Rural Hospital Closure Relief Act of 2021

II 117TH CONGRESS 1ST SESSION S. 644 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 MARCH 9, 2021 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 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 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S644.IS S644 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 644 IS 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 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S644.IS S644 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 644 IS 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 or 22 ‘‘(bb) in a health professional 23 shortage area (as defined in section 24 VerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S644.IS S644 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 644 IS 332(a)(1)(A) of the Public Health 1 Service Act); or 2 ‘‘(II) has a percentage of inpatient 3 days of individuals entitled to benefits 4 under part A of this title, enrolled under 5 part B of this title, or enrolled under a 6 State plan under title XIX that is higher 7 than the national or statewide average in 8 2019 or 2020; 9 ‘‘(iv) subject to subparagraph 10 (G)(ii)(II), has attested to the Secretary 11 two consecutive years of negative operating 12 margins preceding the date of certification 13 described in subparagraph (B)(i)(III); and 14 ‘‘(v) submits to the Secretary— 15 ‘‘(I) at such time and in such 16 manner as the Secretary may require, 17 an attestation outlining the good gov- 18 ernance qualifications and strategic 19 plan for multi-year financial solvency 20 of the hospital; and 21 ‘‘(II) not later than 120 days 22 after the date on which the Secretary 23 issues final regulations pursuant to 24 section 2(b) of the Rural Hospital 25 VerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S644.IS S644 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 644 IS Closure Relief Act of 2021, an appli- 1 cation for certification of the facility 2 as a critical access hospital. 3 ‘‘(G) LIMITATION ON CERTAIN DESIGNA- 4 TIONS.— 5 ‘‘(i) IN GENERAL.—The Secretary 6 may not under subsection (e) certify pur- 7 suant to a certification by a State under 8 subparagraph (B)(i)(III)— 9 ‘‘(I) more than a total of 175 fa- 10 cilities as critical access hospitals, of 11 which not more than 20 percent may 12 be facilities described in clause (ii); 13 and 14 ‘‘(II) within any one State, more 15 than 10 facilities as critical access 16 hospitals. 17 ‘‘(ii) FACILITY DESCRIBED.— 18 ‘‘(I) IN GENERAL.—A facility de- 19 scribed in this clause is a facility that 20 as of the date of enactment of this 21 subparagraph met the criteria for des- 22 ignation as a critical access hospital 23 under subparagraph (B)(i)(I). 24 VerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S644.IS S644 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 644 IS ‘‘(II) NONAPPLICATION OF CER- 1 TAIN CRITERIA.—For purposes of 2 subparagraph (B)(i)(III), the criteria 3 described in subparagraph (F)(iv) 4 shall not apply with respect to the 5 designation of a facility described in 6 subclause (I).’’; and 7 (2) in subsection (e), by inserting ‘‘, subject to 8 subsection (c)(2)(G),’’ after ‘‘The Secretary shall’’. 9 (b) REGULATIONS.—Not later than 120 days after 10 the date of the enactment of this Act, the Secretary of 11 Health and Human Services shall issue final regulations 12 to carry out this section. 13 (c) CLARIFICATION REGARDING FACILITIES THAT 14 MEET DISTANCE OR OTHER CERTIFICATION CRITERIA.— 15 Nothing in this section shall affect the application of cri- 16 teria for designation as a critical access hospital described 17 in subclause (I) or (II) section 1820(c)(2)(B)(i) of the So- 18 cial Security Act (42 U.S.C. 1395i–4(c)(2)(B)(i)). 19 SEC. 3. CMI TESTING OF NEW RURAL HOSPITAL DELIVERY 20 AND PAYMENT MODEL. 21 Section 1115A of the Social Security Act (42 U.S.C. 22 1315a) is amended— 23 (1) in subsection (b)(2)(A), by adding at the 24 end the following new sentence: ‘‘The models se- 25 VerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S644.IS S644 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 644 IS lected under this subparagraph shall include the 1 testing of a new rural hospital delivery and payment 2 model (or models), as described in subsection (h).’’; 3 and 4 (2) by adding at the end the following new sub- 5 section: 6 ‘‘(h) TESTING OF NEW RURAL HOSPITAL DELIVERY 7 AND PAYMENT MODEL.— 8 ‘‘(1) IN GENERAL.— 9 ‘‘(A) TESTING.—The Secretary shall test 10 the implementation of a new rural hospital de- 11 livery and payment model (or models) that the 12 Secretary determines would promote financially 13 sustainable ways to ensure patient access to 14 care in rural communities, which may include 15 models under which such hospitals furnish out- 16 patient emergency care services 24 hours a day, 17 7 days a week for which payment is made 18 under title XVIII based on the amount deter- 19 mined under the prospective payment system 20 for hospital outpatient department services 21 under section 1833(t), plus a fixed rate for the 22 cost of furnishing the emergency services. 23 ‘‘(B) PROMULGATION OF REGULATIONS.— 24 Not later than 3 years after the date of the en- 25 VerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S644.IS S644 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 644 IS actment of this subsection, the Secretary shall 1 promulgate regulations to test a new rural hos- 2 pital delivery and payment model (or models) 3 described in subparagraph (A), unless Congress 4 enacts legislation that establishes such a pay- 5 ment model (or models) prior to the promulga- 6 tion of regulations pursuant to this subpara- 7 graph. 8 ‘‘(2) TRANSITION.—Effective beginning on the 9 date on which the testing of a new rural hospital de- 10 livery and payment model (or models) described in 11 paragraph (1)(A) is implemented under this sub- 12 section or such a payment model (or models) is es- 13 tablished through the enactment of legislation de- 14 scribed in paragraph (1)(B), the Secretary shall pro- 15 vide a process under which— 16 ‘‘(A) all critical access hospitals may tran- 17 sition to such new model or models under this 18 subsection; and 19 ‘‘(B) any facility that was designated as a 20 critical access hospital pursuant to a certifi- 21 cation by a State under section 22 1820(c)(2)(B)(i)(III) may revert to the prospec- 23 tive payment model (or models) under which 24 VerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S644.IS S644 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 644 IS the facility received payment under title XVIII 1 prior to being so designated.’’. 2 Æ VerDate Sep 11 2014 19:35 Apr 04, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\S644.IS S644 pbinns on DSKJLVW7X2PROD with BILLS