(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to services furnished 
on or after January 1, 2018. 
(b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 
TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 
REQUIREMENT.— 
(1) IN
GENERAL.—Section 1820(c)(2) of the 
Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 
amended— 
(A) in subparagraph (B)(iii), by striking 
‘‘provides not more than’’ and inserting ‘‘sub-
ject to subparagraph (F), provides not more 
than’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 
LIMIT REQUIREMENT.— 
‘‘(i) IN GENERAL.—A State may elect 
to treat a facility, with respect to the des-
ignation of the facility for a cost-reporting 
period, as satisfying the requirement of 
subparagraph (B)(iii) relating to a max-
imum number of acute care inpatient beds 
if the facility elects, in accordance with a 
method specified by the Secretary and be-
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fore the beginning of the cost reporting pe-
riod, to meet the requirement under clause 
(ii). 
‘‘(ii) ALTERNATE
REQUIREMENT.— 
The requirement under this clause, with 
respect to a facility and a cost-reporting 
period, is that the total number of inpa-
tient bed days described in subparagraph 
(B)(iii) during such period will not exceed 
7,300. For purposes of this subparagraph, 
an individual who is an inpatient in a bed 
in the facility for a single day shall be 
counted as one inpatient bed day. 
‘‘(iii) WITHDRAWAL OF ELECTION.— 
The option described in clause (i) shall not 
apply to a facility for a cost-reporting pe-
riod if the facility (for any two consecutive 
cost-reporting periods during the previous 
5 cost-reporting periods) was treated under 
such option and had a total number of in-
patient bed days for each of such two cost- 
reporting periods that exceeded the num-
ber specified in such clause.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to cost-reporting peri-
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ods beginning on or after the date of the enactment 
of this Act. 
SEC. 404. COMMUNITY HEALTH CENTER COLLABORATIVE 
ACCESS EXPANSION. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended by adding at the end the fol-
lowing: 
‘‘(t) MISCELLANEOUS PROVISIONS.— 
‘‘(1) RULE OF CONSTRUCTION WITH RESPECT 
TO RURAL HEALTH CLINICS.—Nothing in this sec-
tion shall be construed to prevent a community 
health center from contracting with a federally cer-
tified rural health clinic (as defined by section 
1861(aa)(2) of the Social Security Act) for the deliv-
ery of primary health care and other mental, dental, 
and physical health services that are available at the 
rural health clinic to individuals who would other-
wise be eligible for free or reduced cost care if that 
individual were able to obtain that care at the com-
munity health center. Such services may be limited 
in scope to those primary health care and other 
mental, dental, and physical health services available 
in that rural health clinic. 
‘‘(2) ENABLING SERVICES.—To the extent pos-
sible, enabling services such as transportation and 
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translation assistance shall be provided by rural 
health clinics described in paragraph (1). 
‘‘(3) ASSURANCES.—In order for a rural health 
clinic to receive funds under this section through a 
contract with a community health center for the de-
livery of primary health care and other services de-
scribed in paragraph (1), such rural health clinic 
shall establish policies to ensure— 
‘‘(A) nondiscrimination based upon the 
ability of a patient to pay; 
‘‘(B) the establishment of a sliding fee 
scale for low-income patients; and 
‘‘(C) any such services should be subject to 
full reimbursement according to the Prospective 
Payment System scale.’’. 
Æ 
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