,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #bjec  ,,in ,,the ,,house ,,of  
,,representatives  ,may #bj1 #bjac ,mr4 
,brady of ,texas 7for himself1 ,mr4     
,reed1 ,mr4 ,tiberi1 ,mr4 ,roskam1 ,mr4 
,buchanan1 ,mr4 ,schock1 ,mr4 ,kelly of 
,pennsylvania1 ,mr4 ,renacci1 and ,mr4  
,griffith of ,virginia7 introduced the  
following bill2 which was referred to   
the ,committee on ,ways and ,means  ,a  
,,bill  ,to amend title ,,xviii of the  
,social ,security ,act to apply budget  
neutrality on a ,state-specific basis in
 the calculation of the ,medicare       
hospital wage index floor for non-rural 
areas4  #a4 ,applying budget neutrality 
on a ,state-specific basis in the       
calculation of the ,medicare hospital   
wage index floor for non-rural areas    
7a7 ,in general ,section                
#ahhf7;d77#c77;,e7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#c77;,e77 is amended by      
adding at the end the following new     
clause3  7iv7 ,application of budget    

neutrality relating to floor on wage    
area index in non-rural areas  7,i7     
,application on a ,state-specific basis 
beginning in fiscal year #bjad ,subject 
to subclause 7,,ii71 in the case of     
discharges occurring on or after        
,october #a1 #bjac1 for purposes of     
applying section #ddaj7;b7 of the       
,balanced ,budget ,act of #aiig1 the    
,secretary shall administer such section
 #ddaj7;b7 and paragraph 7e7 of section 
#dab4fd of title #db1 ,code of ,federal 
,regulations1 as if paragraph           
7e77#d77;ii7 of such section #dab4fd had
 never applied and by using the         
methodology promulgated in the ,federal 
,register on ,august #ai1 #bjjh 7#gc    
,fed4 ,reg4 #dhegj7 7applied as if such 
methodology had been fully implemented  
for fiscal year #bjaa using a #ajj      
percent ,state-specific adjustment to   
the area wage index74  7,,ii7           
,construction ,nothing in subclause 7,i7
 shall be construed as preventing the   
,secretary1 for discharges occurring on 

or after ,october #a1 #bjad1 from       
modifying the regulations under such    
section #dab4fd in carrying out the     
budget neutrality requirements of such  
section #ddaj7;b74  4  7b7 ,conforming  
amendment terminating application of    
budget neutrality on a nationwide basis 
,section #cada of the ,patient          
,protection and ,affordable ,care ,act  
7#db ,u4,s4,c4 #acieww note7 is amended 
by inserting and before ,october #a1    
#bjac1 after #bjaj14