,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #dagh  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,octob] #ca1 #bjag,mr4
 ,arr+ton 7= himself1 ,mr4 ,gohm]t1 &   
,mr4 ,conaway7 introduc$ ! foll[+ bill2 
:i* 0 ref]r$ to ! ,committee on ,ways & 
,means  ,a ,,bill  ,to am5d title       
,,xviii ( ! ,social ,security ,act to   
provide = re=m to & a p]man5t ext5sion (
 ! ,m$ic>e-dep5d5t hospital program1 & =
 o!r purposes4  #a4 ,%ort title ,?is    
,act may be cit$ z ! ,heal?c>e          
,enhancem5t = ,am]icas ,rural ,t[ns ,act
 or ! ,,he>t ,act4  #b4 ,re=m & p]man5t 
ext5sion ( ! ,m$ic>e-dep5d5t hospital   
7,,mdh7 program  7a7 ,ext5sion ( ,paym5t
 ,me?odology ,section #ahhf7;d77#e77;,g7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acieww7d77#e77;,g77 is       
am5d$--  7#a7 9 clause 7i71 by /rik+ 1 &
 be=e ,octob] #a1 #bjag & ins]t+ be=e   
,octob] #a1 #bjah2  7#b7 9 clause 7i71  
by add+ at ! end ! foll[+2 ,= fiscal ye>
 #bjah & ea* subsequ5t fiscal ye>1 9 !  
case ( su* a subsection 7d7 hospital1   

paym5t "u p>agraph 7#a77;,a7 %all be    
equal to ! sum ( ! am\nt det]m9$ "u     
p>agraph 7#a77;,a77iii7 & ! am\nt       
det]m9$ by ! increase factor det]m9$ "u 
clause 7v7 = su* hospital & co/ report+ 
p]iod42  7#c7 9 clause 7ii77,,ii71 by   
/rik+ 1 & be=e ,octob] #a1 #bjag &      
ins]t+ be=e ,octob] #a1 #bjah2 &  7#d7  
by add+ at ! end ! foll[+ new clauses3  
7v7 ,subject to subclause 7,,ii71 =     
purposes ( clause 7i71 = fiscal ye>     
#bjai & ea* subsequ5t fiscal ye> )      
respect to a subsection 7d7 hospital :i*
 is a m$ic>e-dep5d5t1 small rural       
hospital1 ! ,secret>y %all det]m9e an   
increase factor to apply to su* hospital
 ) respect to dis*>ges occurr+ dur+ su* 
fiscal ye>4 ,:5 det]m9+ su* increase    
factor1 ! ,secret>y may take into acc\nt
 a me?odology t results 9 a simil> am\nt
 ( reimbursem5t to su* hospital = su*   
fiscal ye> z su* am\nt t w\ld h be5     
det]m9$ if ! fir/ s5t5ce ( clause 7i7   
appli$ ) respect to su* fiscal ye>4     
7vi7 ,! aggregate am\nts det]m9$ = all  

subsection 7d7 hospitals :i* are        
m$ic>e-dep5d5t1 small rural hospitals by
 application ( ! increase factors       
det]m9$ "u clause 7v7 = su* hospitals   
%all n exce$ a total (--  7,i7 = fiscal 
ye> #bjai1 #ajj1jjj1jjj2 &  7,,ii7 = ea*
 subsequ5t fiscal ye>1 ! am\nt specifi$ 
9 ?is clause = ! previ\s fiscal ye>     
increas$ by ! m>ket basket p]c5tage     
increase 7z def9$ 9 subsection          
7b77#c77;,b77iii77 z det]m9$            
prospectively by ! ,secret>y = su*      
subsequ5t fiscal ye>4  4  7b7 ,con=m+   
,am5dm5ts  7#a7 ,ext5sion ( t>get am\nt 
,section #ahhf7;b77#c77;,d7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acieww7b77#c77;,d77 is am5d$-- 7,a7 9 !
 matt] prec$+ clause 7i71 by /rik+ 1 &  
be=e ,octob] #a1 #bjag2  7,b7 9 clause  
7iii71 by /rik+ at ! end &2  7,c7 9     
clause 7iv7--  7i7 by /rik+ ?r\gh fiscal
 ye> #bjag & ins]t+ ?r\gh fiscal ye>    
#bjah2 &  7ii7 by /rik+ ! p]iod at ! end
 & ins]t+ 1 &2 &  7,d7 by add+ at ! end 
! foll[+ new clause3  7v7 ) respect to  

dis*>ges occurr+ dur+ fiscal ye> #bjai  
or a subsequ5t fiscal ye>1 ! t>get am\nt
 = ! prec$+ ye> increas$ by ! applicable
 p]c5tage increase "u subp>agraph       
7,b77iv7 & adju/$ z det]m9$ necess>y by 
! ,secret>y to take into acc\nt !       
application ( subsection                
7d77#e77;,g77vi7 = su* fiscal ye>4  4   
7#b7 ,p]mitt+ hospitals to decl9e       
reclassification ,section #aceja7;e77#b7
 ( ! ,omnibus ,budget ,reconciliation   
,act ( #aiic 7#db ,u4,s4,c4 #acieww     
note7 is am5d$ by /rik+ fiscal ye> #bjjj
 ?r\gh fiscal ye> #bjag & ins]t+ a      
subsequ5t fiscal ye>4  #c4 ,tempor>y    
ext5sion ( ! ,m$ic>e l[-volume adju/m5t 
program ,section #ahhf7;d77#ab7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7d77#ab77 is am5d$-- 7#a7 9      
subp>agraph 7,b71 9 ! matt] prec$+      
clause 7i71 by /rik+ & = dis*>ges       
occurr+ 9 fiscal ye> #bjbj & subsequ5t  
fiscal ye>s2  7#b7 9 subp>agraph        
7,c77i7-- 7,a7 by /rik+ fiscal ye>s     
#bjaa ?r\gh #bjag ea* place x appe>s &  

ins]t+ fiscal ye>s #bjaa ?r\gh #bjai2 & 
7,b7 by /rik+ or portion ( fiscal ye>2 &
  7#c7 9 subp>agraph 7,d7--  7,a7 9 !   
head+1 by /rik+ ,tempor>y applicable    
p]c5tage increase & ins]t+ ,applicable  
p]c5tage increase beg9n+ ) fiscal ye>   
#bjaa2  7,b7 by /rik+ fiscal ye>s #bjaa 
?r\gh #bjag1 & ins]t+ fiscal ye>s #bjaa 
?r\gh #bjai2 &  7,c7 by /rik+ or !      
portion ( fiscal ye> ea* place x appe>s4
  #d4 ,budget neutral pay-= ,= fiscal   
ye> #bjah & ea* subsequ5t fiscal ye>1 ! 
,secret>y ( ,heal? & ,human ,s]vices    
%all adju/ paym5ts "u section #ahhf7;d7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acieww7d77 9 a mann] su* t ! 
e/imat$ aggregate am\nt ( exp5ditures "u
 su* section = su* fiscal ye> )         
application ( ! am5dm5ts made by        
sections #b & #c ( ?is ,act is equal to 
! e/imat$ aggregate am\nt ( exp5ditures 
"u su* section = su* fiscal ye> )\t     
application ( su* am5dm5ts4