I 

117TH CONGRESS 

1ST SESSION H. R. 3069 

To provide relief for small rural hospitals from inaccurate instructions 

provided by certain medicare administrative contractors. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 7, 2021 

Ms. TENNEY (for herself, Mr. REED, Ms. STEFANIK, Mr. DELGADO, and Mr. 

KATKO) introduced the following bill; which was referred to the Committee on Ways and Means 

A BILL 

To provide relief for small rural hospitals from inaccurate 

instructions provided by certain medicare administrative 

contractors. 

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 ‘‘Access for Rural Com5 munities Act’’ or the ‘‘ARC Act’’. 


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1 SEC. 2. RELIEF FOR SMALL RURAL HOSPITALS FROM INAC2 CURATE INSTRUCTIONS PROVIDED BY CER3 TAIN MEDICARE ADMINISTRATIVE CONTRAC4 TORS. 

5 (a) APPLICATION OF REVISED VOLUME DECREASE

6 ADJUSTMENT METHODOLOGY.—Subject to subsection (b), 

7 in the case of a sole community hospital or a medicare8 dependent, small rural hospital with respect to which a 

9 medicare administrative contractor determined a volume 

10 decrease adjustment applies for any specified cost report11 ing period, at the election of the hospital, the Secretary 

12 of Health and Human Services shall recalculate the 

13 amount of the volume decrease adjustment determined by 

14 the medicare administrative contractor for such hospital 

15 and specified cost reporting period using the revised vol16 ume decrease adjustment payment methodology for any 

17 specified cost reporting period requested by the hospital 

18 in its election. 

19 (b) LIMITATION.— 

20 (1) IN GENERAL.—Subsection (a) shall not 

21 apply in the case of a sole community hospital or a 

22 medicare-dependent, small rural hospital for which 

23 the medicare administrative contractor determina24 tion of the volume decrease adjustment with respect 

25 to a specified cost reporting period of the hospital is 

26 administratively final before the date that is three 


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1 years before the date of the enactment of this sec2 tion. 

3 (2) ADMINISTRATIVE FINALITY.—For purposes 

4 of paragraph (1), the date on which the medicare 

5 administrative contractor determination with respect 

6 to a volume decrease adjustment for a specified cost 

7 reporting period is administratively final is the latest 

8 of the following: 

9 (A) The date of the contractor determina10 tion (as defined in section 405.1801 of title 42, 

11 Code of Federal Regulations). 

12 (B) The date of the final outcome of any 

13 reopening of the medicare administrative con14 tractor determination under section 405.1885 

15 of title 42, Code of Federal Regulations. 

16 (C) The date of the final outcome of the 

17 final appeal filed by such hospital with respect 

18 to such volume decrease adjustment for such 

19 specified cost reporting period. 

20 (c) DEFINITIONS.—In this section: 

21 (1) MEDICARE ADMINISTRATIVE CON22 TRACTOR.—The term ‘‘medicare administrative con23 tractor’’ means the entity that has entered into a 

24 contract with the Secretary of Health and Human 

25 Services under section 1874A of the Social Security 


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1 Act (42 U.S.C. 1395kk–1) to service A/B Medicare 

2 Administrative Contractor Jurisdiction K of the 

3 Centers for Medicare & Medicaid Services as of July 

4 1, 2016. 

5 (2) MEDICARE-DEPENDENT, SMALL RURAL

6 HOSPITAL.—The term ‘‘medicare-dependent, small 

7 rural hospital’’ has the meaning given such term 

8 under section 1886(d)(5)(G)(iv) of the Social Secu9 rity Act (42 U.S.C. 1395ww(d)(5)(G)(iv)). 

10 (3) REVISED VOLUME DECREASE ADJUSTMENT

11 PAYMENT METHODOLOGY.—The term ‘‘revised vol12 ume decrease adjustment payment methodology’’ 

13 means the methodology to calculate the volume de14 crease adjustment that is described in the second 

15 sentence of section 412.92(e)(3) of title 42, Code of 

16 Federal Regulations (relating to the methodology to 

17 calculate the volume decrease adjustment for sole 

18 community hospitals (and, pursuant to section 

19 412.108(d)(3) of such title 42, for medicare-depend20 ent, small rural hospitals) that is effective for cost 

21 reporting periods beginning on or after October 1, 

22 2017). 

23 (4) SOLE COMMUNITY HOSPITAL.—The term 

24 ‘‘sole community hospital’’ has the meaning given 

25 such term under section 1886(d)(5)(D)(iii) of the 


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

2 1395ww(d)(5)(D)(iii)). 

3 (5) SPECIFIED COST REPORTING PERIOD.—The 

4 term ‘‘specified cost reporting period’’ means a cost 

5 reporting period of a sole community hospital or a 

6 medicare-dependent, small rural hospital, as the case 

7 may be, that begins during a fiscal year before fiscal 

8 year 2018. 

9 (6) VOLUME DECREASE ADJUSTMENT.—The 

10 term ‘‘volume decrease adjustment’’ means the ad11 justment required with respect to a sole community 

12 hospital or a medicare-dependent, small rural hos13 pital, as the case may be, under subparagraph 

14 (D)(ii) or subparagraph (G)(iii), respectively, of sec15 tion 1886(d)(5) of the Social Security Act (42 

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

Æ 


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