In the Senate of the United States, 

March 25, 2021. 

Resolved, That the bill from the House of Representatives (H.R. 1868) entitled ‘‘An Act to prevent across-theboard direct spending cuts, and for other purposes.’’, do pass 

with the following 

AMENDMENT: 

Strike all after the enacting clause and insert the 

following: 

1 SECTION 1. EXTENSION OF TEMPORARY SUSPENSION OF 

2 MEDICARE SEQUESTRATION. 

3 (a) EXTENSION.— 

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

5 of the CARES Act (2 U.S.C. 901a note) is amended 

6 by striking ‘‘March 31, 2021’’ and inserting ‘‘Decem7 ber 31, 2021’’. 

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

9 paragraph (1) shall take effect as if enacted as part 

10 of the CARES Act (Public Law 116–136). 
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† HR 1868 EAS 

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

2 Budget and Emergency Deficit Control Act of 1985 (2 

3 U.S.C. 901a(6)(C)) is amended— 

4 (1) in clause (i)— 

5 (A) by striking ‘‘first 6 months’’ and inserting ‘‘first 5 1 6 ⁄2 months’’; 

7 (B) by striking ‘‘4.0 percent’’ and inserting 

8 ‘‘2.0 percent’’; and 

9 (C) by striking ‘‘and’’ at the end; 

10 (2) in clause (ii)— 

11 (A) by striking ‘‘second 6 months’’ and in12 serting ‘‘6-month period beginning on the day 

13 after the last day of the period described in 

14 clause (i)’’; and 

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

16 ‘‘4.0 percent; and’’; and 

17 (3) by adding at the end the following: 

‘‘(iii) with respect to the remaining 1 18 ⁄2

19 month in which such order is so effective for such 

20 fiscal year, the payment reduction shall be 0.0 

21 percent.’’. 

22 SEC. 2. TECHNICAL CORRECTIONS. 

23 (a) RURAL HEALTH CLINIC PAYMENTS.— 
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1 (1) IN GENERAL.—Section 1833(f)(3) of the So2 cial Security Act (42 U.S.C. 1395l(f)(3)) is amend3 ed— 

4 (A) in subparagraph (A)— 

5 (i) in clause (i), by striking subclauses 

6 (I) and (II) and inserting the following: 

7 ‘‘(I) with respect to a rural health clin8 ic that had a per visit payment amount es9 tablished for services furnished in 2020— 

10 ‘‘(aa) the per visit payment 

11 amount applicable to such rural health 

12 clinic for rural health clinic services 

13 furnished in 2020, increased by the 

14 percentage increase in the MEI appli15 cable to primary care services fur16 nished as of the first day of 2021; or 

17 ‘‘(bb) the limit described in para18 graph (2)(A); and 

19 ‘‘(II) with respect to a rural health 

20 clinic that did not have a per visit payment 

21 amount established for services furnished in 

22 2020— 

23 ‘‘(aa) the per visit payment 

24 amount applicable to such rural health 
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† HR 1868 EAS 

1 clinic for rural health clinic services 

2 furnished in 2021; or 

3 ‘‘(bb) the limit described in para4 graph (2)(A); and’’; and 

5 (ii) in clause (ii)(I), by striking 

6 ‘‘under clause (i)(I)’’ and inserting ‘‘under 

7 subclause (I) or (II) of clause (i), as appli8 cable,’’; and 

9 (B) by striking subparagraph (B) and in10 serting the following: 

11 ‘‘(B) A rural health clinic described in this subpara12 graph is a rural health clinic that— 

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

14 with less than 50 beds and after such date such hos15 pital continues to have less than 50 beds (not taking 

16 into account any increase in the number of beds pur17 suant to a waiver under subsection (b)(1)(A) of sec18 tion 1135 during the emergency period described in 

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

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

21 under section 1866(j) (including temporary enroll22 ment during such emergency period for such emer23 gency period); or 

24 ‘‘(II) submitted an application for enrollment 

25 under section 1866(j) (or a request for such a tem-
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1 porary enrollment for such emergency period) that 

2 was received not later than December 31, 2020.’’. 

3 (2) EFFECTIVE DATE.—The amendments made 

4 by this subsection shall take effect as if included in 

5 the enactment of the Consolidated Appropriations Act, 

6 2021 (Public Law 116–260). 

7 (b) ADDITIONAL AMOUNT FOR CERTAIN HOSPITALS

8 WITH HIGH DISPROPORTIONATE SHARE.—Effective as if 

9 included in the enactment of section 203(a) of title II of 

10 division CC of Public Law 116–260, subsection (g) of sec11 tion 1923 of the Social Security Act (42 U.S.C. 1396r–4), 

12 as amended by such section, is amended by adding at the 

13 end the following: 

14 ‘‘(3) CONTINUED APPLICATION OF GRAND15 FATHERED TRANSITION RULE.—Notwithstanding 

16 paragraph (2) of this subsection (as in effect on Octo17 ber 1, 2021), paragraph (2) of this subsection (as in 

18 effect on September 30, 2021, and as applied under 

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

20 and amended by section 607 of the Medicare, Med21 icaid, and SCHIP Balanced Budget Refinement Act 

22 of 1999 (Public Law 106–113)) shall apply in deter23 mining whether a payment adjustment for a hospital 

24 in a State referenced in section 4721(e) of the Bal-
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1 anced Budget Act of 1997 during a State fiscal year 

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

Attest: 

Secretary. 

117TH CONGRESS 

1ST SESSION H.R. 1868 

AMENDMENT