II
119THCONGRESS
1
STSESSION S. 335
To amend title XVIII of the Social Security Act to rebase the calculation
of payments for sole community hospitals and Medicare-dependent hos-
pitals, and for other purposes.
IN THE SENATE OF THE UNITED STATES
JANUARY30, 2025
Mr. G
RASSLEY(for himself, Mr. WELCH, Mrs. CAPITO, Mr. KAINE, Mr.
W
ICKER, Mrs. SHAHEEN, Mr. MORAN, Ms. SMITH, Mrs. HYDE-SMITH,
Mr. F
ETTERMAN, Mr. BOOZMAN, and Mr. KELLY) introduced the fol-
lowing bill; which was read twice and referred to the Committee on Fi-
nance
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 pur-
poses.
Be it enacted by the Senate and House of Representa-1
tives of the United States of America in Congress assembled, 2
SECTION 1. SHORT TITLE. 3
This Act may be cited as the ‘‘Rural Hospital Sup-4
port Act’’. 5
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SEC. 2. REBASING OF THE CALCULATION OF PAYMENTS 1
FOR SOLE COMMUNITY HOSPITALS. 2
(a) R
EBASINGPERMITTED.—Section 1886(b)(3) of 3
the Social Security Act (42 U.S.C. 1395ww(b)(3)) is 4
amended by adding at the end the following new subpara-5
graph: 6
‘‘(M)(i) For cost reporting periods begin-7
ning on or after October 1, 2025, in the case 8
of a sole community hospital there shall be sub-9
stituted for the amount otherwise determined 10
under subsection (d)(5)(D)(i) of this section, if 11
such substitution results in a greater amount of 12
payment under this section for the hospital, the 13
subparagraph (M) rebased target amount. 14
‘‘(ii) For purposes of this subparagraph, 15
the term ‘subparagraph (M) rebased target 16
amount’ has the meaning given the term ‘target 17
amount’ in subparagraph (C), except that— 18
‘‘(I) there shall be substituted for the 19
base cost reporting period the 12-month 20
cost reporting period beginning during fis-21
cal year 2016; 22
‘‘(II) any reference in subparagraph 23
(C)(i) to the ‘first cost reporting period’ 24
described in such subparagraph is deemed 25
a reference to the first cost reporting pe-26
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riod beginning on or after October 1, 1
2025; and 2
‘‘(III) the applicable percentage in-3
crease shall only be applied under subpara-4
graph (C)(iv) for discharges occurring on 5
or after October 1, 2025.’’. 6
(b) C
ONFORMING AMENDMENTS.—Section 7
1886(b)(3) of the Social Security Act (42 U.S.C. 8
1395ww(b)(3)) is amended— 9
(1) in subparagraph (C), in the matter pre-10
ceding clause (i), by striking ‘‘subparagraphs (I) and 11
(L)’’ and inserting ‘‘subparagraphs (I), (L), and 12
(M)’’; and 13
(2) in subparagraph (I)(i), in the matter pre-14
ceding subclause (I), by striking ‘‘subparagraph 15
(L)’’ and inserting ‘‘subparagraphs (L) and (M)’’. 16
SEC. 3. REBASING OF THE CALCULATION OF PAYMENTS 17
FOR MEDICARE-DEPENDENT HOSPITALS. 18
Section 1886(b)(3) of the Social Security Act (42 19
U.S.C. 1395ww(b)(3)), as amended by section 2, is 20
amended— 21
(1) in subparagraph (D), by striking ‘‘subpara-22
graph (K)’’ and inserting ‘‘subparagraphs (K) and 23
(N)’’; and 24
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(2) by adding at the end the following new sub-1
paragraph: 2
‘‘(N)(i) With respect to discharges occur-3
ring on or after October 1, 2025, in the case of 4
a medicare-dependent, small rural hospital, for 5
purposes of applying subparagraph (D)— 6
‘‘(I) there shall be substituted for the 7
base cost reporting period described in 8
subparagraph (D)(i) the 12-month cost re-9
porting period beginning during fiscal year 10
2016; and 11
‘‘(II) any reference in such subpara-12
graph to the ‘first cost reporting period’ 13
described in such subparagraph is deemed 14
a reference to the first cost reporting pe-15
riod beginning on or after October 1, 16
2025. 17
‘‘(ii) This subparagraph shall only apply to 18
a hospital if the substitution described in clause 19
(i)(I) results in an increase in the target 20
amount under subparagraph (D) for the hos-21
pital.’’. 22
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SEC. 4. PROHIBITION OF ADJUSTMENTS TO CLASSIFICA-1
TIONS AND WEIGHTING FACTORS RELATING 2
TO THE CALCULATION OF PAYMENTS FOR 3
SOLE COMMUNITY HOSPITALS AND MEDI-4
CARE-DEPENDENT HOSPITALS. 5
Section 1886(d)(4)(C) of the Social Security Act (42 6
U.S.C. 1395ww(d)(4)(C))— 7
(1) in clause (i), by striking ‘‘The Secretary’’ 8
and inserting ‘‘Subject to clause (v), the Secretary’’; 9
and 10
(2) by adding at the end the following new 11
clause: 12
‘‘(v) For discharges using the rebased target amounts 13
described in subparagraph (M) or (N) of subsection 14
(b)(3), the Secretary may not adjust such amounts for ad-15
justments required by clause (iii) prior to October 1, 16
2015.’’. 17
SEC. 5. EXTENSION OF THE MEDICARE-DEPENDENT HOS-18
PITAL (MDH) PROGRAM. 19
(a) E
XTENSION OFPAYMENTMETHODOLOGY.—Sec-20
tion 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 21
1395ww(d)(5)(G)) is amended— 22
(1) in clause (i), by striking ‘‘, and before April 23
1, 2025’’; and 24
(2) in clause (ii)(II), by striking ‘‘, and before 25
April 1, 2025’’. 26
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(b) CONFORMINGAMENDMENTS.— 1
(1) E
XTENSION OF TARGET AMOUNT .—Section 2
1886(b)(3)(D) of the Social Security Act (42 U.S.C. 3
1395ww(b)(3)(D)) is amended— 4
(A) in the matter preceding clause (i), by 5
striking ‘‘, and before April 1, 2025’’; and 6
(B) in clause (iv), by striking ‘‘through fis-7
cal year 2024 and the portion of fiscal year 8
2025 beginning on October 1, 2024, and ending 9
on March 31, 2025’’ and inserting ‘‘or a subse-10
quent fiscal year’’. 11
(2) P
ERMITTING HOSPITALS TO DECLINE RE -12
CLASSIFICATION.—Section 13501(e)(2) of the Omni-13
bus Budget Reconciliation Act of 1993 (42 U.S.C. 14
1395ww note) is amended by striking ‘‘fiscal year 15
2000 through fiscal year 2024, or the portion of fis-16
cal year 2025 beginning on October 1, 2024, and 17
ending on March 31, 2025’’ and inserting ‘‘a subse-18
quent fiscal year’’. 19
SEC. 6. EXTENSION OF THE INCREASED PAYMENTS UNDER 20
THE MEDICARE LOW-VOLUME HOSPITAL 21
PROGRAM. 22
Section 1886(d)(12) of the Social Security Act (42 23
U.S.C. 1395(d)(12)) is amended— 24
(1) in subparagraph (B)— 25
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(A) in the subparagraph heading, by in-1
serting ‘‘
FOR FISCAL YEARS 2005 THROUGH 2
2010’’ after ‘‘INCREASE’’; and 3
(B) in the matter preceding clause (i), by 4
striking ‘‘and for discharges occurring during 5
the portion of fiscal year 2025 beginning on 6
April 1, 2025, and ending on September 30, 7
2025, and in fiscal year 2026 and subsequent 8
fiscal years’’; 9
(2) in subparagraph (C)(i)— 10
(A) in the matter preceding subclause (I), 11
by striking ‘‘fiscal years 2011 through 2024 12
and the portion of fiscal year 2025 beginning 13
on October 1, 2024, and ending on March 31, 14
2025’’ and inserting ‘‘fiscal year 2011 and sub-15
sequent fiscal years’’; 16
(B) in subclause (III)— 17
(i) by striking ‘‘each of fiscal years 18
2019 through 2024 and the portion of fis-19
cal year 2025 beginning on October 1, 20
2024, and ending on March 31, 2025’’ and 21
inserting ‘‘fiscal year 2019 and each subse-22
quent fiscal year’’; and 23
(ii) by striking ‘‘; and’’ at the end and 24
inserting a period; and 25
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(C) by striking subclause (IV); and 1
(3) in subparagraph (D)— 2
(A) by amending the subparagraph head-3
ing to reach as follows: ‘‘A
PPLICABLE PER-4
CENTAGE INCREASE BEGINNING WITH FISCAL 5
YEAR 2011.—’’; 6
(B) in the matter preceding clause (i), by 7
striking ‘‘fiscal years 2011 through 2024 or 8
during the portion of fiscal year 2025 beginning 9
on October 1, 2024, and ending on March 31, 10
2025’’ and inserting ‘‘fiscal year 2011 and sub-11
sequent fiscal years’’; and 12
(C) in clause (ii), by striking ‘‘each of fis-13
cal years 2019 through 2024 and the portion of 14
fiscal year 2025 beginning on October 1, 2024, 15
and ending on March 31, 2025’’ and inserting 16
‘‘fiscal year 2019 and each subsequent fiscal 17
year’’. 18
Æ
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