II 

117TH CONGRESS 

2D SESSION S. 4009 

To amend title XVIII of the Social Security Act to rebase the calculation 

of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 6, 2022 

Mr. CASEY (for himself and Mr. GRASSLEY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to rebase 

the calculation of payments for sole community hospitals 

and Medicare-dependent hospitals, 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, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Rural Hospital Sup5 port Act’’. 


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1 SEC. 2. REBASING OF THE CALCULATION OF PAYMENTS 

2 FOR SOLE COMMUNITY HOSPITALS. 

3 (a) REBASING PERMITTED.—Section 1886(b)(3) of 

4 the Social Security Act (42 U.S.C. 1395ww(b)(3)) is 

5 amended by adding at the end the following new subpara6 graph: 

7 ‘‘(M)(i) For cost reporting periods begin8 ning on or after October 1, 2022, in the case 

9 of a sole community hospital there shall be sub10 stituted for the amount otherwise determined 

11 under subsection (d)(5)(D)(i) of this section, if 

12 such substitution results in a greater amount of 

13 payment under this section for the hospital, the 

14 subparagraph (M) rebased target amount. 

15 ‘‘(ii) For purposes of this subparagraph, 

16 the term ‘subparagraph (M) rebased target 

17 amount’ has the meaning given the term ‘target 

18 amount’ in subparagraph (C), except that— 

19 ‘‘(I) there shall be substituted for the 

20 base cost reporting period the 12-month 

21 cost reporting period beginning during fis22 cal year 2016; 

23 ‘‘(II) any reference in subparagraph 

24 (C)(i) to the ‘first cost reporting period’ 

25 described in such subparagraph is deemed 

26 a reference to the first cost reporting peVerDate Sep 11 2014 04:58 Apr 07, 2022 Jkt 029200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4009.IS S4009

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1 riod beginning on or after October 1, 

2 2022; and 

3 ‘‘(III) the applicable percentage in4 crease shall only be applied under subpara5 graph (C)(iv) for discharges occurring on 

6 or after October 1, 2022.’’. 

7 (b) CONFORMING AMENDMENTS.—Section 

8 1886(b)(3) of the Social Security Act (42 U.S.C. 

9 1395ww(b)(3)) is amended— 

10 (1) in subparagraph (C), in the matter pre11 ceding clause (i), by striking ‘‘subparagraphs (I) and 

12 (L)’’ and inserting ‘‘subparagraphs (I), (L), and 

13 (M)’’; and 

14 (2) in subparagraph (I)(i), in the matter pre15 ceding subclause (I), by striking ‘‘subparagraph 

16 (L)’’ and inserting ‘‘subparagraphs (L) and (M)’’. 

17 SEC. 3. REBASING OF THE CALCULATION OF PAYMENTS 

18 FOR MEDICARE-DEPENDENT HOSPITALS. 

19 Section 1886(b)(3) of the Social Security Act (42 

20 U.S.C. 1395ww(b)(3)), as amended by section 2, is 

21 amended— 

22 (1) in subparagraph (D), by striking ‘‘subpara23 graph (K)’’ and inserting ‘‘subparagraphs (K) and 

24 (N)’’; and 


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1 (2) by adding at the end the following new sub2 paragraph: 

3 ‘‘(N)(i) With respect to discharges occur4 ring on or after October 1, 2022, in the case of 

5 a medicare-dependent, small rural hospital, for 

6 purposes of applying subparagraph (D)— 

7 ‘‘(I) there shall be substituted for the 

8 base cost reporting period described in 

9 subparagraph (D)(i) the 12-month cost re10 porting period beginning during fiscal year 

11 2016; and 

12 ‘‘(II) any reference in such subpara13 graph to the ‘first cost reporting period’ 

14 described in such subparagraph is deemed 

15 a reference to the first cost reporting pe16 riod beginning on or after October 1, 

17 2022. 

18 ‘‘(ii) This subparagraph shall only apply to 

19 a hospital if the substitution described in clause 

20 (i)(I) results in an increase in the target 

21 amount under subparagraph (D) for the hos22 pital.’’. 


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1 SEC. 4. PROHIBITION OF ADJUSTMENTS TO CLASSIFICA2 TIONS AND WEIGHTING FACTORS RELATING 

3 TO THE CALCULATION OF PAYMENTS FOR 

4 SOLE COMMUNITY HOSPITALS AND MEDI5 CARE-DEPENDENT HOSPITALS. 

6 Section 1886(d)(4)(C) of the Social Security Act (42 

7 U.S.C. 1395ww(d)(4)(C))— 

8 (1) in clause (i), by striking ‘‘The Secretary’’ 

9 and inserting ‘‘Subject to clause (v), the Secretary’’; 

10 and 

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

12 clause: 

13 ‘‘(v) For discharges using the rebased target amounts 

14 described in subparagraph (M) or (N) of subsection 

15 (b)(3), the Secretary may not adjust such amounts for ad16 justments required by clause (iii) prior to October 1, 

17 2015.’’. 

18 SEC. 5. EXTENSION OF THE MEDICARE-DEPENDENT HOS19 PITAL (MDH) PROGRAM. 

20 (a) EXTENSION OF PAYMENT METHODOLOGY.—Sec21 tion 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 

22 1395ww(d)(5)(G)) is amended— 

23 (1) in clause (i), by striking ‘‘, and before Octo24 ber 1, 2022’’; and 

25 (2) in clause (ii)(II), by striking ‘‘, and before 

26 October 1, 2022’’. 


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1 (b) CONFORMING AMENDMENTS.— 

2 (1) EXTENSION OF TARGET AMOUNT.—Section 

3 1886(b)(3)(D) of the Social Security Act (42 U.S.C. 

4 1395ww(b)(3)(D)) is amended— 

5 (A) in the matter preceding clause (i), by 

6 striking ‘‘, and before October 1, 2022’’; and 

7 (B) in clause (iv), by striking ‘‘through fis8 cal year 2022’’ and inserting ‘‘or a subsequent 

9 fiscal year’’. 

10 (2) PERMITTING HOSPITALS TO DECLINE RE11 CLASSIFICATION.—Section 13501(e)(2) of the Omni12 bus Budget Reconciliation Act of 1993 (42 U.S.C. 

13 1395ww note) is amended by striking ‘‘fiscal year 

14 2000 through fiscal year 2022’’ and inserting ‘‘a 

15 subsequent fiscal year’’. 

16 SEC. 6. EXTENSION OF THE INCREASED PAYMENTS UNDER 

17 THE MEDICARE LOW-VOLUME HOSPITAL 

18 PROGRAM. 

19 Section 1886(d)(12) of the Social Security Act (42 

20 U.S.C. 1395(d)(12)) is amended— 

21 (1) in subparagraph (B)— 

22 (A) in the subparagraph heading, by in23 serting ‘‘FOR FISCAL YEARS 2005 THROUGH

24 2010’’ after ‘‘INCREASE’’; and 


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1 (B) in the matter preceding clause (i), by 

2 striking ‘‘and for discharges occurring in fiscal 

3 year 2023 and subsequent fiscal years’’; 

4 (2) in subparagraph (C)(i)— 

5 (A) in the matter preceding subclause (I), 

6 by striking ‘‘fiscal years 2011 through 2022’’ 

7 and inserting ‘‘fiscal year 2011 and subsequent 

8 fiscal years’’; 

9 (B) in subclause (II), by adding ‘‘and’’ at 

10 the end; 

11 (C) in subclause (III)— 

12 (i) by striking ‘‘each of fiscal years 

13 2019 through 2022’’ and inserting ‘‘fiscal 

14 year 2019 and each subsequent fiscal 

15 year’’; and 

16 (ii) by striking ‘‘; and’’ at the end and 

17 inserting a period; and 

18 (D) by striking subclause (IV); and 

19 (3) in subparagraph (D)— 

20 (A) by amending the subparagraph head21 ing to reach as follows: ‘‘APPLICABLE PER22 CENTAGE INCREASE BEGINNING WITH FISCAL

23 YEAR 2011.—’’; 

24 (B) in the matter preceding clause (i), by 

25 striking ‘‘fiscal years 2011 through 2022’’ and 


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1 inserting ‘‘fiscal year 2011 and subsequent fis2 cal years’’; and 

3 (C) in clause (ii), by striking ‘‘each of fis4 cal years 2019 through 2022’’ and inserting 

5 ‘‘fiscal year 2019 and each subsequent fiscal 

6 year’’. 

Æ 


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