,,ii  #aagth ,,congress  #ast ,session  
,s4 #icd  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,march #bc1         
#bjba,mr4 ,warner 7for himself and ,mr4 
,blunt7 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 improve rural health  
clinic payments4  #a4 ,short title ,this
 ,act may be cited as the ,strengthening
 ,rural ,health ,clinics ,act of #bjba4 
#b4 ,rural health clinic payments  7a7  
,in general ,section #ahcc7;f77#c7 of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciel7f77#c77 is amended--   
7#a7 in subparagraph 7,a7-- 7,a7 in the 
matter preceding clause 7i71 by         
inserting 7or1 in the case of a rural   
health clinic described in subparagraph 
7,b77ii77,,iii71 in the first year in   
which the rural health clinic furnishes 
such services7 after ,march #ca2  7,b7  
in clause 7i71 by striking subclauses   
7,i7 and 7,,ii7 and inserting the       

following3  7,i7 with respect to a rural
 health clinic that had a per visit     
payment amount established for services 
furnished in #bjbj-- 7aa7 the per visit 
payment amount applicable to such rural 
health clinic for rural health clinic   
services furnished in #bjbj1 increased  
by the percentage increase in the ,,mei 
applicable to primary care services     
furnished as of the first day of #bjba2 
or  7bb7 the limit described in         
paragraph 7#b77;,a72 and  7,,ii7 with   
respect to a rural health clinic that   
did not have a per visit payment amount 
established for services furnished in   
#bjbj-- 7aa7 the per visit payment      
amount applicable to such rural health  
clinic for rural health clinic services 
furnished in #bjba 7or1 in the case of a
 rural health clinic described in       
subparagraph 7,b77ii77,,iii71 the per   
visit payment amount applicable to such 
rural health clinic for rural health    
clinic services furnished in the first  
year in which such rural health clinic  

furnishes such services72 or  7bb7 the  
limit described in paragraph 7#b77;,a7  
7or1 in the case of a rural health      
clinic described in subparagraph        
7,b77ii77,,iii71 the limit established  
under paragraph 7#b7 for such first     
year72  2 and  7,c7 in clause 7ii77,i71 
by striking under clause 7i77,i7 and    
inserting under subclause 7,i7 or 7,,ii7
 of clause 7i71 as applicable12  7#b7 in
 subparagraph 7,b7-- 7,a7 in the matter 
preceding clause 7i71 by striking #bjai1
 was and inserting #bjbj2  7,b7 in      
clause 7i7-- 7i7 by inserting was after 
7i72 and  7ii7 by inserting the         
following before the semicolon3 1 or1 in
 the case of a rural health clinic      
described in clause 7ii77,,iii71 had an 
agreement described in such clause with 
such a hospital2  7,c7 by striking      
clause 7ii7 and inserting the following3
  7ii7 7,i7 was enrolled under section  
#ahff7;j7 7including temporary          
enrollment during the emergency period  
described in section #aace7;g77#a77;,b7 

for such period72  7,,ii7 submitted an  
application for enrollment under section
 #ahff7;j7 7or requested such a         
temporary enrollment for such period7   
that was received not later than        
,december #ca1 #bjbj2 or  7,,iii7 as    
determined by the ,secretary1 had a     
binding written agreement with an       
outside unrelated party for the         
construction1 purchase1 lease1 or other 
establishment of such a rural health    
clinic as of that date4  2 and  7#c7 by 
adding at the end the following new     
subparagraph3  7,c7 7i7 ,in determining 
whether a provider-based rural health   
clinic had an agreement described in    
subparagraph 7,b77ii77,,iii7 as of      
,december #ca1 #bjbj1 the ,secretary may
 consider appropriate evidence relating 
to the agreement submitted by the       
provider4  7ii7 ,not later than #fj days
 after the date of the enactment of this
 subparagraph1 the ,secretary shall     
obtain an attestation 7pursuant to      
section #dac4fe7;b77#c7 of title #db1   

,code of ,federal ,regulations1 or any  
successor regulation7 that such         
provider-based rural health clinic      
meets1 or will meet1 the requirements of
 a provider-based rural health clinic   
specified in section #dac4fe of title   
#db1 ,code of ,federal ,regulations1 or 
any successor regulation4  7iii7 ,the   
,secretary may audit1 as appropriate1   
the compliance with subparagraph        
7,b77ii77,,iii7 with respect to each    
provider-based rural health clinic to   
which such subparagraph applies4 ,if the
 ,secretary finds as a result of an     
audit under this clause that the        
applicable requirements were not met    
with respect to such provider-based     
rural health clinic1 the provider-based 
rural health clinic shall no longer be  
considered to be described in such      
subparagraph for purposes of this       
paragraph4  4  7b7 ,effective date ,the 
amendments made by this section shall   
take effect as if included in the       
enactment of the ,consolidated          

,appropriations ,act1 #bjba 7,public    
,law #aaf-bfj74