Rural Hospital Closure Relief Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 5481 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. IN THE HOUSE OF REPRESENTATIVES DECEMBER 18, 2019 Mr. KINZINGER (for himself, Mr. LOEBSACK, and Mr. PANETTA) introduced the following bill; which was referred to the Committee on Ways and Means 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. 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 2019’’. 5 VerDate Sep 11 2014 22:15 Dec 30, 2019 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H5481.IH H5481 lotter on DSKBCFDHB2PROD with BILLS 2 •HR 5481 IH SEC. 2. RESTORING STATE AUTHORITY TO WAIVE THE 35- 1 MILE RULE FOR CERTAIN MEDICARE CRIT- 2 ICAL ACCESS HOSPITAL DESIGNATIONS. 3 Section 1820 of the Social Security Act (42 U.S.C. 4 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 2019 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 22:15 Dec 30, 2019 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5481.IH H5481 lotter on DSKBCFDHB2PROD with BILLS 3 •HR 5481 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 2019 receives a 7 payment adjustment under section 8 1886(d)(12), or a subsection (d) hospital 9 (as defined in section 1886(d)(1)(B)) that 10 has fewer than 50 beds; 11 ‘‘(ii) is located in a rural area, as de- 12 fined by the Secretary, based on the most 13 recent rural urban commuting area code 14 (or its successor criteria) as set forth by 15 the Office of Management and Budget; 16 ‘‘(iii) as determined by the Secretary, 17 serves a patient population— 18 ‘‘(I) with a high percentage, rel- 19 ative to the national or statewide av- 20 erage, of individuals with income that 21 is below 150 percent of the poverty 22 line; 23 ‘‘(II) in a health professional 24 shortage area (as defined in section 25 VerDate Sep 11 2014 22:15 Dec 30, 2019 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H5481.IH H5481 lotter on DSKBCFDHB2PROD with BILLS 4 •HR 5481 IH 332(a)(1)(A) of the Public Health 1 Service Act); or 2 ‘‘(III) that represents a high pro- 3 portion, relative to the national or 4 statewide average, of individuals enti- 5 tled to part A or enrolled under part 6 B of this title or enrolled under a 7 State plan under title XIX; 8 ‘‘(iv) has demonstrated to the Sec- 9 retary, at such time and in such manner as 10 the Secretary determines appropriate, two 11 consecutive years of financial losses pre- 12 ceding the date of certification described in 13 subparagraph (B)(i)(III); and 14 ‘‘(v) submits to the Secretary, at such 15 time and in such manner as the Secretary 16 may require, an attestation that the Sec- 17 retary determines to be satisfactory, out- 18 lining the good governance qualifications 19 and strategic plan for multi-year financial 20 solvency of the hospital. 21 ‘‘(G) LIMITATION ON CERTAIN DESIGNA- 22 TIONS.— 23 ‘‘(i) IN GENERAL.—The Secretary 24 may not under subsection (e) certify pur- 25 VerDate Sep 11 2014 22:15 Dec 30, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5481.IH H5481 lotter on DSKBCFDHB2PROD with BILLS 5 •HR 5481 IH suant to a certification by a State under 1 subsection (c)(2)(B)(i)(III)— 2 ‘‘(I) more than a total of 200 fa- 3 cilities as critical access hospitals; and 4 ‘‘(II) subject to clause (ii), within 5 any one State, more than 15 facilities 6 as critical access hospitals. 7 ‘‘(ii) STATE PETITION.—The Sec- 8 retary may apply, with respect to a State, 9 the limitation under clause (i)(II) by sub- 10 stituting a number that is greater than the 11 number specified in such clause if the 12 State petitions the Secretary, in accord- 13 ance with a process established by the Sec- 14 retary, to increase such number.’’; and 15 (2) in subsection (e), by inserting ‘‘, subject to 16 subsection (c)(2)(G),’’ after ‘‘The Secretary shall’’. 17 Æ VerDate Sep 11 2014 22:15 Dec 30, 2019 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H5481.IH H5481 lotter on DSKBCFDHB2PROD with BILLS