[Congressional Record Volume 169, Number 80 (Thursday, May 11, 2023)]
[Senate]
[Pages S1627-S1628]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself and Mr. Lankford):
  S. 1571. 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; to the Committee on Finance.
  Mr. DURBIN. Madam 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. 1571

       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

[[Page S1628]]

     (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;
       ``(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 of 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.
                                 ______