ulations) of a facility designated as a critical 
access hospital.’’. 
(c) ALLOWING COORDINATION FOR PROVISION OF 
EMERGENCY SERVICES.—Section 1820(c)(2) of the Social 
Security Act (42 U.S.C. 1395i–4(c)(2)), as amended by 
subsection (b), is further amended— 
(1) in subparagraph (B)(ii), by striking 
‘‘makes’’ and inserting ‘‘subject to subparagraph 
(G), makes’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(G) ALLOWING COORDINATION FOR PRO-
VISION
OF
EMERGENCY
SERVICES.—The Sec-
retary may waive the requirements under sub-
paragraph (B)(ii), with respect to a facility, if 
such facility— 
‘‘(i) is located not more than 15 miles 
of another facility or hospital that has an 
emergency department that satisfies the 
requirement of subparagraph (B)(ii); and 
‘‘(ii) coordinates with such other facil-
ity or hospital with respect to furnishing 
24-hour emergency care services described 
in such subparagraph to the area served by 
such facility.’’. 
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(d) TREATMENT
OF MEDICAID PROVIDER TAXES 
FOR CRITICAL ACCESS HOSPITAL REASONABLE COSTS.— 
(1) INPATIENT
CRITICAL
ACCESS
HOSPITAL 
SERVICES.—Section 1814(l) of the Social Security 
Act (42 U.S.C. 1395f(l)), as amended by subsection 
(a)(1), is further amended by adding at the end the 
following new paragraph: 
‘‘(7)(A) In determining payment and reasonable 
costs under paragraph (1) for inpatient critical ac-
cess services— 
‘‘(i) with respect to a current permissible 
health care related tax imposed and paid by the 
critical access hospital for a cost reporting pe-
riod beginning before the date of enactment of 
this paragraph, the Secretary shall not, through 
recoupment or otherwise, disallow payment to 
the critical access hospital under this subsection 
on the basis that payments to the critical access 
hospital under this subsection offset some or all 
of the costs of such tax; and 
‘‘(ii) with respect to a current permissible 
health care related tax imposed and paid by the 
critical access hospital for a cost reporting pe-
riod beginning on or after the date of enact-
ment of this paragraph, the Secretary shall— 
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‘‘(I) assess the percentage of individ-
uals entitled to benefits under this part 
who are furnished inpatient critical access 
hospital services at such critical access 
hospital during such cost reporting period 
and who are also receiving medical assist-
ance under the Medicaid program under 
title XIX during such period; and 
‘‘(II) adjust payments under this sub-
section with respect to such services fur-
nished during such period in a manner 
specified by the Secretary based on such 
percentage to take into account such tax. 
‘‘(B) For purposes of this paragraph and sec-
tion 1834(g)(7), the term ‘current permissible health 
care related tax’ means a broad-based health care 
related tax (as defined in paragraph (3)(B) of such 
section) that is in effect prior to enactment of this 
paragraph and for which there is not in effect a hold 
harmless provision described in paragraph (4) of 
such section.’’. 
(2) OUTPATIENT
CRITICAL
ACCESS
HOSPITAL 
SERVICES.—Section 1834(g) of the Social Security 
Act (42 U.S.C. 1395m(g)), as amended by sub-
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section (a)(2), is further amended by adding at the 
end the following new paragraph: 
‘‘(7) TREATMENT
OF
MEDICAID
PROVIDER 
TAXES.—In determining payment for outpatient crit-
ical access hospital services under paragraphs (1) 
and (2), the provisions of paragraph (7) of section 
1814(l) shall apply to payment for such services 
under this subsection in the same manner as such 
provisions apply to payment for inpatient critical ac-
cess hospital services under section 1814(l), except 
that in applying subparagraph (B) of such para-
graph (7), the reference to ‘individuals entitled to 
benefits under this part’ shall be deemed a reference 
to ‘individuals enrolled under part B’.’’. 
Æ 
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