[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 4009 Introduced in Senate (IS)]

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117th CONGRESS
  2d Session
                                S. 4009

     To amend title XVIII of the Social Security Act to rebase the 
   calculation of payments for sole community hospitals and Medicare-
              dependent hospitals, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 6, 2022

Mr. Casey (for himself and Mr. Grassley) 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 rebase the 
   calculation of payments for sole community hospitals and Medicare-
              dependent hospitals, and for other purposes.

    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 ``Rural Hospital Support Act''.

SEC. 2. REBASING OF THE CALCULATION OF PAYMENTS FOR SOLE COMMUNITY 
              HOSPITALS.

    (a) Rebasing Permitted.--Section 1886(b)(3) of the Social Security 
Act (42 U.S.C. 1395ww(b)(3)) is amended by adding at the end the 
following new subparagraph:
                    ``(M)(i) For cost reporting periods beginning on or 
                after October 1, 2022, in the case of a sole community 
                hospital there shall be substituted for the amount 
                otherwise determined under subsection (d)(5)(D)(i) of 
                this section, if such substitution results in a greater 
                amount of payment under this section for the hospital, 
                the subparagraph (M) rebased target amount.
                    ``(ii) For purposes of this subparagraph, the term 
                `subparagraph (M) rebased target amount' has the 
                meaning given the term `target amount' in subparagraph 
                (C), except that--
                            ``(I) there shall be substituted for the 
                        base cost reporting period the 12-month cost 
                        reporting period beginning during fiscal year 
                        2016;
                            ``(II) any reference in subparagraph (C)(i) 
                        to the `first cost reporting period' described 
                        in such subparagraph is deemed a reference to 
                        the first cost reporting period beginning on or 
                        after October 1, 2022; and
                            ``(III) the applicable percentage increase 
                        shall only be applied under subparagraph 
                        (C)(iv) for discharges occurring on or after 
                        October 1, 2022.''.
    (b) Conforming Amendments.--Section 1886(b)(3) of the Social 
Security Act (42 U.S.C. 1395ww(b)(3)) is amended--
            (1) in subparagraph (C), in the matter preceding clause 
        (i), by striking ``subparagraphs (I) and (L)'' and inserting 
        ``subparagraphs (I), (L), and (M)''; and
            (2) in subparagraph (I)(i), in the matter preceding 
        subclause (I), by striking ``subparagraph (L)'' and inserting 
        ``subparagraphs (L) and (M)''.

SEC. 3. REBASING OF THE CALCULATION OF PAYMENTS FOR MEDICARE-DEPENDENT 
              HOSPITALS.

    Section 1886(b)(3) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)), as amended by section 2, is amended--
            (1) in subparagraph (D), by striking ``subparagraph (K)'' 
        and inserting ``subparagraphs (K) and (N)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(N)(i) With respect to discharges occurring on or 
                after October 1, 2022, in the case of a medicare-
                dependent, small rural hospital, for purposes of 
                applying subparagraph (D)--
                            ``(I) there shall be substituted for the 
                        base cost reporting period described in 
                        subparagraph (D)(i) the 12-month cost reporting 
                        period beginning during fiscal year 2016; and
                            ``(II) any reference in such subparagraph 
                        to the `first cost reporting period' described 
                        in such subparagraph is deemed a reference to 
                        the first cost reporting period beginning on or 
                        after October 1, 2022.
                    ``(ii) This subparagraph shall only apply to a 
                hospital if the substitution described in clause (i)(I) 
                results in an increase in the target amount under 
                subparagraph (D) for the hospital.''.

SEC. 4. PROHIBITION OF ADJUSTMENTS TO CLASSIFICATIONS AND WEIGHTING 
              FACTORS RELATING TO THE CALCULATION OF PAYMENTS FOR SOLE 
              COMMUNITY HOSPITALS AND MEDICARE-DEPENDENT HOSPITALS.

    Section 1886(d)(4)(C) of the Social Security Act (42 U.S.C. 
1395ww(d)(4)(C))--
            (1) in clause (i), by striking ``The Secretary'' and 
        inserting ``Subject to clause (v), the Secretary''; and
            (2) by adding at the end the following new clause:
    ``(v) For discharges using the rebased target amounts described in 
subparagraph (M) or (N) of subsection (b)(3), the Secretary may not 
adjust such amounts for adjustments required by clause (iii) prior to 
October 1, 2015.''.

SEC. 5. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) PROGRAM.

    (a) Extension of Payment Methodology.--Section 1886(d)(5)(G) of the 
Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended--
            (1) in clause (i), by striking ``, and before October 1, 
        2022''; and
            (2) in clause (ii)(II), by striking ``, and before October 
        1, 2022''.
    (b) Conforming Amendments.--
            (1) Extension of target amount.--Section 1886(b)(3)(D) of 
        the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
        amended--
                    (A) in the matter preceding clause (i), by striking 
                ``, and before October 1, 2022''; and
                    (B) in clause (iv), by striking ``through fiscal 
                year 2022'' and inserting ``or a subsequent fiscal 
                year''.
            (2) Permitting hospitals to decline reclassification.--
        Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 
        1993 (42 U.S.C. 1395ww note) is amended by striking ``fiscal 
        year 2000 through fiscal year 2022'' and inserting ``a 
        subsequent fiscal year''.

SEC. 6. EXTENSION OF THE INCREASED PAYMENTS UNDER THE MEDICARE LOW-
              VOLUME HOSPITAL PROGRAM.

    Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395(d)(12)) is amended--
            (1) in subparagraph (B)--
                    (A) in the subparagraph heading, by inserting ``for 
                fiscal years 2005 through 2010'' after ``increase''; 
                and
                    (B) in the matter preceding clause (i), by striking 
                ``and for discharges occurring in fiscal year 2023 and 
                subsequent fiscal years'';
            (2) in subparagraph (C)(i)--
                    (A) in the matter preceding subclause (I), by 
                striking ``fiscal years 2011 through 2022'' and 
                inserting ``fiscal year 2011 and subsequent fiscal 
                years'';
                    (B) in subclause (II), by adding ``and'' at the 
                end;
                    (C) in subclause (III)--
                            (i) by striking ``each of fiscal years 2019 
                        through 2022'' and inserting ``fiscal year 2019 
                        and each subsequent fiscal year''; and
                            (ii) by striking ``; and'' at the end and 
                        inserting a period; and
                    (D) by striking subclause (IV); and
            (3) in subparagraph (D)--
                    (A) by amending the subparagraph heading to reach 
                as follows: ``Applicable percentage increase beginning 
                with fiscal year 2011.--'';
                    (B) in the matter preceding clause (i), by striking 
                ``fiscal years 2011 through 2022'' and inserting 
                ``fiscal year 2011 and subsequent fiscal years''; and
                    (C) in clause (ii), by striking ``each of fiscal 
                years 2019 through 2022'' and inserting ``fiscal year 
                2019 and each subsequent fiscal year''.
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