and efficient through the development and ex-
pansion of outreach programs that will facili-
tate the establishment of dental homes for chil-
dren and adults, including the aged, blind, and 
disabled populations. 
‘‘(C) To reduce geographic, language, cul-
tural, and similar barriers in the provision of 
dental services. 
‘‘(D) To help reduce the use of emergency 
departments by those who seek dental services 
more appropriately delivered in a dental pri-
mary care setting. 
‘‘(E) To facilitate the provision of dental 
care to nursing home residents who are dis-
proportionately affected by lack of care. 
‘‘(2) ELIGIBLE ENTITY.—In this subsection, the 
term ‘eligible entity’ includes a State or local dental 
association, a State oral health program, or a dental 
education, dental hygiene, or postdoctoral dental 
education program accredited by the Commission on 
Dental Accreditation, and a community-based orga-
nization that partners with an academic institution, 
that— 
VerDate Sep 11 2014 
00:48 Feb 23, 2017
Jkt 069200
PO 00000
Frm 00062
Fmt 6652
Sfmt 6201
E:\BILLS\H1084.IH
H1084
rfrederick on DSKBCBPHB2PROD with BILLS
‘‘(A) is exempt from tax under section 
501(c) of the Internal Revenue Code of 1986; 
and 
‘‘(B) partners with public and private 
stakeholders to facilitate the provision of dental 
services for underserved populations.’’; and 
(3) in subsection (h), as redesignated by para-
graph (1), by striking ‘‘fiscal years 2001 through 
2005’’ and inserting ‘‘fiscal years 2016 through 
2020’’. 
SEC. 403. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 
(a) ELIMINATION OF ISOLATION TEST FOR COST- 
BASED AMBULANCE REIMBURSEMENT.— 
(1) IN
GENERAL.—Section 1834(l)(8) of the 
Social Security Act (42 U.S.C. 1395m(l)(8)) is 
amended— 
(A) in subparagraph (B)— 
(i) by striking ‘‘owned and’’; and 
(ii) by inserting ‘‘(including when 
such services are provided by the entity 
under an arrangement with the hospital)’’ 
after ‘‘hospital’’; and 
(B) by striking the comma at the end of 
subparagraph (B) and all that follows and in-
serting a period. 
VerDate Sep 11 2014 
00:48 Feb 23, 2017
Jkt 069200
PO 00000
Frm 00063
Fmt 6652
Sfmt 6201
E:\BILLS\H1084.IH
H1084
rfrederick on DSKBCBPHB2PROD with BILLS
(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-
VerDate Sep 11 2014 
00:48 Feb 23, 2017
Jkt 069200
PO 00000
Frm 00064
Fmt 6652
Sfmt 6201
E:\BILLS\H1084.IH
H1084
rfrederick on DSKBCBPHB2PROD with BILLS
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-
VerDate Sep 11 2014 
00:48 Feb 23, 2017
Jkt 069200
PO 00000
Frm 00065
Fmt 6652
Sfmt 6201
E:\BILLS\H1084.IH
H1084
rfrederick on DSKBCBPHB2PROD with BILLS
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 
VerDate Sep 11 2014 
00:48 Feb 23, 2017
Jkt 069200
PO 00000
Frm 00066
Fmt 6652
Sfmt 6201
E:\BILLS\H1084.IH
H1084
rfrederick on DSKBCBPHB2PROD with BILLS
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 
VerDate Sep 11 2014 
00:48 Feb 23, 2017
Jkt 069200
PO 00000
Frm 00067
Fmt 6652
Sfmt 6301
E:\BILLS\H1084.IH
H1084
rfrederick on DSKBCBPHB2PROD with BILLS