I 

117TH CONGRESS 

1ST SESSION H. R. 1639 

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 HOUSE OF REPRESENTATIVES 

MARCH 8, 2021 

Mr. KINZINGER (for himself and Mr. PANETTA) introduced the following bill; 

which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of 

such provisions as fall within the jurisdiction of the committee concerned 

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. 

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 2021’’. 


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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 (a) IN GENERAL.—Section 1820 of the Social Secu5 rity Act (42 U.S.C. 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 2021 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 2021 receives a 

8 payment adjustment under section 

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

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

11 fewer than 50 beds, or, subject to the limi12 tation under subparagraph (G)(i)(I), is a 

13 facility described in subparagraph (G)(ii); 

14 ‘‘(ii) is located in a rural area, as de15 fined in section 1886(d)(2)(D); 

16 ‘‘(iii)(I) is located— 

17 ‘‘(aa) in a county that has a per18 centage of individuals with income 

19 that is below 150 percent of the pov20 erty line that is higher than the na21 tional or statewide average in 2020; 

22 ‘‘(bb) in a health professional 

23 shortage area (as defined in section 

24 332(a)(1)(A) of the Public Health 

25 Service Act); or 


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1 ‘‘(II) has a percentage of inpatient 

2 days of individuals entitled to benefits 

3 under part A of this title, enrolled under 

4 part B of this title, or enrolled under a 

5 State plan under title XIX that is higher 

6 than the national or statewide average in 

7 2019 or 2020; 

8 ‘‘(iv) subject to subparagraph 

9 (G)(ii)(II), has attested to the Secretary 

10 two consecutive years of negative operating 

11 margins preceding the date of certification 

12 described in subparagraph (B)(i)(III); and 

13 ‘‘(v) submits to the Secretary— 

14 ‘‘(I) at such time and in such 

15 manner as the Secretary may require, 

16 an attestation outlining the good gov17 ernance qualifications and strategic 

18 plan for multi-year financial solvency 

19 of the hospital; and 

20 ‘‘(II) not later than 120 days 

21 after the date on which the Secretary 

22 issues final regulations pursuant to 

23 section 2(b) of the Rural Hospital 

24 Closure Relief Act of 2021, an appliVerDate Sep 11 2014 05:20 Apr 30, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1639.IH H1639

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1 cation for certification of the facility 

2 as a critical access hospital. 

3 ‘‘(G) LIMITATION ON CERTAIN DESIGNA4 TIONS.— 

5 ‘‘(i) IN GENERAL.—The Secretary 

6 may not under subsection (e) certify pur7 suant to a certification by a State under 

8 subparagraph (B)(i)(III)— 

9 ‘‘(I) more than a total of 175 fa10 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 de19 scribed in this clause is a facility that 

20 as of the date of enactment of this 

21 subparagraph met the criteria for des22 ignation as a critical access hospital 

23 under subparagraph (B)(i)(I). 

24 ‘‘(II) NONAPPLICATION OF CER25 TAIN CRITERIA.—For purposes of 


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1 subparagraph (B)(i)(III), the criteria 

2 described in subparagraph (F)(iv) 

3 shall not apply with respect to the 

4 designation of a facility described in 

5 subclause (I).’’; and 

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

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

8 (b) REGULATIONS.—Not later than 120 days after 

9 the date of the enactment of this Act, the Secretary of 

10 Health and Human Services shall issue final regulations 

11 to carry out this section. 

12 (c) CLARIFICATION REGARDING FACILITIES THAT

13 MEET DISTANCE OR OTHER CERTIFICATION CRITERIA.— 

14 Nothing in this section shall affect the application of cri15 teria for designation as a critical access hospital described 

16 in subclause (I) or (II) of section 1820(c)(2)(B)(i) of the 

17 Social Security Act (42 U.S.C. 1395i–4(c)(2)(B)(i)). 

18 SEC. 3. CMI TESTING OF NEW RURAL HOSPITAL DELIVERY 

19 AND PAYMENT MODEL. 

20 Section 1115A of the Social Security Act (42 U.S.C. 

21 1315a) is amended— 

22 (1) in subsection (b)(2)(A), by adding at the 

23 end the following new sentence: ‘‘The models se24 lected under this subparagraph shall include the 

25 testing of a new rural hospital delivery and payment 


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1 model (or models), as described in subsection (h).’’; 

2 and 

3 (2) by adding at the end the following new sub4 section: 

5 ‘‘(h) TESTING OF NEW RURAL HOSPITAL DELIVERY

6 AND PAYMENT MODEL.— 

7 ‘‘(1) IN GENERAL.— 

8 ‘‘(A) TESTING.—The Secretary shall test 

9 the implementation of a new rural hospital de10 livery and payment model (or models) that the 

11 Secretary determines would promote financially 

12 sustainable ways to ensure patient access to 

13 care in rural communities, which may include 

14 models under which such hospitals furnish out15 patient emergency care services 24 hours a day, 

16 7 days a week for which payment is made 

17 under title XVIII based on the amount deter18 mined under the prospective payment system 

19 for hospital outpatient department services 

20 under section 1833(t), plus a fixed rate for the 

21 cost of furnishing the emergency services. 

22 ‘‘(B) PROMULGATION OF REGULATIONS.— 

23 Not later than 3 years after the date of the en24 actment of this subsection, the Secretary shall 

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1 pital delivery and payment model (or models) 

2 described in subparagraph (A), unless Congress 

3 enacts legislation that establishes such a pay4 ment model (or models) prior to the promulga5 tion of regulations pursuant to this subpara6 graph. 

7 ‘‘(2) TRANSITION.—Effective beginning on the 

8 date on which the testing of a new rural hospital de9 livery and payment model (or models) described in 

10 paragraph (1)(A) is implemented under this sub11 section or such a payment model (or models) is es12 tablished through the enactment of legislation de13 scribed in paragraph (1)(B), the Secretary shall pro14 vide a process under which— 

15 ‘‘(A) all critical access hospitals may tran16 sition to such new model or models under this 

17 subsection; and 

18 ‘‘(B) any facility that was designated as a 

19 critical access hospital pursuant to a certifi20 cation by a State under section 

21 1820(c)(2)(B)(i)(III) may revert to the prospec22 tive payment model (or models) under which 

23 the facility received payment under title XVIII 

24 prior to being so designated.’’. 

Æ 


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