In the Senate of the United States, 
March 25, 2021. 
Resolved, That the bill from the House of Representa-
tives (H.R. 1868) entitled ‘‘An Act to prevent across-the- 
board direct spending cuts, and for other purposes.’’, do pass 
with the following 
AMENDMENT: 
Strike all after the enacting clause and insert the 
following: 
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 ‘‘Decem-
ber 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).
† HR 1868 EAS 
(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 insert-
ing ‘‘first 5 1⁄2 months’’; 
(B) by striking ‘‘4.0 percent’’ and inserting 
‘‘2.0 percent’’; and 
(C) by striking ‘‘and’’ at the end; 
(2) in clause (ii)— 
(A) by striking ‘‘second 6 months’’ and in-
serting ‘‘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.—
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(1) IN GENERAL.—Section 1833(f)(3) of the So-
cial Security Act (42 U.S.C. 1395l(f)(3)) is amend-
ed— 
(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 clin-
ic that had a per visit payment amount es-
tablished 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 appli-
cable to primary care services fur-
nished 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— 
‘‘(aa) the per visit payment 
amount applicable to such rural health
† HR 1868 EAS 
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) by striking subparagraph (B) and in-
serting the following: 
‘‘(B) A rural health clinic described in this subpara-
graph 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 hos-
pital continues to have less than 50 beds (not taking 
into account any increase in the number of beds pur-
suant to a waiver under subsection (b)(1)(A) of sec-
tion 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 enroll-
ment during such emergency period for such emer-
gency period); or 
‘‘(II) submitted an application for enrollment 
under section 1866(j) (or a request for such a tem-
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porary enrollment for such emergency period) that 
was received not later than December 31, 2020.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection 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 enactment of section 203(a) of title II of 
division CC of Public Law 116–260, subsection (g) of sec-
tion 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
GRAND-
FATHERED
TRANSITION
RULE.—Notwithstanding 
paragraph (2) of this subsection (as in effect on Octo-
ber 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, Med-
icaid, and SCHIP Balanced Budget Refinement Act 
of 1999 (Public Law 106–113)) shall apply in deter-
mining whether a payment adjustment for a hospital 
in a State referenced in section 4721(e) of the Bal-
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anced Budget Act of 1997 during a State fiscal year 
shall be considered consistent with subsection (c).’’. 
Attest: 
Secretary.