I 118th CONGRESS 1st Session H. R. 3635 IN THE HOUSE OF REPRESENTATIVES May 24, 2023 Mr. Ferguson (for himself, Ms. Sewell , Mrs. Harshbarger , Mr. Mann , Mr. Allen , Mr. Carter of Georgia , Mr. Thompson of Mississippi , and Mr. Neguse ) introduced the following bill; which was referred to the Committee on Ways and Means , and in addition to the Committee on Energy and Commerce , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend title XVIII of the Social Security Act to ensure fairness in Medicare hospital payments by establishing a floor for the area wage index applied with respect to certain hospitals.

1. Short title This Act may be cited as the Save Rural Hospitals Act of 2023 . 2. Ensuring fairness in medicare hospital payments in a budget neutral manner (a) Hospital inpatient services Section 1886(d)(3)(E) of the Social Security Act ( 42 U.S.C. 1395www(d)(3)(E) ) is amended— (1) in clause (i), by striking or (iv) and inserting (iv), or (v) ; and (2) by adding at the end the following new clause: (v) Floor on area wage index for hospitals in certain other areas (I) In general For discharges occurring on or after October 1, 2023, the area wage index applicable under this subparagraph to any hospital which is not located in a frontier State (as defined in clause (iii)(II)) may not be less than 0.85. (II) Ensuring budget neutrality In order to ensure that the aggregate payments made under this subsection for a fiscal year (beginning with fiscal year 2024) are not greater than the aggregate payments that would have been made under this subsection for such fiscal year without the application of subclause (I), as estimated by the Secretary, the Secretary shall establish pursuant to rulemaking a maximum area wage index to apply under this subparagraph to any hospital which is not located in a frontier State (as defined in clause (iii)(II)). (III) No impact for hospitals with an area wage index between the floor and the maximum index Subclauses (I) and (II) shall have no effect on the area wage index applicable in a fiscal year to a hospital with an area wage index that is greater than the floor under subclause (I) but less than the maximum area wage index established under subclause (II) for the fiscal year. . (b) Hospital outpatient department services Section 1833(t) of the Social Security Act ( 42 U.S.C. 1395l(t) ), is amended— (1) in paragraph (2)(D), by striking paragraph (19), the Secretary and inserting paragraphs (19) and (23), the Secretary ; and (2) by adding at the end the following new paragraph: (23) Floor on area wage adjustment factor for hospital outpatient department services in areas other than in frontier states (A) In general With respect to covered OPD services furnished on or after January 1, 2024, the area wage adjustment factor applicable under the payment system established under this subsection to any hospital outpatient department which is not located in a frontier State (as defined in section 1886(d)(3)(E)(iii)(II)) may not be less than 0.85. (B) Ensuring budget neutrality In order to ensure that the aggregate payments made under this subsection for a year (beginning with 2024) are not greater than the aggregate payments that would have been made under this subsection for such year without the application of subparagraph (A), as estimated by the Secretary, the Secretary shall establish pursuant to rulemaking a maximum area wage adjustment factor to apply under the payment system established under this subsection to any hospital outpatient department which is not located in a frontier State (as defined in clause (iii)(II)). (C) No impact for hospitals with an area wage adjustment factor between the floor and the maximum factor Subparagraphs (A) and (B) shall have no effect on the area wage adjustment factor applicable in a year to a hospital with an area wage adjustment factor that is greater than the floor under subparagraph (A) but less than the maximum area wage adjustment factor established under subparagraph (B) for the year. .