I 
117TH CONGRESS 
1ST SESSION H. R. 4066 
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 HOUSE OF REPRESENTATIVES 
JUNE 22, 2021 
Ms. SEWELL (for herself and Mr. FERGUSON) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Save Rural Hospitals 
Act of 2021’’. 
SEC. 2. ENSURING FAIRNESS IN MEDICARE HOSPITAL PAY-
MENTS. 
(a) HOSPITAL INPATIENT SERVICES.— 
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(1) IN
GENERAL.—Section 1886(d)(3)(E) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395www(d)(3)(E)) is amended— 
(A) in clause (i), in the first sentence, by 
striking ‘‘or (iii)’’ and inserting ‘‘, (iii), or (iv)’’; 
and 
(B) by adding at the end the following new 
clause: 
‘‘(iv) AREA WAGE INDEX FLOOR.— 
‘‘(I) 
IN
GENERAL.—For 
dis-
charges occurring on or after October 
1, 2021, the area wage index applica-
ble under this subparagraph to any 
hospital which is not located in a fron-
tier State (as defined in clause 
(iii)(II)) may not be less than 0.85. 
‘‘(II) WAIVING
BUDGET
NEU-
TRALITY.—Pursuant to the fifth sen-
tence of clause (i), this clause shall 
not be applied in a budget neutral 
manner.’’. 
(2) WAIVING BUDGET NEUTRALITY.— 
(A) TECHNICAL
AMENDATORY
CORREC-
TION.—Section 10324(a)(2) of Public Law 
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111–148 is amended by striking ‘‘third sen-
tence’’ and inserting ‘‘fifth sentence’’. 
(B) WAIVER.—Section 1886(d)(3)(E)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(3)(E)(i)) is amended, in the fifth 
sentence— 
(i) by striking ‘‘and the amendments’’ 
and inserting ‘‘, the amendments’’; and 
(ii) by inserting ‘‘, and the amend-
ments made by section 2(a)(1) of the Save 
Rural Hospitals Act of 2021’’ after ‘‘Care 
Act’’. 
(b) HOSPITAL OUTPATIENT DEPARTMENT SERV-
ICES.—Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)), is amended— 
(1) in paragraph (2)(D), by striking ‘‘(19), the 
Secretary’’and inserting ‘‘(19) and paragraph (23), 
the Secretary’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(23) FLOOR
ON
AREA
WAGE
ADJUSTMENT 
FACTOR FOR HOSPITAL OUTPATIENT DEPARTMENT 
SERVICES.—With respect to covered OPD services 
furnished on or after January 1, 2022, the area 
wage adjustment factor applicable under the pay-
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ment system established under this subsection to 
any hospital outpatient department which is not lo-
cated in a frontier State (as defined in section 
1886(d)(3)(E)(iii)(II)) may not be less than 0.85. 
The preceding sentence shall not be implemented in 
a budget neutral manner.’’. 
Æ 
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