,,ii  #aag? ,,congress  #a/ ,session    
,s4 #icd  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #bc1 #bjba,mr4    
,w>n] 7= himself & ,mr4 ,blunt7         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
improve rural heal? cl9ic paym5ts4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,/r5g!n+ ,rural ,heal? ,cl9ics ,act (   
#bjba4  #b4 ,rural heal? cl9ic paym5ts  
7a7 ,9 g5]al ,section #ahcc7;f77#c7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7f77#c77 is am5d$-- 7#a7 9        
subp>agraph 7,a7-- 7,a7 9 ! matt] prec$+
 clause 7i71 by ins]t+ 7or1 9 ! case ( a
 rural heal? cl9ic describ$ 9           
subp>agraph 7,b77ii77,,iii71 9 ! fir/   
ye> 9 :i* ! rural heal? cl9ic furni%es  
su* s]vices7 aft] ,m>* #ca2  7,b7 9     
clause 7i71 by /rik+ subclauses 7,i7 &  
7,,ii7 & ins]t+ ! foll[+3  7,i7 )       
respect to a rural heal? cl9ic t _h a p]
 visit paym5t am\nt e/abli%$ = s]vices  

furni%$ 9 #bjbj-- 7aa7 ! p] visit paym5t
 am\nt applicable to su* rural heal?    
cl9ic = rural heal? cl9ic s]vices       
furni%$ 9 #bjbj1 increas$ by ! p]c5tage 
increase 9 ! ,,mei applicable to prim>y 
c>e s]vices furni%$ z ( ! fir/ day (    
#bjba2 or  7bb7 ! limit describ$ 9      
p>agraph 7#b77;,a72 &  7,,ii7 ) respect 
to a rural heal? cl9ic t did n h a p]   
visit paym5t am\nt e/abli%$ = s]vices   
furni%$ 9 #bjbj-- 7aa7 ! p] visit paym5t
 am\nt applicable to su* rural heal?    
cl9ic = rural heal? cl9ic s]vices       
furni%$ 9 #bjba 7or1 9 ! case ( a rural 
heal? cl9ic describ$ 9 subp>agraph      
7,b77ii77,,iii71 ! p] visit paym5t am\nt
 applicable to su* rural heal? cl9ic =  
rural heal? cl9ic s]vices furni%$ 9 !   
fir/ ye> 9 :i* su* rural heal? cl9ic    
furni%es su* s]vices72 or  7bb7 ! limit 
describ$ 9 p>agraph 7#b77;,a7 7or1 9 !  
case ( a rural heal? cl9ic describ$ 9   
subp>agraph 7,b77ii77,,iii71 ! limit    
e/abli%$ "u p>agraph 7#b7 = su* fir/    
ye>72  2 &  7,c7 9 clause 7ii77,i71 by  

/rik+ "u clause 7i77,i7 & ins]t+ "u     
subclause 7,i7 or 7,,ii7 ( clause 7i71 z
 applicable12  7#b7 9 subp>agraph 7,b7--
 7,a7 9 ! matt] prec$+ clause 7i71 by   
/rik+ #bjai1 0 & ins]t+ #bjbj2  7,b7 9  
clause 7i7-- 7i7 by ins]t+ 0 aft] 7i72 &
  7ii7 by ins]t+ ! foll[+ be=e !        
semicolon3 1 or1 9 ! case ( a rural     
heal? cl9ic describ$ 9 clause           
7ii77,,iii71 _h an agreem5t describ$ 9  
su* clause ) su* a hospital2  7,c7 by   
/rik+ clause 7ii7 & ins]t+ ! foll[+3    
7ii7 7,i7 0 enroll$ "u section #ahff7;j7
 7includ+ tempor>y enrollm5t dur+ !     
em]g5cy p]iod describ$ 9 section        
#aace7;g77#a77;,b7 = su* p]iod72  7,,ii7
 submitt$ an application = enrollm5t "u 
section #ahff7;j7 7or reque/$ su* a     
tempor>y enrollm5t = su* p]iod7 t 0     
receiv$ n lat] ?an ,decemb] #ca1 #bjbj2 
or  7,,iii7 z det]m9$ by ! ,secret>y1 _h
 a b9d+ writt5 agreem5t ) an outside    
unrelat$ p>ty = ! con/ruction1 pur*ase1 
lease1 or o!r e/abli%m5t ( su* a rural  
heal? cl9ic z ( t date4  2 &  7#c7 by   

add+ at ! end ! foll[+ new subp>agraph3 
7,c7 7i7 ,9 det]m9+ :e!r a provid]-bas$ 
rural heal? cl9ic _h an agreem5t        
describ$ 9 subp>agraph 7,b77ii77,,iii7 z
 ( ,decemb] #ca1 #bjbj1 ! ,secret>y may 
consid] appropriate evid5ce relat+ to ! 
agreem5t submitt$ by ! provid]4  7ii7 ,n
 lat] ?an #fj days aft] ! date ( !      
enactm5t ( ?is subp>agraph1 ! ,secret>y 
%all obta9 an atte/ation 7pursuant to   
section #dac4fe7;b77#c7 ( title #db1    
,code ( ,f$]al ,regulations1 or any     
successor regulation7 t su* provid]-bas$
 rural heal? cl9ic meets1 or w meet1 !  
requirem5ts ( a provid]-bas$ rural heal?
 cl9ic specifi$ 9 section #dac4fe (     
title #db1 ,code ( ,f$]al ,regulations1 
or any successor regulation4  7iii7 ,!  
,secret>y may audit1 z appropriate1 !   
compliance ) subp>agraph 7,b77ii77,,iii7
 ) respect to ea* provid]-bas$ rural    
heal? cl9ic to :i* su* subp>agraph      
applies4 ,if ! ,secret>y f9ds z a result
 ( an audit "u ?is clause t ! applicable
 requirem5ts 7 n met ) respect to su*   

provid]-bas$ rural heal? cl9ic1 !       
provid]-bas$ rural heal? cl9ic %all no  
long] be consid]$ to be describ$ 9 su*  
subp>agraph = purposes ( ?is p>agraph4  
4  7b7 ,effective date ,! am5dm5ts made 
by ?is section %all take effect z if    
includ$ 9 ! enactm5t ( ! ,consolidat$   
,appropriations ,act1 #bjba 7,public    
,law #aaf-bfj74