What This Bill Does
This bill changes how Medicare pays certain rural hospitals. It allows sole community hospitals and Medicare-dependent hospitals to use different calculation methods that may result in higher payments. The bill also extends payment programs for these hospital types.
Who It Affects
Sole community hospitals (rural hospitals that are the only hospital in their area)
Medicare-dependent small rural hospitals
Medicare (the federal health insurance program for people 65 and older)
Key Provisions
Sole community hospitals can choose a new payment calculation method starting October 1, 2023, if it results in higher payments than the current method. This new calculation uses a 12-month cost reporting period (the hospital's accounting year) beginning during fiscal year 2016 as the base year instead of an earlier base year (Sec. 2).
Medicare-dependent small rural hospitals can use the same type of new payment calculation starting October 1, 2023, but only if it increases their target amount (the amount Medicare will pay them) (Sec. 3).
The Secretary of Health and Human Services cannot adjust the new payment amounts for certain required adjustments before October 1, 2015 (Sec. 4).
The Medicare-dependent hospital program and low-volume hospital program are extended to continue beyond their previous end dates (Secs. 5 and 6).
What Changes
Starting October 1, 2023, eligible rural hospitals can request to have their Medicare payments calculated using more recent data from fiscal year 2016 instead of older data. Hospitals only receive this new calculation if it pays them more money. The payment programs that were scheduled to end are now extended to continue indefinitely.
Important Definitions
Sole community hospital: Not defined in bill text
Medicare-dependent hospital: Not defined in bill text
Target amount: Not defined in bill text (the bill references an existing definition elsewhere in the Social Security Act)
Effective Date
October 1, 2023 (for the payment calculation changes for sole community hospitals and Medicare-dependent hospitals)
II
118TH CONGRESS
1ST SESSION
S. 1110
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
MARCH 30, 2023
Mr. CASEY (for himself, Mr. GRASSLEY, Mr. KAINE, Mr. WICKER, Ms.
SINEMA, Mr. MORAN, Ms. SMITH, Mr. MARSHALL, Ms. STABENOW, Mr.
BOOZMAN, Mr. HEINRICH, Mr. HAWLEY, Mrs. SHAHEEN, Mrs. CAPITO,
and Mr. KELLY) 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 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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•S 1110 IS
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, 2023, 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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•S 1110 IS
riod beginning on or after October 1,
1
2023; 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, 2023.’’.
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 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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•S 1110 IS
(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, 2023, 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
2023.
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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•S 1110 IS
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) EXTENSION OF PAYMENT METHODOLOGY.—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 Octo-
23
ber 1, 2024’’; and
24
(2) in clause (ii)(II), by striking ‘‘, and before
25
October 1, 2024’’.
26
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•S 1110 IS
(b) CONFORMING AMENDMENTS.—
1
(1) EXTENSION 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 October 1, 2024’’; and
6
(B) in clause (iv), by striking ‘‘through fis-
7
cal year 2024’’ and inserting ‘‘or a subsequent
8
fiscal year,’’.
9
(2) PERMITTING HOSPITALS TO DECLINE RE-
10
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
11
bus Budget Reconciliation Act of 1993 (42 U.S.C.
12
1395ww note) is amended by striking ‘‘fiscal year
13
2000 through fiscal year 2024’’ and inserting ‘‘a
14
subsequent fiscal year’’.
15
SEC. 6. EXTENSION OF THE INCREASED PAYMENTS UNDER
16
THE
MEDICARE
LOW-VOLUME
HOSPITAL
17
PROGRAM.
18
Section 1886(d)(12) of the Social Security Act (42
19
U.S.C. 1395(d)(12)) is amended—
20
(1) in subparagraph (B)—
21
(A) in the subparagraph heading, by in-
22
serting ‘‘FOR
FISCAL
YEARS
2005
THROUGH
23
2010’’ after ‘‘INCREASE’’; and
24
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•S 1110 IS
(B) in the matter preceding clause (i), by
1
striking ‘‘and for discharges occurring in fiscal
2
year 2025 and subsequent fiscal years’’;
3
(2) in subparagraph (C)(i)—
4
(A) in the matter preceding subclause (I),
5
by striking ‘‘fiscal years 2011 through 2024’’
6
and inserting ‘‘fiscal year 2011 and subsequent
7
fiscal years’’;
8
(B) in subclause (II), by adding ‘‘and’’ at
9
the end;
10
(C) in subclause (III)—
11
(i) by striking ‘‘each of fiscal years
12
2019 through 2024’’ and inserting ‘‘fiscal
13
year 2019 and each subsequent fiscal
14
year’’; and
15
(ii) by striking ‘‘; and’’ at the end and
16
inserting a period; and
17
(D) by striking subclause (IV); and
18
(3) in subparagraph (D)—
19
(A) by amending the subparagraph head-
20
ing to reach as follows: ‘‘APPLICABLE
PER-
21
CENTAGE INCREASE BEGINNING WITH FISCAL
22
YEAR 2011.—’’;
23
(B) in the matter preceding clause (i), by
24
striking ‘‘fiscal years 2011 through 2024’’ and
25
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•S 1110 IS
inserting ‘‘fiscal year 2011 and subsequent fis-
1
cal years’’; and
2
(C) in clause (ii), by striking ‘‘each of fis-
3
cal years 2019 through 2024’’ and inserting
4
‘‘fiscal year 2019 and each subsequent fiscal
5
year’’.
6
Æ
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