S.Amdt. 4742

This amendment, submitted by Mr. Durbin, aims to change how certain hospitals are designated as critical access hospitals by restoring the authority of states to waive the "35-mile rule."

The purpose of this change is to allow specific rural hospitals to be certified as critical access hospitals if the state identifies them as necessary providers of health care services for residents in that area.

Key changes and additions include:

• Eligibility Requirements: To qualify under this state waiver, a hospital must meet specific criteria, including:

  • Being a certain type of hospital (such as a sole community hospital or a low-volume hospital).
  • Being located in a rural area or a specific rural census tract.
  • Being in a county with high poverty levels, a health professional shortage area, or having a high percentage of Medicare Part A inpatient days.
  • Having two consecutive years of negative operating margins.
  • Providing a strategic plan for financial solvency and committing to open or expand a high-demand service line, such as behavioral health or obstetrics.

• Limits on Designations: The Secretary is limited to certifying no more than 120 facilities total, with a maximum of 5 facilities per state.

• Accountability and Reporting: Hospitals receiving this designation must submit reports on their new or expanded services. The Secretary can revoke certification if the hospital fails to comply with reporting requirements.

• Oversight and Sunset:

  • The amendment requires the GAO to study the implementation and impact on Medicare expenditures.
  • The Medicare Payment Advisory Commission must study rural hospital payment systems.
  • The authority to certify hospitals under this state waiver expires 9 years after the enactment date, at which point hospitals must transition to other payment models.

• Repeals: The amendment also repeals most health provisions of Subtitle B of title VII of Public Law 119-21.