I 
118TH CONGRESS 
1ST SESSION H. R. 6430 
To amend title XVIII of the Social Security Act to extend Medicare-dependent 
hospital and Medicare low-volume hospital payments, and to direct the 
Comptroller General of the United States to carry out a report on 
Medicare rural hospital classifications. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 15, 2023 
Mrs. MILLER of West Virginia (for herself and Ms. SEWELL) introduced the 
following bill; which was referred to the Committee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to extend 
Medicare-dependent hospital and Medicare low-volume 
hospital payments, and to direct the Comptroller General 
of the United States to carry out a report on Medicare 
rural hospital classifications. 
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 ‘‘Assistance for Rural 
Community Hospitals Act’’ or the ‘‘ARCH Act’’. 
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SEC. 2. EXTENDING MEDICARE-DEPENDENT HOSPITAL AND 
MEDICARE 
LOW-VOLUME 
HOSPITAL 
PAY-
MENTS. 
(a) MDH EXTENSION.— 
(1) EXTENSION OF PAYMENT METHODOLOGY.— 
Section 1886(d)(5)(G) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(G)) is amended— 
(A) in clause (i), by striking ‘‘October 1, 
2024’’ and inserting ‘‘October 1, 2029’’; and 
(B) in clause (ii)(II), by striking ‘‘October 
1, 2024’’ and inserting ‘‘October 1, 2029’’. 
(2) CONFORMING AMENDMENTS.— 
(A) EXTENSION
OF
TARGET
AMOUNT.— 
Section 1886(b)(3)(D) of the Social Security 
Act (42 U.S.C. 1395ww(b)(3)(D)) is amend-
ed— 
(i) in the matter preceding clause (i), 
by striking ‘‘October 1, 2024’’ and insert-
ing ‘‘October 1, 2029’’ ; and 
(ii) in clause (iv), by striking ‘‘fiscal 
year 2024’’ and inserting ‘‘fiscal year 
2029,’’. 
(B) PERMITTING HOSPITALS TO DECLINE 
RECLASSIFICATION.—Section 
13501(e)(2) 
of 
the Omnibus Budget Reconciliation Act of 1993 
(42 U.S.C. 1395ww note) is amended by strik-
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ing ‘‘fiscal year 2024’’ and inserting ‘‘fiscal 
year 2029,’’. 
(b) LVH EXTENSION.—Section 1886(d)(12) of the 
Social Security Act (42 U.S.C. 1395ww(d)(12)) is amend-
ed— 
(1) in subparagraph (C)(i)— 
(A) in the matter preceding subclause (I), 
by striking ‘‘through 2024’’ and inserting 
‘‘through 2029’’; 
(B) 
in 
subclause 
(III), 
by 
striking 
‘‘through 2024’’ and inserting ‘‘through 2029’’; 
and 
(C) in subclause (IV), by striking ‘‘2025’’ 
and inserting ‘‘2030’’; and 
(2) in subparagraph (D)— 
(A) in the matter preceding clause (i), by 
striking 
‘‘through 
2024’’ 
and 
inserting 
‘‘through 2029’’; and 
(B) in clause (ii), by striking ‘‘through 
2024’’ and inserting ‘‘through 2029’’. 
SEC. 3. GAO REPORT ON MEDICARE RURAL HOSPITAL 
CLASSIFICATIONS. 
Not later than 180 days after the date of the enact-
ment of this Act, the Comptroller General of the United 
States shall submit to Congress a report on Medicare rural 
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hospital classifications that includes the following informa-
tion: 
(1) The total number of hospitals that, with re-
spect to any of the 5 fiscal years preceding such 
date of enactment, had any of the following classi-
fications: 
(A) Classification as a critical access hos-
pital (as defined in section 1861(mm)(1) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1395x(mm)(1))). 
(B) Classification as a rural emergency 
hospital (as defined in section 1861(kkk)(2) of 
such Act (42 U.S.C. 1395x(kkk)(2))). 
(C) Classification as a rural referral center 
(as described in section 1886(d)(5)(C) of such 
Act (42 U.S.C. 1395ww(d)(5)(C)). 
(D) Classification as a sole community 
hospital 
(as 
defined 
in 
section 
1886(d)(5)(D)(iii) of such Act (42 U.S.C. 
1395ww(d)(5)(D)(iii))). 
(E) Classification as a medicare-dependent, 
small rural hospital (as defined in section 
1886(d)(5)(G)(iv) of such Act (42 U.S.C. 
1395ww(d)(5)(G)(iv))). 
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(F) Classification as a low-volume hospital 
(as defined in section 1886(d)(12)(C)(i) of such 
Act (42 U.S.C. 1395ww(d)(12)(C)(i))). 
(2) An analysis of the extent to which there is 
overlap between the criteria for any two or more of 
the classifications described in paragraph (1). 
(3) Recommendations for— 
(A) simplification with respect to such 
classifications and any such overlap; and 
(B) changes with respect to the criteria for 
such classifications that would promote finan-
cial sustainability for rural hospitals and im-
prove access to health care for individuals in 
rural areas. 
(4) The projected effects of allowing sole com-
munity hospitals (as described in paragraph (1)(D)) 
and medicare-dependent, small rural hospitals (as 
described in paragraph (1)(E)) to use a cost report-
ing period beginning during fiscal year 2019 for the 
purpose of calculating adjusted payments under sec-
tion 1886(d)(5) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)). 
Æ 
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