,i  #aaf? ,,congress  #a/ ,session  ,h4 
,r4 #cfgb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #aj1 #bjai,mr4  
,br9disi 7= himself1 ,mr4 ,re$1 & ,ms4  
,/efanik7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,ways &      
,means  ,a ,,bill  ,to provide relief = 
small rural hospitals f inaccurate      
in/ructions provid$ by c]ta9 m$ic>e     
adm9i/rative contractors4  #a4 ,%ort    
title ,?is ,act may be cit$ z ! ,access 
= ,rural ,communities ,act or ! ,,arc   
,act4  #b4 ,relief = small rural        
hospitals f inaccurate in/ructions      
provid$ by c]ta9 m$ic>e adm9i/rative    
contractors  7a7 ,application ( revis$  
volume decrease adju/m5t me?odology     
,subject to subsection 7b71 9 ! case ( a
 sole community hospital or a           
m$ic>e-dep5d5t1 small rural hospital )  
respect to :i* a m$ic>e adm9i/rative    
contractor det]m9$ a volume decrease    
adju/m5t applies = any specifi$ co/     
report+ p]iod1 at ! election ( !        
hospital1 ! ,secret>y ( ,heal? & ,human 

,s]vices %all recalculate ! am\nt ( !   
volume decrease adju/m5t det]m9$ by !   
m$ic>e adm9i/rative contractor = su*    
hospital & specifi$ co/ report+ p]iod   
us+ ! revis$ volume decrease adju/m5t   
paym5t me?odology = any specifi$ co/    
report+ p]iod reque/$ by ! hospital 9   
its election4  7b7 ,limitation  7#a7 ,9 
g5]al ,subsection 7a7 %all n apply 9 !  
case ( a sole community hospital or a   
m$ic>e-dep5d5t1 small rural hospital =  
:i* ! m$ic>e adm9i/rative contractor    
det]m9ation ( ! volume decrease adju/m5t
 ) respect to a specifi$ co/ report+    
p]iod ( ! hospital is adm9i/ratively    
f9al be=e ! date t is ?ree ye>s be=e !  
date ( ! enactm5t ( ?is section4  7#b7  
,adm9i/rative f9ality ,= purposes (     
p>agraph 7#a71 ! date on :i* ! m$ic>e   
adm9i/rative contractor det]m9ation )   
respect to a volume decrease adju/m5t = 
a specifi$ co/ report+ p]iod is         
adm9i/ratively f9al is ! late/ ( !      
foll[+3  7,a7 ,! date ( ! contractor    
det]m9ation 7z def9$ 9 section #dje4ahja

 ( title #db1 ,code ( ,f$]al            
,regulations74  7,b7 ,! date ( ! f9al   
outcome ( any reop5+ ( ! m$ic>e         
adm9i/rative contractor det]m9ation "u  
section #dje4ahhe ( title #db1 ,code (  
,f$]al ,regulations4  7,c7 ,! date ( !  
f9al outcome ( ! f9al appeal fil$ by su*
 hospital ) respect to su* volume       
decrease adju/m5t = su* specifi$ co/    
report+ p]iod4  7c7 ,def9itions ,9 ?is  
section3 7#a7 ,m$ic>e adm9i/rative      
contractor ,! t]m m$ic>e adm9i/rative   
contractor means ! entity t has ent]$   
into a contract ) ! ,secret>y ( ,heal? &
 ,human ,s]vices "u section #ahgd;,a ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciekk-#a7 to s]vice ,a_/,b ,m$ic>e    
,adm9i/rative ,contractor ,jurisdiction 
,k ( ! ,c5t]s = ,m$ic>e  ,m$icaid       
,s]vices z ( ,july #a1 #bjaf4  7#b7     
,m$ic>e-dep5d5t1 small rural hospital ,!
 t]m m$ic>e-dep5d5t1 small rural        
hospital has ! mean+ giv5 su* t]m "u    
section #ahhf7;d77#e77;,g77iv7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   

#acieww7d77#e77;,g77iv774  7#c7 ,revis$ 
volume decrease adju/m5t paym5t         
me?odology ,! t]m revis$ volume decrease
 adju/m5t paym5t me?odology means !     
me?odology to calculate ! volume        
decrease adju/m5t t is describ$ 9 !     
second s5t5ce ( section #dab4ib7;e77#c7 
( title #db1 ,code ( ,f$]al ,regulations
 7relat+ to ! me?odology to calculate ! 
volume decrease adju/m5t = sole         
community hospitals 7&1 pursuant to     
section #dab4ajh7;d77#c7 ( su* title    
#db1 = m$ic>e-dep5d5t1 small rural      
hospitals7 t is effective = co/ report+ 
p]iods beg9n+ on or aft] ,octob] #a1    
#bjag74  7#d7 ,sole community hospital  
,! t]m sole community hospital has !    
mean+ giv5 su* t]m "u section           
#ahhf7;d77#e77;,d77iii7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77;,d77iii774  7#e7        
,specifi$ co/ report+ p]iod ,! t]m      
specifi$ co/ report+ p]iod means a co/  
report+ p]iod ( a sole community        
hospital or a m$ic>e-dep5d5t1 small     

rural hospital1 z ! case may be1 t beg9s
 dur+ a fiscal ye> be=e fiscal ye>      
#bjah4  7#f7 ,volume decrease adju/m5t  
,! t]m volume decrease adju/m5t means ! 
adju/m5t requir$ ) respect to a sole    
community hospital or a m$ic>e-dep5d5t1 
small rural hospital1 z ! case may be1  
"u subp>agraph 7,d77ii7 or subp>agraph  
7,g77iii71 respectively1 ( section      
#ahhf7;d77#e7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acieww7d77#e774