S. 644Senate117th Congress (2021-2023)In Committee

Rural Hospital Closure Relief Act of 2021

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Updated February 7, 2026 at 11:58 PM UTC

The Rural Hospital Closure Relief Act of 2021 changes Medicare rules so states can waive the 35‑mile distance requirement for designating certain small rural hospitals as critical access hospitals. It sets new eligibility criteria, caps how many hospitals can receive the waiver, and orders the Health and Human Services Secretary to issue regulations and test a new payment model to help keep rural hospitals financially viable.

Key Provisions

Restores state authority to waive the 35‑mile rule for hospitals that meet specific rural, size, and financial‑hardship criteria.
Defines eligible hospitals (sole community, Medicare‑dependent, low‑volume, under 50 beds, etc.) and adds poverty‑area or health‑professional‑shortage area requirements.
Limits waivers to a maximum of 175 nationwide and no more than 10 per state, with no more than 20% of a certain type of facility.
Requires hospitals seeking a waiver to show two consecutive years of negative operating margins and submit a multi‑year financial solvency plan.
Directs HHS to issue final regulations within 120 days and to test a new rural hospital delivery and payment model within three years, allowing all critical access hospitals to transition to it.

Legislative Activity

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1 earlier action

SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance. (text: CR S1426)

Finance Committee

March 9, 2021

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SenateIntro Referral

Introduced in Senate

March 9, 2021

SenateIntro Referral

Read twice and referred to the Committee on Finance. (text: CR S1426)

Finance Committee

March 9, 2021

Floor Debate

2 members

What members said about S. 644 on the floor

2 Democrats

Sen. Mazie K. HironoD-HI · Mar 9, 2021

Mr. President, I rise today to introduce the Inventor Diversity for Economic Advancement Act of 2021. I thank my colleague from North Carolina, Senator Tillis, for working with me on this important piece of legislation, which serves as a first step to closing the diversity gap in our patent system by collecting demographic data on patent applicants.

Women and racial minorities have made some of the most significant inventions in this Nation's history. The $75 billion home security industry grew from an initial home security system invented by Marie Van Brittan Brown. The computer would never have become the multimedia device it is today without the microcomputer system invented by Mark Dean. The genetic revolution would still be science fiction if not for the CRISPR gene-editing tool discovered by Jennifer Doudna--raised on Hawaii's Big Island.

We should celebrate these inventors and the many others like them who have contributed to innovation in this Nation. But we must also recognize the hard truth that women, racial minorities, and many other groups are greatly underrepresented in the U.S. patent system.

The Patent and Trademark Office's recent report on women inventors shines a spotlight on one part of this problem. The PTO found that only 22 percent of U.S. patents list a woman as an inventor and that women make up only 13 percent of all inventors. This is true even though women held 43 percent of all full-time jobs in 2016 and 28 percent of STEM jobs in 2015.

Other reports highlight racial patent gaps. For example, a report by the Institute for Women's Policy Research found that the percentage of African American and Hispanic college graduates who hold patents is approximately half that of their white counterparts.

Closing these gaps would turbocharge our economy. According to a study by Michigan State University Professor Lisa Cook, including more women and African Americans in the ``initial stage of the process of innovation'' could increase GDP by as much as $640 billion.

Another study by the National Bureau of Economic Research found that eliminating the patent gap for women with science and engineering degrees alone would increase GDP by over $500 billion.

It's simply good policy and good business to want to fully integrate people of all types into our innovation economy. But if we have any hope of closing the various patent gaps, we must first get a firm grasp on the scope of the problem.

Studies of the demographic makeup of patentees, like the ones I described, are few and far between. The reason is a simple one. A lack of data. The PTO does not collect any data on applicants beyond their first and last names and city, State, and country of residence. As a result, those wishing to study patent gaps between different demographic groups are forced to guess the gender of an applicant based on his or her name, determine the race of an applicant by cross- referencing census data, or explore a number of other options that are time-consuming, unreliable, or both.

The IDEA Act solves this problem. It would require the PTO to collect demographic data--including gender, race, and military or veteran status--from patent applicants on a voluntary basis. It would further require the PTO to issue reports on the data collected and, perhaps more importantly, make the data available to the public with appropriate protections for personally identifiable information. Outside researchers could therefore conduct their own analyses and offer insights into the various patent gaps in our society.

Let me be clear. Closing the information gap facing researchers alone will not solve the patent gap facing women, racial minorities, and so many others. But it is a critical first step. I therefore encourage my colleagues to support the IDEA Act.

Sen. Richard J. DurbinD-IL · Mar 9, 2021

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Bill Text

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Introduced in SenateIssued March 9, 2021

117th CONGRESS

1st Session

S. 644

IN THE SENATE OF THE UNITED STATES

March 9, 2021

Mr. Durbin (for himself and Mr. Lankford) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to restore State authority to waive for certain facilities the 35-mile rule for designating critical access hospitals under the Medicare program, and for other purposes.

Short title

This Act may be cited as the Rural Hospital Closure Relief Act of 2021.

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 at the end or;

(ii)

in subclause (II), by inserting at the end or; 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 the Rural Hospital Closure Relief Act of 2021 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), a subsection (d) hospital (as defined in section 1886(d)(1)(B)) that has fewer than 50 beds, or, subject to the limitation under subparagraph (G)(i)(I), is a facility described in subparagraph (G)(ii);

(ii)

is located in a rural area, as defined in section 1886(d)(2)(D);

(iii)

(I)

is located—

(aa)

in a county that has a percentage of individuals with income that is below 150 percent of the poverty line that is higher than the national or statewide average in 2020; 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, enrolled under part B of this title, or enrolled under a State plan under title XIX that is higher than the national or statewide average in 2019 or 2020;

(iv)

subject to subparagraph (G)(ii)(II), has attested to the Secretary two consecutive years of negative operating margins preceding the date of certification described in subparagraph (B)(i)(III); and

(v)

submits to the Secretary—

(I)

at such time and in such manner as the Secretary may require, an attestation outlining the good governance qualifications and strategic plan for multi-year financial solvency of the hospital; and

(II)

not later than 120 days after the date on which the Secretary issues final regulations pursuant to section 2(b) of the Rural Hospital Closure Relief Act of 2021, an application for certification of the facility as a critical access hospital.

(G)

Limitation on certain designations

(i)

In general

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 175 facilities as critical access hospitals, of which not more than 20 percent may be facilities described in clause (ii); and

(II)

within any one State, more than 10 facilities as critical access hospitals.

(ii)

Facility described

(I)

In general

A facility described in this clause is a facility that as of the date of enactment of this subparagraph met the criteria for designation as a critical access hospital under subparagraph (B)(i)(I).

(II)

Nonapplication of certain criteria

For purposes of subparagraph (B)(i)(III), the criteria described in subparagraph (F)(iv) shall not apply with respect to the designation of a facility described in subclause (I).

; and

(2)

in subsection (e), by inserting , subject to subsection (c)(2)(G), after The Secretary shall.

(b)

Regulations

Not later than 120 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall issue final regulations to carry out this section.

(c)

Clarification regarding facilities that meet distance or other certification criteria

Nothing in this section shall affect the application of criteria for designation as a critical access hospital described in subclause (I) or (II) section 1820(c)(2)(B)(i) of the Social Security Act (42 U.S.C. 1395i–4(c)(2)(B)(i)).

CMI testing of new rural hospital delivery and payment model

Section 1115A of the Social Security Act (42 U.S.C. 1315a) is amended—

(1)

in subsection (b)(2)(A), by adding at the end the following new sentence: “The models selected under this subparagraph shall include the testing of a new rural hospital delivery and payment model (or models), as described in subsection (h).”; and

(2)

by adding at the end the following new subsection:

(h)

Testing of new rural hospital delivery and payment model

(1)

In general

(A)

Testing

The Secretary shall test the implementation of a new rural hospital delivery and payment model (or models) that the Secretary determines would promote financially sustainable ways to ensure patient access to care in rural communities, which may include models under which such hospitals furnish outpatient emergency care services 24 hours a day, 7 days a week for which payment is made under title XVIII based on the amount determined under the prospective payment system for hospital outpatient department services under section 1833(t), plus a fixed rate for the cost of furnishing the emergency services.

(B)

Promulgation of regulations

Not later than 3 years after the date of the enactment of this subsection, the Secretary shall promulgate regulations to test a new rural hospital delivery and payment model (or models) described in subparagraph (A), unless Congress enacts legislation that establishes such a payment model (or models) prior to the promulgation of regulations pursuant to this subparagraph.

(2)

Transition

Effective beginning on the date on which the testing of a new rural hospital delivery and payment model (or models) described in paragraph (1)(A) is implemented under this subsection or such a payment model (or models) is established through the enactment of legislation described in paragraph (1)(B), the Secretary shall provide a process under which—

(A)

all critical access hospitals may transition to such new model or models under this subsection; and

(B)

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) may revert to the prospective payment model (or models) under which the facility received payment under title XVIII prior to being so designated.