,i  #aaith ,,congress  #b;d ,session    
,h4 ,r4 #gdji  ,,in ,,the ,,house ,,of  
,,representatives  ,february #e1        
#bjbf,mr4 ,taylor 7for himself and ,mrs4
 ,miller of ,west ,virginia7 introduced 
the following bill2 which was referred  
to the ,committee on ,ways and ,means   
,a ,,bill  ,to amend title ,,xviii of   
the ,social ,security ,act to limit the 
geographic reclassification of certain  
hospitals under the ,medicare program4  
#a4 ,short title ,this ,act may be cited
 as the ,defend ,rural ,health ,act of  
#bjbf4  #b4 ,limiting geographic        
reclassification of hospitals under     
,medicare  7a7 ,in general ,section     
#ahhf7;d77#h77;,e7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#h77;,e77 is amended-- 7#a7  
in clause 7i71 by striking described in 
clause 7ii7 and inserting that is       
located in an urban area 7as defined in 
paragraph 7#b77;,d77 and meets any of   
the criteria described in subclause     
7,i71 7,,ii71 or 7,,iv7 of clause 7ii7  

7or1 with respect to a hospital         
submitting such an application before   
,october #a1 #bjbf1 meets any of the    
criteria described in such clause72     
7#b7 in clause 7ii7-- 7,a7 in the matter
 preceding subclause 7,i71 by striking a
 subsection 7d7 hospital and all that   
follows through criteria3 and inserting 
the criteria described in this clause   
are the following32 and  7,b7 in        
subclause 7,,ii7-- 7i7 by inserting that
 is before designated by any law2 and   
7ii7 by inserting 1 and that was so     
designated as of ,january #a1 #bjbf     
before the period at the end2 and  7#c7 
by adding at the end the following new  
clause3  7iii7 ,no subsection 7d7       
hospital shall be treated as being      
located in a rural area of a ,state     
under this subparagraph on or after     
,october #a1 #bjbi1 regardless of any   
application described in clause 7i7     
submitted prior to ,october #a1 #bjbf1  
unless such hospital demonstrates to the
 ,secretary 7in a form and manner       

specified by the ,secretary7 that such  
hospital meets any of the criteria      
described in subclause 7,i71 7,,ii71 or 
7,,iv7 of clause 7ii74  4  7b7          
,prohibiting dual reclassifications     
through the ,medicare ,geographic       
,classification ,review ,board ,section 
#ahhf7;d77#aj77;,d7 of the ,social      
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#aj77;,d77 is amended-- 7#a7 
in clause 7v71 by striking ,any decision
 and inserting ,subject to clause       
7viii71 any decision2 and  7#b7 by      
adding at the end the following new     
clauses3  7vii7 ,such guidelines shall  
provide that the ,board may not approve 
an application described in subparagraph
 7,c77i7 submitted by a subsection 7d7  
hospital requesting a change in         
geographic classification for a fiscal  
year beginning on or after ,october #a1 
#bjbf1 if such hospital is treated as   
being located in a rural area under     
paragraph 7#h77;,e7 for such fiscal     
year4  7viii7 ,with respect to a fiscal 

year beginning on or after ,october #a1 
#bjbf1 no change in the geographic      
classification of a subsection 7d7      
hospital that would otherwise be in     
effect for such fiscal year pursuant to 
a decision of the ,board shall be       
effective for any portion of such fiscal
 year during which such hospital is     
treated as being located in a rural area
 under paragraph 7#h77;,e74  4