Title: Protecting Rural Access to Care Act
Policy area: Health

Summary:
Protecting Rural Access to Care Act
This bill limits the scope of guidance issued by the Centers for Medicare & Medicaid Services (CMS) regarding the secondary road criteria for Medicare critical access hospitals (CAHs).
Currently, in order to qualify as a CAH under Medicare, a hospital must either (1) be located more than 35 miles (15 miles in mountainous regions or areas with only secondary roads) from another hospital, or (2) have been certified prior to January 1, 2006, by the state as a necessary provider of services in the area.
The CMS issued guidance on July 31, 2015, that provided more detail as to the differences between primary and secondary roads for purposes of CAH certification. The bill specifies that this guidance does not apply to CAHs that were certified prior to July 31, 2015, and that these CAHs are instead subject to the standards that were in place before the guidance was issued. Ongoing CAH certifications are also subject to pre-guidance standards until the CMS issues new guidance after a specified public comment period.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 489 Introduced in House (IH)]

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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 previously 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Rural Access to Care 
Act''.

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 designation specified in clause (i) of subsection 
        (c)(2)(B), a State (and the Secretary) 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.''.

SEC. 3. REQUIREMENT FOR PUBLIC NOTICE AND COMMENT PERIOD FOR ANY 
              GUIDANCE OR REGULATION 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 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 opportunity to comment on such guidance or regulation and the 
Secretary evaluates any such comments.
    (b) Retroactive Application to Guidance Relating to Application of 
the 15-Mile Secondary Road Distance Requirement.--In applying the 
criteria described in subsection (a), a State (and the Secretary) 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 paragraph (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 subsection.
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