I 
116TH CONGRESS 
2D SESSION 
H. R. 6753 
To amend the Medicare Prescription Drug, Improvement, and Modernization 
Act of 2003 to extend the rural community hospital demonstration program. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 8, 2020 
Ms. FINKENAUER (for herself and Mr. YOUNG) introduced the following bill; 
which was referred to the Committee on Ways and Means 
A BILL 
To amend the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 to extend the rural com-
munity hospital demonstration 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 Community Hos-
pital Demonstration Extension Act of 2020’’. 
SEC. 2. FIVE-YEAR EXTENSION OF THE RURAL COMMUNITY 
HOSPITAL DEMONSTRATION PROGRAM. 
(a) EXTENSION.— 
(1) IN GENERAL.—Subsection (a)(5) of section 
410A of the Medicare Prescription Drug, Improve-
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ment, and Modernization Act of 2003 (Public Law 
108–173; 42 U.S.C. 1395ww note), is amended by 
striking ‘‘10-year extension period’’ and inserting 
‘‘15-year extension period’’. 
(2) CONFORMING
AMENDMENTS
FOR
EXTEN-
SION.— 
(A) EXTENSION OF DEMONSTRATION PE-
RIOD.—Subsection (g) of such section 410A is 
amended— 
(i) in the subsection heading, by strik-
ing ‘‘TEN-YEAR’’ and inserting ‘‘FIFTEEN- 
YEAR’’; 
(ii) in paragraph (1)— 
(I) by striking ‘‘additional 10- 
year’’ and inserting ‘‘additional 15- 
year’’; and 
(II) by striking ‘‘10-year exten-
sion period’’ and inserting ‘‘15-year 
extension period’’; 
(iii) in paragraph (2), by striking ‘‘10- 
year extension period’’ and inserting ‘‘15- 
year extension period’’; 
(iv) in paragraph (3), by striking ‘‘10- 
year extension period’’ and inserting ‘‘15- 
year extension period’’; 
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(v) in paragraph (4), by striking ‘‘10- 
year extension period’’ each place it ap-
pears and inserting ‘‘15-year extension pe-
riod’’; 
(vi) in paragraph (5), by striking ‘‘10- 
year extension period’’ and inserting ‘‘15- 
year extension period’’; and 
(vii) in subparagraph (A) of para-
graph (6), by striking ‘‘10-year extension 
period’’ and inserting ‘‘15-year extension 
period’’. 
(B) RULE FOR HOSPITALS THAT ARE NOT 
ORIGINAL PARTICIPANTS IN THE DEMONSTRA-
TION.—Paragraph (5) of subsection (g) of such 
section 410A is amended— 
(i) by striking ‘‘PROGRAM.—During’’ 
and inserting ‘‘PROGRAM.— 
‘‘(A) CURES ACT EXTENSION.—During’’; 
and 
(ii) by adding at the end the following 
new subparagraph: 
‘‘(B) ADDITIONAL
EXTENSION.—During 
the third 5 years of the 15-year extension pe-
riod, the Secretary shall apply the provisions of 
paragraph (4) to rural community hospitals 
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that are not described in paragraph (4) but are 
participating in the demonstration program 
under this section as of December 30, 2019, in 
a similar manner as such provisions apply to 
rural community hospitals described in para-
graph (4).’’. 
(C) SOLICITATION
OF
APPLICATIONS.— 
Subparagraph (A) of subsection (g)(6) of such 
section 410A is amended— 
(i) by striking ‘‘IN
GENERAL.—The 
Secretary’’ and inserting ‘‘IN GENERAL.— 
‘‘(i) CURES ACT SOLICITATION.—The 
Secretary’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(ii) ADDITIONAL
SOLICITATION.— 
The Secretary shall, notwithstanding sub-
section (a)(2) or paragraph (2) of this sub-
section, not later than 120 days after the 
date of the enactment of this clause, issue 
a solicitation for applications to select up 
to the maximum number of additional 
rural community hospitals located in any 
State to participate in the demonstration 
program under this section for the third 5 
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years of the 15-year extension period with-
out exceeding the limitation under para-
graph (3) of this subsection.’’. 
(b) CLARIFICATION OF APPLICATION OF CASE MIX 
ADJUSTMENT.—Subsection (b) of such section 410A is 
amended by adding at the end the following new para-
graph: 
‘‘(3) CASE MIX ADJUSTMENT.—The Secretary 
shall provide for an appropriate adjustment under 
this paragraph to take into account variations in 
case mix of rural community hospitals, using the 
most recent case-mix data available.’’. 
(c) CHANGE IN TIMING FOR REPORT.—Subsection 
(e) of such section 410A is amended by striking ‘‘Not later 
than August 1, 2018’’ and inserting ‘‘Not later than Au-
gust 1, 2023’’. 
(d) CLARIFYING TECHNICAL AMENDMENTS.—Such 
section 410A, as amended by subsections (a), (b), and (c), 
is further amended— 
(1) in subsection (a)(1), by inserting ‘‘of Health 
and Human Services’’ after ‘‘Secretary’’; 
(2) in subsection (f)(1)(A)(iv) by inserting ‘‘of 
the Social Security Act (42 U.S.C. 1395i–4)’’ after 
‘‘section 1820’’; and 
(3) in subsection (g)— 
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(A) in the heading of paragraph (4), by 
striking ‘‘HOSPITALS IN DEMONSTRATION PRO-
GRAM ON DATE OF ENACTMENT’’ and inserting 
‘‘HOSPITALS
PARTICIPATING
IN
THE
DEM-
ONSTRATION PROGRAM DURING THE INITIAL 5- 
YEAR PERIOD’’; and 
(B) in clause (i) of paragraph (6)(A), as 
amended by subsection (a)(2)(C)(i), by striking 
‘‘not later than 120 days after the date of the 
enactment of this paragraph’’ and inserting 
‘‘not later than April 12, 2017’’. 
Æ 
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