II 

117TH CONGRESS 

1ST SESSION S. 934 

To amend title XVIII of the Social Security Act to improve rural health 

clinic payments. 

IN THE SENATE OF THE UNITED STATES 

MARCH 23, 2021 

Mr. WARNER (for himself and Mr. BLUNT) 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 improve 

rural health clinic payments. 

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 ‘‘Strengthening Rural 

5 Health Clinics Act of 2021’’. 

6 SEC. 2. RURAL HEALTH CLINIC PAYMENTS. 

7 (a) IN GENERAL.—Section 1833(f)(3) of the Social 

8 Security Act (42 U.S.C. 1395l(f)(3)) is amended— 

9 (1) in subparagraph (A)— 


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

2 inserting ‘‘(or, in the case of a rural health clin3 ic described in subparagraph (B)(ii)(III), in the 

4 first year in which the rural health clinic fur5 nishes such services)’’ after ‘‘March 31’’; 

6 (B) in clause (i), by striking subclauses (I) 

7 and (II) and inserting the following: 

8 ‘‘(I) with respect to a rural 

9 health clinic that had a per visit pay10 ment amount established for services 

11 furnished in 2020— 

12 ‘‘(aa) the per visit payment 

13 amount applicable to such rural 

14 health clinic for rural health clin15 ic services furnished in 2020, in16 creased by the percentage in17 crease in the MEI applicable to 

18 primary care services furnished 

19 as of the first day of 2021; or 

20 ‘‘(bb) the limit described in 

21 paragraph (2)(A); and 

22 ‘‘(II) with respect to a rural 

23 health clinic that did not have a per 

24 visit payment amount established for 

25 services furnished in 2020— 


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1 ‘‘(aa) the per visit payment 

2 amount applicable to such rural 

3 health clinic for rural health clin4 ic services furnished in 2021 (or, 

5 in the case of a rural health clin6 ic described in subparagraph 

7 (B)(ii)(III), the per visit payment 

8 amount applicable to such rural 

9 health clinic for rural health clin10 ic services furnished in the first 

11 year in which such rural health 

12 clinic furnishes such services); or 

13 ‘‘(bb) the limit described in 

14 paragraph (2)(A) (or, in the case 

15 of a rural health clinic described 

16 in subparagraph (B)(ii)(III), the 

17 limit established under paragraph 

18 (2) for such first year);’’; and 

19 (C) in clause (ii)(I), by striking ‘‘under 

20 clause (i)(I)’’ and inserting ‘‘under subclause 

21 (I) or (II) of clause (i), as applicable,’’; 

22 (2) in subparagraph (B)— 

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

24 striking ‘‘2019, was’’ and inserting ‘‘2020’’; 

25 (B) in clause (i)— 


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1 (i) by inserting ‘‘was’’ after ‘‘(i)’’; and 

2 (ii) by inserting the following before 

3 the semicolon: ‘‘, or, in the case of a rural 

4 health clinic described in clause (ii)(III), 

5 had an agreement described in such clause 

6 with such a hospital’’; 

7 (C) by striking clause (ii) and inserting the 

8 following: 

9 ‘‘(ii)(I) was enrolled under section 

10 1866(j) (including temporary enrollment 

11 during the emergency period described in 

12 section 1135(g)(1)(B) for such period); 

13 ‘‘(II) submitted an application for en14 rollment under section 1866(j) (or re15 quested such a temporary enrollment for 

16 such period) that was received not later 

17 than December 31, 2020; or 

18 ‘‘(III) as determined by the Secretary, 

19 had a binding written agreement with an 

20 outside unrelated party for the construc21 tion, purchase, lease, or other establish22 ment of such a rural health clinic as of 

23 that date.’’; and 

24 (3) by adding at the end the following new sub25 paragraph: 


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1 ‘‘(C)(i) In determining whether a provider-based 

2 rural health clinic had an agreement described in subpara3 graph (B)(ii)(III) as of December 31, 2020, the Secretary 

4 may consider appropriate evidence relating to the agree5 ment submitted by the provider. 

6 ‘‘(ii) Not later than 60 days after the date of the en7 actment of this subparagraph, the Secretary shall obtain 

8 an attestation (pursuant to section 413.65(b)(3) of title 

9 42, Code of Federal Regulations, or any successor regula10 tion) that such provider-based rural health clinic meets, 

11 or will meet, the requirements of a provider-based rural 

12 health clinic specified in section 413.65 of title 42, Code 

13 of Federal Regulations, or any successor regulation. 

14 ‘‘(iii) The Secretary may audit, as appropriate, the 

15 compliance with subparagraph (B)(ii)(III) with respect to 

16 each provider-based rural health clinic to which such sub17 paragraph applies. If the Secretary finds as a result of 

18 an audit under this clause that the applicable require19 ments were not met with respect to such provider-based 

20 rural health clinic, the provider-based rural health clinic 

21 shall no longer be considered to be described in such sub22 paragraph for purposes of this paragraph.’’. 

23 (b) EFFECTIVE DATE.—The amendments made by 

24 this section shall take effect as if included in the enactVerDate Sep 11 2014 04:42 Apr 14, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S934.IS S934

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1 ment of the Consolidated Appropriations Act, 2021 (Pub2 lic Law 116–260). 

Æ 


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