[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1571 Introduced in Senate (IS)]

<DOC>






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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