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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Hospital Closure 

5 Relief Act of 2019’’. 


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1 SEC. 2. RESTORING STATE AUTHORITY TO WAIVE THE 35- 

2 MILE RULE FOR CERTAIN MEDICARE CRIT3 ICAL ACCESS HOSPITAL DESIGNATIONS. 

4 Section 1820 of the Social Security Act (42 U.S.C. 

5 1395i–4) is amended— 

6 (1) in subsection (c)(2)— 

7 (A) in subparagraph (B)(i)— 

8 (i) in subclause (I), by striking at the 

9 end ‘‘or’’; 

10 (ii) in subclause (II), by inserting at 

11 the end ‘‘or’’; and 

12 (iii) by adding at the end the fol13 lowing new subclause: 

14 ‘‘(III) subject to subparagraph 

15 (G), is a hospital described in sub16 paragraph (F) and is certified on or 

17 after the date of the enactment of the 

18 Rural Hospital Closure Relief Act of 

19 2019 by the State as being a nec20 essary provider of health care services 

21 to residents in the area;’’; and 

22 (B) by adding at the end the following new 

23 subparagraphs: 

24 ‘‘(F) HOSPITAL DESCRIBED.—For pur25 poses of subparagraph (B)(i)(III), a hospital 


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1 described in this subparagraph is a hospital 

2 that— 

3 ‘‘(i) is a sole community hospital (as 

4 defined in section 1886(d)(5)(D)(iii)), a 

5 medicare dependent, small rural hospital 

6 (as defined in section 1886(d)(5)(G)(iv)), a 

7 low-volume hospital that in 2019 receives a 

8 payment adjustment under section 

9 1886(d)(12), or a subsection (d) hospital 

10 (as defined in section 1886(d)(1)(B)) that 

11 has fewer than 50 beds; 

12 ‘‘(ii) is located in a rural area, as de13 fined by the Secretary, based on the most 

14 recent rural urban commuting area code 

15 (or its successor criteria) as set forth by 

16 the Office of Management and Budget; 

17 ‘‘(iii) as determined by the Secretary, 

18 serves a patient population— 

19 ‘‘(I) with a high percentage, rel20 ative to the national or statewide av21 erage, of individuals with income that 

22 is below 150 percent of the poverty 

23 line; 

24 ‘‘(II) in a health professional 

25 shortage area (as defined in section 


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1 332(a)(1)(A) of the Public Health 

2 Service Act); or 

3 ‘‘(III) that represents a high pro4 portion, relative to the national or 

5 statewide average, of individuals enti6 tled to part A or enrolled under part 

7 B of this title or enrolled under a 

8 State plan under title XIX; 

9 ‘‘(iv) has demonstrated to the Sec10 retary, at such time and in such manner as 

11 the Secretary determines appropriate, two 

12 consecutive years of financial losses pre13 ceding the date of certification described in 

14 subparagraph (B)(i)(III); and 

15 ‘‘(v) submits to the Secretary, at such 

16 time and in such manner as the Secretary 

17 may require, an attestation that the Sec18 retary determines to be satisfactory, out19 lining the good governance qualifications 

20 and strategic plan for multi-year financial 

21 solvency of the hospital. 

22 ‘‘(G) LIMITATION ON CERTAIN DESIGNA23 TIONS.— 

24 ‘‘(i) IN GENERAL.—The Secretary 

25 may not under subsection (e) certify purVerDate Sep 11 2014 22:15 Dec 30, 2019 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5481.IH H5481

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1 suant to a certification by a State under 

2 subsection (c)(2)(B)(i)(III)— 

3 ‘‘(I) more than a total of 200 fa4 cilities as critical access hospitals; and 

5 ‘‘(II) subject to clause (ii), within 

6 any one State, more than 15 facilities 

7 as critical access hospitals. 

8 ‘‘(ii) STATE PETITION.—The Sec9 retary may apply, with respect to a State, 

10 the limitation under clause (i)(II) by sub11 stituting a number that is greater than the 

12 number specified in such clause if the 

13 State petitions the Secretary, in accord14 ance with a process established by the Sec15 retary, to increase such number.’’; and 

16 (2) in subsection (e), by inserting ‘‘, subject to 

17 subsection (c)(2)(G),’’ after ‘‘The Secretary shall’’. 

Æ 


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