,,ii  #aag? ,,congress  #a/ ,session    
,s4 #fdd  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #i1 #bjba,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$ic>e  
program1 & = o!r purposes4  #a4 ,%ort   
title ,?is ,act may be cit$ z ! ,rural  
,hospital ,closure ,relief ,act ( #bjba4
  #b4 ,re/or+ ,/ate au?ority to waive ! 
#ce-mile rule = c]ta9 ,m$ic>e critical  
access hospital designations  7a7 ,9    
g5]al ,section #ahbj ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acie;i-#d7 is am5d$-- 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 (
 #bjba 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 #bjba receives
 a paym5t adju/m5t "u section           
#ahhf7;d77#ab71 a subsection 7d7        
hospital 7z def9$ 9 section             
#ahhf7;d77#a77;,b77 t has few] ?an #ej  
b$s1 or1 subject to ! limitation "u     
subp>agraph 7,g77i77,i71 is a facility  
describ$ 9 subp>agraph 7,g77ii72  7ii7  
is locat$ 9 a rural area1 z def9$ 9     
section #ahhf7;d77#b77;,d72  7iii7 7,i7 

is locat$-- 7aa7 9 a c\nty t has a      
p]c5tage ( individuals ) income t is    
bel[ #aej p]c5t ( ! pov]ty l9e t is     
high] ?an ! national or /atewide av]age 
9 #bjbj2 or  7bb7 9 a heal? pr(essional 
%ortage area 7z def9$ 9 section         
#ccb7;a77#a77;,a7 ( ! ,public ,heal?    
,s]vice ,act72 or  7,,ii7 has a p]c5tage
 ( inpati5t days ( individuals entitl$  
to b5efits "u "p ,a ( ?is title1 enroll$
 "u "p ,b ( ?is title1 or enroll$ "u a  
,/ate plan "u title ,,xix t is high] ?an
 ! national or /atewide av]age 9 #bjai  
or #bjbj2  7iv7 subject to subp>agraph  
7,g77ii77,,ii71 has atte/$ to !         
,secret>y two consecutive ye>s (        
negative op]at+ m>g9s prec$+ ! date (   
c]tification describ$ 9 subp>agraph     
7,b77i77,,iii72 &  7v7 submits to !     
,secret>y-- 7,i7 at su* "t & 9 su* mann]
 z ! ,secret>y may require1 an          
atte/ation outl9+ ! good gov]nance      
qualifications & /rategic plan =        
multi-ye> f9ancial solv5cy ( ! hospital2
 &  7,,ii7 n lat] ?an #abj days aft] !  

date on :i* ! ,secret>y issues f9al     
regulations pursuant to section #b7;b7 (
 ! ,rural ,hospital ,closure ,relief    
,act ( #bjba1 an application =          
c]tification ( ! facility z a critical  
access 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 subp>agraph 7,b77i77,,iii7-- 7,i7 m  
?an a total ( #age facilities z critical
 access hospitals1 ( :i* n m ?an #bj    
p]c5t may be facilities describ$ 9      
clause 7ii72 &  7,,ii7 )9 any "o ,/ate1 
m ?an #aj facilities z critical access  
hospitals4  7ii7 ,facility describ$     
7,i7 ,9 g5]al ,a facility describ$ 9 ?is
 clause is a facility t z ( ! date (    
enactm5t ( ?is subp>agraph met ! crit]ia
 = designation z a critical access      
hospital "u subp>agraph 7,b77i77,i74    
7,,ii7 ,nonapplication ( c]ta9 crit]ia  
,= purposes ( subp>agraph               
7,b77i77,,iii71 ! crit]ia describ$ 9    
subp>agraph 7,f77iv7 %all n apply )     

respect to ! designation ( a facility   
describ$ 9 subclause 7,i74  2 &  7#b7 9 
subsection 7e71 by ins]t+ 1 subject to  
subsection 7c77#b77;,g71 aft] ,!        
,secret>y %all4  7b7 ,regulations ,n    
lat] ?an #abj days aft] ! date ( !      
enactm5t ( ?is ,act1 ! ,secret>y (      
,heal? & ,human ,s]vices %all issue f9al
 regulations to c>ry out ?is section4   
7c7 ,cl>ification reg>d+ facilities t   
meet di/ance or o!r c]tification crit]ia
 ,no?+ 9 ?is section %all affect !      
application ( crit]ia = designation z a 
critical access hospital describ$ 9     
subclause 7,i7 or 7,,ii7 section        
#ahbj7;c77#b77;,b77i7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acie;i-#d7;c77#b77;,b77i774  #c4 ,,cmi 
te/+ ( new rural hospital deliv]y &     
paym5t model ,section #aaae;,a ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acae;a7 is am5d$-- 7#a7 9 subsection   
7b77#b77;,a71 by add+ at ! end ! foll[+ 
new s5t5ce3 8,! models select$ "u ?is   
subp>agraph %all include ! te/+ ( a new 

rural hospital deliv]y & paym5t model   
7or models71 z describ$ 9 subsection    
7h7402 &  7#b7 by add+ at ! end ! foll[+
 new subsection3  7h7 ,te/+ ( new rural 
hospital deliv]y & paym5t model  7#a7 ,9
 g5]al  7,a7 ,te/+ ,! ,secret>y %all te/
 ! implem5tation ( a new rural hospital 
deliv]y & paym5t model 7or models7 t !  
,secret>y det]m9es w\ld promote         
f9ancially su/a9able ways to ensure     
pati5t access to c>e 9 rural            
communities1 :i* may include models "u  
:i* su* hospitals furni% outpati5t      
em]g5cy c>e s]vices #bd h\rs a day1 #g  
days a week = :i* paym5t is made "u     
title ,,xviii bas$ on ! am\nt det]m9$ "u
 ! prospective paym5t sy/em = hospital  
outpati5t dep>tm5t s]vices "u section   
#ahcc7t71 plus a fix$ rate = ! co/ (    
furni%+ ! em]g5cy s]vices4  7,b7        
,promulgation ( regulations ,n lat] ?an 
#c ye>s aft] ! date ( ! enactm5t ( ?is  
subsection1 ! ,secret>y %all promulgate 
regulations to te/ a new rural hospital 
deliv]y & paym5t model 7or models7      

describ$ 9 subp>agraph 7,a71 unless     
,congress enacts legislation t e/abli%es
 su* a paym5t model 7or models7 prior to
 ! promulgation ( regulations pursuant  
to ?is subp>agraph4  7#b7 ,transition   
,effective beg9n+ on ! date on :i* !    
te/+ ( a new rural hospital deliv]y &   
paym5t model 7or models7 describ$ 9     
p>agraph 7#a77;,a7 is implem5t$ "u ?is  
subsection or su* a paym5t model 7or    
models7 is e/abli%$ ?r\gh ! enactm5t (  
legislation describ$ 9 p>agraph         
7#a77;,b71 ! ,secret>y %all provide a   
process "u :i*-- 7,a7 all critical      
access hospitals may transition to su*  
new model or models "u ?is subsection2 &
  7,b7 any facility t 0 designat$ z a   
critical access hospital pursuant to a  
c]tification by a ,/ate "u section      
#ahbj7;c77#b77;,b77i77,,iii7 may rev]t  
to ! prospective paym5t model 7or       
models7 "u :i* ! facility receiv$ paym5t
 "u title ,,xviii prior to be+ s        
designat$4  4