II 

111TH CONGRESS 

1ST SESSION S. 1279 

To amend the Medicare Prescription Drug, Improvement, and Modernization 

Act of 2003 to extend the Rural Community Hospital Demonstration 

Program. 

IN THE SENATE OF THE UNITED STATES 

JUNE 17, 2009 

Mr. NELSON of Nebraska (for himself, Mr. HATCH, Mr. BEGICH, Mr. THUNE, 

Mr. TESTER, Mr. JOHANNS, Mr. DORGAN, and Ms. MURKOWSKI) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend the Medicare Prescription Drug, Improvement, 

and Modernization Act of 2003 to extend the Rural 

Community Hospital Demonstration Program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Community Hos5 pital Demonstration Extension Act of 2009’’. 


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1 SEC. 2. EXTENSION OF RURAL COMMUNITY HOSPITAL DEM2 ONSTRATION PROGRAM. 

3 (a) 5-YEAR EXTENSION.—Section 410A of the Medi4 care Prescription Drug, Improvement, and Modernization 

5 Act of 2003 (Public Law 108–173; 117 Stat. 2272) is 

6 amended by adding at the end the following new sub7 section: 

8 ‘‘(g) 5-YEAR EXTENSION OF DEMONSTRATION PRO9 GRAM.— 

10 ‘‘(1) IN GENERAL.—Subject to the succeeding 

11 provisions of this subsection, the Secretary shall con12 duct the demonstration program under this section 

13 for an additional 5-year period (in this section re14 ferred to as the ‘5-year extension period’) that be15 gins on the date immediately following the last day 

16 of the initial 5-year period under subsection (a)(5). 

17 ‘‘(2) EXPANSION OF DEMONSTRATION

18 STATES.—Notwithstanding subsection (a)(2), during 

19 the 5-year extension period, the program shall be 

20 conducted in rural areas in any State. 

21 ‘‘(3) INCREASE IN MAXIMUM NUMBER OF HOS22 PITALS PARTICIPATING IN THE DEMONSTRATION

23 PROGRAM.—Notwithstanding subsection (a)(4), dur24 ing the 5-year extension period, not more than 30 

25 rural community hospitals may participate in the 

26 demonstration program under this section. 


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1 ‘‘(4) HOSPITALS IN DEMONSTRATION PROGRAM

2 ON DATE OF ENACTMENT.—In the case of a rural 

3 community hospital that is participating in the dem4 onstration program under this section as of the last 

5 day of the initial 5-year period, the Secretary— 

6 ‘‘(A) shall provide for the continued par7 ticipation of such rural community hospital in 

8 the demonstration program during the 5-year 

9 extension period unless the rural community 

10 hospital makes an election, in such form and 

11 manner as the Secretary may specify, to dis12 continue such participation; and 

13 ‘‘(B) in calculating the amount of payment 

14 under subsection (b) to the rural community 

15 hospital for covered inpatient hospital services 

16 furnished by the hospital during such 5-year ex17 tension period, shall substitute, under para18 graph (1)(A) of such subsection— 

19 ‘‘(i) the reasonable costs of providing 

20 such services for discharges occurring in 

21 the first cost reporting period beginning on 

22 or after the first day of the 5-year exten23 sion period, for 

24 ‘‘(ii) the reasonable costs of providing 

25 such services for discharges occurring in 


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1 the first cost reporting period beginning on 

2 or after the implementation of the dem3 onstration program.’’. 

4 (b) CONFORMING AMENDMENTS.— 

5 (1) DURATION.—Subsection (a)(5) of section 

6 410A of the Medicare Prescription Drug, Improve7 ment, and Modernization Act of 2003 (Public Law 

8 108–173; 117 Stat. 2272) is amended by inserting 

9 ‘‘(in this section referred to as the ‘initial 5-year pe10 riod’) and, as provided in subsection (g), for the 5- 

11 year extension period’’ after ‘‘5-year period’’. 

12 (2) ADDITIONAL REPORT.—Subsection (e) of 

13 section 410A of the Medicare Prescription Drug, 

14 Improvement, and Modernization Act of 2003 (Pub15 lic Law 108–173; 117 Stat. 2272) is amended to 

16 read as follows: 

17 ‘‘(e) REPORTS.— 

18 ‘‘(1) REPORT ON INITIAL 5-YEAR PERIOD.—Not 

19 later than 6 months after the last day of the initial 

20 5-year period, the Secretary shall submit to Con21 gress a report on the conduct of the demonstration 

22 program under this section during such period, to23 gether with recommendations for such legislation 

24 and administrative action as the Secretary deter25 mines to be appropriate. 


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1 ‘‘(2) FINAL REPORT.—Not later than 6 months 

2 after the last day of the 5-year extension period, the 

3 Secretary shall submit to Congress a report on the 

4 demonstration program under this section, together 

5 with recommendations for such legislation and ad6 ministrative action as the Secretary determines to be 

7 appropriate.’’. 

8 (c) TECHNICAL AMENDMENTS.— 

9 (1) Subsection (b) of section 410A of the Medi10 care Prescription Drug, Improvement, and Mod11 ernization Act of 2003 (Public Law 108–173; 117 

12 Stat. 2272) is amended— 

13 (A) in paragraph (1)(B)(ii), by striking 

14 ‘‘2)’’ and inserting ‘‘2))’’; and 

15 (B) in paragraph (2), by inserting ‘‘cost’’ 

16 before ‘‘reporting period’’ the first place such 

17 term appears in each of subparagraphs (A) and 

18 (B). 

19 (2) Subsection (f)(1) of section 410A of the 

20 Medicare Prescription Drug, Improvement, and 

21 Modernization Act of 2003 (Public Law 108–173; 

22 117 Stat. 2272) is amended— 

23 (A) in subparagraph (A)(ii), by striking 

24 ‘‘paragraph (2)’’ and inserting ‘‘subparagraph 

25 (B)’’; and 


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1 (B) in subparagraph (B), by striking 

2 ‘‘paragraph (1)(B)’’ and inserting ‘‘subpara3 graph (A)(ii)’’. 

Æ 


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