I 
117TH CONGRESS 
1ST SESSION H. R. 5883 
To establish a value-based care program to exempt eligible rural health 
clinics from certain payment limitations, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 4, 2021 
Ms. SEWELL (for herself and Mr. SMITH of Nebraska) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To establish a value-based care program to exempt eligible 
rural health clinics from certain payment limitations, 
and for other purposes. 
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 Health Fairness 
in Competition Act’’. 
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SEC. 2. MEDICARE RURAL HEALTH CLINIC VALUE-BASED 
CARE PROGRAM. 
(a) MEDICARE RURAL HEALTH CLINIC VALUE- 
BASED PROGRAM.—Not later than 90 days after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services (hereinafter referred to as the ‘‘Sec-
retary’’) shall establish a Medicare Rural Health Clinic 
Value-Based Care Program under which an eligible clinic 
(as defined in subsection (b)(1)(B)) shall be exempt from 
any limitation on payment established under section 
1833(a) of the Social Security Act (42 U.S.C. 1395l(a)) 
if such clinic submits reports required under subsection 
(b)(2). 
(b) PROGRAM REQUIREMENTS.— 
(1) APPLICATION.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a process by which an eligible clinic may 
apply for participation in the program described 
in subsection (a). 
(B) ELIGIBLE
CLINIC.—For purposes of 
this section, an eligible clinic is a rural health 
clinic (as defined in section 1861(aa)(2) of the 
Social Security Act (42 U.S.C. 1395x(aa)(2))) 
that— 
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(i) is owned or operated by a hospital, 
including a critical access hospital, with 
less than 50 beds; 
(ii) is enrolled under section 1866(j) 
of such Act (including temporary enroll-
ment during the emergency period de-
scribed in section 1135(g)(1)(B) of such 
Act); and 
(iii) meets the reporting requirements 
established under paragraph (2); or 
(iv) is participating in a Medicare 
quality program, including the National 
Committee for Quality Assurance Patient- 
Centered Medical Home Recognition Pro-
gram, or another value-based care program 
as determined by the Secretary. 
(2) REPORTS.— 
(A) IN GENERAL.—Not later than the end 
of the first calendar year in which an eligible 
clinic participates in the program described 
under subsection (a), and annually thereafter, 
each eligible clinic shall submit to the Adminis-
trator of the Centers for Medicare & Medicaid 
Services a report on the quality measures de-
scribed in subsection (c)(1). 
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(B) SUBSEQUENT YEARS.—Not later than 
the end of the third calendar year in which an 
eligible clinic has participated in the program 
described under subsection (a), and annually 
thereafter, such eligible clinic shall submit to 
the Administrator a report containing the infor-
mation required under subparagraph (A), and 
may submit additional information with respect 
to performance measures (described in sub-
section (c)(2)) as the Administrator may re-
quire. 
(C) PUBLICATION OF REPORTS.—Not later 
than 90 days after the last day of each calendar 
year for which an eligible clinic has submitted 
a report pursuant to this paragraph, the Ad-
ministrator shall make such report publicly 
available on the website of the Centers for 
Medicare & Medicaid Services. 
(3) DURATION.—The exemption from payment 
limitations under section 1833(a) shall apply for as 
long as an eligible clinic meets the requirements set 
forth in this subsection. 
(c) SELECTION OF QUALITY MEASURES; PERFORM-
ANCE STANDARDS.— 
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(1) SELECTION OF QUALITY MEASURES.—Not 
later than 90 days after the date of the enactment 
of this Act, the Secretary shall select quality meas-
ures for purposes of the reporting requirements 
under subsection (b)(2). In selecting quality meas-
ures, the Secretary shall select such measure that 
are— 
(A) used in existing programs; 
(B) focused on primary care; or 
(C) based on input from stakeholders. 
(2) PERFORMANCE
STANDARDS.—Not later 
than 2 years after the date of the enactment of this 
Act, the Secretary may establish performance meas-
urements standards for purposes of the reporting re-
quirements under subsection (b)(2). 
Æ 
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