H. R. 1868 
One Hundred Seventeenth Congress 
of the 
United States of America 
AT THE FIRST SESSION 
Begun and held at the City of Washington on Sunday, 
the third day of January, two thousand and twenty-one 
An Act 
To prevent across-the-board direct spending cuts, and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. EXTENSION OF TEMPORARY SUSPENSION OF MEDICARE 
SEQUESTRATION. 
(a) EXTENSION.— 
(1) IN
GENERAL.—Section 3709(a) of division A of the 
CARES Act (2 U.S.C. 901a note) is amended by striking ‘‘March 
31, 2021’’ and inserting ‘‘December 31, 2021’’. 
(2) EFFECTIVE DATE.—The amendment made by paragraph 
(1) shall take effect as if enacted as part of the CARES Act 
(Public Law 116–136). 
(b) OFFSET.—Section 251A(6)(C) of the Balanced Budget and 
Emergency Deficit Control Act of 1985 (2 U.S.C. 901a(6)(C)) is 
amended— 
(1) in clause (i)— 
(A) by striking ‘‘first 6 months’’ and inserting ‘‘first 
5 1⁄2 months’’; 
(B) by striking ‘‘4.0 percent’’ and inserting ‘‘2.0 per-
cent’’; and 
(C) by striking ‘‘and’’ at the end; 
(2) in clause (ii)— 
(A) by striking ‘‘second 6 months’’ and inserting ‘‘6- 
month period beginning on the day after the last day 
of the period described in clause (i)’’; and 
(B) by striking ‘‘0.0 percent.’’ and inserting ‘‘4.0 percent; 
and’’; and 
(3) by adding at the end the following: 
‘‘(iii) with respect to the remaining 1⁄2 month in which 
such order is so effective for such fiscal year, the payment 
reduction shall be 0.0 percent.’’. 
SEC. 2. TECHNICAL CORRECTIONS. 
(a) RURAL HEALTH CLINIC PAYMENTS.— 
(1) IN GENERAL.—Section 1833(f)(3) of the Social Security 
Act (42 U.S.C. 1395l(f)(3)) is amended— 
(A) in subparagraph (A)— 
(i) in clause (i), by striking subclauses (I) and 
(II) and inserting the following: 
‘‘(I) with respect to a rural health clinic that had 
a per visit payment amount established for services 
furnished in 2020—
H. R. 1868—2 
‘‘(aa) the per visit payment amount applicable 
to such rural health clinic for rural health clinic 
services furnished in 2020, increased by the 
percentage increase in the MEI applicable to pri-
mary care services furnished as of the first day 
of 2021; or 
‘‘(bb) the limit described in paragraph (2)(A); 
and 
‘‘(II) with respect to a rural health clinic that did 
not have a per visit payment amount established for 
services furnished in 2020— 
‘‘(aa) the per visit payment amount applicable 
to such rural health clinic for rural health clinic 
services furnished in 2021; or 
‘‘(bb) the limit described in paragraph (2)(A); 
and’’; and 
(ii) in clause (ii)(I), by striking ‘‘under clause (i)(I)’’ 
and inserting ‘‘under subclause (I) or (II) of clause 
(i), as applicable,’’; and 
(B) by striking subparagraph (B) and inserting the 
following: 
‘‘(B) A rural health clinic described in this subparagraph is 
a rural health clinic that— 
‘‘(i) as of December 31, 2020, was in a hospital with less 
than 50 beds and after such date such hospital continues to 
have less than 50 beds (not taking into account any increase 
in the number of beds pursuant to a waiver under subsection 
(b)(1)(A) of section 1135 during the emergency period described 
in subsection (g)(1)(B) of such section); and 
‘‘(ii)(I) as of December 31, 2020, was enrolled under section 
1866(j) (including temporary enrollment during such emergency 
period for such emergency period); or 
‘‘(II) submitted an application for enrollment under section 
1866(j) (or a request for such a temporary enrollment for such 
emergency period) that was received not later than December 
31, 2020.’’. 
(2) EFFECTIVE DATE.—The amendments made by this sub-
section shall take effect as if included in the enactment of 
the Consolidated Appropriations Act, 2021 (Public Law 116– 
260). 
(b) ADDITIONAL AMOUNT FOR CERTAIN HOSPITALS WITH HIGH 
DISPROPORTIONATE SHARE.—Effective as if included in the enact-
ment of section 203(a) of title II of division CC of Public Law 
116–260, subsection (g) of section 1923 of the Social Security Act 
(42 U.S.C. 1396r–4), as amended by such section, is amended by 
adding at the end the following: 
‘‘(3) CONTINUED APPLICATION OF GRANDFATHERED TRANSI-
TION RULE.—Notwithstanding paragraph (2) of this subsection 
(as in effect on October 1, 2021), paragraph (2) of this subsection 
(as in effect on September 30, 2021, and as applied under 
section 4721(e) of the Balanced Budget Act of 1997, and 
amended by section 607 of the Medicare, Medicaid, and SCHIP 
Balanced Budget Refinement Act of 1999 (Public Law 106– 
113)) shall apply in determining whether a payment adjustment 
for a hospital in a State referenced in section 4721(e) of the