Save Rural Hospitals Act of 2023

I 118TH CONGRESS 1ST SESSION H. R. 3635 To amend title XVIII of the Social Security Act to ensure fairness in Medicare hospital payments by establishing a floor for the area wage index applied with respect to certain hospitals. IN THE HOUSE OF REPRESENTATIVES MAY 24, 2023 Mr. FERGUSON (for himself, Ms. SEWELL, Mrs. HARSHBARGER, Mr. MANN, Mr. ALLEN, Mr. CARTER of Georgia, Mr. THOMPSON of Mississippi, and Mr. NEGUSE) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on En- ergy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to ensure fairness in Medicare hospital payments by establishing a floor for the area wage index applied with respect to certain hospitals. 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 ‘‘Save Rural Hospitals 4 Act of 2023’’. 5 VerDate Sep 11 2014 03:45 Jun 16, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3635.IH H3635 pbinns on DSKJLVW7X2PROD with $$_JOB 2 •HR 3635 IH SEC. 2. ENSURING FAIRNESS IN MEDICARE HOSPITAL PAY- 1 MENTS IN A BUDGET NEUTRAL MANNER. 2 (a) HOSPITAL INPATIENT SERVICES.—Section 3 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 4 1395www(d)(3)(E)) is amended— 5 (1) in clause (i), by striking ‘‘or (iv)’’ and in- 6 serting ‘‘(iv), or (v)’’; and 7 (2) by adding at the end the following new 8 clause: 9 ‘‘(v) FLOOR ON AREA WAGE INDEX FOR 10 HOSPITALS IN CERTAIN OTHER AREAS.— 11 ‘‘(I) IN GENERAL.—For discharges 12 occurring on or after October 1, 2023, the 13 area wage index applicable under this sub- 14 paragraph to any hospital which is not lo- 15 cated in a frontier State (as defined in 16 clause (iii)(II)) may not be less than 0.85. 17 ‘‘(II) ENSURING BUDGET NEU- 18 TRALITY.—In order to ensure that the ag- 19 gregate payments made under this sub- 20 section for a fiscal year (beginning with 21 fiscal year 2024) are not greater than the 22 aggregate payments that would have been 23 made under this subsection for such fiscal 24 year without the application of subclause 25 (I), as estimated by the Secretary, the Sec- 26 VerDate Sep 11 2014 03:45 Jun 16, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3635.IH H3635 pbinns on DSKJLVW7X2PROD with $$_JOB 3 •HR 3635 IH retary shall establish pursuant to rule- 1 making a maximum area wage index to 2 apply under this subparagraph to any hos- 3 pital which is not located in a frontier 4 State (as defined in clause (iii)(II)). 5 ‘‘(III) NO IMPACT FOR HOSPITALS 6 WITH AN AREA WAGE INDEX BETWEEN 7 THE FLOOR AND THE MAXIMUM INDEX.— 8 Subclauses (I) and (II) shall have no effect 9 on the area wage index applicable in a fis- 10 cal year to a hospital with an area wage 11 index that is greater than the floor under 12 subclause (I) but less than the maximum 13 area wage index established under sub- 14 clause (II) for the fiscal year.’’. 15 (b) HOSPITAL OUTPATIENT DEPARTMENT SERV- 16 ICES.—Section 1833(t) of the Social Security Act (42 17 U.S.C. 1395l(t)), is amended— 18 (1) in paragraph (2)(D), by striking ‘‘para- 19 graph (19), the Secretary’’ and inserting ‘‘para- 20 graphs (19) and (23), the Secretary’’; and 21 (2) by adding at the end the following new 22 paragraph: 23 ‘‘(23) FLOOR ON AREA WAGE ADJUSTMENT 24 FACTOR FOR HOSPITAL OUTPATIENT DEPARTMENT 25 VerDate Sep 11 2014 03:45 Jun 16, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3635.IH H3635 pbinns on DSKJLVW7X2PROD with $$_JOB 4 •HR 3635 IH SERVICES IN AREAS OTHER THAN IN FRONTIER 1 STATES.— 2 ‘‘(A) IN GENERAL.—With respect to cov- 3 ered OPD services furnished on or after Janu- 4 ary 1, 2024, the area wage adjustment factor 5 applicable under the payment system estab- 6 lished under this subsection to any hospital out- 7 patient department which is not located in a 8 frontier State (as defined in section 9 1886(d)(3)(E)(iii)(II)) may not be less than 10 0.85. 11 ‘‘(B) ENSURING BUDGET NEUTRALITY.— 12 In order to ensure that the aggregate payments 13 made under this subsection for a year (begin- 14 ning with 2024) are not greater than the aggre- 15 gate payments that would have been made 16 under this subsection for such year without the 17 application of subparagraph (A), as estimated 18 by the Secretary, the Secretary shall establish 19 pursuant to rulemaking a maximum area wage 20 adjustment factor to apply under the payment 21 system established under this subsection to any 22 hospital outpatient department which is not lo- 23 cated in a frontier State (as defined in clause 24 (iii)(II)). 25 VerDate Sep 11 2014 03:45 Jun 16, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3635.IH H3635 pbinns on DSKJLVW7X2PROD with $$_JOB 5 •HR 3635 IH ‘‘(C) NO IMPACT FOR HOSPITALS WITH AN 1 AREA WAGE ADJUSTMENT FACTOR BETWEEN 2 THE FLOOR AND THE MAXIMUM FACTOR.—Sub- 3 paragraphs (A) and (B) shall have no effect on 4 the area wage adjustment factor applicable in a 5 year to a hospital with an area wage adjust- 6 ment factor that is greater than the floor under 7 subparagraph (A) but less than the maximum 8 area wage adjustment factor established under 9 subparagraph (B) for the year.’’. 10 Æ VerDate Sep 11 2014 03:45 Jun 16, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H3635.IH H3635 pbinns on DSKJLVW7X2PROD with $$_JOB