To prevent across-the-board direct spending cuts, and for other purposes.

Bill: 117-hr-1868
Sponsor: full_name: Rep. Yarmuth, John A. [D-KY-3]
Introduced: 2021-03-12
Policy area: Health
Subjects: Budget deficits and national debt

Budget process

Cardiovascular and respiratory health

Child health

Emergency medical services and trauma care

Health care costs and insurance

Health facilities and institutions

Health programs administration and funding

Hospital care

Infectious and parasitic diseases

Medicaid

Medicare

Poverty and welfare assistance

Rural conditions and development

Unemployment
Latest action: action_date: 2021-04-14
text: Became Public Law No: 117-7.

Summaries:
action_date: 2021-03-12
action_desc: Introduced in House
text: <p>This bill makes several budgetary and technical changes to provisions under Medicare, Medicaid, and the American Rescue Plan Act of 2021, which provided additional relief to address the ongoing impact of COVID-19 (i.e., coronavirus disease 2019).</p> <p>The bill exempts the budgetary effects of the American Rescue Plan Act of 2021 and this bill from the Statutory Pay-As-You-Go Act of 2010 (PAYGO), and exempts this bill from the Senate PAYGO rule. The bill also continues to exempt Medicare from sequestration until December 31, 2021. (Sequestration is a process of automatic, usually across-the-board spending reductions under which budgetary resources are permanently cancelled to enforce specific budget policy goals.) </p> <p>The bill also specifically</p> <ul> <li>excludes mixed-earner unemployment compensation from Medicaid and Children's Health Insurance Program (CHIP) eligibility determinations;</li> <li>applies certain modified payment limits to rural health clinics that temporarily enrolled in Medicare during the public health emergency or that applied to enroll by December 31, 2020; and</li> <li> preserves higher Medicaid disproportionate-share hospital payments for public hospitals in California under forthcoming payment methodology changes.</li> </ul>

action_date: 2021-03-19
action_desc: Passed House
text: <p>This bill makes several budgetary and technical changes to provisions under Medicare, Medicaid, and the American Rescue Plan Act of 2021, which provided additional relief to address the ongoing impact of COVID-19 (i.e., coronavirus disease 2019).</p> <p>The bill exempts the budgetary effects of the American Rescue Plan Act of 2021 and this bill from the Statutory Pay-As-You-Go Act of 2010 (PAYGO), and exempts this bill from the Senate PAYGO rule. The bill also continues to exempt Medicare from sequestration until December 31, 2021. (Sequestration is a process of automatic, usually across-the-board spending reductions under which budgetary resources are permanently cancelled to enforce specific budget policy goals.) </p> <p>The bill also specifically</p> <ul> <li>excludes mixed-earner unemployment compensation from Medicaid and Children's Health Insurance Program (CHIP) eligibility determinations;</li> <li>applies certain modified payment limits to rural health clinics that temporarily enrolled in Medicare during the public health emergency or that applied to enroll by December 31, 2020; and</li> <li> preserves higher Medicaid disproportionate-share hospital payments for public hospitals in California under forthcoming payment methodology changes.</li> </ul>

action_date: 2021-03-25
action_desc: Passed Senate
text: <p>This bill makes several budgetary and technical changes to provisions under Medicare and Medicaid.</p> <p> The bill continues to exempt Medicare from sequestration until December 31, 2021. (Sequestration is a process of automatic, usually across-the-board spending reductions under which budgetary resources are permanently cancelled to enforce specific budget policy goals.) </p> <p>The bill also specifically</p> <ul> <li>applies certain modified payment limits to rural health clinics that temporarily enrolled in Medicare during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019) or that applied to enroll by December 31, 2020; and</li> <li> preserves higher Medicaid disproportionate-share hospital payments for public hospitals in California under forthcoming payment methodology changes.</li> </ul>

action_date: 2021-04-13
action_desc: House agreed to Senate amendment
text: <p>This bill makes several budgetary and technical changes to provisions under Medicare and Medicaid.</p> <p> The bill continues to exempt Medicare from sequestration until December 31, 2021. (Sequestration is a process of automatic, usually across-the-board spending reductions under which budgetary resources are permanently cancelled to enforce specific budget policy goals.) </p> <p>The bill also specifically</p> <ul> <li>applies certain modified payment limits to rural health clinics that temporarily enrolled in Medicare during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019) or that applied to enroll by December 31, 2020; and</li> <li> preserves higher Medicaid disproportionate-share hospital payments for public hospitals in California under forthcoming payment methodology changes.</li> </ul>

action_date: 2021-04-14
action_desc: Public Law
text: <p>This bill makes several budgetary and technical changes to provisions under Medicare and Medicaid.</p> <p> The bill continues to exempt Medicare from sequestration until December 31, 2021. (Sequestration is a process of automatic, usually across-the-board spending reductions under which budgetary resources are permanently cancelled to enforce specific budget policy goals.) </p> <p>The bill also specifically</p> <ul> <li>applies certain modified payment limits to rural health clinics that temporarily enrolled in Medicare during the public health emergency relating to COVID-19 (i.e., coronavirus disease 2019) or that applied to enroll by December 31, 2020; and</li> <li> preserves higher Medicaid disproportionate-share hospital payments for public hospitals in California under forthcoming payment methodology changes.</li> </ul>

tv_txt: 117th CONGRESS 1st Session H.R. 1868 In the Senate of the United States, March 25, 2021. Amendment:

That the bill from the House of Representatives (H.R. 1868) entitled An Act to prevent across-the-board direct spending cuts, and for other purposes. , do pass with the following Strike all after the enacting clause and insert the following: 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 December 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 ). (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 inserting 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 inserting 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. . 2. Technical corrections (a) Rural health clinic payments (1) In general Section 1833(f)(3) of the Social Security Act ( 42 U.S.C. 1395l(f)(3) ) is amended— (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 clinic that had a per visit payment amount established 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 applicable to primary care services furnished as of the first day of 2021; or (bb) the limit described in paragraph (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 clinic for rural health clinic services furnished in 2021; or (bb) the limit described in paragraph (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 applicable, ; and (B) by striking subparagraph (B) and inserting the following: (B) A rural health clinic described in this subparagraph 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 hospital continues to have less than 50 beds (not taking into account any increase in the number of beds pursuant to a waiver under subsection (b)(1)(A) of section 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 enrollment during such emergency period for such emergency period); or (II) submitted an application for enrollment under section 1866(j) (or a request for such a temporary 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 section 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 grandfathered transition rule Notwithstanding paragraph (2) of this subsection (as in effect on October 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, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 ( Public Law 106–113 )) shall apply in determining whether a payment adjustment for a hospital in a State referenced in section 4721(e) of the Balanced Budget Act of 1997 during a State fiscal year shall be considered consistent with subsection (c). .

Secretary

tv_txt: I 117th CONGRESS 1st Session H. R. 1868 IN THE HOUSE OF REPRESENTATIVES AN ACT To prevent across-the-board direct spending cuts, and for other purposes.

1. Preventing PAYGO sequestration (a) Statutory PAYGO scorecards The budgetary effects of this Act and the American Rescue Plan Act of 2021 ( Public Law 117–2 ) shall not be counted on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010 ( 2 U.S.C. 933(d) ). (b) Senate PAYGO scorecards The budgetary effects of this Act shall not be counted on any PAYGO scorecard maintained for purposes of section 4106 of H. Con. Res. 71 (115th Congress). 2. Extension of temporary suspension of medicare sequestration (a) 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 December 31, 2021 . (b) Effective date The amendment made by subsection (a) shall take effect as if enacted as part of the CARES Act ( Public Law 116–136 ). 3. Technical corrections (a) Disregard of certain additional compensation for purposes of medicaid and chip Section 2104(h) of the CARES Act ( 15 U.S.C. 9023(h) ) is amended by striking Federal pandemic unemployment compensation and inserting Federal Pandemic Unemployment Compensation or Mixed Earner Unemployment Compensation . (b) Rural health clinic payments (1) In general Section 1833(f)(3) of the Social Security Act ( 42 U.S.C. 1395l(f)(3) ) is amended— (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 clinic that had a per visit payment amount established 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 applicable to primary care services furnished as of the first day of 2021; or (bb) the limit described in paragraph (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 clinic for rural health clinic services furnished in 2021; or (bb) the limit described in paragraph (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 applicable, ; and (B) in subparagraph (B)— (i) in the matter preceding clause (i), by striking 2019, was and inserting 2020 ; (ii) in clause (i), by inserting was after (i) ; and (iii) by striking clause (ii) and inserting the following: (ii) (I) was enrolled under section 1866(j) (including temporary enrollment during the emergency period described in section 1135(g)(1)(B) for such period); or (II) submitted an application for enrollment under section 1866(j) (or requested such a temporary enrollment for such 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 ). (c) Eligibility for reemployment services Section 306(a) of the Social Security Act ( 42 U.S.C. 506(a) ) is amended— (1) by striking individuals referred to reemployment services as described in section 303(j) and inserting claimants for unemployment compensation, including claimants referred to reemployment services as described in section 303(j), ; and (2) by striking such individuals and inserting such claimants . (d) Additional amount for certain hospitals with high disproporationate 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 section 1923 of the Social Security Act ( 42 U.S.C. 1396r–4 ) amended by such section 203(a) is amended by adding at the end the following new paragraph: (3) Additional amount for certain hospitals with high disproporationate share (A) In general In the case of a hospital with high disproportionate share (as defined in subparagraph (B)) located in a State referenced in subsection (e) of section 4721 of the Balanced Budget Act of 1997, a payment adjustment during a State fiscal year shall be considered consistent with subsection (c) if the payment adjustment does not exceed 175 percent of the costs of furnishing hospital services during the year, but only if the Governor of the State certifies to the satisfaction of the Secretary that the hospital’s applicable minimum amount is used for health services during the year. In determining the amount that is used for such services during a year, there shall be excluded any amounts received under the Public Health Service Act, title V, title XVIII, or from third party payors (not including the State plan under this title) that are used for providing such services during the year. (B) Hospital with high disproporationate share defined In subparagraph (A), a hospital is a hospital with high disproportionate share if— (i) the hospital is owned or operated by the State (or by an instrumentality or a unit of government within the State); and (ii) the hospital— (I) meets the requirement described in subparagraphs (A) or (B) of subsection (b)(1); or (II) has the largest number of inpatient days attributable to individuals entitled to benefits under the State plan of any hospital in such State for the previous fiscal year. (C) Applicable minimum amount defined In subparagraph (A), the applicable minimum amount for a hospital for a fiscal year is equal to the difference between the amount of the hospital’s payment adjustment for the fiscal year and the costs to the hospital of furnishing hospital services described in paragraph (1)(A) during the fiscal year. .

Passed the House of Representatives March 19, 2021. Cheryl L. Johnson, Clerk.

tv_txt: I 117th CONGRESS 1st Session H. R. 1868 IN THE HOUSE OF REPRESENTATIVES March 12, 2021 Mr. Yarmuth (for himself, Mr. Neal , Mr. Pallone , and Mr. David Scott of Georgia ) introduced the following bill; which was referred to the Committee on the Budget , and in addition to the Committees on Energy and Commerce , and Ways and Means , 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 prevent across-the-board direct spending cuts, and for other purposes.

1. Preventing PAYGO sequestration (a) Statutory PAYGO scorecards The budgetary effects of this Act and the American Rescue Plan Act of 2021 ( Public Law 117–2 ) shall not be counted on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010 ( 2 U.S.C. 933(d) ). (b) Senate PAYGO scorecards The budgetary effects of this Act shall not be counted on any PAYGO scorecard maintained for purposes of section 4106 of H. Con. Res. 71 (115th Congress). 2. Extension of temporary suspension of medicare sequestration (a) 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 December 31, 2021 . (b) Effective date The amendment made by subsection (a) shall take effect as if enacted as part of the CARES Act ( Public Law 116–136 ). 3. Technical corrections (a) Disregard of certain additional compensation for purposes of medicaid and chip Section 2104(h) of the CARES Act ( 15 U.S.C. 9023(h) ) is amended by striking Federal pandemic unemployment compensation and inserting Federal Pandemic Unemployment Compensation or Mixed Earner Unemployment Compensation . (b) Rural health clinic payments (1) In general Section 1833(f)(3) of the Social Security Act ( 42 U.S.C. 1395l(f)(3) ) is amended— (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 clinic that had a per visit payment amount established 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 applicable to primary care services furnished as of the first day of 2021; or (bb) the limit described in paragraph (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 clinic for rural health clinic services furnished in 2021; or (bb) the limit described in paragraph (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 applicable, ; and (B) in subparagraph (B)— (i) in the matter preceding clause (i), by striking 2019, was and inserting 2020 ; (ii) in clause (i), by inserting was after (i) ; and (iii) by striking clause (ii) and inserting the following: (ii) (I) was enrolled under section 1866(j) (including temporary enrollment during the emergency period described in section 1135(g)(1)(B) for such period); or (II) submitted an application for enrollment under section 1866(j) (or requested such a temporary enrollment for such 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 ). (c) Eligibility for reemployment services Section 306(a) of the Social Security Act ( 42 U.S.C. 506(a) ) is amended— (1) by striking individuals referred to reemployment services as described in section 303(j) and inserting claimants for unemployment compensation, including claimants referred to reemployment services as described in section 303(j), ; and (2) by striking such individuals and inserting such claimants . (d) Additional amount for certain hospitals with high disproporationate 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 section 1923 of the Social Security Act ( 42 U.S.C. 1396r–4 ) amended by such section 203(a) is amended by adding at the end the following new paragraph: (3) Additional amount for certain hospitals with high disproporationate share (A) In general In the case of a hospital with high disproportionate share (as defined in subparagraph (B)) located in a State referenced in subsection (e) of section 4721 of the Balanced Budget Act of 1997, a payment adjustment during a State fiscal year shall be considered consistent with subsection (c) if the payment adjustment does not exceed 175 percent of the costs of furnishing hospital services during the year, but only if the Governor of the State certifies to the satisfaction of the Secretary that the hospital’s applicable minimum amount is used for health services during the year. In determining the amount that is used for such services during a year, there shall be excluded any amounts received under the Public Health Service Act, title V, title XVIII, or from third party payors (not including the State plan under this title) that are used for providing such services during the year. (B) Hospital with high disproporationate share defined In subparagraph (A), a hospital is a hospital with high disproportionate share if— (i) the hospital is owned or operated by the State (or by an instrumentality or a unit of government within the State); and (ii) the hospital— (I) meets the requirement described in subparagraphs (A) or (B) of subsection (b)(1); or (II) has the largest number of inpatient days attributable to individuals entitled to benefits under the State plan of any hospital in such State for the previous fiscal year. (C) Applicable minimum amount defined In subparagraph (A), the applicable minimum amount for a hospital for a fiscal year is equal to the difference between the amount of the hospital’s payment adjustment for the fiscal year and the costs to the hospital of furnishing hospital services described in paragraph (1)(A) during the fiscal year. .

tv_txt: II Calendar No. 31 117th CONGRESS 1st Session H. R. 1868 IN THE SENATE OF THE UNITED STATES March 22, 2021 Received March 24, 2021 Read the first time March 25, 2021 Read the second time and placed on the calendar AN ACT To prevent across-the-board direct spending cuts, and for other purposes.

1. Preventing PAYGO sequestration (a) Statutory PAYGO scorecards The budgetary effects of this Act and the American Rescue Plan Act of 2021 ( Public Law 117–2 ) shall not be counted on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010 ( 2 U.S.C. 933(d) ). (b) Senate PAYGO scorecards The budgetary effects of this Act shall not be counted on any PAYGO scorecard maintained for purposes of section 4106 of H. Con. Res. 71 (115th Congress). 2. Extension of temporary suspension of medicare sequestration (a) 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 December 31, 2021 . (b) Effective date The amendment made by subsection (a) shall take effect as if enacted as part of the CARES Act ( Public Law 116–136 ). 3. Technical corrections (a) Disregard of certain additional compensation for purposes of medicaid and chip Section 2104(h) of the CARES Act ( 15 U.S.C. 9023(h) ) is amended by striking Federal pandemic unemployment compensation and inserting Federal Pandemic Unemployment Compensation or Mixed Earner Unemployment Compensation . (b) Rural health clinic payments (1) In general Section 1833(f)(3) of the Social Security Act ( 42 U.S.C. 1395l(f)(3) ) is amended— (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 clinic that had a per visit payment amount established 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 applicable to primary care services furnished as of the first day of 2021; or (bb) the limit described in paragraph (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 clinic for rural health clinic services furnished in 2021; or (bb) the limit described in paragraph (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 applicable, ; and (B) in subparagraph (B)— (i) in the matter preceding clause (i), by striking 2019, was and inserting 2020 ; (ii) in clause (i), by inserting was after (i) ; and (iii) by striking clause (ii) and inserting the following: (ii) (I) was enrolled under section 1866(j) (including temporary enrollment during the emergency period described in section 1135(g)(1)(B) for such period); or (II) submitted an application for enrollment under section 1866(j) (or requested such a temporary enrollment for such 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 ). (c) Eligibility for reemployment services Section 306(a) of the Social Security Act ( 42 U.S.C. 506(a) ) is amended— (1) by striking individuals referred to reemployment services as described in section 303(j) and inserting claimants for unemployment compensation, including claimants referred to reemployment services as described in section 303(j), ; and (2) by striking such individuals and inserting such claimants . (d) Additional amount for certain hospitals with high disproporationate 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 section 1923 of the Social Security Act ( 42 U.S.C. 1396r–4 ) amended by such section 203(a) is amended by adding at the end the following new paragraph: (3) Additional amount for certain hospitals with high disproporationate share (A) In general In the case of a hospital with high disproportionate share (as defined in subparagraph (B)) located in a State referenced in subsection (e) of section 4721 of the Balanced Budget Act of 1997, a payment adjustment during a State fiscal year shall be considered consistent with subsection (c) if the payment adjustment does not exceed 175 percent of the costs of furnishing hospital services during the year, but only if the Governor of the State certifies to the satisfaction of the Secretary that the hospital’s applicable minimum amount is used for health services during the year. In determining the amount that is used for such services during a year, there shall be excluded any amounts received under the Public Health Service Act, title V, title XVIII, or from third party payors (not including the State plan under this title) that are used for providing such services during the year. (B) Hospital with high disproporationate share defined In subparagraph (A), a hospital is a hospital with high disproportionate share if— (i) the hospital is owned or operated by the State (or by an instrumentality or a unit of government within the State); and (ii) the hospital— (I) meets the requirement described in subparagraphs (A) or (B) of subsection (b)(1); or (II) has the largest number of inpatient days attributable to individuals entitled to benefits under the State plan of any hospital in such State for the previous fiscal year. (C) Applicable minimum amount defined In subparagraph (A), the applicable minimum amount for a hospital for a fiscal year is equal to the difference between the amount of the hospital’s payment adjustment for the fiscal year and the costs to the hospital of furnishing hospital services described in paragraph (1)(A) during the fiscal year. .

Passed the House of Representatives March 19, 2021. Cheryl L. Johnson, Clerk.

March 25, 2021 Read the second time and placed on the calendar

tv_txt: I One Hundred Seventeenth Congress of the United States of America At the First Session Begun and held at the City of Washington on Sunday, the third day of January, two thousand and twenty-one H. R. 1868 AN ACT To prevent across-the-board direct spending cuts, and for other purposes.

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 December 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). (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 inserting 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 inserting 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. . 2. Technical corrections (a) Rural health clinic payments (1) In general Section 1833(f)(3) of the Social Security Act (42 U.S.C. 1395l(f)(3)) is amended— (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 clinic that had a per visit payment amount established 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 applicable to primary care services furnished as of the first day of 2021; or (bb) the limit described in paragraph (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 clinic for rural health clinic services furnished in 2021; or (bb) the limit described in paragraph (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 applicable, ; and (B) by striking subparagraph (B) and inserting the following: (B) A rural health clinic described in this subparagraph 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 hospital continues to have less than 50 beds (not taking into account any increase in the number of beds pursuant to a waiver under subsection (b)(1)(A) of section 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 enrollment during such emergency period for such emergency period); or (II) submitted an application for enrollment under section 1866(j) (or a request for such a temporary 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 section 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 grandfathered transition rule Notwithstanding paragraph (2) of this subsection (as in effect on October 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, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106–113)) shall apply in determining whether a payment adjustment for a hospital in a State referenced in section 4721(e) of the Balanced Budget Act of 1997 during a State fiscal year shall be considered consistent with subsection (c). .

Speaker of the House of Representatives. Vice President of the United States and President of the Senate.