I 
114TH CONGRESS 
2D SESSION 
H. R. 4553 
To amend title XVIII of the Social Security Act to clarify reasonable costs 
for critical access hospital payments under the Medicare program, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 12, 2016 
Mr. HARPER (for himself, Mr. LOEBSACK, Mr. PETERSON, Mr. PALAZZO, Mr. 
KELLY of Mississippi, and Mr. THOMPSON of Mississippi) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend title XVIII of the Social Security Act to clarify 
reasonable costs for critical access hospital payments 
under the Medicare program, 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 ‘‘Critical Access and 
Rural Equity Act of 2016’’ or the ‘‘CARE Act of 2016’’. 
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SEC. 2. CLARIFYING REASONABLE COSTS FOR CRITICAL 
ACCESS HOSPITAL MEDICARE PAYMENTS. 
(a) INCLUSION OF CERTAIN COSTS AS REASONABLE 
COSTS.— 
(1) INPATIENT
CRITICAL
ACCESS
HOSPITAL 
SERVICES.—Section 1814(l) of the Social Security 
Act (42 U.S.C. 1395f(l)) is amended by adding at 
the end the following new paragraph: 
‘‘(6) In determining payment and reasonable 
costs under paragraph (1) for inpatient critical ac-
cess services, the Secretary shall recognize as allow-
able costs of the critical access hospital at least the 
following: 
‘‘(A) Costs of services that would be con-
sidered bona fide emergency services (as defined 
in section 1861(v)(1)(K)(ii)) if provided in a 
hospital emergency room, including professional 
services and any associated surgical on-call and 
standby costs. 
‘‘(B) Costs of a test or procedure per-
formed at a critical access hospital or an entity 
owned by the critical access hospital, including 
a clinical diagnostic laboratory test, mammo-
gram (as defined in section 354(a)(5) of the 
Public Health Service Act), colonoscopy, cardiac 
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stress test, pulmonary function test, echocardio-
gram, and bone density study. 
‘‘(C) Standby and on-call costs for certified 
registered nurse anesthetist services, regardless 
of the number of surgical procedures requiring 
anesthesia services and regardless of the num-
ber of full-time equivalent physicians. 
‘‘(D) Costs of services provided by the crit-
ical access hospital or satellite facility of the 
critical access hospital that improve the total 
health of communities, including immunization 
programs, health clinics, and medical homes. 
‘‘(E) Costs of services provided by an off- 
campus provider-based clinic described in sec-
tion 1820(c)(2)(F) of the critical access hos-
pital, regardless of distance of such clinic from 
a hospital or another critical access hospital.’’. 
(2) OUTPATIENT
CRITICAL
ACCESS
HOSPITAL 
SERVICES.—Section 1834(g) of the Social Security 
Act (42 U.S.C. 1395m(g)) is amended by adding at 
the end the following new paragraph: 
‘‘(6) COVERAGE
OF
CERTAIN
ADDITIONAL 
COSTS AS REASONABLE COSTS.—In determining the 
reasonable costs of outpatient critical access hospital 
services under paragraphs (1) and (2)(A), the Sec-
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retary shall recognize as allowable the costs de-
scribed in paragraph (6) of section 1814(l).’’. 
(3) 
CONFORMING
AMENDMENT.—Section 
1861(v)(7) of the Social Security Act (42 U.S.C. 
1395x(v)(7)) is amended by adding at the end the 
following new subparagraph: 
‘‘(E) For provisions further describing costs 
recognized as reasonable costs for inpatient and out-
patient critical access hospital services, see sections 
1814(l)(6) and 1834(g)(6).’’. 
(b) TREATMENT OF PROVIDER-BASED CLINICS OF 
CRITICAL ACCESS HOSPITALS.—Section 1820(c)(2) of the 
Social Security Act (42 U.S.C. 1395i–4(c)(2)) is amend-
ed— 
(1) in subparagraph (B)(i)(I), by striking ‘‘is 
located’’ and inserting ‘‘subject to subparagraph 
(E), is located’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) 
TREATMENT
OF
OFF-CAMPUS 
PROVIDER-BASED
CLINICS.—Subparagraph 
(B)(i)(I) shall not apply to an off-campus 
provider-based clinic (as described in section 
485.610 of title 45 of the Code of Federal Reg-
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