ,,house ,,of  
,,representatives  ,july #aj1 #bjai,mr4 
,brindisi 7for himself1 ,mr4 ,reed1 and 
,ms4 ,stefanik7 introduced the following
 bill2 which was referred to the        
,committee on ,ways and ,means  ,a      
,,bill  ,to provide relief for small    
rural hospitals from inaccurate         
instructions provided by certain        
medicare administrative contractors4    
#a4 ,short title ,this ,act may be cited
 as the ,access for ,rural ,communities 
,act or the ,,arc ,act4  #b4 ,relief for
 small rural hospitals from inaccurate  
instructions provided by certain        
medicare administrative contractors  7a7
 ,application of revised volume decrease
 adjustment methodology ,subject to     
subsection 7b71 in the case of a sole   
community hospital or a                 
medicare-dependent1 small rural hospital
 with respect to which a medicare       
administrative contractor determined a  
volume decrease adjustment applies for  

any specified cost reporting period1 at 
the election of the hospital1 the       
,secretary of ,health and ,human        
,services shall recalculate the amount  
of the volume decrease adjustment       
determined by the medicare              
administrative contractor for such      
hospital and specified cost reporting   
period using the revised volume decrease
 adjustment payment methodology for any 
specified cost reporting period         
requested by the hospital in its        
election4  7b7 ,limitation  7#a7 ,in    
general ,subsection 7a7 shall not apply 
in the case of a sole community hospital
 or a medicare-dependent1 small rural   
hospital for which the medicare         
administrative contractor determination 
of the volume decrease adjustment with  
respect to a specified cost reporting   
period of the hospital is               
administratively final before the date  
that is three years before the date of  
the enactment of this section4  7#b7    
,administrative finality ,for purposes  

of paragraph 7#a71 the date on which the
 medicare administrative contractor     
determination with respect to a volume  
decrease adjustment for a specified cost
 reporting period is administratively   
final is the latest of the following3   
7,a7 ,the date of the contractor        
determination 7as defined in section    
#dje4ahja of title #db1 ,code of        
,federal ,regulations74  7,b7 ,the date 
of the final outcome of any reopening of
 the medicare administrative contractor 
determination under section #dje4ahhe of
 title #db1 ,code of ,federal           
,regulations4  7,c7 ,the date of the    
final outcome of the final appeal filed 
by such hospital with respect to such   
volume decrease adjustment for such     
specified cost reporting period4  7c7   
,definitions ,in this section3 7#a7     
,medicare administrative contractor ,the
 term medicare administrative contractor
 means the entity that has entered into 
a contract with the ,secretary of       
,health and ,human ,services under      

section #ahgd;,a of the ,social         
,security ,act 7#db ,u4,s4,c4           
#aciekk-#a7 to service ,a_/,b ,medicare 
,administrative ,contractor             
,jurisdiction ,k of the ,centers for    
,medicare  ,medicaid ,services as of    
,july #a1 #bjaf4  7#b7                  
,medicare-dependent1 small rural        
hospital ,the term medicare-dependent1  
small rural hospital has the meaning    
given such term under section           
#ahhf7;d77#e77;,g77iv7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77;,g77iv774  7#c7 ,revised
 volume decrease adjustment payment     
methodology ,the term revised volume    
decrease adjustment payment methodology 
means the methodology to calculate the  
volume decrease adjustment that is      
described in the second sentence of     
section #dab4ib7;e77#c7 of title #db1   
,code of ,federal ,regulations 7relating
 to the methodology to calculate the    
volume decrease adjustment for sole     
community hospitals 7and1 pursuant to   

section #dab4ajh7;d77#c7 of such title  
#db1 for medicare-dependent1 small rural
 hospitals7 that is effective for cost  
reporting periods beginning on or after 
,october #a1 #bjag74  7#d7 ,sole        
community hospital ,the term sole       
community hospital has the meaning given
 such term under section                
#ahhf7;d77#e77;,d77iii7 of the ,social  
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77;,d77iii774  7#e7        
,specified cost reporting period ,the   
term specified cost reporting period    
means a cost reporting period of a sole 
community hospital or a                 
medicare-dependent1 small rural         
hospital1 as the case may be1 that      
begins during a fiscal year before      
fiscal year #bjah4  7#f7 ,volume        
decrease adjustment ,the term volume    
decrease adjustment means the adjustment
 required with respect to a sole        
community hospital or a                 
medicare-dependent1 small rural         
hospital1 as the case may be1 under     

subparagraph 7,d77ii7 or subparagraph   
7,g77iii71 respectively1 of section     
#ahhf7;d77#e7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acieww7d77#e774