I 

118TH CONGRESS 

1ST SESSION H. R. 6430 

To amend title XVIII of the Social Security Act to extend Medicare-dependent 

hospital and Medicare low-volume hospital payments, and to direct the 

Comptroller General of the United States to carry out a report on 

Medicare rural hospital classifications. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 15, 2023 

Mrs. MILLER of West Virginia (for herself and Ms. SEWELL) 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 extend 

Medicare-dependent hospital and Medicare low-volume 

hospital payments, and to direct the Comptroller General 

of the United States to carry out a report on Medicare 

rural hospital classifications. 

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 ‘‘Assistance for Rural 

5 Community Hospitals Act’’ or the ‘‘ARCH Act’’. 


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1 SEC. 2. EXTENDING MEDICARE-DEPENDENT HOSPITAL AND 

2 MEDICARE LOW-VOLUME HOSPITAL PAY3 MENTS. 

4 (a) MDH EXTENSION.— 

5 (1) EXTENSION OF PAYMENT METHODOLOGY.— 

6 Section 1886(d)(5)(G) of the Social Security Act (42 

7 U.S.C. 1395ww(d)(5)(G)) is amended— 

8 (A) in clause (i), by striking ‘‘October 1, 

9 2024’’ and inserting ‘‘October 1, 2029’’; and 

10 (B) in clause (ii)(II), by striking ‘‘October 

11 1, 2024’’ and inserting ‘‘October 1, 2029’’. 

12 (2) CONFORMING AMENDMENTS.— 

13 (A) EXTENSION OF TARGET AMOUNT.— 

14 Section 1886(b)(3)(D) of the Social Security 

15 Act (42 U.S.C. 1395ww(b)(3)(D)) is amend16 ed— 

17 (i) in the matter preceding clause (i), 

18 by striking ‘‘October 1, 2024’’ and insert19 ing ‘‘October 1, 2029’’ ; and 

20 (ii) in clause (iv), by striking ‘‘fiscal 

21 year 2024’’ and inserting ‘‘fiscal year 

22 2029,’’. 

23 (B) PERMITTING HOSPITALS TO DECLINE

24 RECLASSIFICATION.—Section 13501(e)(2) of 

25 the Omnibus Budget Reconciliation Act of 1993 

26 (42 U.S.C. 1395ww note) is amended by strikVerDate Sep 11 2014 22:04 Nov 27, 2023 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6430.IH H6430

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1 ing ‘‘fiscal year 2024’’ and inserting ‘‘fiscal 

2 year 2029,’’. 

3 (b) LVH EXTENSION.—Section 1886(d)(12) of the 

4 Social Security Act (42 U.S.C. 1395ww(d)(12)) is amend5 ed— 

6 (1) in subparagraph (C)(i)— 

7 (A) in the matter preceding subclause (I), 

8 by striking ‘‘through 2024’’ and inserting 

9 ‘‘through 2029’’; 

10 (B) in subclause (III), by striking 

11 ‘‘through 2024’’ and inserting ‘‘through 2029’’; 

12 and 

13 (C) in subclause (IV), by striking ‘‘2025’’ 

14 and inserting ‘‘2030’’; and 

15 (2) in subparagraph (D)— 

16 (A) in the matter preceding clause (i), by 

17 striking ‘‘through 2024’’ and inserting 

18 ‘‘through 2029’’; and 

19 (B) in clause (ii), by striking ‘‘through 

20 2024’’ and inserting ‘‘through 2029’’. 

21 SEC. 3. GAO REPORT ON MEDICARE RURAL HOSPITAL 

22 CLASSIFICATIONS. 

23 Not later than 180 days after the date of the enact24 ment of this Act, the Comptroller General of the United 

25 States shall submit to Congress a report on Medicare rural 


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1 hospital classifications that includes the following informa2 tion: 

3 (1) The total number of hospitals that, with re4 spect to any of the 5 fiscal years preceding such 

5 date of enactment, had any of the following classi6 fications: 

7 (A) Classification as a critical access hos8 pital (as defined in section 1861(mm)(1) of the 

9 Social Security Act (42 U.S.C. 

10 1395x(mm)(1))). 

11 (B) Classification as a rural emergency 

12 hospital (as defined in section 1861(kkk)(2) of 

13 such Act (42 U.S.C. 1395x(kkk)(2))). 

14 (C) Classification as a rural referral center 

15 (as described in section 1886(d)(5)(C) of such 

16 Act (42 U.S.C. 1395ww(d)(5)(C)). 

17 (D) Classification as a sole community 

18 hospital (as defined in section 

19 1886(d)(5)(D)(iii) of such Act (42 U.S.C. 

20 1395ww(d)(5)(D)(iii))). 

21 (E) Classification as a medicare-dependent, 

22 small rural hospital (as defined in section 

23 1886(d)(5)(G)(iv) of such Act (42 U.S.C. 

24 1395ww(d)(5)(G)(iv))). 


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1 (F) Classification as a low-volume hospital 

2 (as defined in section 1886(d)(12)(C)(i) of such 

3 Act (42 U.S.C. 1395ww(d)(12)(C)(i))). 

4 (2) An analysis of the extent to which there is 

5 overlap between the criteria for any two or more of 

6 the classifications described in paragraph (1). 

7 (3) Recommendations for— 

8 (A) simplification with respect to such 

9 classifications and any such overlap; and 

10 (B) changes with respect to the criteria for 

11 such classifications that would promote finan12 cial sustainability for rural hospitals and im13 prove access to health care for individuals in 

14 rural areas. 

15 (4) The projected effects of allowing sole com16 munity hospitals (as described in paragraph (1)(D)) 

17 and medicare-dependent, small rural hospitals (as 

18 described in paragraph (1)(E)) to use a cost report19 ing period beginning during fiscal year 2019 for the 

20 purpose of calculating adjusted payments under sec21 tion 1886(d)(5) of the Social Security Act (42 

22 U.S.C. 1395ww(d)(5)). 

Æ 


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