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March 20, 2026
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Download official Senate Record PDFReturn to issue contextSA 4742. Mr. DURBIN submitted an amendment intended to be proposed by him to the bill S. 1383, to establish the Veterans Advisory Committee on Equal Access, and for other purposes; which was ordered to lie on the table; as follows:
At the appropriate place, insert the following:
SEC. __. RESTORING STATE AUTHORITY TO WAIVE THE 35-MILE RULE
FOR CERTAIN MEDICARE CRITICAL ACCESS HOSPITAL
DESIGNATIONS.
(a) In General.—Section 1820 of the Social Security Act
(42 U.S.C. 1395i-4) is amended—
(1) in subsection (c)(2)—
(A) in subparagraph (B)(i)—
(i) in subclause (I), by striking “or” at the end;
(ii) in subclause (II), by inserting “or” at the end; and
(iii) by adding at the end the following new subclause:
“(III) subject to subparagraph (G), is a hospital
described in subparagraph (F) and is certified, on or after
the date of the enactment of this subclause, and before the
date that is 9 years after the date of enactment of
this subclause, by the State as being a necessary provider of
health care services to residents in the area;”; and
(B) by adding at the end the following new subparagraphs:
“(F) Hospital described.—For purposes of subparagraph
(B)(i)(III), a hospital described in this subparagraph is a
hospital that—
“(i) is a sole community hospital (as defined in section
1886(d)(5)(D)(iii)), a medicare dependent, small rural
hospital (as defined in section 1886(d)(5)(G)(iv)), a low-
volume hospital that in 2021 receives a payment adjustment
under section 1886(d)(12), or a subsection (d) hospital (as
defined in section 1886(d)(1)(B));
“(ii) is located in a rural area, as defined in section
1886(d)(2)(D), or a rural census tract of a metropolitan
statistical area (as determined under the most recent
modification of the Goldsmith Modification, originally
published in the Federal Register on February 27, 1992 (57
Fed. Reg. 6725));
“(iii)(I) is located—
“(aa) in a county that has a percentage of individuals
with income at or below the Federal poverty level in 2023 or
2024 that is higher than the national or statewide average in
that year; or
“(bb) in a health professional shortage area (as defined
in section 332(a)(1)(A) of the Public Health Service Act); or
“(II) has a percentage of inpatient days of individuals
entitled to benefits under part A of this title in 2023 or
2024 that is higher than the national or statewide average in
that year;
“(iv) has attested to the Secretary that the hospital—
“(I) was operating as of the date of enactment of this
subparagraph; and
“(II) had 2 consecutive years of negative operating
margins preceding the date of certification described in
subparagraph (B)(i)(III), as defined by the Secretary in the
regulations or program instruction issued pursuant to
subparagraph (I); and
“(v) submits to the Secretary, at such time and in such
manner as the Secretary may require, an application for
certification of the facility as a critical access hospital,
including an attestation outlining—
“(I) the good governance qualifications and strategic plan
for multi-year financial solvency of the hospital; and
“(II) the hospital's commitment to open and maintain, for
the duration of the hospital's designation as a critical
access hospital under this section, a new service line or
expanded service capacity for a service that is in high
demand or limited supply in the hospital's service area
(determined based on the hospital's most recent community
health needs assessment under section 501(r)(3) of the
Internal Revenue Code of 1986 (or other comparable
assessment)), such as obstetrics or behavioral health care
services.
“(G) Limitation on certain designations.—
“(i) In general.—Subject to clauses (ii) and (iii), the
Secretary may not under subsection (e) certify pursuant to a
certification by a State under subparagraph (B)(i)(III)—
“(I) more than a total of 120 facilities as critical
access hospitals; and
“(II) within any one State, more than 5 facilities as
critical access hospitals.
“(ii) Process.—The Secretary shall follow the following
process in carrying out clause (i) with respect to each year
in which the Secretary determines that the limitation under
clause (i)(I) has not been reached:
“(I) Initial assessment.—The Secretary shall conduct an
initial assessment of the total number of hospitals described
in paragraph (2)(F).
“(II) Initial allocation.—Of the total number of
designations available under clause (i), the Secretary shall
allocate 1 for a hospital in each State that the Secretary
determines (based on the initial assessment under subclause
(I)) has one or more hospitals described in paragraph (2)(F).
“(III) Remaining allocation.—Of the total number of
designations available under clause (i), after application of
subclause (II), the Secretary shall allocate the remaining
number on a proportional basis based on the total number of
hospitals described in paragraph (2)(F) in each State that
are eligible (as determined based on the initial assessment
under subclause (I)).
“(iii) Sunset.—Effective beginning on the date that is 9
years after the date of enactment of this subparagraph, the
Secretary may not certify a hospital as a critical access
hospital pursuant to a certification by a State under
subparagraph (B)(i)(III).
“(H) Information submission requirements for hospitals
certified pursuant to rural hospital closure relief act.—
“(i) In general.—A critical access hospital that is
certified under subsection (e) pursuant to a certification by
a State under subparagraph (B)(i)(III) shall submit to the
Secretary the following at a time, and in a manner, specified
by the Secretary:
“(I) Reports.—Reports containing such information as the
Secretary may specify with respect to items and services
furnished as part of the new service line or expanded service
capacity for a service as described in the attestation
submitted by the critical access hospital under subparagraph
(F)(v)(II). To the extent practicable, the Secretary shall
align such reporting with other reporting requirements
applicable to critical access hospitals under this
subsection.
“(II) Notice.—If the critical access hospital materially
changes the new service line or expanded capacity for a
service as so described, notice of such changes along with a
plan to satisfactorily maintain access to care (as determined
by the Secretary).
“(ii) Revocation of certification for noncompliance.—If
the Secretary determines that a critical access hospital
described in clause (i) has failed to submit an annual report
required under subclause (I) of such clause or a notice
required under subclause (II) of such clause, the Secretary
may, as the Secretary determines appropriate, revoke the
certification of the critical access hospital under
subsection (e).
“(I) Implementation.—Not later than 1 year after the date
of the enactment of this subparagraph, the Secretary shall
issue final regulations or program instruction to carry out
subparagraphs (B)(i)(III), (F), (G), and (H).”; and
(2) in subsection (e), by inserting “, subject to
subsection (c)(2)(G),” after “The Secretary shall”.
(b) Clarification Regarding Facilities That Meet Distance
or Other Criteria and Application of Other Criteria.—Nothing
in this section shall affect—
(1) the application of criteria for designation as a
critical access hospital described in subclause (I) or (II)
of section 1820(c)(2)(B)(i) of the Social Security Act (42
U.S.C. 1395i-4(c)(2)(B)(i)); or
(2) the application of criteria for designation as a
critical access hospital described in clauses (ii) through
(v) of section 1820(c)(2)(B) of the Social Security Act (42
U.S.C. 1395i-4(c)(2)(B)).
(c) GAO Study and Report.—
(1) Study.—The Comptroller General of the United States
(in this section referred to as the “Comptroller General”)
shall conduct a study on the implementation of the amendments
made by subsection (a). To the extent such data are available
and reliable, such study shall include—
(A) an analysis of—
(i) the characteristics of facilities designated as
critical access hospitals pursuant to section
1820(c)(2)(B)(i)(III) of the Social Security Act, as added by
subsection (a);
(ii) an analysis of the financial status and outlook for
such facilities based on their designation as a critical
access hospital pursuant to such section; and
(iii) an analysis of any increase in expenditures under the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) as a result of such designation,
relative to the expected baseline expenditures under the
Medicare program if such facilities had not received such
designation; and
(B) an assessment of whether the authority to designate
facilities as critical access hospitals pursuant to such
section 1820(c)(2)(B)(i)(III) promotes access to care in
rural areas.
(2) Report.—Not later than 6 years after the date of the
enactment of this Act, the Comptroller General shall submit
to Congress a report containing the results of the study
conducted under subsection (a), together with recommendations
for such legislation and administrative action as the
Comptroller General determines appropriate.
(d) MedPAC Study and Report on Payment Systems for Rural
Hospitals.—
(1) Study.—The Medicare Payment Advisory Commission (in
this subsection referred to as the “Commission”) shall
conduct a study, using data from 2018 through 2028, on
payment systems for rural hospitals under the Medicare
program under title XVIII of the Social Security Act (42
U.S.C. 1395 et seq.). Such study shall include an analysis
of—
(A) facilities designated as critical access hospitals
pursuant to section 1820(c)(2)(B)(i)(III) of the Social
Security Act, as added by subsection (a);
(B) features of payment systems for rural hospitals,
including value-based payment systems, that would—
(i) ensure financial sustainability for the Medicare
program; and
(ii) preserve access to care for Medicare beneficiaries;
and
(C) if the Commission recommends any new payment system for
rural hospitals under the Medicare program, to the extent
feasible, the impacts of transition from existing payment
systems to such new payment system.
(2) Report.—Not later than 8 years after the date of
enactment of this Act, the Commission shall submit to
Congress a report on the study conducted under paragraph (1),
together with recommendations for such legislation and
administrative action as the Commission determines
appropriate.
(3) Definition of rural hospital.—In this subsection, the
term “rural hospital” means—
(A) a critical access hospital (as defined in section
1861(mm)(1) of the Social Security Act (42 U.S.C.
1395x(mm)(1)));
(B) a subsection (d) hospital (as defined in section
1886(d)(1)(B) of the Social Security Act (42 U.S.C.
1395ww(d)(1)(B))) that is located in a rural census tract of
a metropolitan statistical area (as determined under the most
recent modification of the Goldsmith Modification, originally
published in the Federal Register on February 27, 1992 (57
Fed. Reg. 6725));
(C) a sole community hospital (as defined in section
1886(d)(5)(D)(iii)) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(D)(iii)));
(D) a medicare dependent, small rural hospital (as defined
in section 1886(d)(5)(G)(iv) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(G)(iv))); and
(E) a low-volume hospital (as defined in section
1886(d)(12)(C)(i) of the Social Security Act (42 U.S.C.
1395ww(d)(12)(C)(i))).
(e) Sunset.—Not later than 9 years after the date of
enactment of this Act, the Secretary shall establish a
mechanism and provide guidance and technical assistance under
which any facility that was designated as a critical access
hospital pursuant to a certification by a State under section
1820(c)(2)(B)(i)(III) of the Social Security Act, as added by
subsection (a), may transition within 1 year to one of the
following payment models:
(1) Such new model or models recommended by the Medicare
Payment Advisory Commission in the report submitted under
subsection d.
(2) The prospective payment model (or models) under which
the facility received payment under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.) prior to being so
designated pursuant to such certification.
(3) Payment as a rural emergency hospital under section
1834(x) of the Social Security Act (42 U.S.C. 1395m(x)).
SEC. __. REPEAL OF OBBBA HEALTH PROVISIONS.
Subtitle B of title VII of the Act titled “An Act to
provide for reconciliation pursuant to title II of H. Con.
Res. 14” (Public Law 119-21) (other than sections 71202 and
71401 of such subtitle) is repealed and any law or regulation
referred to in such subtitle shall be applied as if such
subtitle and the amendments made by such subtitle (other than
such sections) had not been enacted.