ARC Act

To provide relief for small rural hospitals from inaccurate instructions provided by certain medicare administrative contractors. 1. Short title This Act may be cited as the Access for Rural Communities Act ARC Act 2. Relief for small rural hospitals from inaccurate instructions provided by certain medicare administrative contractors (a) Application of revised volume decrease adjustment methodology Subject to subsection (b), in the case of a sole community hospital or a medicare-dependent, small rural hospital with respect to which a medicare administrative contractor determined a volume decrease adjustment applies for any specified cost reporting period, at the election of the hospital, the Secretary of Health and Human Services shall recalculate the amount of the volume decrease adjustment determined by the medicare administrative contractor for such hospital and specified cost reporting period using the revised volume decrease adjustment payment methodology for any specified cost reporting period requested by the hospital in its election. (b) Limitation (1) In general Subsection (a) shall not apply in the case of a sole community hospital or a medicare-dependent, small rural hospital for which the medicare administrative contractor determination of the volume decrease adjustment with respect to a specified cost reporting period of the hospital is administratively final before the date that is three years before the date of the enactment of this section. (2) Administrative finality For purposes of paragraph (1), the date on which the medicare administrative contractor determination with respect to a volume decrease adjustment for a specified cost reporting period is administratively final is the latest of the following: (A) The date of the contractor determination (as defined in section 405.1801 of title 42, Code of Federal Regulations). (B) The date of the final outcome of any reopening of the medicare administrative contractor determination under section 405.1885 of title 42, Code of Federal Regulations. (C) The date of the final outcome of the final appeal filed by such hospital with respect to such volume decrease adjustment for such specified cost reporting period. (c) Definitions In this section: (1) Medicare administrative contractor The term medicare administrative contractor 42 U.S.C. 1395kk–1 (2) Medicare-dependent, small rural hospital The term medicare-dependent, small rural hospital 42 U.S.C. 1395ww(d)(5)(G)(iv) (3) Revised volume decrease adjustment payment methodology The term revised volume decrease adjustment payment methodology (4) Sole community hospital The term sole community hospital 42 U.S.C. 1395ww(d)(5)(D)(iii) (5) Specified cost reporting period The term specified cost reporting period (6) Volume decrease adjustment The term volume decrease adjustment 42 U.S.C. 1395ww(d)(5)

Summary: Access for Rural Communities Act or the ARC Act This bill allows sole community hospitals and Medicare-dependent small rural hospitals to have the Centers for Medicare &amp; Medicaid Services (CMS) recalculate certain payment adjustments that were initially determined by Medicare administrative contractors. Specifically, if a hospital received a volume decrease adjustment from an administrative contractor prior to FY2018, the hospital may elect to have the CMS recalculate the adjustment using methodology that took effect in FY2018, as specified. The bill's provisions do not apply to final determinations made by administrative contractors more than three years before the date of enactment of this bill.