[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6430 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 6430

  To amend title XVIII of the Social Security Act to extend Medicare-
 dependent hospital and Medicare low-volume hospital payments, and to 
  direct the Comptroller General of the United States to carry out a 
           report on Medicare rural hospital classifications.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 15, 2023

 Mrs. Miller of West Virginia (for herself and Ms. Sewell) 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 extend Medicare-
 dependent hospital and Medicare low-volume hospital payments, and to 
  direct the Comptroller General of the United States to carry out a 
           report on Medicare rural hospital classifications.

    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 ``Assistance for Rural Community 
Hospitals Act'' or the ``ARCH Act''.

SEC. 2. EXTENDING MEDICARE-DEPENDENT HOSPITAL AND MEDICARE LOW-VOLUME 
              HOSPITAL PAYMENTS.

    (a) MDH Extension.--
            (1) Extension of payment methodology.--Section 
        1886(d)(5)(G) of the Social Security Act (42 U.S.C. 
        1395ww(d)(5)(G)) is amended--
                    (A) in clause (i), by striking ``October 1, 2024'' 
                and inserting ``October 1, 2029''; and
                    (B) in clause (ii)(II), by striking ``October 1, 
                2024'' and inserting ``October 1, 2029''.
            (2) Conforming amendments.--
                    (A) Extension of target amount.--Section 
                1886(b)(3)(D) of the Social Security Act (42 U.S.C. 
                1395ww(b)(3)(D)) is amended--
                            (i) in the matter preceding clause (i), by 
                        striking ``October 1, 2024'' and inserting 
                        ``October 1, 2029'' ; and
                            (ii) in clause (iv), by striking ``fiscal 
                        year 2024'' and inserting ``fiscal year 
                        2029,''.
                    (B) Permitting hospitals to decline 
                reclassification.--Section 13501(e)(2) of the Omnibus 
                Budget Reconciliation Act of 1993 (42 U.S.C. 1395ww 
                note) is amended by striking ``fiscal year 2024'' and 
                inserting ``fiscal year 2029,''.
    (b) LVH Extension.--Section 1886(d)(12) of the Social Security Act 
(42 U.S.C. 1395ww(d)(12)) is amended--
            (1) in subparagraph (C)(i)--
                    (A) in the matter preceding subclause (I), by 
                striking ``through 2024'' and inserting ``through 
                2029'';
                    (B) in subclause (III), by striking ``through 
                2024'' and inserting ``through 2029''; and
                    (C) in subclause (IV), by striking ``2025'' and 
                inserting ``2030''; and
            (2) in subparagraph (D)--
                    (A) in the matter preceding clause (i), by striking 
                ``through 2024'' and inserting ``through 2029''; and
                    (B) in clause (ii), by striking ``through 2024'' 
                and inserting ``through 2029''.

SEC. 3. GAO REPORT ON MEDICARE RURAL HOSPITAL CLASSIFICATIONS.

    Not later than 180 days after the date of the enactment of this 
Act, the Comptroller General of the United States shall submit to 
Congress a report on Medicare rural hospital classifications that 
includes the following information:
            (1) The total number of hospitals that, with respect to any 
        of the 5 fiscal years preceding such date of enactment, had any 
        of the following classifications:
                    (A) Classification as a critical access hospital 
                (as defined in section 1861(mm)(1) of the Social 
                Security Act (42 U.S.C. 1395x(mm)(1))).
                    (B) Classification as a rural emergency hospital 
                (as defined in section 1861(kkk)(2) of such Act (42 
                U.S.C. 1395x(kkk)(2))).
                    (C) Classification as a rural referral center (as 
                described in section 1886(d)(5)(C) of such Act (42 
                U.S.C. 1395ww(d)(5)(C)).
                    (D) Classification as a sole community hospital (as 
                defined in section 1886(d)(5)(D)(iii) of such Act (42 
                U.S.C. 1395ww(d)(5)(D)(iii))).
                    (E) Classification as a medicare-dependent, small 
                rural hospital (as defined in section 1886(d)(5)(G)(iv) 
                of such Act (42 U.S.C. 1395ww(d)(5)(G)(iv))).
                    (F) Classification as a low-volume hospital (as 
                defined in section 1886(d)(12)(C)(i) of such Act (42 
                U.S.C. 1395ww(d)(12)(C)(i))).
            (2) An analysis of the extent to which there is overlap 
        between the criteria for any two or more of the classifications 
        described in paragraph (1).
            (3) Recommendations for--
                    (A) simplification with respect to such 
                classifications and any such overlap; and
                    (B) changes with respect to the criteria for such 
                classifications that would promote financial 
                sustainability for rural hospitals and improve access 
                to health care for individuals in rural areas.
            (4) The projected effects of allowing sole community 
        hospitals (as described in paragraph (1)(D)) and medicare-
        dependent, small rural hospitals (as described in paragraph 
        (1)(E)) to use a cost reporting period beginning during fiscal 
        year 2019 for the purpose of calculating adjusted payments 
        under section 1886(d)(5) of the Social Security Act (42 U.S.C. 
        1395ww(d)(5)).
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