H. R. 1868 

One Hundred Seventeenth Congress 

of the 

United States of America 

AT THE FIRST SESSION 

Begun and held at the City of Washington on Sunday, 

the third day of January, two thousand and twenty-one 

An Act 

To prevent across-the-board direct spending cuts, and for other purposes. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. EXTENSION OF TEMPORARY SUSPENSION OF MEDICARE 

SEQUESTRATION. 

(a) EXTENSION.— 

(1) IN GENERAL.—Section 3709(a) of division A of the 

CARES Act (2 U.S.C. 901a note) is amended by striking ‘‘March 

31, 2021’’ and inserting ‘‘December 31, 2021’’. 

(2) EFFECTIVE DATE.—The amendment made by paragraph 

(1) shall take effect as if enacted as part of the CARES Act 

(Public Law 116–136). 

(b) OFFSET.—Section 251A(6)(C) of the Balanced Budget and 

Emergency Deficit Control Act of 1985 (2 U.S.C. 901a(6)(C)) is 

amended— 

(1) in clause (i)— 

(A) by striking ‘‘first 6 months’’ and inserting ‘‘first 

5 1⁄2 months’’; 

(B) by striking ‘‘4.0 percent’’ and inserting ‘‘2.0 percent’’; and 

(C) by striking ‘‘and’’ at the end; 

(2) in clause (ii)— 

(A) by striking ‘‘second 6 months’’ and inserting ‘‘6- 

month period beginning on the day after the last day 

of the period described in clause (i)’’; and 

(B) by striking ‘‘0.0 percent.’’ and inserting ‘‘4.0 percent; 

and’’; and 

(3) by adding at the end the following: 

‘‘(iii) with respect to the remaining 1⁄2 month in which 

such order is so effective for such fiscal year, the payment 

reduction shall be 0.0 percent.’’. 

SEC. 2. TECHNICAL CORRECTIONS. 

(a) RURAL HEALTH CLINIC PAYMENTS.— 

(1) IN GENERAL.—Section 1833(f)(3) of the Social Security 

Act (42 U.S.C. 1395l(f)(3)) is amended— 

(A) in subparagraph (A)— 

(i) in clause (i), by striking subclauses (I) and 

(II) and inserting the following: 

‘‘(I) with respect to a rural health clinic that had 

a per visit payment amount established for services 

furnished in 2020— 
H. R. 1868—2 

‘‘(aa) the per visit payment amount applicable 

to such rural health clinic for rural health clinic 

services furnished in 2020, increased by the 

percentage increase in the MEI applicable to primary care services furnished as of the first day 

of 2021; or 

‘‘(bb) the limit described in paragraph (2)(A); 

and 

‘‘(II) with respect to a rural health clinic that did 

not have a per visit payment amount established for 

services furnished in 2020— 

‘‘(aa) the per visit payment amount applicable 

to such rural health clinic for rural health clinic 

services furnished in 2021; or 

‘‘(bb) the limit described in paragraph (2)(A); 

and’’; and 

(ii) in clause (ii)(I), by striking ‘‘under clause (i)(I)’’ 

and inserting ‘‘under subclause (I) or (II) of clause 

(i), as applicable,’’; and 

(B) by striking subparagraph (B) and inserting the 

following: 

‘‘(B) A rural health clinic described in this subparagraph is 

a rural health clinic that— 

‘‘(i) as of December 31, 2020, was in a hospital with less 

than 50 beds and after such date such hospital continues to 

have less than 50 beds (not taking into account any increase 

in the number of beds pursuant to a waiver under subsection 

(b)(1)(A) of section 1135 during the emergency period described 

in subsection (g)(1)(B) of such section); and 

‘‘(ii)(I) as of December 31, 2020, was enrolled under section 

1866(j) (including temporary enrollment during such emergency 

period for such emergency period); or 

‘‘(II) submitted an application for enrollment under section 

1866(j) (or a request for such a temporary enrollment for such 

emergency period) that was received not later than December 

31, 2020.’’. 

(2) EFFECTIVE DATE.—The amendments made by this subsection shall take effect as if included in the enactment of 

the Consolidated Appropriations Act, 2021 (Public Law 116– 

260). 

(b) ADDITIONAL AMOUNT FOR CERTAIN HOSPITALS WITH HIGH

DISPROPORTIONATE SHARE.—Effective as if included in the enactment of section 203(a) of title II of division CC of Public Law 

116–260, subsection (g) of section 1923 of the Social Security Act 

(42 U.S.C. 1396r–4), as amended by such section, is amended by 

adding at the end the following: 

‘‘(3) CONTINUED APPLICATION OF GRANDFATHERED TRANSITION RULE.—Notwithstanding paragraph (2) of this subsection 

(as in effect on October 1, 2021), paragraph (2) of this subsection 

(as in effect on September 30, 2021, and as applied under 

section 4721(e) of the Balanced Budget Act of 1997, and 

amended by section 607 of the Medicare, Medicaid, and SCHIP 

Balanced Budget Refinement Act of 1999 (Public Law 106– 

113)) shall apply in determining whether a payment adjustment 

for a hospital in a State referenced in section 4721(e) of the 
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Balanced Budget Act of 1997 during a State fiscal year shall 

be considered consistent with subsection (c).’’. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.