,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #hjbe  ,,in ,,the ,,house ,,of  
,,representatives  ,august #aa1 #bjbj   
,ms4 ,stefanik 7for herself and ,mr4    
,delgado7 introduced the following bill2
 which was referred to the ,committee on
 ,ways and ,means  ,a ,,bill  ,to amend 
title ,,xviii of the ,social ,security  
,act to clarify the application of the  
#ae-mile secondary road distance        
requirement with respect to previously  
designated critical access hospitals    
under the ,medicare program4  #a4 ,short
 title ,this ,act may be cited as the   
,protecting ,rural ,access to ,care     
,act4  #b4 ,clarifying the application  
of the #ae-mile secondary road distance 
requirement with respect to previously  
designated critical access hospitals    
,section #ahbj7;h7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;i-#d7;h77 is amended by adding at 
the end the following new paragraph3    
7#d7 ,application of #ae-mile secondary 
roads criteria ,in the case of a        

facility that was designated as a       
critical access hospital before ,july   
#ca1 #bjae1 in applying the criteria for
 such designation specified in clause   
7i7 of subsection 7c77#b77;,b71 a ,state
 7and the ,secretary7 shall so apply    
such criteria1 insofar as such criteria 
relates to a facility located in an area
 with only secondary roads available1   
using such guidance and regulations as  
were in effect on ,july #cj1 #bjae4  4  
#c4 ,requirement for public notice and  
comment period for any guidance or      
regulation relating to designation      
criteria for critical access hospitals  
7a7 ,in general ,with respect to any    
guidance or regulation issued by the    
,secretary of ,health and ,human        
,services 7in this section referred to  
as the ,secretary7 on or after the date 
of the enactment of this ,act relating  
to the criteria for designation of a    
facility as a critical access hospital  
7as specified in section                
#ahbj7;c77#b77;,b7 of the ,social       

,security ,act 7#db ,u4,s4,c4           
#acie;i-#d7;c77#b77;,b7771 such guidance
 or regulation shall not take effect    
prior to the expiration of a notice and 
comment period of not less than #fj days
 under which the public is given the    
opportunity to comment on such guidance 
or regulation and the ,secretary        
evaluates any such comments4  7b7       
,retroactive application to guidance    
relating to application of the #ae-,mile
 secondary road distance requirement ,in
 applying the criteria described in     
subsection 7a71 a ,state 7and the       
,secretary7 shall so apply such         
criteria1 insofar as such criteria      
relates to a facility located in an area
 with only secondary roads available1   
using such guidance and regulations as  
were in effect on ,july #cj1 #bjae1     
until1 subject to paragraph 7#d7 of     
section #ahbj7;h7 of the ,social        
,security ,act 7as added by section #b71
 such time as the ,secretary issues     
guidance or regulations in accordance   

with such subsection4