I 
111TH CONGRESS 
1ST SESSION H. R. 3256 
To amend the Medicare Prescription Drug, Improvement, and Modernization 
Act of 2003 to extend the Rural Community Hospital Demonstration 
Program. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 17, 2009 
Mr. SMITH of Nebraska (for himself and Mr. YOUNG of Alaska) introduced 
the following bill; which was referred to the Committee on Ways and Means 
A BILL 
To amend the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 to extend the Rural 
Community Hospital Demonstration Program. 
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 Community Hos-
pital Demonstration Extension Act of 2009’’. 
SEC. 2. EXTENSION OF RURAL COMMUNITY HOSPITAL DEM-
ONSTRATION PROGRAM. 
(a) 5-YEAR EXTENSION.—Section 410A of the Medi-
care Prescription Drug, Improvement, and Modernization 
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Act of 2003 (Public Law 108–173; 117 Stat. 2272) is 
amended by adding at the end the following new sub-
section: 
‘‘(g) 5-YEAR EXTENSION OF DEMONSTRATION PRO-
GRAM.— 
‘‘(1) IN GENERAL.—Subject to the succeeding 
provisions of this subsection, the Secretary shall con-
duct the demonstration program under this section 
for an additional 5-year period (in this section re-
ferred to as the ‘5-year extension period’) that be-
gins on the date immediately following the last day 
of the initial 5-year period under subsection (a)(5). 
‘‘(2) 
EXPANSION
OF
DEMONSTRATION 
STATES.—Notwithstanding subsection (a)(2), during 
the 5-year extension period, the program shall be 
conducted in rural areas in any State. 
‘‘(3) INCREASE IN MAXIMUM NUMBER OF HOS-
PITALS
PARTICIPATING
IN
THE
DEMONSTRATION 
PROGRAM.—Notwithstanding subsection (a)(4), dur-
ing the 5-year extension period, not more than 30 
rural community hospitals may participate in the 
demonstration program under this section. 
‘‘(4) HOSPITALS IN DEMONSTRATION PROGRAM 
ON DATE OF ENACTMENT.—In the case of a rural 
community hospital that is participating in the dem-
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onstration program under this section as of the last 
day of the initial 5-year period, the Secretary— 
‘‘(A) shall provide for the continued par-
ticipation of such rural community hospital in 
the demonstration program during the 5-year 
extension period unless the rural community 
hospital makes an election, in such form and 
manner as the Secretary may specify, to dis-
continue such participation; and 
‘‘(B) in calculating the amount of payment 
under subsection (b) to the rural community 
hospital for covered inpatient hospital services 
furnished by the hospital during such 5-year ex-
tension period, shall substitute, under para-
graph (1)(A) of such subsection— 
‘‘(i) the reasonable costs of providing 
such services for discharges occurring in 
the first cost reporting period beginning on 
or after the first day of the 5-year exten-
sion period, for 
‘‘(ii) the reasonable costs of providing 
such services for discharges occurring in 
the first cost reporting period beginning on 
or after the implementation of the dem-
onstration program.’’. 
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(b) CONFORMING AMENDMENTS.— 
(1) DURATION.—Subsection (a)(5) of section 
410A of the Medicare Prescription Drug, Improve-
ment, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2272) is amended by inserting 
‘‘(in this section referred to as the ‘initial 5-year pe-
riod’) and, as provided in subsection (g), for the 5- 
year extension period’’ after ‘‘5-year period’’. 
(2) ADDITIONAL
REPORT.—Subsection (e) of 
section 410A of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Pub-
lic Law 108–173; 117 Stat. 2272) is amended to 
read as follows: 
‘‘(e) REPORTS.— 
‘‘(1) REPORT ON INITIAL 5-YEAR PERIOD.—Not 
later than 6 months after the last day of the initial 
5-year period, the Secretary shall submit to Con-
gress a report on the conduct of the demonstration 
program under this section during such period, to-
gether with recommendations for such legislation 
and administrative action as the Secretary deter-
mines to be appropriate. 
‘‘(2) FINAL REPORT.—Not later than 6 months 
after the last day of the 5-year extension period, the 
Secretary shall submit to Congress a report on the 
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