II 
Calendar No. 31 
117TH CONGRESS 
1ST SESSION H. R. 1868 
IN THE SENATE OF THE UNITED STATES 
MARCH 22, 2021 
Received 
MARCH 24, 2021 
Read the first time 
MARCH 25, 2021 
Read the second time and placed on the calendar 
AN ACT 
To prevent across-the-board direct spending cuts, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. PREVENTING PAYGO SEQUESTRATION. 
(a) STATUTORY PAYGO SCORECARDS.—The budg-
etary effects of this Act and the American Rescue Plan 
Act of 2021 (Public Law 117–2) shall not be counted on 
either PAYGO scorecard maintained pursuant to section 
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4(d) of the Statutory Pay-As-You-Go Act of 2010 (2 
U.S.C. 933(d)). 
(b) SENATE PAYGO SCORECARDS.—The budgetary 
effects of this Act shall not be counted on any PAYGO 
scorecard maintained for purposes of section 4106 of H. 
Con. Res. 71 (115th Congress). 
SEC. 2. EXTENSION OF TEMPORARY SUSPENSION OF MEDI-
CARE SEQUESTRATION. 
(a) IN GENERAL.—Section 3709(a) of division A of 
the CARES Act (2 U.S.C. 901a note) is amended by strik-
ing ‘‘March 31, 2021’’ and inserting ‘‘December 31, 
2021’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect as if enacted as part of 
the CARES Act (Public Law 116–136). 
SEC. 3. TECHNICAL CORRECTIONS. 
(a) DISREGARD
OF CERTAIN ADDITIONAL COM-
PENSATION FOR PURPOSES OF MEDICAID AND CHIP.— 
Section 2104(h) of the CARES Act (15 U.S.C. 9023(h)) 
is amended by striking ‘‘Federal pandemic unemployment 
compensation’’ and inserting ‘‘Federal Pandemic Unem-
ployment Compensation or Mixed Earner Unemployment 
Compensation’’. 
(b) RURAL HEALTH CLINIC PAYMENTS.— 
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(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— 
‘‘(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 primary care services 
furnished as of the first day of 2021; 
or 
‘‘(bb) the limit described in para-
graph (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— 
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‘‘(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 para-
graph (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 appli-
cable,’’; and 
(B) in subparagraph (B)— 
(i) in the matter preceding clause (i), 
by striking ‘‘2019, was’’ and inserting 
‘‘2020’’; 
(ii) in clause (i), by inserting ‘‘was’’ 
after ‘‘(i)’’; and 
(iii) by striking clause (ii) and insert-
ing the following: 
‘‘(ii)(I) was enrolled under section 1866(j) 
(including temporary enrollment during the 
emergency 
period 
described 
in 
section 
1135(g)(1)(B) for such period); or 
‘‘(II) submitted an application for enroll-
ment under section 1866(j) (or requested such 
a temporary enrollment for such period) that 
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‘‘(A) IN GENERAL.—In the case of a hos-
pital with high disproportionate share (as de-
fined in subparagraph (B)) located in a State 
referenced in subsection (e) of section 4721 of 
the Balanced Budget Act of 1997, a payment 
adjustment during a State fiscal year shall be 
considered consistent with subsection (c) if the 
payment adjustment does not exceed 175 per-
cent of the costs of furnishing hospital services 
during the year, but only if the Governor of the 
State certifies to the satisfaction of the Sec-
retary that the hospital’s applicable minimum 
amount is used for health services during the 
year. In determining the amount that is used 
for such services during a year, there shall be 
excluded any amounts received under the Public 
Health Service Act, title V, title XVIII, or from 
third party payors (not including the State plan 
under this title) that are used for providing 
such services during the year. 
‘‘(B) 
HOSPITAL
WITH
HIGH 
DISPROPORATIONATE
SHARE
DEFINED.—In 
subparagraph (A), a hospital is a ‘hospital with 
high disproportionate share’ if— 
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‘‘(i) the hospital is owned or operated 
by the State (or by an instrumentality or 
a unit of government within the State); 
and 
‘‘(ii) the hospital— 
‘‘(I) meets the requirement de-
scribed in subparagraphs (A) or (B) 
of subsection (b)(1); or 
‘‘(II) has the largest number of 
inpatient days attributable to individ-
uals entitled to benefits under the 
State plan of any hospital in such 
State for the previous fiscal year. 
‘‘(C) APPLICABLE MINIMUM AMOUNT DE-
FINED.—In subparagraph (A), the ‘applicable 
minimum amount’ for a hospital for a fiscal 
year is equal to the difference between the 
amount of the hospital’s payment adjustment 
for the fiscal year and the costs to the hospital 
of furnishing hospital services described in 
paragraph (1)(A) during the fiscal year.’’. 
Passed the House of Representatives March 19, 
2021. 
Attest: 
CHERYL L. JOHNSON, 
Clerk. 
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Calendar No. 31 
117TH CONGRESS 
1ST SESSION 
H. R. 1868 
AN ACT 
To prevent across-the-board direct spending cuts, 
and for other purposes. 
MARCH 25, 2021 
Read the second time and placed on the calendar 
VerDate Sep 11 2014 
01:39 Mar 26, 2021
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PO 00000
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