I 
117TH CONGRESS 
1ST SESSION 
H. R. 489 
To amend title XVIII of the Social Security Act to clarify the application 
of the 15-mile secondary road distance requirement with respect to pre-
viously designated critical access hospitals under the Medicare program. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 25, 2021 
Ms. STEFANIK (for herself and Mr. DELGADO) 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 clarify 
the application of the 15-mile secondary road distance 
requirement with respect to previously designated critical 
access hospitals under the Medicare program. 
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 ‘‘Protecting Rural Ac-
cess to Care Act’’. 
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SEC. 2. CLARIFYING THE APPLICATION OF THE 15-MILE 
SECONDARY ROAD DISTANCE REQUIREMENT 
WITH RESPECT TO PREVIOUSLY DESIGNATED 
CRITICAL ACCESS HOSPITALS. 
Section 1820(h) of the Social Security Act (42 U.S.C. 
1395i–4(h)) is amended by adding at the end the following 
new paragraph: 
‘‘(4) APPLICATION
OF
15-MILE
SECONDARY 
ROADS CRITERIA.—In the case of a facility that was 
designated as a critical access hospital before July 
31, 2015, in applying the criteria for such designa-
tion specified in clause (i) of subsection (c)(2)(B), a 
State (and the Secretary) shall so apply such cri-
teria, insofar as such criteria relates to a facility lo-
cated in an area with only secondary roads available, 
using such guidance and regulations as were in ef-
fect on July 30, 2015.’’. 
SEC. 3. REQUIREMENT FOR PUBLIC NOTICE AND COMMENT 
PERIOD FOR ANY GUIDANCE OR REGULA-
TION RELATING TO DESIGNATION CRITERIA 
FOR CRITICAL ACCESS HOSPITALS. 
(a) IN GENERAL.—With respect to any guidance or 
regulation issued by the Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) 
on or after the date of the enactment of this Act relating 
to the criteria for designation of a facility as a critical 
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access hospital (as specified in section 1820(c)(2)(B) of 
the Social Security Act (42 U.S.C. 1395i–4(c)(2)(B))), 
such guidance or regulation shall not take effect prior to 
the expiration of a notice and comment period of not less 
than 60 days under which the public is given the oppor-
tunity to comment on such guidance or regulation and the 
Secretary evaluates any such comments. 
(b) RETROACTIVE APPLICATION TO GUIDANCE RE-
LATING TO APPLICATION OF THE 15-MILE SECONDARY 
ROAD DISTANCE REQUIREMENT.—In applying the cri-
teria described in subsection (a), a State (and the Sec-
retary) shall so apply such criteria, insofar as such criteria 
relates to a facility located in an area with only secondary 
roads available, using such guidance and regulations as 
were in effect on July 30, 2015, until, subject to para-
graph (4) of section 1820(h) of the Social Security Act 
(as added by section 2), such time as the Secretary issues 
guidance or regulations in accordance with such sub-
section. 
Æ 
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