Rural Hospital Closure Relief Act of 2023

II 118TH CONGRESS 1ST SESSION S. 1571 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 MAY 11, 2023 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 2023’’. 5 VerDate Sep 11 2014 23:09 May 23, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1571.IS S1571 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •S 1571 IS SEC. 2. RESTORING STATE AUTHORITY TO WAIVE THE 35- 1 MILE RULE FOR CERTAIN MEDICARE CRIT- 2 ICAL ACCESS HOSPITAL DESIGNATIONS. 3 (a) IN GENERAL.—Section 1820 of the Social Secu- 4 rity Act (42 U.S.C. 1395i–4) is amended— 5 (1) in subsection (c)(2)— 6 (A) in subparagraph (B)(i)— 7 (i) in subclause (I), by striking ‘‘or’’ 8 at the end; 9 (ii) in subclause (II), by inserting 10 ‘‘or’’ at the end; and 11 (iii) by adding at the end the fol- 12 lowing new subclause: 13 ‘‘(III) subject to subparagraph 14 (G), is a hospital described in sub- 15 paragraph (F) and is certified on or 16 after the date of the enactment of the 17 Rural Hospital Closure Relief Act of 18 2023 by the State as being a nec- 19 essary provider of health care services 20 to residents in the area;’’; and 21 (B) by adding at the end the following new 22 subparagraphs: 23 ‘‘(F) HOSPITAL DESCRIBED.—For pur- 24 poses of subparagraph (B)(i)(III), a hospital 25 VerDate Sep 11 2014 23:09 May 23, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1571.IS S1571 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •S 1571 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 2021; 21 or 22 ‘‘(bb) in a health professional 23 shortage area (as defined in section 24 VerDate Sep 11 2014 23:09 May 23, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1571.IS S1571 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •S 1571 IS 332(a)(1)(A) of the Public Health 1 Service Act); or 2 ‘‘(II) has a percentage of inpatient 3 days of individuals entitled to benefits 4 under part A of this title, enrolled under 5 part B of this title, or enrolled under a 6 State plan under title XIX that is higher 7 than the national or statewide average in 8 2020 or 2021; 9 ‘‘(iv) subject to subparagraph 10 (G)(ii)(II), has attested to the Secretary 11 two consecutive years of negative operating 12 margins preceding the date of certification 13 described in subparagraph (B)(i)(III); and 14 ‘‘(v) submits to the Secretary— 15 ‘‘(I) at such time and in such 16 manner as the Secretary may require, 17 an attestation outlining the good gov- 18 ernance qualifications and strategic 19 plan for multi-year financial solvency 20 of the hospital; and 21 ‘‘(II) not later than 120 days 22 after the date on which the Secretary 23 issues final regulations pursuant to 24 section 2(b) of the Rural Hospital 25 VerDate Sep 11 2014 23:09 May 23, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1571.IS S1571 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •S 1571 IS Closure Relief Act of 2023, 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 23:09 May 23, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1571.IS S1571 pbinns on DSKJLVW7X2PROD with $$_JOB 6 •S 1571 IS ‘‘(II) NONAPPLICATION OF CER- 1 TAIN CRITERIA.—For purposes of 2 subparagraph (B)(i)(III), the criteria 3 described in subparagraph (F)(iv) 4 shall not apply with respect to the 5 designation of a facility described in 6 subclause (I).’’; and 7 (2) in subsection (e), by inserting ‘‘, subject to 8 subsection (c)(2)(G),’’ after ‘‘The Secretary shall’’. 9 (b) REGULATIONS.—Not later than 120 days after 10 the date of the enactment of this Act, the Secretary of 11 Health and Human Services shall issue final regulations 12 to carry out subsection (a). 13 (c) CLARIFICATION REGARDING FACILITIES THAT 14 MEET DISTANCE OR OTHER CERTIFICATION CRITERIA.— 15 Nothing in this section shall affect the application of cri- 16 teria for designation as a critical access hospital described 17 in subclause (I) or (II) section 1820(c)(2)(B)(i) of the So- 18 cial Security Act (42 U.S.C. 1395i–4(c)(2)(B)(i)). 19 (d) GAO STUDY AND REPORT.— 20 (1) STUDY.—The Comptroller General of the 21 United States (in this section referred to as the 22 ‘‘Comptroller General’’), in consultation with the Ad- 23 ministrator of the Centers for Medicare & Medicaid 24 Services, shall conduct a study on the implementa- 25 VerDate Sep 11 2014 23:09 May 23, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1571.IS S1571 pbinns on DSKJLVW7X2PROD with $$_JOB 7 •S 1571 IS tion of the amendments made by subsection (a). 1 Such study shall include an analysis of— 2 (A) the characteristics of facilities des- 3 ignated as critical access hospitals pursuant to 4 section 1820(c)(2)(B)(i)(III) of the Social Secu- 5 rity Act, as added by subsection (a); 6 (B) the financial status and outlook for 7 such facilities based on their designation as a 8 critical access hospital pursuant to such section; 9 (C) any increase in expenditures under the 10 Medicare program under title XVIII of the So- 11 cial Security Act (42 U.S.C. 1395 et seq.) as a 12 result of such designation, relative to the ex- 13 pected baseline expenditures under the Medi- 14 care program if such facilities had not received 15 such designation; and 16 (D) whether the authority to designate fa- 17 cilities as critical access hospitals pursuant to 18 such section 1820(c)(2)(B)(i)(III) should be 19 maintained as is, modified in scale or scope, or 20 sunset. 21 (2) REPORT.—Not later than 7 years after the 22 date of the enactment of this Act, the Comptroller 23 General shall submit to Congress a report containing 24 the results of the study conducted under subsection 25 VerDate Sep 11 2014 23:09 May 23, 2023 Jkt 039200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1571.IS S1571 pbinns on DSKJLVW7X2PROD with $$_JOB 8 •S 1571 IS (a), together with recommendations for such legisla- 1 tion and administrative action as the Comptroller 2 General determines appropriate. 3 (e) GUIDANCE.—Not later than 2 years after the date 4 on which the Comptroller General submits the report to 5 Congress under subsection (d)(2), the Administrator of 6 the Centers for Medicare & Medicaid Services shall estab- 7 lish a mechanism and provide guidance and technical as- 8 sistance to facilities that have been designated as a critical 9 access hospital pursuant to section 1820(c)(2)(B)(i)(III) 10 of the Social Security Act, as added by subsection (a), on 11 how such facilities may consider transitioning to a dif- 12 ferent payment model under the Medicare program. 13 Æ VerDate Sep 11 2014 23:09 May 23, 2023 Jkt 039200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\S1571.IS S1571 pbinns on DSKJLVW7X2PROD with $$_JOB