I 
117TH CONGRESS 
1ST SESSION H. R. 1887 
To amend title XVIII of the Social Security Act to rebase the calculation 
of payments for sole community hospitals and Medicare-dependent hos-
pitals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 12, 2021 
Mr. REED (for himself and Ms. SEWELL) introduced the following bill; which 
was referred to the Committee on Ways and Means 
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 pur-
poses. 
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 ‘‘Rural Hospital Sup-
port Act’’. 
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SEC. 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)) is 
amended by adding at the end the following new subpara-
graph: 
‘‘(M)(i) For cost reporting periods begin-
ning on or after October 1, 2021, in the case 
of a sole community hospital there shall be sub-
stituted 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’ has the meaning given the term ‘target 
amount’ in subparagraph (C), except that— 
‘‘(I) there shall be substituted for the 
base cost reporting period the 12-month 
cost reporting period beginning during fis-
cal year 2016; 
‘‘(II) any reference in subparagraph 
(C)(i) to the ‘first cost reporting period’ 
described in such subparagraph is deemed 
a reference to the first cost reporting pe-
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riod beginning on or after October 1, 
2021; and 
‘‘(III) the applicable percentage in-
crease shall only be applied under subpara-
graph (C)(iv) for discharges occurring on 
or after October 1, 2021.’’. 
(b) 
CONFORMING
AMENDMENTS.—Section 
1886(b)(3) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)) is amended— 
(1) in subparagraph (C), in the matter pre-
ceding clause (i), by striking ‘‘subparagraphs (I) and 
(L)’’ and inserting ‘‘subparagraphs (I), (L), and 
(M)’’; and 
(2) in subparagraph (I)(i), in the matter pre-
ceding subclause (I), by striking ‘‘subparagraph 
(L)’’ and inserting ‘‘subparagraphs (L) and (M)’’. 
SEC. 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)), as amended by subsection (a), is 
further amended— 
(1) in subparagraph (D), by striking ‘‘subpara-
graph (K)’’ and inserting ‘‘subparagraphs (K) and 
(N)’’; and 
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(2) by adding at the end the following new sub-
paragraph: 
‘‘(N)(i) With respect to discharges occur-
ring on or after October 1, 2021, 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 re-
porting period beginning during fiscal year 
2016; and 
‘‘(II) any reference in such subpara-
graph to the ‘first cost reporting period’ 
described in such subparagraph is deemed 
a reference to the first cost reporting pe-
riod beginning on or after October 1, 
2021. 
‘‘(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 hos-
pital.’’. 
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SEC. 4. PROHIBITION OF ADJUSTMENTS TO CLASSIFICA-
TIONS AND WEIGHTING FACTORS RELATING 
TO THE CALCULATION OF PAYMENTS FOR 
SOLE COMMUNITY HOSPITALS AND MEDI-
CARE-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’’ 
and inserting ‘‘Subject to clause (v), the Secretary’’; 
and 
(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 Sec-
retary may not adjust such amounts for 
adjustments required by clause (iii) prior 
to October 1, 2015.’’. 
SEC. 5. EXTENSION OF THE MEDICARE-DEPENDENT HOS-
PITAL (MDH) PROGRAM. 
(a) EXTENSION OF PAYMENT METHODOLOGY.—Sec-
tion 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(G)) is amended— 
(1) in clause (i), by striking ‘‘, and before Octo-
ber 1, 2022’’; and 
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inserting ‘‘fiscal year 2019 and each subsequent 
fiscal year’’; and 
(C) in clause (ii), by striking ‘‘each of fis-
cal years 2019 through 2022’’ and inserting 
‘‘fiscal year 2019 and each subsequent fiscal 
year’’. 
Æ 
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