,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #ggbg  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,febru>y #bf1         
#bjbf,mr4 ,al=d 7= himself1 ,mr4        
,?ompson ( ,p5nsylvania1 ,ms4 ,tokuda1 &
 ,mr4 ,cuell>7 introduc$ ! foll[+ bill2 
:i* 0 ref]r$ to ! ,committee on ,ways & 
,means  ,a ,,bill  ,to am5d title       
,,xviii ( ! ,social ,security ,act to   
ensure ! cont9u$ designation ( c]ta9    
critical access hospitals "u ! ,m$ic>e  
program1 & = o!r purposes4  #a4 ,%ort   
title ,?is ,act may be cit$ z ! ,su/a9+ 
,rural ,heal?c>e ,act4  #b4 ,ensur+ !   
cont9u$ designation ( c]ta9 critical    
access hospitals "u ! ,m$ic>e program   
,section #ahbj7;c77#b7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acie;i-#d7;c77#b77 is am5d$ by add+ at 
! end ! foll[+ new subp>agraph3  7,f7   
,ensur+ cont9u$ designation ( c]ta9     
critical access hospitals ,a facility t 
is designat$ z a critical access        
hospital by a ,/ate "u subp>agraph 7,b7 
t meets ! crit]ion specifi$ 9 clause    

7i77,i7 z ( ! date ( su* designation & t
 w\ld cont9ue to be eligible = su*      
designation b = application ( su*       
crit]ion %all be deem$ to meet su*      
crit]ion = a p]iod specifi$ by !        
,secret>y 7n to exce$ #c ye>s7 if !     
,secret>y det]m9es t loss ( su*         
designation w\ld r$uce access to        
necess>y heal? c>e items & s]vices =    
individuals resid+ 9 ! s]vice area ( su*
 facility4  4  #c4 ,discretion>y        
au?ority = /abilization p>ity  7a7 ,9   
g5]al ,not)/&+ any o!r provision ( law1 
! ,secret>y may designate a hospital z a
 ,critical ,access 9 ,"* = purposes (   
,m$ic>e reimbursem5t if ! ,secret>y     
det]m9es t ! hospital is critical to    
ensur+ access to ess5tial heal? s]vices 
9 ! community x s]ves4  7b7 ,eligibility
 crit]ia ,a hospital may qualify =      
designation "u subsection 7a7 if !      
hospital-- 7#a7 is locat$ 9 a rural     
area1 z def9$ "u section                
#ahhf7;d77#b77;,d7 ( ! ,social ,security
 ,act or a rural c5sus tract ( a        

metropolitan /ati/ical area 7z det]m9$  
"u ! mo/ rec5t modification ( !         
,goldsmi? ,modification1 orig9ally      
publi%$ 9 ! ,f$]al ,regi/] on ,febru>y  
#bg1 #aiib 7#eg ,f$4 ,reg4 #fgbe772     
7#b7 is locat$ 9 an area designat$ by ! 
,secret>y z a heal? pr(essional %ortage 
area2  7#c7 s]ves m$ically und]s]v$1    
p]si/5t pov]ty1 ,tribal1 or fronti]     
communities2  7#d7 s]ves a high         
proportion ( ,m$ic>e b5efici>ies1 z     
det]m9$ by ! ,secret>y bas$ on !        
p]c5tage ( inpati5t or outpati5t        
enc\nt]s attributable to individuals    
entitl$ to b5efits "u ,m$ic>e2 &  7#e7  
faces a significant risk ( full or      
p>tial closure or a mat]ial r$uction 9 !
 scope ( s]vices furni%$1 z det]m9$ by !
 ,secret>y us+ f9ancial or op]ational   
p]=mance indicators4  7c7 ,paym5t p>ity 
au?ority ,a hospital receiv+ a          
designation "u ?is section %all1 = !    
p]iod ( su* designation1 be eligible to 
receive reimbursem5t = inpati5t &       
outpati5t s]vices "u ,m$ic>e at paym5t  

rates equival5t to ^? applicable to a   
,critical ,access ,hospital1 subject to 
su* limitations & conditions z !        
,secret>y may e/abli%4  7d7 ,duration ,a
 designation "u ?is section %all rema9 9
 effect only until ! hospital is        
f9ancially & op]ationally /abiliz$1 z   
det]m9$ by ! ,secret>y1 b may n ext5d   
beyond a p]iod ( #c ye>s unless r5ew$ by
 ! ,secret>y = good cause4  7e7         
,guidance & implem5tation ,n lat] ?an   
#ab mon?s aft] ! date ( enactm5t1 !     
,secret>y %all issue guidance describ+  
eligibility /&>ds1 docum5tation         
requirem5ts1 & r5ewal conditions2       
e/abli% monitor+ & report+ requirem5ts  
to ensure p]=mance1 pati5t access1 &    
f9ancial /ability improvem5ts dur+ !    
/abilization p]iod2 & collaborate ) !   
,dep>tm5t ( ,agriculture to make        
available no-co/ ,te*nical ,assi/ance   
?r\gh ! ,community ,facilities ,program 
to designat$ hospitals to /r5g!n _!     
f9ancial & op]ational /atus4  7f7 ,no   
adv]se prec$5t ,a designation "u ?is    

section %all n be con/ru$ z conf]r+     
,critical ,access ,hospital /atus =     
purposes ( any o!r provision ( law4  7g7
 ,f9ancial risk /&>d ,9 conduct+ a      
review "u subsection 7a71 ! ,secret>y   
%all det]m9e :e!r ! hospital is at      
significant f9ancial risk ( r$uc$ access
 to ess5tial heal? s]vices 9 ! community
 x s]ves4 ,su* det]m9ation %all be bas$ 
on evid5ce t ! hospital's f9ancial      
di/ress-- 7#a7 results prim>ily f !     
unique op]ational *all5ges ( furni%+    
heal? c>e 9 a rural area1 includ+ l[    
pati5t volumes1 work=ce %ortages1       
geographic isolation1 or pay] mix       
*>act]i/ics typical ( rural communities2
 &  7#b7 does n result prim>ily f       
improp] f9ancial managem5t1 includ+ b n 
limit$ to misallocation ( res\rces1     
avoidable adm9i/rative ineffici5cies1 or
 non rural bus9ess decisions unrelat$ to
 ! provision ( rural heal? s]vices4  7h7
 ,docum5tation ,! ,secret>y may require 
! hospital to submit su* f9ancial       
/atem5ts1 op]ational data1 & o!r        

docum5tation z ! ,secret>y det]m9es     
necess>y to evaluate ! crit]ia describ$ 
9 subsection 7b74  7i7 ,rule (          
con/ruction ,no?+ 9 ?is section %all be 
con/ru$ to limit ! ,secret>y's au?ority 
to impose additional conditions or      
ov]sight necess>y to ensure ! integrity 
( ! ,critical ,access ,hospital program4