; (II) in a health professional shortage area (as defined in section 332(a)(1)(A) of the Public Health Service Act); or (III) that represents a high proportion, relative to the national or statewide average, of individuals entitled to part A or enrolled under part B of this title or enrolled under a State plan under title XIX; (iv) has demonstrated to the Secretary, at such time and in such manner as the Secretary determines appropriate, two consecutive years of financial losses preceding the date of certification described in subparagraph (B)(i)(III); and (v) submits to the Secretary, at such time and in such manner as the Secretary may require, an attestation that the Secretary determines to be satisfactory, outlining the good governance qualifications and strategic plan for multi-year financial solvency of the 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 subsection (c)(2)(B)(i)(III)— (I) more than a total of 200 facilities as critical access hospitals; and (II) subject to clause (ii), within any one State, more than 15 facilities as critical access hospitals. (ii) State petition The Secretary may apply, with respect to a State, the limitation under clause (i)(II) by substituting a number that is greater than the number specified in such clause if the State petitions the Secretary, in accordance with a process established by the Secretary, to increase such number. ; and (2) in subsection (e), by inserting , subject to subsection (c)(2)(G), after The Secretary shall .