,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #cajc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #ah1 #bjai,mr4
 ,durb9 7= himself & ,mr4 ,lank=d7      
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
re/ore ,/ate au?ority to waive = c]ta9  
facilities ! #ce-mile rule = designat+  
critical access hospitals "u ! ,m$ic>e  
program4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,rural ,hospital ,closure   
,relief ,act ( #bjai4  #b4 ,re/or+ ,/ate
 au?ority to waive ! #ce-mile rule =    
c]ta9 ,m$ic>e critical access hospital  
designations ,section #ahbj ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;i-#d7 is am5d$--  7#a7 9          
subsection 7c77#b7-- 7,a7 9 subp>agraph 
7,b77i7--  7i7 9 subclause 7,i71 by     
/rik+ at ! end or2  7ii7 9 subclause    
7,,ii71 by ins]t+ at ! end or2 &  7iii7 
by add+ at ! end ! foll[+ new subclause3
  7,,iii7 subject to subp>agraph 7,g71  

is a hospital describ$ 9 subp>agraph    
7,f7 & is c]tifi$ on or aft] ! date ( ! 
enactm5t ( ! ,rural ,hospital ,closure  
,relief ,act ( #bjai by ! ,/ate z be+ a 
necess>y provid] ( heal? c>e s]vices to 
resid5ts 9 ! area2  2 &  7,b7 by add+ at
 ! end ! foll[+ new subp>agraphs3  7,f7 
,hospital describ$ ,= purposes (        
subp>agraph 7,b77i77,,iii71 a hospital  
describ$ 9 ?is subp>agraph is a hospital
 t--  7i7 is a sole community hospital  
7z def9$ 9 section                      
#ahhf7;d77#e77;,d77iii771 a m$ic>e      
dep5d5t1 small rural hospital 7z def9$ 9
 section #ahhf7;d77#e77;,g77iv771 a     
l[-volume hospital t 9 #bjai receives a 
paym5t adju/m5t "u section              
#ahhf7;d77#ab71 or a subsection 7d7     
hospital 7z def9$ 9 section             
#ahhf7;d77#a77;,b77 t has few] ?an #ej  
b$s2  7ii7 is locat$ 9 a rural area1 z  
def9$ by ! ,secret>y1 bas$ on ! mo/     
rec5t rural urban commut+ area code 7or 
its successor crit]ia7 z set =? by !    
,(fice ( ,managem5t & ,budget2  7iii7 z 

det]m9$ by ! ,secret>y1 s]ves a pati5t  
population-- 7,i7 ) a high p]c5tage1    
relative to ! national or /atewide      
av]age1 ( individuals ) income t is bel[
 #aej p]c5t ( ! pov]ty l9e2  7,,ii7 9 a 
heal? pr(essional %ortage area 7z def9$ 
9 section #ccb7;a77#a77;,a7 ( ! ,public 
,heal? ,s]vice ,act72 or  7,,iii7 t     
repres5ts a high proportion1 relative to
 ! national or /atewide av]age1 (       
individuals entitl$ to "p ,a or enroll$ 
"u "p ,b ( ?is title or enroll$ "u a    
,/ate plan "u title ,,xix2  7iv7 has    
demon/rat$ to ! ,secret>y1 at su* "t & 9
 su* mann] z ! ,secret>y det]m9es       
appropriate1 two consecutive ye>s (     
f9ancial losses prec$+ ! date (         
c]tification describ$ 9 subp>agraph     
7,b77i77,,iii72 &  7v7 submits to !     
,secret>y1 at su* "t & 9 su* mann] z !  
,secret>y may require1 an atte/ation t !
 ,secret>y det]m9es to be satisfactory1 
outl9+ ! good gov]nance qualifications &
 /rategic plan = multi-ye> f9ancial     
solv5cy ( ! hospital4  7,g7 ,limitation 

on c]ta9 designations  7i7 ,9 g5]al ,!  
,secret>y may n "u subsection 7e7 c]tify
 pursuant to a c]tification by a ,/ate  
"u subsection 7c77#b77;,b77i77,,iii7--  
7,i7 m ?an a total ( #bjj facilities z  
critical access hospitals2 &  7,,ii7    
subject to clause 7ii71 )9 any "o ,/ate1
 m ?an #ae facilities z critical access 
hospitals4  7ii7 ,/ate petition ,!      
,secret>y may apply1 ) respect to a     
,/ate1 ! limitation "u clause 7i77,,ii7 
by sub/itut+ a numb] t is great] ?an !  
numb] specifi$ 9 su* clause if ! ,/ate  
petitions ! ,secret>y1 9 accordance ) a 
process e/abli%$ by ! ,secret>y1 to     
increase su* numb]4  2 &  7#b7 9        
subsection 7e71 by ins]t+ 1 subject to  
subsection 7c77#b77;,g71 aft] ,!        
,secret>y %all4