SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Healthcare Enhancement for Americas 
Rural Towns Act'' or the ``HEART Act''.

SEC. 2. REFORM AND PERMANENT EXTENSION OF THE MEDICARE-DEPENDENT 
              HOSPITAL (MDH) PROGRAM.

    (a) Extension of Payment Methodology.--Section 1886(d)(5)(G) of the 
Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended--
            (1) in clause (i), by striking ``, and before October 1, 
        2017'' and inserting ``before October 1, 2018'';
            (2) in clause (i), by adding at the end the following; 
        ``For fiscal year 2018 and each subsequent fiscal year, in the 
        case of such a subsection (d) hospital, payment under paragraph 
        (1)(A) shall be equal to the sum of the amount determined under 
        paragraph (1)(A)(iii) and the amount determined by the increase 
        factor determined under clause (v) for such hospital and cost 
        reporting period.'';
            (3) in clause (ii)(II), by striking ``, and before October 
        1, 2017'' and inserting ``before October 1, 2018''; and
            (4) by adding at the end the following new clauses:
                            ``(v) Subject to subclause (II), for 
                        purposes of clause (i), for fiscal year 2019 
                        and each subsequent fiscal year with respect to 
                        a subsection (d) hospital which is a medicare-
                        dependent, small rural hospital, the Secretary 
                        shall determine an increase factor to apply to 
                        such hospital with respect to discharges 
                        occurring during such fiscal year. When 
                        determining such increase factor, the Secretary 
                        may take into account a methodology that 
                        results in a similar amount of reimbursement to 
                        such hospital for such fiscal year as such 
                        amount that would have been determined if the 
                        first sentence of clause (i) applied with 
                        respect to such fiscal year.
                            ``(vi) The aggregate amounts determined for 
                        all subsection (d) hospitals which are 
                        medicare-dependent, small rural hospitals by 
                        application of the increase factors determined 
                        under clause (v) for such hospitals shall not 
                        exceed a total of--
                                    ``(I) for fiscal year 2019, 
                                $100,000,000; and
                                    ``(II) for each subsequent fiscal 
                                year, the amount specified in this 
                                clause for the previous fiscal year 
                                increased by the market basket 
                                percentage increase (as defined in 
                                subsection (b)(3)(B)(iii)) as 
                                determined prospectively by the 
                                Secretary for such subsequent fiscal 
                                year.''.
    (b) Conforming Amendments.--
            (1) Extension of target amount.--Section 1886(b)(3)(D) of 
        the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
        amended--
                    (A) in the matter preceding clause (i), by striking 
                ``, and before October 1, 2017'';
                    (B) in clause (iii), by striking at the end 
                ``and'';
                    (C) in clause (iv)--
                            (i) by striking ``through fiscal year 
                        2017'' and inserting ``through fiscal year 
                        2018''; and
                            (ii) by striking the period at the end and 
                        inserting ``, and''; and
                    (D) by adding at the end the following new clause:
                            ``(v) with respect to discharges occurring 
                        during fiscal year 2019 or a subsequent fiscal 
                        year, the target amount for the preceding year 
                        increased by the applicable percentage increase 
                        under subparagraph (B)(iv) and adjusted as 
                        determined necessary by the Secretary to take 
                        into account the application of subsection 
                        (d)(5)(G)(vi) for such fiscal year.''.
            (2) Permitting hospitals to decline reclassification.--
        Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 
        1993 (42 U.S.C. 1395ww note) is amended by striking ``fiscal 
        year 2000 through fiscal year 2017'' and inserting ``a 
        subsequent fiscal year''.

SEC. 3. TEMPORARY EXTENSION OF THE MEDICARE LOW-VOLUME ADJUSTMENT 
              PROGRAM.

    Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) is amended--
            (1) in subparagraph (B), in the matter preceding clause 
        (i), by striking ``and for discharges occurring in fiscal year 
        2020 and subsequent fiscal years'';
            (2) in subparagraph (C)(i)--
                    (A) by striking ``fiscal years 2011 through 2017'' 
                each place it appears and inserting ``fiscal years 2011 
                through 2019''; and
                    (B) by striking ``or portion of fiscal year''; and
            (3) in subparagraph (D)--
                    (A) in the heading, by striking ``Temporary 
                applicable percentage increase'' and inserting 
                ``Applicable percentage increase beginning with fiscal 
                year 2011'';
                    (B) by striking ``fiscal years 2011 through 2017,'' 
                and inserting ``fiscal years 2011 through 2019''; and
                    (C) by striking ``or the portion of fiscal year'' 
                each place it appears.

SEC. 4. BUDGET NEUTRAL PAY-FOR.

    For fiscal year 2018 and each subsequent fiscal year, the Secretary 
of Health and Human Services shall adjust payments under section 
1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) in a manner 
such that the estimated aggregate amount of expenditures under such 
section for such fiscal year with application of the amendments made by 
sections 2 and 3 of this Act is equal to the estimated aggregate amount 
of expenditures under such section for such fiscal year without 
application of such amendments.
Healthcare Enhancement for Americas Rural Towns Act or the HEART Act This bill permanently extends&nbsp;and otherwise revises&nbsp;the Medicare-Dependent Hospital program (which provides increased payments to certain smaller, rural hospitals&nbsp;that serve a proportionally&nbsp;high number of Medicare patients).&nbsp;The bill also&nbsp;extends through FY 2019 the program for increased payments under Medicare for low-volume hospitals. 
Healthcare Enhancement for Americas Rural Towns Act