[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5481 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 5481

   To amend title XVIII of the Social Security Act to restore State 
    authority to waive for certain facilities the 35-mile rule for 
   designating critical access hospitals under the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 18, 2019

 Mr. Kinzinger (for himself, Mr. Loebsack, and Mr. Panetta) introduced 
  the following bill; which was referred to the Committee on Ways and 
                                 Means

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to restore State 
    authority to waive for certain facilities the 35-mile rule for 
   designating critical access hospitals under the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Rural Hospital Closure Relief Act of 
2019''.

SEC. 2. RESTORING STATE AUTHORITY TO WAIVE THE 35-MILE RULE FOR CERTAIN 
              MEDICARE CRITICAL ACCESS HOSPITAL DESIGNATIONS.

    Section 1820 of the Social Security Act (42 U.S.C. 1395i-4) is 
amended--
            (1) in subsection (c)(2)--
                    (A) in subparagraph (B)(i)--
                            (i) in subclause (I), by striking at the 
                        end ``or'';
                            (ii) in subclause (II), by inserting at the 
                        end ``or''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(III) subject to subparagraph 
                                (G), is a hospital described in 
                                subparagraph (F) and is certified on or 
                                after the date of the enactment of the 
                                Rural Hospital Closure Relief Act of 
                                2019 by the State as being a necessary 
                                provider of health care services to 
                                residents in the area;''; and
                    (B) by adding at the end the following new 
                subparagraphs:
                    ``(F) Hospital described.--For purposes of 
                subparagraph (B)(i)(III), a hospital described in this 
                subparagraph is a hospital that--
                            ``(i) is a sole community hospital (as 
                        defined in section 1886(d)(5)(D)(iii)), a 
                        medicare dependent, small rural hospital (as 
                        defined in section 1886(d)(5)(G)(iv)), a low-
                        volume hospital that in 2019 receives a payment 
                        adjustment under section 1886(d)(12), or a 
                        subsection (d) hospital (as defined in section 
                        1886(d)(1)(B)) that has fewer than 50 beds;
                            ``(ii) is located in a rural area, as 
                        defined by the Secretary, based on the most 
                        recent rural urban commuting area code (or its 
                        successor criteria) as set forth by the Office 
                        of Management and Budget;
                            ``(iii) as determined by the Secretary, 
                        serves a patient population--
                                    ``(I) with a high percentage, 
                                relative to the national or statewide 
                                average, of individuals with income 
                                that is below 150 percent of the 
                                poverty line;
                                    ``(II) in a health professional 
                                shortage area (as defined in section 
                                332(a)(1)(A) of the Public Health 
                                Service Act); or
                                    ``(III) that represents a high 
                                proportion, relative to the national or 
                                statewide average, of individuals 
                                entitled to part A or enrolled under 
                                part B of this title or enrolled under 
                                a State plan under title XIX;
                            ``(iv) has demonstrated to the Secretary, 
                        at such time and in such manner as the 
                        Secretary determines appropriate, two 
                        consecutive years of financial losses preceding 
                        the date of certification described in 
                        subparagraph (B)(i)(III); and
                            ``(v) submits to the Secretary, at such 
                        time and in such manner as the Secretary may 
                        require, an attestation that the Secretary 
                        determines to be satisfactory, outlining the 
                        good governance qualifications and strategic 
                        plan for multi-year financial solvency of the 
                        hospital.
                    ``(G) Limitation on certain designations.--
                            ``(i) In general.--The Secretary may not 
                        under subsection (e) certify pursuant to a 
                        certification by a State under subsection 
                        (c)(2)(B)(i)(III)--
                                    ``(I) more than a total of 200 
                                facilities as critical access 
                                hospitals; and
                                    ``(II) subject to clause (ii), 
                                within any one State, more than 15 
                                facilities as critical access 
                                hospitals.
                            ``(ii) State petition.--The Secretary may 
                        apply, with respect to a State, the limitation 
                        under clause (i)(II) by substituting a number 
                        that is greater than the number specified in 
                        such clause if the State petitions the 
                        Secretary, in accordance with a process 
                        established by the Secretary, to increase such 
                        number.''; and
            (2) in subsection (e), by inserting ``, subject to 
        subsection (c)(2)(G),'' after ``The Secretary shall''.
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