II 

117TH CONGRESS 

1ST SESSION S. 999 

To amend the title XVIII of the Social Security Act to preserve access 

to rural health care by ensuring fairness in Medicare hospital payments. 

IN THE SENATE OF THE UNITED STATES 

MARCH 25, 2021 

Mr. WARNER (for himself, Mrs. BLACKBURN, Mr. CORNYN, Mr. WARNOCK, 

and Mr. KAINE) introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To amend the title XVIII of the Social Security Act to 

preserve access to rural health care by ensuring fairness 

in Medicare hospital payments. 

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 ‘‘Save Rural Hospitals 

5 Act of 2021’’. 

6 SEC. 2. ENSURING FAIRNESS IN MEDICARE HOSPITAL PAY7 MENTS. 

8 (a) HOSPITAL INPATIENT SERVICES.— 


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•S 999 IS

1 (1) IN GENERAL.—Section 1886(d)(3)(E) of 

2 the Social Security Act (42 U.S.C. 

3 1395www(d)(3)(E)) is amended— 

4 (A) in clause (i), in the first sentence, by 

5 striking ‘‘or (iii)’’ and inserting ‘‘, (iii), or (iv)’’; 

6 and 

7 (B) by adding at the end the following new 

8 clause: 

9 ‘‘(iv) AREA WAGE INDEX FLOOR.— 

10 ‘‘(I) IN GENERAL.—For dis11 charges occurring on or after October 

12 1, 2021, the area wage index applica13 ble under this subparagraph to any 

14 hospital which is not located in a fron15 tier State (as defined in clause 

16 (iii)(II)) may not be less than 0.85. 

17 ‘‘(II) WAIVING BUDGET NEU18 TRALITY.—Pursuant to the fifth sen19 tence of clause (i), this clause shall 

20 not be applied in a budget neutral 

21 manner.’’. 

22 (2) WAIVING BUDGET NEUTRALITY.— 

23 (A) TECHNICAL AMENDATORY CORREC24 TION.—Section 10324(a)(2) of Public Law 


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•S 999 IS

1 111–148 is amended by striking ‘‘third sen2 tence’’ and inserting ‘‘fifth sentence’’. 

3 (B) WAIVER.—Section 1886(d)(3)(E)(i) of 

4 the Social Security Act (42 U.S.C. 

5 1395ww(d)(3)(E)(i)) is amended, in the fifth 

6 sentence— 

7 (i) by striking ‘‘and the amendments’’ 

8 and inserting ‘‘, the amendments’’; and 

9 (ii) by inserting ‘‘, and the amend10 ments made by section 2(a)(1) of the Save 

11 Rural Hospitals Act of 2021’’ after ‘‘Care 

12 Act’’. 

13 (b) HOSPITAL OUTPATIENT DEPARTMENT SERV14 ICES.—Section 1833(t) of the Social Security Act (42 

15 U.S.C. 1395l(t)), is amended— 

16 (1) in paragraph (2)(D), by striking ‘‘(19), the 

17 Secretary’’ and inserting ‘‘(19) and paragraph (23), 

18 the Secretary’’; and 

19 (2) by adding at the end the following new 

20 paragraph: 

21 ‘‘(23) FLOOR ON AREA WAGE ADJUSTMENT

22 FACTOR FOR HOSPITAL OUTPATIENT DEPARTMENT

23 SERVICES.—With respect to covered OPD services 

24 furnished on or after January 1, 2022, the area 

25 wage adjustment factor applicable under the payVerDate Sep 11 2014 00:46 Apr 22, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S999.IS S999

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•S 999 IS

1 ment system established under this subsection to 

2 any hospital outpatient department which is not lo3 cated in a frontier State (as defined in section 

4 1886(d)(3)(E)(iii)(II)) may not be less than 0.85. 

5 The preceding sentence shall not be implemented in 

6 a budget neutral manner.’’. 

Æ 


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