I 

111TH CONGRESS 

1ST SESSION H. R. 3256 

To amend the Medicare Prescription Drug, Improvement, and Modernization 

Act of 2003 to extend the Rural Community Hospital Demonstration 

Program. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 17, 2009 

Mr. SMITH of Nebraska (for himself and Mr. YOUNG of Alaska) introduced 

the following bill; which was referred to the Committee on Ways and Means 

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’’. 

6 SEC. 2. EXTENSION OF RURAL COMMUNITY HOSPITAL DEM7 ONSTRATION PROGRAM. 

8 (a) 5-YEAR EXTENSION.—Section 410A of the Medi9 care Prescription Drug, Improvement, and Modernization 


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

2 amended by adding at the end the following new sub3 section: 

4 ‘‘(g) 5-YEAR EXTENSION OF DEMONSTRATION PRO5 GRAM.— 

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

7 provisions of this subsection, the Secretary shall con8 duct the demonstration program under this section 

9 for an additional 5-year period (in this section re10 ferred to as the ‘5-year extension period’) that be11 gins on the date immediately following the last day 

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

13 ‘‘(2) EXPANSION OF DEMONSTRATION

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

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

16 conducted in rural areas in any State. 

17 ‘‘(3) INCREASE IN MAXIMUM NUMBER OF HOS18 PITALS PARTICIPATING IN THE DEMONSTRATION

19 PROGRAM.—Notwithstanding subsection (a)(4), dur20 ing the 5-year extension period, not more than 30 

21 rural community hospitals may participate in the 

22 demonstration program under this section. 

23 ‘‘(4) HOSPITALS IN DEMONSTRATION PROGRAM

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

25 community hospital that is participating in the demVerDate Nov 24 2008 02:19 Jul 18, 2009 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3256.IH H3256

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1 onstration program under this section as of the last 

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

3 ‘‘(A) shall provide for the continued par4 ticipation of such rural community hospital in 

5 the demonstration program during the 5-year 

6 extension period unless the rural community 

7 hospital makes an election, in such form and 

8 manner as the Secretary may specify, to dis9 continue such participation; and 

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

11 under subsection (b) to the rural community 

12 hospital for covered inpatient hospital services 

13 furnished by the hospital during such 5-year ex14 tension period, shall substitute, under para15 graph (1)(A) of such subsection— 

16 ‘‘(i) the reasonable costs of providing 

17 such services for discharges occurring in 

18 the first cost reporting period beginning on 

19 or after the first day of the 5-year exten20 sion period, for 

21 ‘‘(ii) the reasonable costs of providing 

22 such services for discharges occurring in 

23 the first cost reporting period beginning on 

24 or after the implementation of the dem25 onstration program.’’. 


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1 (b) CONFORMING AMENDMENTS.— 

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

3 410A of the Medicare Prescription Drug, Improve4 ment, and Modernization Act of 2003 (Public Law 

5 108–173; 117 Stat. 2272) is amended by inserting 

6 ‘‘(in this section referred to as the ‘initial 5-year pe7 riod’) and, as provided in subsection (g), for the 5- 

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

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

10 section 410A of the Medicare Prescription Drug, 

11 Improvement, and Modernization Act of 2003 (Pub12 lic Law 108–173; 117 Stat. 2272) is amended to 

13 read as follows: 

14 ‘‘(e) REPORTS.— 

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

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

17 5-year period, the Secretary shall submit to Con18 gress a report on the conduct of the demonstration 

19 program under this section during such period, to20 gether with recommendations for such legislation 

21 and administrative action as the Secretary deter22 mines to be appropriate. 

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

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

25 Secretary shall submit to Congress a report on the 


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1 demonstration program under this section, together 

2 with recommendations for such legislation and ad3 ministrative action as the Secretary determines to be 

4 appropriate.’’. 

5 (c) TECHNICAL AMENDMENTS.— 

6 (1) Subsection (b) of section 410A of the Medi7 care Prescription Drug, Improvement, and Mod8 ernization Act of 2003 (Public Law 108–173; 117 

9 Stat. 2272) is amended— 

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

11 ‘‘2)’’ and inserting ‘‘2))’’; and 

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

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

14 term appears in each of subparagraphs (A) and 

15 (B). 

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

17 Medicare Prescription Drug, Improvement, and 

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

19 117 Stat. 2272) is amended— 

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

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

22 (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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