I 
117TH CONGRESS 
2D SESSION 
H. R. 9034 
To amend title XVIII of the Social Security Act to provide for reform 
to and a permanent extension of the Medicare-dependent hospital pro-
gram, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2022 
Mr. ARRINGTON 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 provide 
for reform to and a permanent extension of the Medi-
care-dependent hospital program, 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. SHORT TITLE. 
This Act may be cited as the ‘‘Healthcare Enhance-
ment for Americas Rural Towns Act’’ or the ‘‘HEART 
Act’’. 
VerDate Sep 11 2014 
01:24 Oct 14, 2022
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H9034.IH
H9034
kjohnson on DSK79L0C42PROD with BILLS
SEC. 2. REFORM AND PERMANENT EXTENSION OF THE 
MEDICARE-DEPENDENT 
HOSPITAL 
(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 inserting ‘‘, and before October 1, 
2023’’; 
(2) in clause (i), by adding at the end the fol-
lowing; ‘‘For fiscal year 2024 and each subsequent 
fiscal year, in the case of such a subsection (d) hos-
pital, payment under paragraph (1)(A) shall be 
equal to the sum of the amount determined under 
paragraph (1)(A)(iii) and the amount determined by 
the increase factor determined under clause (v) for 
such hospital and cost reporting period.’’; 
(3) in clause (ii)(II), by striking ‘‘, and before 
October 1, 2022’’ and inserting ‘‘, and before Octo-
ber 1, 2023’’; and 
(4) by adding at the end the following new 
clauses: 
‘‘(v)(I) Subject to subclause (II), for pur-
poses of clause (i), for fiscal year 2024 and 
each subsequent fiscal year with respect to a 
subsection (d) hospital which is a medicare-de-
VerDate Sep 11 2014 
01:24 Oct 14, 2022
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H9034.IH
H9034
kjohnson on DSK79L0C42PROD with BILLS
pendent, small rural hospital, the Secretary 
shall determine an increase factor to apply to 
such hospital with respect to discharges occur-
ring during such fiscal year. When determining 
such increase factor, the Secretary may take 
into account a methodology that results in a 
similar amount of reimbursement to such hos-
pital for such fiscal year as such amount that 
would have been determined if the first sen-
tence of clause (i) applied with respect to such 
fiscal year. 
‘‘(II) The aggregate amounts determined 
for all subsection (d) hospitals which are medi-
care-dependent, small rural hospitals by appli-
cation of the increase factors determined under 
this clause for such hospitals shall not exceed a 
total of— 
‘‘(aa) 
for 
fiscal 
year 
2024, 
$100,000,000; and 
‘‘(bb) for each subsequent fiscal year, 
the amount specified in this clause for the 
previous fiscal year increased by the mar-
ket basket percentage increase (as defined 
in subsection (b)(3)(B)(iii)) as determined 
VerDate Sep 11 2014 
01:24 Oct 14, 2022
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H9034.IH
H9034
kjohnson on DSK79L0C42PROD with BILLS
prospectively by the Secretary for such 
subsequent fiscal year.’’. 
(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)) is amended— 
(A) in the matter preceding clause (i), by 
striking ‘‘, and before October 1, 2022’’; 
(B) in clause (iii), by striking at the end 
‘‘and’’; 
(C) in clause (iv)— 
(i) by striking ‘‘through fiscal year 
2022’’ and inserting ‘‘through fiscal year 
2023’’; and 
(ii) by striking the period at the end 
and inserting ‘‘, and’’; and 
(D) by adding at the end the following new 
clause: 
‘‘(v) with respect to discharges occurring 
during fiscal year 2024 or a subsequent fiscal 
year, the target amount for the preceding year 
increased by the applicable percentage increase 
under subparagraph (B)(iv) and adjusted as de-
termined necessary by the Secretary to take 
VerDate Sep 11 2014 
01:24 Oct 14, 2022
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H9034.IH
H9034
kjohnson on DSK79L0C42PROD with BILLS
into account the application of subsection 
(d)(5)(G)(vi) for such fiscal year.’’. 
(2) PERMITTING HOSPITALS TO DECLINE RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C. 
1395ww note) is amended by striking ‘‘through fis-
cal year 2022’’ and inserting ‘‘or a subsequent fiscal 
year’’. 
SEC. 3. TEMPORARY EXTENSION OF THE MEDICARE LOW- 
VOLUME ADJUSTMENT PROGRAM. 
Section 1886(d)(12) of the Social Security Act (42 
U.S.C. 1395ww(d)(12)) is amended— 
(1) in subparagraph (B), in the matter pre-
ceding clause (i), by striking ‘‘fiscal year 2023’’ and 
inserting ‘‘fiscal year 2028’’; 
(2) in subparagraph (C)(i)— 
(A) by striking ‘‘fiscal years 2011 through 
2022’’ each place it appears and inserting ‘‘fis-
cal years 2011 through 2027’’; and 
(B) by striking ‘‘or portion of fiscal year’’; 
and 
(3) in subparagraph (D)— 
(A) in the heading, by striking ‘‘TEM-
PORARY APPLICABLE PERCENTAGE INCREASE’’ 
VerDate Sep 11 2014 
01:24 Oct 14, 2022
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H9034.IH
H9034
kjohnson on DSK79L0C42PROD with BILLS