I 
116TH CONGRESS 
1ST SESSION H. R. 5481 
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. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 18, 2019 
Mr. KINZINGER (for himself, Mr. LOEBSACK, and Mr. PANETTA) 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 restore 
State authority to waive for certain facilities the 35- 
mile rule for designating critical access hospitals under 
the Medicare program. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Rural Hospital Closure 
Relief Act of 2019’’. 
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SEC. 2. RESTORING STATE AUTHORITY TO WAIVE THE 35- 
MILE RULE FOR CERTAIN MEDICARE CRIT-
ICAL ACCESS HOSPITAL DESIGNATIONS. 
Section 1820 of the Social Security Act (42 U.S.C. 
1395i–4) is amended— 
(1) in subsection (c)(2)— 
(A) in subparagraph (B)(i)— 
(i) in subclause (I), by striking at the 
end ‘‘or’’; 
(ii) in subclause (II), by inserting at 
the end ‘‘or’’; and 
(iii) by adding at the end the fol-
lowing new subclause: 
‘‘(III) subject to subparagraph 
(G), is a hospital described in sub-
paragraph (F) and is certified on or 
after the date of the enactment of the 
Rural Hospital Closure Relief Act of 
2019 by the State as being a nec-
essary provider of health care services 
to residents in the area;’’; and 
(B) by adding at the end the following new 
subparagraphs: 
‘‘(F) HOSPITAL
DESCRIBED.—For pur-
poses of subparagraph (B)(i)(III), a hospital 
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described in this subparagraph is a hospital 
that— 
‘‘(i) is a sole community hospital (as 
defined in section 1886(d)(5)(D)(iii)), a 
medicare dependent, small rural hospital 
(as defined in section 1886(d)(5)(G)(iv)), a 
low-volume hospital that in 2019 receives a 
payment 
adjustment 
under 
section 
1886(d)(12), or a subsection (d) hospital 
(as defined in section 1886(d)(1)(B)) that 
has fewer than 50 beds; 
‘‘(ii) is located in a rural area, as de-
fined by the Secretary, based on the most 
recent rural urban commuting area code 
(or its successor criteria) as set forth by 
the Office of Management and Budget; 
‘‘(iii) as determined by the Secretary, 
serves a patient population— 
‘‘(I) with a high percentage, rel-
ative to the national or statewide av-
erage, of individuals with income that 
is below 150 percent of the poverty 
line; 
‘‘(II) in a health professional 
shortage area (as defined in section 
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332(a)(1)(A) of the Public Health 
Service Act); or 
‘‘(III) that represents a high pro-
portion, relative to the national or 
statewide average, of individuals enti-
tled to part A or enrolled under part 
B of this title or enrolled under a 
State plan under title XIX; 
‘‘(iv) has demonstrated to the Sec-
retary, at such time and in such manner as 
the Secretary determines appropriate, two 
consecutive years of financial losses pre-
ceding the date of certification described in 
subparagraph (B)(i)(III); and 
‘‘(v) submits to the Secretary, at such 
time and in such manner as the Secretary 
may require, an attestation that the Sec-
retary determines to be satisfactory, out-
lining the good governance qualifications 
and strategic plan for multi-year financial 
solvency of the hospital. 
‘‘(G) LIMITATION ON CERTAIN DESIGNA-
TIONS.— 
‘‘(i) IN
GENERAL.—The Secretary 
may not under subsection (e) certify pur-
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suant to a certification by a State under 
subsection (c)(2)(B)(i)(III)— 
‘‘(I) more than a total of 200 fa-
cilities as critical access hospitals; and 
‘‘(II) subject to clause (ii), within 
any one State, more than 15 facilities 
as critical access hospitals. 
‘‘(ii) STATE
PETITION.—The Sec-
retary may apply, with respect to a State, 
the limitation under clause (i)(II) by sub-
stituting a number that is greater than the 
number specified in such clause if the 
State petitions the Secretary, in accord-
ance with a process established by the Sec-
retary, to increase such number.’’; and 
(2) in subsection (e), by inserting ‘‘, subject to 
subsection (c)(2)(G),’’ after ‘‘The Secretary shall’’. 
Æ 
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