,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #dagh  ,,in ,,the ,,house ,,of  
,,representatives  ,october #ca1        
#bjag,mr4 ,arrington 7for himself1 ,mr4 
,gohmert1 and ,mr4 ,conaway7 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 provide   
for reform to and a permanent extension 
of the ,medicare-dependent hospital     
program1 and for other purposes4  #a4   
,short title ,this ,act may be cited as 
the ,healthcare ,enhancement for        
,americas ,rural ,towns ,act or the     
,,heart ,act4  #b4 ,reform and permanent
 extension of the ,medicare-dependent   
hospital 7,,mdh7 program  7a7 ,extension
 of ,payment ,methodology ,section      
#ahhf7;d77#e77;,g7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77;,g77 is amended--  7#a7 
in clause 7i71 by striking 1 and before 
,october #a1 #bjag and inserting before 
,october #a1 #bjah2  7#b7 in clause 7i71

 by adding at the end the following2    
,for fiscal year #bjah and each         
subsequent fiscal year1 in the case of  
such a subsection 7d7 hospital1 payment 
under paragraph 7#a77;,a7 shall be equal
 to the sum of the amount determined    
under paragraph 7#a77;,a77iii7 and the  
amount determined by the increase factor
 determined under clause 7v7 for such   
hospital and cost reporting period42    
7#c7 in clause 7ii77,,ii71 by striking 1
 and before ,october #a1 #bjag and      
inserting before ,october #a1 #bjah2 and
  7#d7 by adding at the end the         
following new clauses3  7v7 ,subject to 
subclause 7,,ii71 for purposes of clause
 7i71 for fiscal year #bjai and each    
subsequent fiscal year with respect to a
 subsection 7d7 hospital which is a     
medicare-dependent1 small rural         
hospital1 the ,secretary shall determine
 an increase factor to apply to such    
hospital with respect to discharges     
occurring during such fiscal year4 ,when
 determining such increase factor1 the  

,secretary may take into account a      
methodology that results in a similar   
amount of reimbursement to such hospital
 for such fiscal year as such amount    
that would have been determined if the  
first sentence of clause 7i7 applied    
with respect to such fiscal year4  7vi7 
,the aggregate amounts determined for   
all subsection 7d7 hospitals which are  
medicare-dependent1 small rural         
hospitals by application of the increase
 factors determined under clause 7v7 for
 such hospitals shall not exceed a total
 of--  7,i7 for fiscal year #bjai1      
#ajj1jjj1jjj2 and  7,,ii7 for each      
subsequent fiscal year1 the amount      
specified in this clause for the        
previous fiscal year increased by the   
market basket percentage increase 7as   
defined in subsection 7b77#c77;,b77iii77
 as determined prospectively by the     
,secretary for such subsequent fiscal   
year4  4  7b7 ,conforming ,amendments   
7#a7 ,extension of target amount        
,section #ahhf7;b77#c77;,d7 of the      

,social ,security ,act 7#db ,u4,s4,c4   
#acieww7b77#c77;,d77 is amended-- 7,a7  
in the matter preceding clause 7i71 by  
striking 1 and before ,october #a1      
#bjag2  7,b7 in clause 7iii71 by        
striking at the end and2  7,c7 in clause
 7iv7--  7i7 by striking through fiscal 
year #bjag and inserting through fiscal 
year #bjah2 and  7ii7 by striking the   
period at the end and inserting 1 and2  
and  7,d7 by adding at the end the      
following new clause3  7v7 with respect 
to discharges occurring during fiscal   
year #bjai or a subsequent fiscal year1 
the target amount for the preceding year
 increased by the applicable percentage 
increase under subparagraph 7,b77iv7 and
 adjusted as determined necessary by the
 ,secretary to take into account the    
application of subsection               
7d77#e77;,g77vi7 for such fiscal year4  
4  7#b7 ,permitting hospitals to decline
 reclassification ,section              
#aceja7;e77#b7 of the ,omnibus ,budget  
,reconciliation ,act of #aiic 7#db      

,u4,s4,c4 #acieww note7 is amended by   
striking fiscal year #bjjj through      
fiscal year #bjag and inserting a       
subsequent fiscal year4  #c4 ,temporary 
extension of the ,medicare low-volume   
adjustment program ,section             
#ahhf7;d77#ab7 of the ,social ,security 
,act 7#db ,u4,s4,c4 #acieww7d77#ab77 is 
amended-- 7#a7 in subparagraph 7,b71 in 
the matter preceding clause 7i71 by     
striking and for discharges occurring in
 fiscal year #bjbj and subsequent fiscal
 years2  7#b7 in subparagraph 7,c77i7-- 
7,a7 by striking fiscal years #bjaa     
through #bjag each place it appears and 
inserting fiscal years #bjaa through    
#bjai2 and  7,b7 by striking or portion 
of fiscal year2 and  7#c7 in            
subparagraph 7,d7--  7,a7 in the        
heading1 by striking ,temporary         
applicable percentage increase and      
inserting ,applicable percentage        
increase beginning with fiscal year     
#bjaa2  7,b7 by striking fiscal years   
#bjaa through #bjag1 and inserting      

fiscal years #bjaa through #bjai2 and   
7,c7 by striking or the portion of      
fiscal year each place it appears4  #d4 
,budget neutral pay-for ,for fiscal year
 #bjah and each subsequent fiscal year1 
the ,secretary of ,health and ,human    
,services shall adjust payments under   
section #ahhf7;d7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#acieww7d77 in a manner such that the   
estimated aggregate amount of           
expenditures under such section for such
 fiscal year with application of the    
amendments made by sections #b and #c of
 this ,act is equal to the estimated    
aggregate amount of expenditures under  
such section for such fiscal year       
without application of such amendments4