[Congressional Record Volume 165, Number 205 (Wednesday, December 18, 2019)]
[Senate]
[Page S7161]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself and Mr. Lankford):
  S. 3103. 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; to the Committee on Finance.
  Mr. DURBIN. Mr. President, I ask unanimous consent that the text of 
the bill be printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 3103

       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''.
                                 ______