plan for multi-year financial solvency 
of the hospital; and 
‘‘(II) not later than 120 days 
after the date on which the Secretary 
issues final regulations pursuant to 
section 113(b) of the Save America’s 
Rural Hospitals Act, an application 
for certification of the facility as a 
critical access hospital. 
‘‘(G) LIMITATION ON CERTAIN DESIGNA-
TIONS.— 
‘‘(i) IN
GENERAL.—The Secretary 
may not under subsection (e) certify pur-
suant to a certification by a State under 
subparagraph (B)(i)(III)— 
‘‘(I) more than a total of 175 fa-
cilities as critical access hospitals, of 
which not more than 20 percent may 
be facilities described in clause (ii); 
and 
‘‘(II) within any one State, more 
than 10 facilities as critical access 
hospitals. 
‘‘(ii) FACILITY DESCRIBED.— 
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‘‘(I) IN GENERAL.—A facility de-
scribed in this clause is a facility that 
as of the date of enactment of this 
subparagraph met the criteria for des-
ignation as a critical access hospital 
under subparagraph (B)(i)(I). 
‘‘(II) NONAPPLICATION OF CER-
TAIN
CRITERIA.—For purposes of 
subparagraph (B)(i)(III), the criteria 
described in subparagraph (F)(iv) 
shall not apply with respect to the 
designation of a facility described in 
subclause (I).’’; and 
(2) in subsection (e), by inserting ‘‘, subject to 
subsection (c)(2)(G),’’ after ‘‘The Secretary shall’’. 
(b) REGULATIONS.—Not later than 120 days after 
the date of the enactment of this Act, the Secretary of 
Health and Human Services shall issue final regulations 
to carry out this section. 
(c) CLARIFICATION REGARDING FACILITIES THAT 
MEET DISTANCE OR OTHER CERTIFICATION CRITERIA.— 
Nothing in this section shall affect the application of cri-
teria for designation as a critical access hospital described 
in subclause (I) or (II) of section 1820(c)(2)(B)(i) of the 
Social Security Act (42 U.S.C. 1395i–4(c)(2)(B)(i)). 
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TITLE II—RURAL MEDICARE 
BENEFICIARY EQUITY 
SEC. 201. EQUALIZING BENEFICIARY COPAYMENTS FOR 
SERVICES FURNISHED BY CAHS. 
(a) IN GENERAL.—Section 1866(a)(2)(A) of the So-
cial Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended 
by adding at the end the following: ‘‘In the case of out-
patient critical access hospital services for which payment 
is made under section 1834(g), clause (ii) of the first sen-
tence shall be applied by substituting ‘20 percent of the 
lesser of the actual charge or the payment basis under 
this part for such services if the critical access hospital 
were treated as a hospital’ for ‘20 per centum of the rea-
sonable charges for such items and services’.’’. 
(b) APPLICABILITY.—The amendment made by this 
section applies with respect to services furnished during 
a year that begins more than 60 days after the date of 
the enactment of this Act. 
TITLE III—REGULATORY RELIEF 
SEC. 301. ELIMINATING 96-HOUR REQUIREMENTS WITH RE-
SPECT TO INPATIENT CAH SERVICES. 
(a) PHYSICIAN
CERTIFICATION
REQUIREMENT.— 
Section 1814(a) of the Social Security Act (42 U.S.C. 
1395f(a)) is amended— 
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(1) in paragraph (6), by adding ‘‘and’’ at the 
end; 
(2) in paragraph (7)(E), by striking ‘‘; and’’ 
and inserting a period; and 
(3) by striking paragraph (8). 
(b) AVERAGE LENGTH OF STAY REQUIREMENT.— 
Section 1820(c)(2)(B)(iii) of the Social Security Act (42 
U.S.C. 1395i–4(c)(2)(B)(iii)) is amended by striking ‘‘for 
providing inpatient care for a period that does not exceed, 
as determined on an annual, average basis, 96 hours per 
patient’’. 
(c) APPLICABILITY.—The amendments made by this 
section apply with respect to services furnished during a 
year that begins more than 60 days after the date of the 
enactment of this Act. 
SEC. 302. ELIMINATING HOSPITALIZATION REQUIREMENT 
FOR EXTENDED CARE SERVICES FURNISHED 
BY CERTAIN HOSPITALS. 
Section 1812(f) of the Social Security Act (42 U.S.C. 
1395d(f)) is amended by adding at the end the following 
new paragraph: 
‘‘(3) The Secretary shall provide for coverage under 
subsection (a)(2)(B) of extended care services (that are 
not posthospital extended care services) furnished on or 
after the date that is 60 days after the date of the enact-
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ment of this paragraph by a hospital described in sub-
section (b) of section 1883 pursuant to an agreement 
under such section for such a duration as the Secretary 
determines appropriate such that the coverage of such 
services for such duration does not alter the acute care 
nature of the benefit described in subsection (a)(2).’’. 
TITLE IV—FUTURE OF RURAL 
HEALTH CARE 
SEC. 401. MEDICARE RURAL HOSPITAL FLEXIBILITY PRO-
GRAM GRANTS. 
Section 1820(g) of the Social Security Act (42 U.S.C. 
1395i–4(g)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (C), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (D), by striking the 
period at the end and inserting a semicolon; 
and 
(C) by adding at the end the following new 
subparagraphs: 
‘‘(E) rural emergency hospitals providing 
support for critical access hospitals to convert 
to rural emergency hospitals to stabilize hos-
pital emergency services in their communities; 
and 
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