,,ii  #aafth ,,congress  #ast ,session  
,s4 #cajc  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,december #ah1 
#bjai,mr4 ,durbin 7for himself and ,mr4 
,lankford7 introduced the following     
bill2 which was read twice and referred 
to the ,committee on ,finance  ,a ,,bill
  ,to amend title ,,xviii of the ,social
 ,security ,act to restore ,state       
authority to waive for certain          
facilities the #ce-mile rule for        
designating critical access hospitals   
under the ,medicare program4  #a4 ,short
 title ,this ,act may be cited as the   
,rural ,hospital ,closure ,relief ,act  
of #bjai4  #b4 ,restoring ,state        
authority to waive the #ce-mile rule for
 certain ,medicare critical access      
hospital designations ,section #ahbj of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i-#d7 is amended--  7#a7
 in subsection 7c77#b7-- 7,a7 in        
subparagraph 7,b77i7--  7i7 in subclause
 7,i71 by striking at the end or2  7ii7 
in subclause 7,,ii71 by inserting at the

 end or2 and  7iii7 by adding at the end
 the following new subclause3  7,,iii7  
subject to subparagraph 7,g71 is a      
hospital described in subparagraph 7,f7 
and is certified on or after the date of
 the enactment of the ,rural ,hospital  
,closure ,relief ,act of #bjai by the   
,state as being a necessary provider of 
health care services to residents in the
 area2  2 and  7,b7 by adding at the end
 the following new subparagraphs3  7,f7 
,hospital described ,for purposes of    
subparagraph 7,b77i77,,iii71 a hospital 
described in this subparagraph is a     
hospital that--  7i7 is a sole community
 hospital 7as defined in section        
#ahhf7;d77#e77;,d77iii771 a medicare    
dependent1 small rural hospital 7as     
defined in section                      
#ahhf7;d77#e77;,g77iv771 a low-volume   
hospital that in #bjai receives a       
payment adjustment under section        
#ahhf7;d77#ab71 or a subsection 7d7     
hospital 7as defined in section         
#ahhf7;d77#a77;,b77 that has fewer than 

#ej beds2  7ii7 is located in a rural   
area1 as defined by the ,secretary1     
based on the most recent rural urban    
commuting area code 7or its successor   
criteria7 as set forth by the ,office of
 ,management and ,budget2  7iii7 as     
determined by the ,secretary1 serves a  
patient population-- 7,i7 with a high   
percentage1 relative to the national or 
statewide average1 of individuals with  
income that is below #aej percent of the
 poverty line2  7,,ii7 in a health      
professional shortage area 7as defined  
in section #ccb7;a77#a77;,a7 of the     
,public ,health ,service ,act72 or      
7,,iii7 that represents a high          
proportion1 relative to the national or 
statewide average1 of individuals       
entitled to part ,a or enrolled under   
part ,b of this title or enrolled under 
a ,state plan under title ,,xix2  7iv7  
has demonstrated to the ,secretary1 at  
such time and in such manner as the     
,secretary determines appropriate1 two  
consecutive years of financial losses   

preceding the date of certification     
described in subparagraph               
7,b77i77,,iii72 and  7v7 submits to the 
,secretary1 at such time and in such    
manner as the ,secretary may require1 an
 attestation that the ,secretary        
determines to be satisfactory1 outlining
 the good governance qualifications and 
strategic plan for multi-year financial 
solvency of the hospital4  7,g7         
,limitation on certain designations  7i7
 ,in general ,the ,secretary may not    
under subsection 7e7 certify pursuant to
 a certification by a ,state under      
subsection 7c77#b77;,b77i77,,iii7--     
7,i7 more than a total of #bjj          
facilities as critical access hospitals2
 and  7,,ii7 subject to clause 7ii71    
within any one ,state1 more than #ae    
facilities as critical access hospitals4
  7ii7 ,state petition ,the ,secretary  
may apply1 with respect to a ,state1 the
 limitation under clause 7i77,,ii7 by   
substituting a number that is greater   
than the number specified in such clause

 if the ,state petitions the ,secretary1
 in accordance with a process           
established by the ,secretary1 to       
increase such number4  2 and  7#b7 in   
subsection 7e71 by inserting 1 subject  
to subsection 7c77#b77;,g71 after ,the  
,secretary shall4