II 117th CONGRESS 2d Session S. 4009 IN THE SENATE OF THE UNITED STATES April 6, 2022 Mr. Casey (for himself and Mr. Grassley ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to rebase the calculation of payments for sole community hospitals and Medicare-dependent hospitals, and for other purposes.

1. Short title This Act may be cited as the Rural Hospital Support Act . 2. Rebasing of the calculation of payments for sole community hospitals (a) Rebasing permitted Section 1886(b)(3) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3) ) is amended by adding at the end the following new subparagraph: (M) (i) For cost reporting periods beginning on or after October 1, 2022, in the case of a sole community hospital there shall be substituted for the amount otherwise determined under subsection (d)(5)(D)(i) of this section, if such substitution results in a greater amount of payment under this section for the hospital, the subparagraph (M) rebased target amount. (ii) For purposes of this subparagraph, the term subparagraph (M) rebased target amount has the meaning given the term target amount in subparagraph (C), except that— (I) there shall be substituted for the base cost reporting period the 12-month cost reporting period beginning during fiscal year 2016; (II) any reference in subparagraph (C)(i) to the first cost reporting period described in such subparagraph is deemed a reference to the first cost reporting period beginning on or after October 1, 2022; and (III) the applicable percentage increase shall only be applied under subparagraph (C)(iv) for discharges occurring on or after October 1, 2022. . (b) Conforming amendments Section 1886(b)(3) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3) ) is amended— (1) in subparagraph (C), in the matter preceding clause (i), by striking subparagraphs (I) and (L) and inserting subparagraphs (I), (L), and (M) ; and (2) in subparagraph (I)(i), in the matter preceding subclause (I), by striking subparagraph (L) and inserting subparagraphs (L) and (M) . 3. Rebasing of the calculation of payments for Medicare-dependent hospitals Section 1886(b)(3) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3) ), as amended by section 2, is amended— (1) in subparagraph (D), by striking subparagraph (K) and inserting subparagraphs (K) and (N) ; and (2) by adding at the end the following new subparagraph: (N) (i) With respect to discharges occurring on or after October 1, 2022, in the case of a medicare-dependent, small rural hospital, for purposes of applying subparagraph (D)— (I) there shall be substituted for the base cost reporting period described in subparagraph (D)(i) the 12-month cost reporting period beginning during fiscal year 2016; and (II) any reference in such subparagraph to the first cost reporting period described in such subparagraph is deemed a reference to the first cost reporting period beginning on or after October 1, 2022. (ii) This subparagraph shall only apply to a hospital if the substitution described in clause (i)(I) results in an increase in the target amount under subparagraph (D) for the hospital. . 4. Prohibition of adjustments to classifications and weighting factors relating to the calculation of payments for sole community hospitals and Medicare-dependent hospitals Section 1886(d)(4)(C) of the Social Security Act ( 42 U.S.C. 1395ww(d)(4)(C) )— (1) in clause (i), by striking The Secretary and inserting Subject to clause (v), the Secretary ; and (2) by adding at the end the following new clause: (v) For discharges using the rebased target amounts described in subparagraph (M) or (N) of subsection (b)(3), the Secretary may not adjust such amounts for adjustments required by clause (iii) prior to October 1, 2015. . 5. Extension of the medicare-dependent hospital (MDH) program (a) Extension of payment methodology Section 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 October 1, 2022 ; and (2) in clause (ii)(II), by striking , and before October 1, 2022 . (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 ; and (B) in clause (iv), by striking through fiscal year 2022 and inserting or a subsequent fiscal year . (2) Permitting hospitals to decline reclassification Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 ( 42 U.S.C. 1395ww note) is amended by striking fiscal year 2000 through fiscal year 2022 and inserting a subsequent fiscal year . 6. Extension of the increased payments under the Medicare low-volume hospital program Section 1886(d)(12) of the Social Security Act ( 42 U.S.C. 1395(d)(12) ) is amended— (1) in subparagraph (B)— (A) in the subparagraph heading, by inserting for fiscal years 2005 through 2010 after increase ; and (B) in the matter preceding clause (i), by striking and for discharges occurring in fiscal year 2023 and subsequent fiscal years ; (2) in subparagraph (C)(i)— (A) in the matter preceding subclause (I), by striking fiscal years 2011 through 2022 and inserting fiscal year 2011 and subsequent fiscal years ; (B) in subclause (II), by adding and at the end; (C) in subclause (III)— (i) by striking each of fiscal years 2019 through 2022 and inserting fiscal year 2019 and each subsequent fiscal year ; and (ii) by striking ; and at the end and inserting a period; and (D) by striking subclause (IV); and (3) in subparagraph (D)— (A) by amending the subparagraph heading to reach as follows: Applicable percentage increase beginning with fiscal year 2011 .— ; (B) in the matter preceding clause (i), by striking fiscal years 2011 through 2022 and inserting fiscal year 2011 and subsequent fiscal years ; and (C) in clause (ii), by striking each of fiscal years 2019 through 2022 and inserting fiscal year 2019 and each subsequent fiscal year .