,,ii  #aah? ,,congress  #b;d ,session   
,s4 #dcbb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #ad1 #bjbd,mr4    
,moran 7= himself & ,ms4 ,smi?7         
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
make improvem5ts relat+ to ! designation
 ( rural em]g5cy hospitals4  #a4 ,%ort  
title ,?is ,act may be cit$ z ! ,rural  
,em]g5cy ,hospital ,designation         
,improvem5t ,act4  #b4 ,eligibility     
*anges  7a7 ,9 g5]al ,section           
#ahfa7kkk77#c7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciex7kkk77#c77 is 
am5d$1 9 ! matt] prec$+ subp>agraph     
7,a71 by /rik+ z ( & ins]t+ at any po9t 
dur+ ! p]iod beg9n+ on ,janu>y #a1      
#bjae1 & end+ on4  7b7 ,waiv] ( c]ta9   
requirem5ts ,section #ahfa7kkk77#c7 ( ! 
,social ,security 7#db ,u4,s4,c4        
#aciex7kkk77#c71 z am5d$ by subsection  
7a71 is am5d$-- 7#a7 by r$esignat+      
subp>agraphs 7,a7 & 7,b7 z clauses 7i7 &

 7ii71 respectively2  7#b7 by /rik+     
describ$4--,a facility & ins]t+         
8describ$4--  7,a7 ,9 g5]al ,subject to 
subp>agraph 7,b71 a facility  2 &  7#c7 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,b7 ,waiv] ,n lat] ?an "o
 ye> aft] ! date ( enactm5t ( ?is       
subp>agraph1 ! ,secret>y %all promulgate
 regulations to waive subp>agraph 7,a7 )
 respect to facilities t op]ate simil>ly
 to a rural em]g5cy hospital 9 ord] =   
su* facilities to be eligible =         
conv]sion to a rural em]g5cy hospital "u
 ?is subsection4  4  #c4 ,di/9ct "p     
units ,section #ahfa7kkk77#f7 ( !       
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7kkk77#f77 is am5d$-- 7#a7 9      
subp>agraph 7,a71 by /rik+ & at ! end2  
7#b7 9 subp>agraph 7,b71 by /rik+ !     
p]iod at ! end & ins]t+ a semicolon2 &  
7#c7 by add+ at ! end ! foll[+ new      
subp>agraphs3  7,c7 ma9ta9 or include a 
unit ( ! facility t is a di/9ct "p      
lic5s$ z an inpati5t psy*iatric unit =  
behavioral heal? pati5ts & all[s =      

inpati5t c>e2  7,d7 ma9ta9 or include a 
unit ( ! facility t is a di/9ct "p      
lic5s$ z an inpati5t rehabilitation     
facility & all[s = inpati5t c>e2 &  7,e7
 ma9ta9 or include a unit ( ! facility t
 is a di/9ct "p unit lic5s$ z an        
ob/etric w+1 labor & deliv]y unit1 or   
ob/etric em]g5cy dep>tm5t4  4  #d4      
,add-on paym5t = diagno/ic laboratory   
te/s ,section #ahcd7x77#a7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#aciem7x77#a77 is am5d$-- 7#a7 by /rik+ 
hospitals4-- & all t foll[s ?r\gh ,9 !  
case & ins]t+ 8hospitals4--  7#a7 ,9    
g5]al  7,a7 ,paym5t = rural em]g5cy     
hospital s]vices ,9 ! case  2 &  7#b7 by
 add+ at ! end ! foll[+ new subp>agraph3
  7,b7 ,paym5t = diagno/ic laboratory   
te/s ,9 ! case ( cl9ical diagno/ic      
laboratory te/s & o!r diagno/ic         
laboratory te/s t are n cov]$ ,,opd     
s]vices 7z def9$ 9 section              
#ahcc7t77#a77;,b77 furni%$ by a rural   
em]g5cy hospital 7z def9$ 9 section     
#ahfa7kkk77#b77 on or aft] ,janu>y #a1  

#bjbe1 ! am\nt ( paym5t = su* te/s %all 
be equal to ! am\nt ( paym5t t w\ld     
o!rwise apply "u ! applicable fee       
s*$ule1 increas$ by #e p]c5t to reflect 
! high] co/s incurr$ by su* hospitals1 &
 %all include ! application ( any       
copaym5t am\nt det]m9$ "u ?is "p z if   
su* increase _h n occurr$  4  #e4 ,sw+  
b$s ,section #ahfa7kkk77#f7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciex7kkk77#f771 z am5d$ by section #c1
 is am5d$-- 7#a7 9 subp>agraph 7,b71 by 
/rik+ & at ! end2  7#b7 9 subp>agraph   
7,c71 by /rik+ ! p]iod at ! end & ins]t+
 2 &2 &  7#c7 by add+ at ! end ! foll[+ 
new subp>agraph3  7,d7 may ent] into an 
agreem5t describ$ 9 section #ahhc4  4   
#f4 ,necess>y provid] /atus = facilities
 t rev]t to critical access hospital    
designation ,n lat] ?an "o ye> aft] !   
date ( ! enactm5t ( ?is ,act1 !         
,secret>y ( ,heal? & ,human ,s]vices    
%all promulgate regulations to p]mit a  
rural em]g5cy hospital 7z def9$ 9       
section #ahfa7kkk77#b7 ( ! ,social      

,security ,act 7#db ,u4,s4,c4           
#aciex7kkk77#b777 t rev]ts back to its  
previ\s designation z a critical access 
hospital 7z def9$ 9 section             
#ahfa7mm77#a7 ( su* ,act 7#db ,u4,s4,c4 
#aciex7m777 to rega9 its /atus z a      
necess>y provid] ( heal? c>e s]vices    
pursuant to section                     
#ahbj7;c77#b77;,b77i77,,ii7 ( su* ,act  
7#db ,u4,s4,c4                          
#acie;i-#d7;c77#b77;,b77i77,,ii771 b    
only if ! facility 0 designat$ z a      
necess>y provid] ( heal? c>e s]vices    
pursuant to su* section prior to conv]t+
 to a rural em]g5cy hospital4  #g4      
,national ,heal? ,s]vice ,corps ,site   
,eligibility ,! ,secret>y ( ,heal? &    
,human ,s]vices1 act+ ?r\gh !           
,adm9i/rator ( ! ,heal? ,res\rces &     
,s]vices ,adm9i/ration1 %all promulgate 
regulations to deem a rural em]g5cy     
hospital 7z def9$ 9 section             
#ahfa7kkk77#b7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #aciex7kkk77#b777 to
 be a heal? pr(essional %ortage area 9  

accordance ) section #ccb7;a77#a77;,c7 (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #bed;e7a77#a77;,c774  #h4     
,small rural hospital improvem5t program
 grants ,section #ahbj7;g7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4 #db       
,u4,s4,c4 #acie;i-#d7;g77 is am5d$--    
7#a7 9 p>agraph 7#a77;,d71 by ins]t+ or 
rural em]g5cy hospitals 7z def9$ 9      
section #ahfa7kkk77#b77 aft] critical   
access hospitals2 &  7#b7 9 p>agraph    
7#c77;,a71 by ins]t+ or rural em]g5cy   
hospitals 7z def9$ 9 section            
#ahfa7kkk77#b77 aft] small rural        
hospitals4