Rural Hospital Support Act

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. Short title This Act may be cited as the Rural Hospital Support Act 2. Rebasing of the calculation of payments for sole community hospitals (a) Rebasing permitted Section 1886(b)(3) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3) (M) (i) For cost reporting periods beginning on or after October 1, 2023, in the case of a sole community hospital there shall be substituted for the amount otherwise determined under subsection (d)(5)(D)(i) of this section, if such substitution results in a greater amount of payment under this section for the hospital, the subparagraph (M) rebased target amount. (ii) For purposes of this subparagraph, the term subparagraph (M) rebased target amount target amount (I) there shall be substituted for the base cost reporting period the 12-month cost reporting period beginning during fiscal year 2016; (II) any reference in subparagraph (C)(i) to the first cost reporting period (III) the applicable percentage increase shall only be applied under subparagraph (C)(iv) for discharges occurring on or after October 1, 2023. . (b) Conforming amendments Section 1886(b)(3) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3) (1) in subparagraph (C), in the matter preceding clause (i), by striking subparagraphs (I) and (L) subparagraphs (I), (L), and (M) (2) in subparagraph (I)(i), in the matter preceding subclause (I), by striking subparagraph (L) subparagraphs (L) and (M) 3. Rebasing of the calculation of payments for Medicare-dependent hospitals Section 1886(b)(3) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3) (1) in subparagraph (D), by striking subparagraph (K) subparagraphs (K) and (N) (2) by adding at the end the following new subparagraph: (N) (i) With respect to discharges occurring on or after October 1, 2023, in the case of a medicare-dependent, small rural hospital, for purposes of applying subparagraph (D)— (I) there shall be substituted for the base cost reporting period described in subparagraph (D)(i) the 12-month cost reporting period beginning during fiscal year 2016; and (II) any reference in such subparagraph to the first cost reporting period (ii) This subparagraph shall only apply to a hospital if the substitution described in clause (i)(I) results in an increase in the target amount under subparagraph (D) for the hospital. . 4. Prohibition of adjustments to classifications and weighting factors relating to the calculation of payments for sole community hospitals and Medicare-dependent hospitals Section 1886(d)(4)(C) of the Social Security Act ( 42 U.S.C. 1395ww(d)(4)(C) (1) in clause (i), by striking The Secretary Subject to clause (v), the Secretary (2) by adding at the end the following new clause: (v) For discharges using the rebased target amounts described in subparagraph (M) or (N) of subsection (b)(3), the Secretary may not adjust such amounts for adjustments required by clause (iii) prior to October 1, 2015. . 5. Extension of the medicare-dependent hospital (MDH) program (a) Extension of payment methodology Section 1886(d)(5)(G) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(G) (1) in clause (i), by striking , and before October 1, 2024 (2) in clause (ii)(II), by striking , and before October 1, 2024 (b) Conforming amendments (1) Extension of target amount Section 1886(b)(3)(D) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3)(D) (A) in the matter preceding clause (i), by striking , and before October 1, 2024 (B) in clause (iv), by striking through fiscal year 2024 or a subsequent fiscal year, (2) Permitting hospitals to decline reclassification Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 ( 42 U.S.C. 1395ww fiscal year 2000 through fiscal year 2024 a subsequent fiscal year 6. Extension of the increased payments under the Medicare low-volume hospital program Section 1886(d)(12) of the Social Security Act ( 42 U.S.C. 1395(d)(12) (1) in subparagraph (B)— (A) in the subparagraph heading, by inserting for fiscal years 2005 through 2010 increase (B) in the matter preceding clause (i), by striking and for discharges occurring in fiscal year 2025 and subsequent fiscal years (2) in subparagraph (C)(i)— (A) in the matter preceding subclause (I), by striking fiscal years 2011 through 2024 fiscal year 2011 and subsequent fiscal years (B) in subclause (II), by adding and (C) in subclause (III)— (i) by striking each of fiscal years 2019 through 2024 fiscal year 2019 and each subsequent fiscal year (ii) by striking ; and (D) by striking subclause (IV); and (3) in subparagraph (D)— (A) by amending the subparagraph heading to reach as follows: Applicable percentage increase beginning with fiscal year 2011 (B) in the matter preceding clause (i), by striking fiscal years 2011 through 2024 fiscal year 2011 and subsequent fiscal years (C) in clause (ii), by striking each of fiscal years 2019 through 2024 fiscal year 2019 and each subsequent fiscal year

Summary: Rural Hospital Support Act This bill modifies and extends certain payment adjustments for rural hospitals under Medicare's inpatient prospective payment system. Specifically, the bill indexes payment adjustments for sole community hospitals and Medicare-dependent hospitals to FY2016 operating costs, if it results in higher payments for such hospitals. The bill also makes payment adjustments for Medicare-dependent hospitals and low-volume hospitals permanent (the adjustments currently expire at the end of FY2024).