,,ii #aaith ,,congress #ast ,session ,s4 #ejb ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #aj1 #bjbe,mr4 ,durbin 7for himself1 ,mr4 ,lankford1 and ,ms4 ,smith7 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 restore ,state authority to waive for certain facilities the #ce-mile rule for designating critical access hospitals under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,rural ,hospital ,closure ,relief ,act of #bjbe4 #b4 ,restoring ,state authority to waive the #ce-mile rule for certain ,medicare critical access hospital designations 7a7 ,in general ,section #ahbj of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7 is amended-- 7#a7 in subsection 7c77#b7-- 7,a7 in subparagraph 7,b77i7-- 7i7 in subclause 7,i71 by striking or at the end2 7ii7 in subclause 7,,ii71 by inserting or at the end2 and 7iii7 by adding at the end the following new subclause3 7,,iii7 subject to subparagraph 7,g71 is a hospital described in subparagraph 7,f7 and is certified1 on or after the date of the enactment of the ,rural ,hospital ,closure ,relief ,act of #bjbe1 and before the date that is #i years after the date of enactment of this subclause1 by the ,state as being a necessary provider of health care services to residents in the area2 2 and 7,b7 by adding at the end the following new subparagraphs3 7,f7 ,hospital described ,for purposes of subparagraph 7,b77i77,,iii71 a hospital described in this subparagraph is a hospital that-- 7i7 is a sole community hospital 7as defined in section #ahhf7;d77#e77;,d77iii771 a medicare dependent1 small rural hospital 7as defined in section #ahhf7;d77#e77;,g77iv771 a low-volume hospital that in #bjba receives a payment adjustment under section #ahhf7;d77#ab71 or a subsection 7d7 hospital 7as defined in section #ahhf7;d77#a77;,b772 7ii7 is located in a rural area1 as defined in section #ahhf7;d77#b77;,d71 or a rural census tract of a metropolitan statistical area 7as determined under the most recent modification of the ,goldsmith ,modification1 originally published in the ,federal ,register on ,february #bg1 #aiib 7#eg ,fed4 ,reg4 #fgbe772 7iii7 7,i7 is located-- 7aa7 in a county that has a percentage of individuals with income at or below the ,federal poverty level in #bjbc or #bjbd that is higher than the national or statewide average in that year2 or 7bb7 in a health professional shortage area 7as defined in section #ccb7;a77#a77;,a7 of the ,public ,health ,service ,act72 or 7,,ii7 has a percentage of inpatient days of individuals entitled to benefits under part ,a of this title in #bjbc or #bjbd that is higher than the national or statewide average in that year2 7iv7 has attested to the ,secretary that the hospital-- 7,i7 was operating as of the date of enactment of this subparagraph2 and 7,,ii7 had #b consecutive years of negative operating margins preceding the date of certification described in subparagraph 7,b77i77,,iii71 as defined by the ,secretary in the regulations or program instruction issued pursuant to section #b7;b7 of the ,rural ,hospital ,closure ,relief ,act of #bjbe2 and 7v7 submits to the ,secretary1 at such time and in such manner as the ,secretary may require1 an application for certification of the facility as a critical access hospital1 including an attestation outlining-- 7,i7 the good governance qualifications and strategic plan for multi-year financial solvency of the hospital2 and 7,,ii7 the hospital's commitment to open and maintain1 for the duration of the hospital's designation as a critical access hospital under this section1 a new service line or expanded service capacity for a service that is in high demand or limited supply in the hospital's service area 7determined based on the hospital's most recent community health needs assessment under section #eja7r77#c7 of the ,internal ,revenue ,code of #aihf 7or other comparable assessment771 such as obstetrics or behavioral health care services4 7,g7 ,limitation on certain designations 7i7 ,in general ,subject to clauses 7ii7 and 7iii71 the ,secretary may not under subsection 7e7 certify pursuant to a certification by a ,state under subparagraph 7,b77i77,,iii7-- 7,i7 more than a total of #abj facilities as critical access hospitals2 and 7,,ii7 within any one ,state1 more than #e facilities as critical access hospitals4 7ii7 ,process ,the ,secretary shall follow the following process in carrying out clause 7i7 with respect to each year in which the ,secretary determines that the limitation under clause 7i77,i7 has not been reached3 7,i7 ,initial assessment ,the ,secretary shall conduct an initial assessment of the total number of hospitals described in paragraph 7#b77;,f74 7,,ii7 ,initial allocation ,of the total number of designations available under clause 7i71 the ,secretary shall allocate #a for a hospital in each ,state that the ,secretary determines 7based on the initial assessment under subclause 7,i77 has one or more hospitals described in paragraph 7#b77;,f74 7,,iii7 ,remaining allocation ,of the total number of designations available under clause 7i71 after application of subclause 7,,ii71 the ,secretary shall allocate the remaining number on a proportional basis based on the total number of hospitals described in paragraph 7#b77;,f7 in each ,state that are eligible 7as determined based on the initial assessment under subclause 7,i774 7iii7 ,sunset ,effective beginning on the date that is #i years after the date of enactment of this subparagraph1 the ,secretary may not certify a hospital as a critical access hospital pursuant to a certification by a ,state under subparagraph 7,b77i77,,iii74 7,h7 ,information submission requirements for hospitals certified pursuant to ,rural ,hospital ,closure ,relief ,act 7i7 ,in general ,a critical access hospital that is certified under subsection 7e7 pursuant to a certification by a ,state under subparagraph 7,b77i77,,iii7 shall submit to the ,secretary the following at a time1 and in a manner1 specified by the ,secretary3 7,i7 ,reports ,reports containing such information as the ,secretary may specify with respect to items and services furnished as part of the new service line or expanded service capacity for a service as described in the attestation submitted by the critical access hospital under subparagraph 7,f77v77,,ii74 ,to the extent practicable1 the ,secretary shall align such reporting with other reporting requirements applicable to critical access hospitals under this subsection4 7,,ii7 ,notice ,if the critical access hospital materially changes the new service line or expanded capacity for a service as so described1 notice of such changes along with a plan to satisfactorily maintain access to care 7as determined by the ,secretary74 7ii7 ,revocation of certification for noncompliance ,if the ,secretary determines that a critical access hospital described in clause 7i7 has failed to submit an annual report required under subclause 7,i7 of such clause or a notice required under subclause 7,,ii7 of such clause1 the ,secretary may1 as the ,secretary determines appropriate1 revoke the certification of the critical access hospital under subsection 7e74 2 and 7#b7 in subsection 7e71 by inserting 1 subject to subsection 7c77#b77;,g71 after ,the ,secretary shall4 7b7 ,implementation ,not later than #a year after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services shall issue final regulations or program instruction to carry out subsection 7a74 7c7 ,clarification regarding facilities that meet distance or other criteria and application of other criteria ,nothing in this section shall affect-- 7#a7 the application of criteria for designation as a critical access hospital described in subclause 7,i7 or 7,,ii7 of section #ahbj7;c77#b77;,b77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;c77#b77;,b77i772 or 7#b7 the application of criteria for designation as a critical access hospital described in clauses 7ii7 through 7v7 of section #ahbj7;c77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;c77#b77;,b774 7d7 ,,gao study and report 7#a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on the implementation of the amendments made by subsection 7a74 ,to the extent such data are available and reliable1 such study shall include-- 7,a7 an analysis of-- 7i7 the characteristics of facilities designated as critical access hospitals pursuant to section #ahbj7;c77#b77;,b77i77,,iii7 of the ,social ,security ,act1 as added by subsection 7a72 7ii7 an analysis of the financial status and outlook for such facilities based on their designation as a critical access hospital pursuant to such section2 and 7iii7 an analysis of any increase in expenditures under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 as a result of such designation1 relative to the expected baseline expenditures under the ,medicare program if such facilities had not received such designation2 and 7,b7 an assessment of whether the authority to designate facilities as critical access hospitals pursuant to such section #ahbj7;c77#b77;,b77i77,,iii7 promotes access to care in rural areas4 7#b7 ,report ,not later than #f years after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #c4 ,med,p,a,c study and report on payment systems for rural hospitals 7a7 ,study ,the ,medicare ,payment ,advisory ,commission 7in this section referred to as the ,commission7 shall conduct a study1 using data from #bjah through #bjbh1 on payment systems for rural hospitals under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 ,such study shall include an analysis of-- 7#a7 facilities designated as critical access hospitals pursuant to section #ahbj7;c77#b77;,b77i77,,iii7 of the ,social ,security ,act1 as added by section #b7;a72 7#b7 features of payment systems for rural hospitals1 including value-based payment systems1 that would-- 7,a7 ensure financial sustainability for the ,medicare program2 and 7,b7 preserve access to care for ,medicare beneficiaries2 and 7#c7 if the ,commission recommends any new payment system for rural hospitals under the ,medicare program1 to the extent feasible1 the impacts of transition from existing payment systems to such new payment system4 7b7 ,report ,not later than #h years after the date of enactment of this ,act1 the ,commission shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,commission determines appropriate4 7c7 ,definition of rural hospital ,in this section1 the term rural hospital means-- 7#a7 a critical access hospital 7as defined in section #ahfa7mm77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7mm77#a7772 7#b7 a subsection 7d7 hospital 7as defined in section #ahhf7;d77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#a77;,b777 that is located in a rural census tract of a metropolitan statistical area 7as determined under the most recent modification of the ,goldsmith ,modification1 originally published in the ,federal ,register on ,february #bg1 #aiib 7#eg ,fed4 ,reg4 #fgbe772 7#c7 a sole community hospital 7as defined in section #ahhf7;d77#e77;,d77iii77 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,d77iii7772 7#d7 a medicare dependent1 small rural hospital 7as defined in section #ahhf7;d77#e77;,g77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#e77;,g77iv7772 and 7#e7 a low-volume hospital 7as defined in section #ahhf7;d77#ab77;,c77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieww7d77#ab77;,c77i7774 #d4 ,sunset ,not later than #i years after the date of enactment of this ,act1 the ,secretary shall establish a mechanism and provide guidance and technical assistance under which any facility that was designated as a critical access hospital pursuant to a certification by a ,state under section #ahbj7;c77#b77;,b77i77,,iii7 of the ,social ,security ,act1 as added by section #b7;a71 may transition within #a year to one of the following payment models3 7#a7 ,such new model or models recommended by the ,medicare ,payment ,advisory ,commission in the report submitted under section #c4 7#b7 ,the prospective payment model 7or models7 under which the facility received payment under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 prior to being so designated pursuant to such certification4 7#c7 ,payment as a rural emergency hospital under section #ahcd7x7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7x774