Rural Hospital Closure Relief Act of 2021

I 117TH CONGRESS 1ST SESSION H. R. 1639 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 HOUSE OF REPRESENTATIVES MARCH 8, 2021 Mr. KINZINGER (for himself and Mr. PANETTA) introduced the following bill; which was referred to the Committee on Ways and Means, and in addi- tion to the Committee on Energy and Commerce, for a period to be sub- sequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 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 Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Rural Hospital Closure 4 Relief Act of 2021’’. 5 VerDate Sep 11 2014 05:20 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1639.IH H1639 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 1639 IH SEC. 2. RESTORING STATE AUTHORITY TO WAIVE THE 35- 1 MILE RULE FOR CERTAIN MEDICARE CRIT- 2 ICAL ACCESS HOSPITAL DESIGNATIONS. 3 (a) IN GENERAL.—Section 1820 of the Social Secu- 4 rity Act (42 U.S.C. 1395i–4) is amended— 5 (1) in subsection (c)(2)— 6 (A) in subparagraph (B)(i)— 7 (i) in subclause (I), by striking at the 8 end ‘‘or’’; 9 (ii) in subclause (II), by inserting at 10 the end ‘‘or’’; and 11 (iii) by adding at the end the fol- 12 lowing new subclause: 13 ‘‘(III) subject to subparagraph 14 (G), is a hospital described in sub- 15 paragraph (F) and is certified on or 16 after the date of the enactment of the 17 Rural Hospital Closure Relief Act of 18 2021 by the State as being a nec- 19 essary provider of health care services 20 to residents in the area;’’; and 21 (B) by adding at the end the following new 22 subparagraphs: 23 ‘‘(F) HOSPITAL DESCRIBED.—For pur- 24 poses of subparagraph (B)(i)(III), a hospital 25 VerDate Sep 11 2014 05:20 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1639.IH H1639 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 1639 IH described in this subparagraph is a hospital 1 that— 2 ‘‘(i) is a sole community hospital (as 3 defined in section 1886(d)(5)(D)(iii)), a 4 medicare dependent, small rural hospital 5 (as defined in section 1886(d)(5)(G)(iv)), a 6 low-volume hospital that in 2021 receives a 7 payment adjustment under section 8 1886(d)(12), a subsection (d) hospital (as 9 defined in section 1886(d)(1)(B)) that has 10 fewer than 50 beds, or, subject to the limi- 11 tation under subparagraph (G)(i)(I), is a 12 facility described in subparagraph (G)(ii); 13 ‘‘(ii) is located in a rural area, as de- 14 fined in section 1886(d)(2)(D); 15 ‘‘(iii)(I) is located— 16 ‘‘(aa) in a county that has a per- 17 centage of individuals with income 18 that is below 150 percent of the pov- 19 erty line that is higher than the na- 20 tional or statewide average in 2020; 21 ‘‘(bb) in a health professional 22 shortage area (as defined in section 23 332(a)(1)(A) of the Public Health 24 Service Act); or 25 VerDate Sep 11 2014 05:20 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1639.IH H1639 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 1639 IH ‘‘(II) has a percentage of inpatient 1 days of individuals entitled to benefits 2 under part A of this title, enrolled under 3 part B of this title, or enrolled under a 4 State plan under title XIX that is higher 5 than the national or statewide average in 6 2019 or 2020; 7 ‘‘(iv) subject to subparagraph 8 (G)(ii)(II), has attested to the Secretary 9 two consecutive years of negative operating 10 margins preceding the date of certification 11 described in subparagraph (B)(i)(III); and 12 ‘‘(v) submits to the Secretary— 13 ‘‘(I) at such time and in such 14 manner as the Secretary may require, 15 an attestation outlining the good gov- 16 ernance qualifications and strategic 17 plan for multi-year financial solvency 18 of the hospital; and 19 ‘‘(II) not later than 120 days 20 after the date on which the Secretary 21 issues final regulations pursuant to 22 section 2(b) of the Rural Hospital 23 Closure Relief Act of 2021, an appli- 24 VerDate Sep 11 2014 05:20 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1639.IH H1639 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 1639 IH cation for certification of the facility 1 as a critical access hospital. 2 ‘‘(G) LIMITATION ON CERTAIN DESIGNA- 3 TIONS.— 4 ‘‘(i) IN GENERAL.—The Secretary 5 may not under subsection (e) certify pur- 6 suant to a certification by a State under 7 subparagraph (B)(i)(III)— 8 ‘‘(I) more than a total of 175 fa- 9 cilities as critical access hospitals, of 10 which not more than 20 percent may 11 be facilities described in clause (ii); 12 and 13 ‘‘(II) within any one State, more 14 than 10 facilities as critical access 15 hospitals. 16 ‘‘(ii) FACILITY DESCRIBED.— 17 ‘‘(I) IN GENERAL.—A facility de- 18 scribed in this clause is a facility that 19 as of the date of enactment of this 20 subparagraph met the criteria for des- 21 ignation as a critical access hospital 22 under subparagraph (B)(i)(I). 23 ‘‘(II) NONAPPLICATION OF CER- 24 TAIN CRITERIA.—For purposes of 25 VerDate Sep 11 2014 05:20 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1639.IH H1639 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 1639 IH subparagraph (B)(i)(III), the criteria 1 described in subparagraph (F)(iv) 2 shall not apply with respect to the 3 designation of a facility described in 4 subclause (I).’’; and 5 (2) in subsection (e), by inserting ‘‘, subject to 6 subsection (c)(2)(G),’’ after ‘‘The Secretary shall’’. 7 (b) REGULATIONS.—Not later than 120 days after 8 the date of the enactment of this Act, the Secretary of 9 Health and Human Services shall issue final regulations 10 to carry out this section. 11 (c) CLARIFICATION REGARDING FACILITIES THAT 12 MEET DISTANCE OR OTHER CERTIFICATION CRITERIA.— 13 Nothing in this section shall affect the application of cri- 14 teria for designation as a critical access hospital described 15 in subclause (I) or (II) of section 1820(c)(2)(B)(i) of the 16 Social Security Act (42 U.S.C. 1395i–4(c)(2)(B)(i)). 17 SEC. 3. CMI TESTING OF NEW RURAL HOSPITAL DELIVERY 18 AND PAYMENT MODEL. 19 Section 1115A of the Social Security Act (42 U.S.C. 20 1315a) is amended— 21 (1) in subsection (b)(2)(A), by adding at the 22 end the following new sentence: ‘‘The models se- 23 lected under this subparagraph shall include the 24 testing of a new rural hospital delivery and payment 25 VerDate Sep 11 2014 05:20 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1639.IH H1639 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 1639 IH model (or models), as described in subsection (h).’’; 1 and 2 (2) by adding at the end the following new sub- 3 section: 4 ‘‘(h) TESTING OF NEW RURAL HOSPITAL DELIVERY 5 AND PAYMENT MODEL.— 6 ‘‘(1) IN GENERAL.— 7 ‘‘(A) TESTING.—The Secretary shall test 8 the implementation of a new rural hospital de- 9 livery and payment model (or models) that the 10 Secretary determines would promote financially 11 sustainable ways to ensure patient access to 12 care in rural communities, which may include 13 models under which such hospitals furnish out- 14 patient emergency care services 24 hours a day, 15 7 days a week for which payment is made 16 under title XVIII based on the amount deter- 17 mined under the prospective payment system 18 for hospital outpatient department services 19 under section 1833(t), plus a fixed rate for the 20 cost of furnishing the emergency services. 21 ‘‘(B) PROMULGATION OF REGULATIONS.— 22 Not later than 3 years after the date of the en- 23 actment of this subsection, the Secretary shall 24 promulgate regulations to test a new rural hos- 25 VerDate Sep 11 2014 05:20 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1639.IH H1639 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 1639 IH pital delivery and payment model (or models) 1 described in subparagraph (A), unless Congress 2 enacts legislation that establishes such a pay- 3 ment model (or models) prior to the promulga- 4 tion of regulations pursuant to this subpara- 5 graph. 6 ‘‘(2) TRANSITION.—Effective beginning on the 7 date on which the testing of a new rural hospital de- 8 livery and payment model (or models) described in 9 paragraph (1)(A) is implemented under this sub- 10 section or such a payment model (or models) is es- 11 tablished through the enactment of legislation de- 12 scribed in paragraph (1)(B), the Secretary shall pro- 13 vide a process under which— 14 ‘‘(A) all critical access hospitals may tran- 15 sition to such new model or models under this 16 subsection; and 17 ‘‘(B) any facility that was designated as a 18 critical access hospital pursuant to a certifi- 19 cation by a State under section 20 1820(c)(2)(B)(i)(III) may revert to the prospec- 21 tive payment model (or models) under which 22 the facility received payment under title XVIII 23 prior to being so designated.’’. 24 Æ VerDate Sep 11 2014 05:20 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\H1639.IH H1639 kjohnson on DSK79L0C42PROD with BILLS