[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1571 Introduced in Senate (IS)]
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118th CONGRESS
1st Session
S. 1571
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, and
for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 11, 2023
Mr. Durbin (for himself and Mr. Lankford) introduced the following
bill; 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 35-mile rule for
designating critical access hospitals under the Medicare program, and
for other purposes.
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
2023''.
SEC. 2. RESTORING STATE AUTHORITY TO WAIVE THE 35-MILE RULE FOR CERTAIN
MEDICARE CRITICAL ACCESS HOSPITAL DESIGNATIONS.
(a) In General.--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 ``or'' at
the end;
(ii) in subclause (II), by inserting ``or''
at the end; 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
2023 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 2021 receives a payment
adjustment under section 1886(d)(12), a
subsection (d) hospital (as defined in section
1886(d)(1)(B)) that has fewer than 50 beds, or,
subject to the limitation under subparagraph
(G)(i)(I), is a facility described in
subparagraph (G)(ii);
``(ii) is located in a rural area, as
defined in section 1886(d)(2)(D);
``(iii)(I) is located--
``(aa) in a county that has a
percentage of individuals with income
that is below 150 percent of the
poverty line that is higher than the
national or statewide average in 2021;
or
``(bb) in a health professional
shortage area (as defined in section
332(a)(1)(A) of the Public Health
Service Act); or
``(II) has a percentage of inpatient days
of individuals entitled to benefits under part
A of this title, enrolled under part B of this
title, or enrolled under a State plan under
title XIX that is higher than the national or
statewide average in 2020 or 2021;
``(iv) subject to subparagraph (G)(ii)(II),
has attested to the Secretary two consecutive
years of negative operating margins preceding
the date of certification described in
subparagraph (B)(i)(III); and
``(v) submits to the Secretary--
``(I) at such time and in such
manner as the Secretary may require, an
attestation outlining the good
governance qualifications and strategic
plan for multi-year financial solvency
of the hospital; and
``(II) not later than 120 days
after the date on which the Secretary
issues final regulations pursuant to
section 2(b) of the Rural Hospital
Closure Relief Act of 2023, an
application for certification of the
facility as a critical access 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 subparagraph
(B)(i)(III)--
``(I) more than a total of 175
facilities as critical access
hospitals, of which not more than 20
percent may be facilities described in
clause (ii); and
``(II) within any one State, more
than 10 facilities as critical access
hospitals.
``(ii) Facility described.--
``(I) In general.--A facility
described in this clause is a facility
that as of the date of enactment of
this subparagraph met the criteria for
designation as a critical access
hospital under subparagraph (B)(i)(I).
``(II) Nonapplication of certain
criteria.--For purposes of subparagraph
(B)(i)(III), the criteria described in
subparagraph (F)(iv) shall not apply
with respect to the designation of a
facility described in subclause (I).'';
and
(2) in subsection (e), by inserting ``, subject to
subsection (c)(2)(G),'' after ``The Secretary shall''.
(b) Regulations.--Not later than 120 days after the date of the
enactment of this Act, the Secretary of Health and Human Services shall
issue final regulations to carry out subsection (a).
(c) Clarification Regarding Facilities That Meet Distance or Other
Certification Criteria.--Nothing in this section shall affect the
application of criteria for designation as a critical access hospital
described in subclause (I) or (II) section 1820(c)(2)(B)(i) of the
Social Security Act (42 U.S.C. 1395i-4(c)(2)(B)(i)).
(d) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
(in this section referred to as the ``Comptroller General''),
in consultation with the Administrator of the Centers for
Medicare & Medicaid Services, shall conduct a study on the
implementation of the amendments made by subsection (a). Such
study shall include an analysis of--
(A) the characteristics of facilities designated as
critical access hospitals pursuant to section
1820(c)(2)(B)(i)(III) of the Social Security Act, as
added by subsection (a);
(B) the financial status and outlook for such
facilities based on their designation as a critical
access hospital pursuant to such section;
(C) any increase in expenditures under the Medicare
program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) as a result of such
designation, relative to the expected baseline
expenditures under the Medicare program if such
facilities had not received such designation; and
(D) whether the authority to designate facilities
as critical access hospitals pursuant to such section
1820(c)(2)(B)(i)(III) should be maintained as is,
modified in scale or scope, or sunset.
(2) Report.--Not later than 7 years after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report containing the results of the study conducted
under subsection (a), together with recommendations for such
legislation and administrative action as the Comptroller
General determines appropriate.
(e) Guidance.--Not later than 2 years after the date on which the
Comptroller General submits the report to Congress under subsection
(d)(2), the Administrator of the Centers for Medicare & Medicaid
Services shall establish a mechanism and provide guidance and technical
assistance to facilities that have been designated as a critical access
hospital pursuant to section 1820(c)(2)(B)(i)(III) of the Social
Security Act, as added by subsection (a), on how such facilities may
consider transitioning to a different payment model under the Medicare
program.
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