| 1 | 1 | | II |
|---|
| 2 | 2 | | 119THCONGRESS |
|---|
| 3 | 3 | | 1 |
|---|
| 4 | 4 | | STSESSION S. 335 |
|---|
| 5 | 5 | | To amend title XVIII of the Social Security Act to rebase the calculation |
|---|
| 6 | 6 | | of payments for sole community hospitals and Medicare-dependent hos- |
|---|
| 7 | 7 | | pitals, and for other purposes. |
|---|
| 8 | 8 | | IN THE SENATE OF THE UNITED STATES |
|---|
| 9 | 9 | | JANUARY30, 2025 |
|---|
| 10 | 10 | | Mr. G |
|---|
| 11 | 11 | | RASSLEY(for himself, Mr. WELCH, Mrs. CAPITO, Mr. KAINE, Mr. |
|---|
| 12 | 12 | | W |
|---|
| 13 | 13 | | ICKER, Mrs. SHAHEEN, Mr. MORAN, Ms. SMITH, Mrs. HYDE-SMITH, |
|---|
| 14 | 14 | | Mr. F |
|---|
| 15 | 15 | | ETTERMAN, Mr. BOOZMAN, and Mr. KELLY) introduced the fol- |
|---|
| 16 | 16 | | lowing bill; which was read twice and referred to the Committee on Fi- |
|---|
| 17 | 17 | | nance |
|---|
| 18 | 18 | | A BILL |
|---|
| 19 | 19 | | To amend title XVIII of the Social Security Act to rebase |
|---|
| 20 | 20 | | the calculation of payments for sole community hospitals |
|---|
| 21 | 21 | | and Medicare-dependent hospitals, and for other pur- |
|---|
| 22 | 22 | | poses. |
|---|
| 23 | 23 | | Be it enacted by the Senate and House of Representa-1 |
|---|
| 24 | 24 | | tives of the United States of America in Congress assembled, 2 |
|---|
| 25 | 25 | | SECTION 1. SHORT TITLE. 3 |
|---|
| 26 | 26 | | This Act may be cited as the ‘‘Rural Hospital Sup-4 |
|---|
| 27 | 27 | | port Act’’. 5 |
|---|
| 28 | 28 | | VerDate Sep 11 2014 02:37 Feb 26, 2025 Jkt 059200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S335.IS S335 |
|---|
| 29 | 29 | | ssavage on LAPJG3WLY3PROD with BILLS 2 |
|---|
| 30 | 30 | | •S 335 IS |
|---|
| 31 | 31 | | SEC. 2. REBASING OF THE CALCULATION OF PAYMENTS 1 |
|---|
| 32 | 32 | | FOR SOLE COMMUNITY HOSPITALS. 2 |
|---|
| 33 | 33 | | (a) R |
|---|
| 34 | 34 | | EBASINGPERMITTED.—Section 1886(b)(3) of 3 |
|---|
| 35 | 35 | | the Social Security Act (42 U.S.C. 1395ww(b)(3)) is 4 |
|---|
| 36 | 36 | | amended by adding at the end the following new subpara-5 |
|---|
| 37 | 37 | | graph: 6 |
|---|
| 38 | 38 | | ‘‘(M)(i) For cost reporting periods begin-7 |
|---|
| 39 | 39 | | ning on or after October 1, 2025, in the case 8 |
|---|
| 40 | 40 | | of a sole community hospital there shall be sub-9 |
|---|
| 41 | 41 | | stituted for the amount otherwise determined 10 |
|---|
| 42 | 42 | | under subsection (d)(5)(D)(i) of this section, if 11 |
|---|
| 43 | 43 | | such substitution results in a greater amount of 12 |
|---|
| 44 | 44 | | payment under this section for the hospital, the 13 |
|---|
| 45 | 45 | | subparagraph (M) rebased target amount. 14 |
|---|
| 46 | 46 | | ‘‘(ii) For purposes of this subparagraph, 15 |
|---|
| 47 | 47 | | the term ‘subparagraph (M) rebased target 16 |
|---|
| 48 | 48 | | amount’ has the meaning given the term ‘target 17 |
|---|
| 49 | 49 | | amount’ in subparagraph (C), except that— 18 |
|---|
| 50 | 50 | | ‘‘(I) there shall be substituted for the 19 |
|---|
| 51 | 51 | | base cost reporting period the 12-month 20 |
|---|
| 52 | 52 | | cost reporting period beginning during fis-21 |
|---|
| 53 | 53 | | cal year 2016; 22 |
|---|
| 54 | 54 | | ‘‘(II) any reference in subparagraph 23 |
|---|
| 55 | 55 | | (C)(i) to the ‘first cost reporting period’ 24 |
|---|
| 56 | 56 | | described in such subparagraph is deemed 25 |
|---|
| 57 | 57 | | a reference to the first cost reporting pe-26 |
|---|
| 58 | 58 | | VerDate Sep 11 2014 02:37 Feb 26, 2025 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S335.IS S335 |
|---|
| 59 | 59 | | ssavage on LAPJG3WLY3PROD with BILLS 3 |
|---|
| 60 | 60 | | •S 335 IS |
|---|
| 61 | 61 | | riod beginning on or after October 1, 1 |
|---|
| 62 | 62 | | 2025; and 2 |
|---|
| 63 | 63 | | ‘‘(III) the applicable percentage in-3 |
|---|
| 64 | 64 | | crease shall only be applied under subpara-4 |
|---|
| 65 | 65 | | graph (C)(iv) for discharges occurring on 5 |
|---|
| 66 | 66 | | or after October 1, 2025.’’. 6 |
|---|
| 67 | 67 | | (b) C |
|---|
| 68 | 68 | | ONFORMING AMENDMENTS.—Section 7 |
|---|
| 69 | 69 | | 1886(b)(3) of the Social Security Act (42 U.S.C. 8 |
|---|
| 70 | 70 | | 1395ww(b)(3)) is amended— 9 |
|---|
| 71 | 71 | | (1) in subparagraph (C), in the matter pre-10 |
|---|
| 72 | 72 | | ceding clause (i), by striking ‘‘subparagraphs (I) and 11 |
|---|
| 73 | 73 | | (L)’’ and inserting ‘‘subparagraphs (I), (L), and 12 |
|---|
| 74 | 74 | | (M)’’; and 13 |
|---|
| 75 | 75 | | (2) in subparagraph (I)(i), in the matter pre-14 |
|---|
| 76 | 76 | | ceding subclause (I), by striking ‘‘subparagraph 15 |
|---|
| 77 | 77 | | (L)’’ and inserting ‘‘subparagraphs (L) and (M)’’. 16 |
|---|
| 78 | 78 | | SEC. 3. REBASING OF THE CALCULATION OF PAYMENTS 17 |
|---|
| 79 | 79 | | FOR MEDICARE-DEPENDENT HOSPITALS. 18 |
|---|
| 80 | 80 | | Section 1886(b)(3) of the Social Security Act (42 19 |
|---|
| 81 | 81 | | U.S.C. 1395ww(b)(3)), as amended by section 2, is 20 |
|---|
| 82 | 82 | | amended— 21 |
|---|
| 83 | 83 | | (1) in subparagraph (D), by striking ‘‘subpara-22 |
|---|
| 84 | 84 | | graph (K)’’ and inserting ‘‘subparagraphs (K) and 23 |
|---|
| 85 | 85 | | (N)’’; and 24 |
|---|
| 86 | 86 | | VerDate Sep 11 2014 02:37 Feb 26, 2025 Jkt 059200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S335.IS S335 |
|---|
| 87 | 87 | | ssavage on LAPJG3WLY3PROD with BILLS 4 |
|---|
| 88 | 88 | | •S 335 IS |
|---|
| 89 | 89 | | (2) by adding at the end the following new sub-1 |
|---|
| 90 | 90 | | paragraph: 2 |
|---|
| 91 | 91 | | ‘‘(N)(i) With respect to discharges occur-3 |
|---|
| 92 | 92 | | ring on or after October 1, 2025, in the case of 4 |
|---|
| 93 | 93 | | a medicare-dependent, small rural hospital, for 5 |
|---|
| 94 | 94 | | purposes of applying subparagraph (D)— 6 |
|---|
| 95 | 95 | | ‘‘(I) there shall be substituted for the 7 |
|---|
| 96 | 96 | | base cost reporting period described in 8 |
|---|
| 97 | 97 | | subparagraph (D)(i) the 12-month cost re-9 |
|---|
| 98 | 98 | | porting period beginning during fiscal year 10 |
|---|
| 99 | 99 | | 2016; and 11 |
|---|
| 100 | 100 | | ‘‘(II) any reference in such subpara-12 |
|---|
| 101 | 101 | | graph to the ‘first cost reporting period’ 13 |
|---|
| 102 | 102 | | described in such subparagraph is deemed 14 |
|---|
| 103 | 103 | | a reference to the first cost reporting pe-15 |
|---|
| 104 | 104 | | riod beginning on or after October 1, 16 |
|---|
| 105 | 105 | | 2025. 17 |
|---|
| 106 | 106 | | ‘‘(ii) This subparagraph shall only apply to 18 |
|---|
| 107 | 107 | | a hospital if the substitution described in clause 19 |
|---|
| 108 | 108 | | (i)(I) results in an increase in the target 20 |
|---|
| 109 | 109 | | amount under subparagraph (D) for the hos-21 |
|---|
| 110 | 110 | | pital.’’. 22 |
|---|
| 111 | 111 | | VerDate Sep 11 2014 02:37 Feb 26, 2025 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S335.IS S335 |
|---|
| 112 | 112 | | ssavage on LAPJG3WLY3PROD with BILLS 5 |
|---|
| 113 | 113 | | •S 335 IS |
|---|
| 114 | 114 | | SEC. 4. PROHIBITION OF ADJUSTMENTS TO CLASSIFICA-1 |
|---|
| 115 | 115 | | TIONS AND WEIGHTING FACTORS RELATING 2 |
|---|
| 116 | 116 | | TO THE CALCULATION OF PAYMENTS FOR 3 |
|---|
| 117 | 117 | | SOLE COMMUNITY HOSPITALS AND MEDI-4 |
|---|
| 118 | 118 | | CARE-DEPENDENT HOSPITALS. 5 |
|---|
| 119 | 119 | | Section 1886(d)(4)(C) of the Social Security Act (42 6 |
|---|
| 120 | 120 | | U.S.C. 1395ww(d)(4)(C))— 7 |
|---|
| 121 | 121 | | (1) in clause (i), by striking ‘‘The Secretary’’ 8 |
|---|
| 122 | 122 | | and inserting ‘‘Subject to clause (v), the Secretary’’; 9 |
|---|
| 123 | 123 | | and 10 |
|---|
| 124 | 124 | | (2) by adding at the end the following new 11 |
|---|
| 125 | 125 | | clause: 12 |
|---|
| 126 | 126 | | ‘‘(v) For discharges using the rebased target amounts 13 |
|---|
| 127 | 127 | | described in subparagraph (M) or (N) of subsection 14 |
|---|
| 128 | 128 | | (b)(3), the Secretary may not adjust such amounts for ad-15 |
|---|
| 129 | 129 | | justments required by clause (iii) prior to October 1, 16 |
|---|
| 130 | 130 | | 2015.’’. 17 |
|---|
| 131 | 131 | | SEC. 5. EXTENSION OF THE MEDICARE-DEPENDENT HOS-18 |
|---|
| 132 | 132 | | PITAL (MDH) PROGRAM. 19 |
|---|
| 133 | 133 | | (a) E |
|---|
| 134 | 134 | | XTENSION OFPAYMENTMETHODOLOGY.—Sec-20 |
|---|
| 135 | 135 | | tion 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 21 |
|---|
| 136 | 136 | | 1395ww(d)(5)(G)) is amended— 22 |
|---|
| 137 | 137 | | (1) in clause (i), by striking ‘‘, and before April 23 |
|---|
| 138 | 138 | | 1, 2025’’; and 24 |
|---|
| 139 | 139 | | (2) in clause (ii)(II), by striking ‘‘, and before 25 |
|---|
| 140 | 140 | | April 1, 2025’’. 26 |
|---|
| 141 | 141 | | VerDate Sep 11 2014 02:37 Feb 26, 2025 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S335.IS S335 |
|---|
| 142 | 142 | | ssavage on LAPJG3WLY3PROD with BILLS 6 |
|---|
| 143 | 143 | | •S 335 IS |
|---|
| 144 | 144 | | (b) CONFORMINGAMENDMENTS.— 1 |
|---|
| 145 | 145 | | (1) E |
|---|
| 146 | 146 | | XTENSION OF TARGET AMOUNT .—Section 2 |
|---|
| 147 | 147 | | 1886(b)(3)(D) of the Social Security Act (42 U.S.C. 3 |
|---|
| 148 | 148 | | 1395ww(b)(3)(D)) is amended— 4 |
|---|
| 149 | 149 | | (A) in the matter preceding clause (i), by 5 |
|---|
| 150 | 150 | | striking ‘‘, and before April 1, 2025’’; and 6 |
|---|
| 151 | 151 | | (B) in clause (iv), by striking ‘‘through fis-7 |
|---|
| 152 | 152 | | cal year 2024 and the portion of fiscal year 8 |
|---|
| 153 | 153 | | 2025 beginning on October 1, 2024, and ending 9 |
|---|
| 154 | 154 | | on March 31, 2025’’ and inserting ‘‘or a subse-10 |
|---|
| 155 | 155 | | quent fiscal year’’. 11 |
|---|
| 156 | 156 | | (2) P |
|---|
| 157 | 157 | | ERMITTING HOSPITALS TO DECLINE RE -12 |
|---|
| 158 | 158 | | CLASSIFICATION.—Section 13501(e)(2) of the Omni-13 |
|---|
| 159 | 159 | | bus Budget Reconciliation Act of 1993 (42 U.S.C. 14 |
|---|
| 160 | 160 | | 1395ww note) is amended by striking ‘‘fiscal year 15 |
|---|
| 161 | 161 | | 2000 through fiscal year 2024, or the portion of fis-16 |
|---|
| 162 | 162 | | cal year 2025 beginning on October 1, 2024, and 17 |
|---|
| 163 | 163 | | ending on March 31, 2025’’ and inserting ‘‘a subse-18 |
|---|
| 164 | 164 | | quent fiscal year’’. 19 |
|---|
| 165 | 165 | | SEC. 6. EXTENSION OF THE INCREASED PAYMENTS UNDER 20 |
|---|
| 166 | 166 | | THE MEDICARE LOW-VOLUME HOSPITAL 21 |
|---|
| 167 | 167 | | PROGRAM. 22 |
|---|
| 168 | 168 | | Section 1886(d)(12) of the Social Security Act (42 23 |
|---|
| 169 | 169 | | U.S.C. 1395(d)(12)) is amended— 24 |
|---|
| 170 | 170 | | (1) in subparagraph (B)— 25 |
|---|
| 171 | 171 | | VerDate Sep 11 2014 02:37 Feb 26, 2025 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S335.IS S335 |
|---|
| 172 | 172 | | ssavage on LAPJG3WLY3PROD with BILLS 7 |
|---|
| 173 | 173 | | •S 335 IS |
|---|
| 174 | 174 | | (A) in the subparagraph heading, by in-1 |
|---|
| 175 | 175 | | serting ‘‘ |
|---|
| 176 | 176 | | FOR FISCAL YEARS 2005 THROUGH 2 |
|---|
| 177 | 177 | | 2010’’ after ‘‘INCREASE’’; and 3 |
|---|
| 178 | 178 | | (B) in the matter preceding clause (i), by 4 |
|---|
| 179 | 179 | | striking ‘‘and for discharges occurring during 5 |
|---|
| 180 | 180 | | the portion of fiscal year 2025 beginning on 6 |
|---|
| 181 | 181 | | April 1, 2025, and ending on September 30, 7 |
|---|
| 182 | 182 | | 2025, and in fiscal year 2026 and subsequent 8 |
|---|
| 183 | 183 | | fiscal years’’; 9 |
|---|
| 184 | 184 | | (2) in subparagraph (C)(i)— 10 |
|---|
| 185 | 185 | | (A) in the matter preceding subclause (I), 11 |
|---|
| 186 | 186 | | by striking ‘‘fiscal years 2011 through 2024 12 |
|---|
| 187 | 187 | | and the portion of fiscal year 2025 beginning 13 |
|---|
| 188 | 188 | | on October 1, 2024, and ending on March 31, 14 |
|---|
| 189 | 189 | | 2025’’ and inserting ‘‘fiscal year 2011 and sub-15 |
|---|
| 190 | 190 | | sequent fiscal years’’; 16 |
|---|
| 191 | 191 | | (B) in subclause (III)— 17 |
|---|
| 192 | 192 | | (i) by striking ‘‘each of fiscal years 18 |
|---|
| 193 | 193 | | 2019 through 2024 and the portion of fis-19 |
|---|
| 194 | 194 | | cal year 2025 beginning on October 1, 20 |
|---|
| 195 | 195 | | 2024, and ending on March 31, 2025’’ and 21 |
|---|
| 196 | 196 | | inserting ‘‘fiscal year 2019 and each subse-22 |
|---|
| 197 | 197 | | quent fiscal year’’; and 23 |
|---|
| 198 | 198 | | (ii) by striking ‘‘; and’’ at the end and 24 |
|---|
| 199 | 199 | | inserting a period; and 25 |
|---|
| 200 | 200 | | VerDate Sep 11 2014 02:37 Feb 26, 2025 Jkt 059200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S335.IS S335 |
|---|
| 201 | 201 | | ssavage on LAPJG3WLY3PROD with BILLS 8 |
|---|
| 202 | 202 | | •S 335 IS |
|---|
| 203 | 203 | | (C) by striking subclause (IV); and 1 |
|---|
| 204 | 204 | | (3) in subparagraph (D)— 2 |
|---|
| 205 | 205 | | (A) by amending the subparagraph head-3 |
|---|
| 206 | 206 | | ing to reach as follows: ‘‘A |
|---|
| 207 | 207 | | PPLICABLE PER-4 |
|---|
| 208 | 208 | | CENTAGE INCREASE BEGINNING WITH FISCAL 5 |
|---|
| 209 | 209 | | YEAR 2011.—’’; 6 |
|---|
| 210 | 210 | | (B) in the matter preceding clause (i), by 7 |
|---|
| 211 | 211 | | striking ‘‘fiscal years 2011 through 2024 or 8 |
|---|
| 212 | 212 | | during the portion of fiscal year 2025 beginning 9 |
|---|
| 213 | 213 | | on October 1, 2024, and ending on March 31, 10 |
|---|
| 214 | 214 | | 2025’’ and inserting ‘‘fiscal year 2011 and sub-11 |
|---|
| 215 | 215 | | sequent fiscal years’’; and 12 |
|---|
| 216 | 216 | | (C) in clause (ii), by striking ‘‘each of fis-13 |
|---|
| 217 | 217 | | cal years 2019 through 2024 and the portion of 14 |
|---|
| 218 | 218 | | fiscal year 2025 beginning on October 1, 2024, 15 |
|---|
| 219 | 219 | | and ending on March 31, 2025’’ and inserting 16 |
|---|
| 220 | 220 | | ‘‘fiscal year 2019 and each subsequent fiscal 17 |
|---|
| 221 | 221 | | year’’. 18 |
|---|
| 222 | 222 | | Æ |
|---|
| 223 | 223 | | VerDate Sep 11 2014 02:37 Feb 26, 2025 Jkt 059200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\S335.IS S335 |
|---|
| 224 | 224 | | ssavage on LAPJG3WLY3PROD with BILLS |
|---|