II 

118TH CONGRESS 

2D SESSION S. 4322 

To amend title XVIII of the Social Security Act to make improvements 

relating to the designation of rural emergency hospitals. 

IN THE SENATE OF THE UNITED STATES 

MAY 14, 2024 

Mr. MORAN (for himself and Ms. SMITH) 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 make 

improvements relating to the designation of rural emergency hospitals. 

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 Emergency Hos5 pital Designation Improvement Act’’. 

6 SEC. 2. ELIGIBILITY CHANGES. 

7 (a) IN GENERAL.—Section 1861(kkk)(3) of the So8 cial Security Act (42 U.S.C. 1395x(kkk)(3)) is amended, 

9 in the matter preceding subparagraph (A), by striking ‘‘as 


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1 of’’ and inserting ‘‘at any point during the period begin2 ning on January 1, 2015, and ending on’’. 

3 (b) WAIVER OF CERTAIN REQUIREMENTS.—Section 

4 1861(kkk)(3) of the Social Security (42 U.S.C. 

5 1395x(kkk)(3), as amended by subsection (a), is amend6 ed— 

7 (1) by redesignating subparagraphs (A) and 

8 (B) as clauses (i) and (ii), respectively; 

9 (2) by striking ‘‘DESCRIBED.—A facility’’ and 

10 inserting ‘‘DESCRIBED.— 

11 ‘‘(A) IN GENERAL.—Subject to subpara12 graph (B), a facility’’; and 

13 (3) by adding at the end the following new sub14 paragraph: 

15 ‘‘(B) WAIVER.—Not later than one year 

16 after the date of enactment of this subpara17 graph, the Secretary shall promulgate regula18 tions to waive subparagraph (A) with respect to 

19 facilities that operate similarly to a rural emer20 gency hospital in order for such facilities to be 

21 eligible for conversion to a rural emergency hos22 pital under this subsection.’’. 

23 SEC. 3. DISTINCT PART UNITS. 

24 Section 1861(kkk)(6) of the Social Security Act (42 

25 U.S.C. 1395x(kkk)(6)) is amended— 


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1 (1) in subparagraph (A), by striking ‘‘and’’ at 

2 the end; 

3 (2) in subparagraph (B), by striking the period 

4 at the end and inserting a semicolon; and 

5 (3) by adding at the end the following new sub6 paragraphs: 

7 ‘‘(C) maintain or include a unit of the fa8 cility that is a distinct part licensed as an inpa9 tient psychiatric unit for behavioral health pa10 tients and allows for inpatient care; 

11 ‘‘(D) maintain or include a unit of the fa12 cility that is a distinct part licensed as an inpa13 tient rehabilitation facility and allows for inpa14 tient care; and 

15 ‘‘(E) maintain or include a unit of the fa16 cility that is a distinct part unit licensed as an 

17 obstetric wing, labor and delivery unit, or ob18 stetric emergency department.’’. 

19 SEC. 4. ADD-ON PAYMENT FOR DIAGNOSTIC LABORATORY 

20 TESTS. 

21 Section 1834(x)(1) of the Social Security Act (42 

22 U.S.C. 1395m(x)(1)) is amended— 

23 (1) by striking ‘‘HOSPITALS.—’’ and all that 

24 follows through ‘‘In the case’’ and inserting ‘‘HOS25 PITALS.— 


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1 ‘‘(1) IN GENERAL.— 

2 ‘‘(A) PAYMENT FOR RURAL EMERGENCY

3 HOSPITAL SERVICES.—In the case’’; and 

4 (2) by adding at the end the following new sub5 paragraph: 

6 ‘‘(B) PAYMENT FOR DIAGNOSTIC LABORA7 TORY TESTS.—In the case of clinical diagnostic 

8 laboratory tests and other diagnostic laboratory 

9 tests that are not covered OPD services (as de10 fined in section 1833(t)(1)(B)) furnished by a 

11 rural emergency hospital (as defined in section 

12 1861(kkk)(2)) on or after January 1, 2025, the 

13 amount of payment for such tests shall be equal 

14 to the amount of payment that would otherwise 

15 apply under the applicable fee schedule, in16 creased by 5 percent to reflect the higher costs 

17 incurred by such hospitals, and shall include the 

18 application of any copayment amount deter19 mined under this part as if such increase had 

20 not occurred’’. 

21 SEC. 5. SWING BEDS. 

22 Section 1861(kkk)(6) of the Social Security Act (42 

23 U.S.C. 1395x(kkk)(6)), as amended by section 3, is 

24 amended— 


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1 (1) in subparagraph (B), by striking ‘‘and’’ at 

2 the end; 

3 (2) in subparagraph (C), by striking the period 

4 at the end and inserting ‘‘; and’’; and 

5 (3) by adding at the end the following new sub6 paragraph: 

7 ‘‘(D) may enter into an agreement de8 scribed in section 1883.’’. 

9 SEC. 6. NECESSARY PROVIDER STATUS FOR FACILITIES 

10 THAT REVERT TO CRITICAL ACCESS HOS11 PITAL DESIGNATION. 

12 Not later than one year after the date of the enact13 ment of this Act, the Secretary of Health and Human 

14 Services shall promulgate regulations to permit a rural 

15 emergency hospital (as defined in section 1861(kkk)(2) of 

16 the Social Security Act (42 U.S.C. 1395x(kkk)(2))) that 

17 reverts back to its previous designation as a critical access 

18 hospital (as defined in section 1861(mm)(1) of such Act 

19 (42 U.S.C. 1395x(m))) to regain its status as a necessary 

20 provider of health care services pursuant to section 

21 1820(c)(2)(B)(i)(II) of such Act (42 U.S.C. 1395i– 

22 4(c)(2)(B)(i)(II)), but only if the facility was designated 

23 as a necessary provider of health care services pursuant 

24 to such section prior to converting to a rural emergency 

25 hospital. 


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1 SEC. 7. NATIONAL HEALTH SERVICE CORPS SITE ELIGI2 BILITY. 

3 The Secretary of Health and Human Services, acting 

4 through the Administrator of the Health Resources and 

5 Services Administration, shall promulgate regulations to 

6 deem a rural emergency hospital (as defined in section 

7 1861(kkk)(2) of the Social Security Act (42 U.S.C. 

8 1395x(kkk)(2))) to be a health professional shortage area 

9 in accordance with section 332(a)(1)(C) of the Public 

10 Health Service Act (42 U.S.C. 254e(a)(1)(C)). 

11 SEC. 8. SMALL RURAL HOSPITAL IMPROVEMENT PROGRAM 

12 GRANTS. 

13 Section 1820(g) of the Social Security Act (42 U.S.C. 

14 42 U.S.C. 1395i–4(g)) is amended— 

15 (1) in paragraph (1)(D), by inserting ‘‘or rural 

16 emergency hospitals (as defined in section 

17 1861(kkk)(2))’’ after ‘‘critical access hospitals’’; and 

18 (2) in paragraph (3)(A), by inserting ‘‘or rural 

19 emergency hospitals (as defined in section 

20 1861(kkk)(2))’’ after ‘‘small rural hospitals’’. 

Æ 


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