117TH CONGRESS 

1ST SESSION H. R. 1868 

AN ACT 

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

other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. PREVENTING PAYGO SEQUESTRATION. 

2 (a) STATUTORY PAYGO SCORECARDS.—The budg3 etary effects of this Act and the American Rescue Plan 

4 Act of 2021 (Public Law 117–2) shall not be counted on 

5 either PAYGO scorecard maintained pursuant to section 

6 4(d) of the Statutory Pay-As-You-Go Act of 2010 (2 

7 U.S.C. 933(d)). 

8 (b) SENATE PAYGO SCORECARDS.—The budgetary 

9 effects of this Act shall not be counted on any PAYGO 

10 scorecard maintained for purposes of section 4106 of H. 

11 Con. Res. 71 (115th Congress). 

12 SEC. 2. EXTENSION OF TEMPORARY SUSPENSION OF MEDI13 CARE SEQUESTRATION. 

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

15 the CARES Act (2 U.S.C. 901a note) is amended by strik16 ing ‘‘March 31, 2021’’ and inserting ‘‘December 31, 

17 2021’’. 

18 (b) EFFECTIVE DATE.—The amendment made by 

19 subsection (a) shall take effect as if enacted as part of 

20 the CARES Act (Public Law 116–136). 

21 SEC. 3. TECHNICAL CORRECTIONS. 

22 (a) DISREGARD OF CERTAIN ADDITIONAL COM23 PENSATION FOR PURPOSES OF MEDICAID AND CHIP.— 

24 Section 2104(h) of the CARES Act (15 U.S.C. 9023(h)) 

25 is amended by striking ‘‘Federal pandemic unemployment 

26 compensation’’ and inserting ‘‘Federal Pandemic Unem-
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1 ployment Compensation or Mixed Earner Unemployment 

2 Compensation’’. 

3 (b) RURAL HEALTH CLINIC PAYMENTS.— 

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

5 Social Security Act (42 U.S.C. 1395l(f)(3)) is 

6 amended— 

7 (A) in subparagraph (A)— 

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

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

10 ‘‘(I) with respect to a rural health 

11 clinic that had a per visit payment amount 

12 established for services furnished in 

13 2020— 

14 ‘‘(aa) the per visit payment 

15 amount applicable to such rural 

16 health clinic for rural health clinic 

17 services furnished in 2020, increased 

18 by the percentage increase in the MEI 

19 applicable to primary care services 

20 furnished as of the first day of 2021; 

21 or 

22 ‘‘(bb) the limit described in para23 graph (2)(A); and 

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

25 clinic that did not have a per visit payment 
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1 amount established for services furnished 

2 in 2020— 

3 ‘‘(aa) the per visit payment 

4 amount applicable to such rural 

5 health clinic for rural health clinic 

6 services furnished in 2021; or 

7 ‘‘(bb) the limit described in para8 graph (2)(A); and’’; and 

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

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

11 subclause (I) or (II) of clause (i), as appli12 cable,’’; and 

13 (B) in subparagraph (B)— 

14 (i) in the matter preceding clause (i), 

15 by striking ‘‘2019, was’’ and inserting 

16 ‘‘2020’’; 

17 (ii) in clause (i), by inserting ‘‘was’’ 

18 after ‘‘(i)’’; and 

19 (iii) by striking clause (ii) and insert20 ing the following: 

21 ‘‘(ii)(I) was enrolled under section 1866(j) 

22 (including temporary enrollment during the 

23 emergency period described in section 

24 1135(g)(1)(B) for such period); or 
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1 ‘‘(II) submitted an application for enroll2 ment under section 1866(j) (or requested such 

3 a temporary enrollment for such period) that 

4 was received not later than December 31, 

5 2020.’’. 

6 (2) EFFECTIVE DATE.—The amendments made 

7 by this subsection shall take effect as if included in 

8 the enactment of the Consolidated Appropriations 

9 Act, 2021 (Public Law 116–260). 

10 (c) ELIGIBILITY FOR REEMPLOYMENT SERVICES.— 

11 Section 306(a) of the Social Security Act (42 U.S.C. 

12 506(a)) is amended— 

13 (1) by striking ‘‘individuals referred to reem14 ployment services as described in section 303(j)’’ 

15 and inserting ‘‘claimants for unemployment com16 pensation, including claimants referred to reemploy17 ment services as described in section 303(j),’’; and 

18 (2) by striking ‘‘such individuals’’ and inserting 

19 ‘‘such claimants’’. 

20 (d) ADDITIONAL AMOUNT FOR CERTAIN HOSPITALS

21 WITH HIGH DISPROPORATIONATE SHARE.—Effective as 

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

23 of division CC of Public Law 116–260, subsection (g) of 

24 section 1923 of the Social Security Act (42 U.S.C. 1396r– 
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1 4) amended by such section 203(a) is amended by adding 

2 at the end the following new paragraph: 

3 ‘‘(3) ADDITIONAL AMOUNT FOR CERTAIN HOS4 PITALS WITH HIGH DISPROPORATIONATE SHARE.— 

5 ‘‘(A) IN GENERAL.—In the case of a hos6 pital with high disproportionate share (as de7 fined in subparagraph (B)) located in a State 

8 referenced in subsection (e) of section 4721 of 

9 the Balanced Budget Act of 1997, a payment 

10 adjustment during a State fiscal year shall be 

11 considered consistent with subsection (c) if the 

12 payment adjustment does not exceed 175 per13 cent of the costs of furnishing hospital services 

14 during the year, but only if the Governor of the 

15 State certifies to the satisfaction of the Sec16 retary that the hospital’s applicable minimum 

17 amount is used for health services during the 

18 year. In determining the amount that is used 

19 for such services during a year, there shall be 

20 excluded any amounts received under the Public 

21 Health Service Act, title V, title XVIII, or from 

22 third party payors (not including the State plan 

23 under this title) that are used for providing 

24 such services during the year. 
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1 ‘‘(B) HOSPITAL WITH HIGH

2 DISPROPORATIONATE SHARE DEFINED.—In 

3 subparagraph (A), a hospital is a ‘hospital with 

4 high disproportionate share’ if— 

5 ‘‘(i) the hospital is owned or operated 

6 by the State (or by an instrumentality or 

7 a unit of government within the State); 

8 and 

9 ‘‘(ii) the hospital— 

10 ‘‘(I) meets the requirement de11 scribed in subparagraphs (A) or (B) 

12 of subsection (b)(1); or 

13 ‘‘(II) has the largest number of 

14 inpatient days attributable to individ15 uals entitled to benefits under the 

16 State plan of any hospital in such 

17 State for the previous fiscal year. 

18 ‘‘(C) APPLICABLE MINIMUM AMOUNT DE19 FINED.—In subparagraph (A), the ‘applicable 

20 minimum amount’ for a hospital for a fiscal 

21 year is equal to the difference between the 

22 amount of the hospital’s payment adjustment 

23 for the fiscal year and the costs to the hospital 
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1 of furnishing hospital services described in 

2 paragraph (1)(A) during the fiscal year.’’. 

Passed the House of Representatives March 19, 

2021. 

Attest: 

Clerk. 

117TH CONGRESS 

1ST SESSION H. R. 1868 

AN ACT 

To prevent across-the-board direct spending cuts, 

and for other purposes.