,,ii  #aai? ,,congress  #b;d ,session   
,s4 #eafd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #bi1 #bjbf,mr4   
,moran 7= himself1 ,ms4 ,smi?1 ,mr4     
,tub]ville1 ,mrs4 ,britt1 ,mrs4 ,capito1
 ,mrs4 ,hyde-,smi?1 & ,mr4 ,m>%all7     
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d titles     
,,xviii & ,,xix ( ! ,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$ 9 ! matt] prec$+ subp>agraph 7,a71
 by /rik+ z ( & ins]t+ at any po9t dur+ 
! p]iod beg9n+ on ,janu>y #a1 #bjae1 &  
end+ on4  7b7 ,waiv] ( c]ta9 requirem5ts
 ,section #ahfa7kkk77#c7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciex7kkk77#c771 z am5d$ 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$4--  7,a7  ,9 g5]al  ,subject  
to subp>agraph 7,b71 a facility  2 &    
7#c7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,b7  ,waiv]  ,n lat] ?an 
#a ye> aft] ! date ( enactm5t ( ?is     
subp>agraph1 ! ,secret>y %all promulgate
 regulations to waive ! requirem5ts "u  
subp>agraph 7,a7 ) respect to facilities
 t op]ate simil>ly to a rural em]g5cy   
hospital 9 ord] = su* facilities to be  
eligible = conv]sion to a rural em]g5cy 
hospital "u ?is subsection4  4  #c4     
,di/9ct "p units ,section #ahfa7kkk77#f7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #aciex7kkk77#f77 is am5d$--   
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 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  
#bjbg1 ! 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$-- 7#a7 9 subp>agraph 7,d71 by 
/rik+ & at ! end2  7#b7 9 subp>agraph   
7,e71 by /rik+ ! p]iod at ! end & ins]t+
 2 &2 &  7#c7 by add+ at ! end ! foll[+ 
new subp>agraph3  7,f7 may ent] into an 
agreem5t ) ! ,secret>y "u :i* its       
facilities may be us$ = ! furni%+ (     
s]vices ( ! type :i*1 if furni%$ by a   
skill$ nurs+ facility w\ld con/itute    
ext5d$ c>e s]vices4 ,paym5t to a rural  
em]g5cy hospital = s]vices furni%$ "u   
su* an agreem5t %all be bas$ ^u !       
reasonable co/ ( ! s]vices z det]m9$ "u 

section #ahhc7;a77#b77;,b7 7if su*      
section 7 appli$ by submitt+ rural      
em]g5cy hospital = hospital & inpati5t  
hospital 9 clauses 7ii7 & 7iii71        
respectively1 ( su* section74  4  #f4   
,necess>y provid] /atus = facilities t  
rev]t to critical access hospital       
designation ,n lat] ?an #a 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 
#aciex7m77#a777 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  #i4 ,inclusion ( rural      
em]g5cy hospital s]vices "u ,m$icaid    
7a7 ,9 g5]al ,section #aije7;a7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acif;d7a77 is am5d$-- 7#a7 9 p>agraph  
7#b77;,a71 by ins]t+ 7includ+ rural     
em]g5cy hospital s]vices1 z def9$ 9     
section #ahfa7kkk77#a71 :i* are lic5s$  
or o!rwise approv$ by ! ,/ate7 aft]     
s]vices2 &  7#b7 9 p>agraph 7#d77;,a71  
by ins]t+ b includ+ s]vices provid$ 9 a 
nurs+ facility t is a di/9ct "p unit ( a
 rural em]g5cy hospital1 z def9$ 9      
section #ahfa7kkk77#b7 aft] diseases4   
7b7 ,effective date  7#a7 ,9 g5]al      
,subject to p>agraph 7#b71 ! am5dm5ts   
made by ?is subsection %all apply )     
respect to m$ical assi/ance provid$ on  
or aft] ! date ( enactm5t ( ?is ,act4   
7#b7 ,exception = /ate legislation ,9 ! 
case ( a ,/ate plan "u title ,,xix ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acif et seq47 t ! ,secret>y ( ,heal? & 

,human ,s]vices det]m9es requires ,/ate 
legislation 9 ord] = su* plan to meet   
any requirem5t impos$ by ! am5dm5ts made
 by ?is section1 su* plan %all n be     
reg>d$ z fail+ to comply ) ! requirem5ts
 ( su* title solely on ! basis ( its    
failure to meet su* an additional       
requirem5t be=e ! fir/ day ( ! fir/     
cal5d> qu>t] beg9n+ aft] ! close ( !    
fir/ regul> session ( ! ,/ate           
legislature t beg9s aft] ! date ( !     
enactm5t ( ?is ,act4 ,= purposes ( !    
previ\s s5t5ce1 9 ! case ( a ,/ate t has
 a #b-ye> legislative session1 ea* ye> (
 ! session %all be consid]$ to be a     
sep>ate regul> session ( ! ,/ate        
legislature4