Rural Hospital Support Act

I 117TH CONGRESS 1ST SESSION H. R. 1887 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 HOUSE OF REPRESENTATIVES MARCH 12, 2021 Mr. REED (for himself and Ms. SEWELL) introduced the following bill; which was referred to the Committee on Ways and Means 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 VerDate Sep 11 2014 23:04 May 12, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1887.IH H1887 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1887 IH SEC. 2. REBASING OF THE CALCULATION OF PAYMENTS 1 FOR SOLE COMMUNITY HOSPITALS. 2 (a) REBASING PERMITTED.—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, 2021, 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 VerDate Sep 11 2014 23:04 May 12, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1887.IH H1887 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1887 IH riod beginning on or after October 1, 1 2021; 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, 2021.’’. 6 (b) CONFORMING 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 subsection (a), is 20 further amended— 21 (1) in subparagraph (D), by striking ‘‘subpara- 22 graph (K)’’ and inserting ‘‘subparagraphs (K) and 23 (N)’’; and 24 VerDate Sep 11 2014 23:04 May 12, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1887.IH H1887 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1887 IH (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, 2021, 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 2021. 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 VerDate Sep 11 2014 23:04 May 12, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1887.IH H1887 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 1887 IH 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 13 target amounts described in subparagraph 14 (M) or (N) of subsection (b)(3), the Sec- 15 retary may not adjust such amounts for 16 adjustments required by clause (iii) prior 17 to October 1, 2015.’’. 18 SEC. 5. EXTENSION OF THE MEDICARE-DEPENDENT HOS- 19 PITAL (MDH) PROGRAM. 20 (a) EXTENSION OF PAYMENT METHODOLOGY.—Sec- 21 tion 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 22 1395ww(d)(5)(G)) is amended— 23 (1) in clause (i), by striking ‘‘, and before Octo- 24 ber 1, 2022’’; and 25 VerDate Sep 11 2014 23:04 May 12, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1887.IH H1887 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 1887 IH (2) in clause (ii)(II), by striking ‘‘, and before 1 October 1, 2022’’. 2 (b) CONFORMING AMENDMENTS.— 3 (1) EXTENSION OF TARGET AMOUNT.—Section 4 1886(b)(3)(D) of the Social Security Act (42 U.S.C. 5 1395ww(b)(3)(D)) is amended— 6 (A) in the matter preceding clause (i), by 7 striking ‘‘, and before October 1, 2022’’; and 8 (B) in clause (iv), by striking ‘‘through fis- 9 cal year 2022’’ and inserting ‘‘or a subsequent 10 fiscal year’’. 11 (2) PERMITTING 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 2022’’ and inserting ‘‘a 16 subsequent fiscal year’’. 17 SEC. 6. EXTENSION OF THE INCREASED PAYMENTS UNDER 18 THE MEDICARE LOW-VOLUME HOSPITAL 19 PROGRAM. 20 Section 1886(d)(12) of the Social Security Act (42 21 U.S.C. 1395ll(d)(12)) is amended— 22 (1) in subparagraph (B)— 23 VerDate Sep 11 2014 23:04 May 12, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1887.IH H1887 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 1887 IH (A) in the header, by inserting ‘‘FOR FIS- 1 CAL YEARS 2005 THROUGH 2010’’ after ‘‘IN- 2 CREASE’’; and 3 (B) in the matter preceding clause (i), by 4 striking ‘‘and for discharges occurring in fiscal 5 year 2023 and subsequent fiscal years’’; 6 (2) in subparagraph (C)(i)— 7 (A) in the matter preceding subclause (I), 8 by striking ‘‘through 2022’’ and inserting ‘‘and 9 each subsequent fiscal year’’; 10 (B) in subclause (II), by adding at the end 11 ‘‘and’’; 12 (C) in subclause (III)— 13 (i) by striking ‘‘fiscal years 2019 14 through 2022’’ and inserting ‘‘fiscal year 15 2019 and each subsequent fiscal year’’; 16 (ii) by striking ‘‘; and’’ and inserting 17 a period; and 18 (D) by striking subclause (IV); and 19 (3) in subparagraph (D)— 20 (A) by revising the header to reach as fol- 21 lows: ‘‘APPLICABLE PERCENTAGE INCREASE 22 BEGINNING WITH FISCAL YEAR 2011.—’’; 23 (B) in the matter preceding clause (i), by 24 striking ‘‘fiscal years 2011 through 2022’’ and 25 VerDate Sep 11 2014 23:04 May 12, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1887.IH H1887 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 1887 IH inserting ‘‘fiscal year 2019 and each subsequent 1 fiscal year’’; and 2 (C) in clause (ii), by striking ‘‘each of fis- 3 cal years 2019 through 2022’’ and inserting 4 ‘‘fiscal year 2019 and each subsequent fiscal 5 year’’. 6 Æ VerDate Sep 11 2014 23:04 May 12, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\H1887.IH H1887 pamtmann on DSKBC07HB2PROD with BILLS