,,ii  #aafth ,,congress  #b;d ,session  
,s4 #cfae  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #f1       
#bjbj,ms4 ,murkowski 7for herself1 ,mr4 
,bennet1 and ,mr4 ,sullivan7 introduced 
the following bill2 which was read twice
 and referred to the ,committee on      
,finance  ,a ,,bill  ,to amend the      
,medicare ,prescription ,drug1          
,improvement1 and ,modernization ,act of
 #bjjc to extend the rural community    
hospital demonstration program4  #a4    
,short title ,this ,act may be cited as 
the ,rural ,community ,hospital         
,demonstration ,extension ,act of #bjbj4
  #b4 ,five-year extension of the rural 
community hospital demonstration program
  7a7 ,extension  7#a7 ,in general      
,subsection 7a77#e7 of section #daj;,a  
of the ,medicare ,prescription ,drug1   
,improvement1 and ,modernization ,act of
 #bjjc 7,public ,law #ajh-agc2 #db      
,u4,s4,c4 #acieww note71 is amended by  
striking #aj-year extension period and  
inserting #ae-year extension period4    

7#b7 ,conforming amendments for         
extension  7,a7 ,extension of           
demonstration period ,subsection 7g7 of 
such section #daj;,a is amended-- 7i7 in
 the subsection heading1 by striking    
,ten-,year and inserting ,fifteen-,year2
  7ii7 in paragraph 7#a7-- 7,i7 by      
striking additional #aj-year and        
inserting additional #ae-year2 and      
7,,ii7 by striking #aj-year extension   
period and inserting #ae-year extension 
period2  7iii7 in paragraph 7#b71 by    
striking #aj-year extension period and  
inserting #ae-year extension period2    
7iv7 in paragraph 7#c71 by striking     
#aj-year extension period and inserting 
#ae-year extension period2  7v7 in      
paragraph 7#d71 by striking #aj-year    
extension period each place it appears  
and inserting #ae-year extension period2
  7vi7 in paragraph 7#e71 by striking   
#aj-year extension period and inserting 
#ae-year extension period2 and  7vii7 in
 subparagraph 7,a7 of paragraph 7#f71 by
 striking #aj-year extension period and 

inserting #ae-year extension period4    
7,b7 ,rule for hospitals that are not   
original participants in the            
demonstration ,paragraph 7#e7 of        
subsection 7g7 of such section #daj;,a  
is amended-- 7i7 by striking            
program4--,during and inserting         
program4-- 7,a7 ,,cures ,act extension  
,during  2 and  7ii7 by adding at the   
end the following new subparagraph3     
7,b7 ,additional extension ,during the  
third #e years of the #ae-year extension
 period1 the ,secretary shall apply the 
provisions of paragraph 7#d7 to rural   
community hospitals that are not        
described in paragraph 7#d7 but are     
participating in the demonstration      
program under this section as of        
,december #cj1 #bjai1 in a similar      
manner as such provisions apply to rural
 community hospitals described in       
paragraph 7#d74  4  7,c7 ,solicitation  
of applications ,subparagraph 7,a7 of   
subsection 7g77#f7 of such section      
#daj;,a is amended-- 7i7 by striking    

general4--,the ,secretary and inserting 
,in general4-- 7i7 ,,cures ,act         
solicitation ,the ,secretary  2 and     
7ii7 by adding at the end the following 
new clause3  7ii7 ,additional           
solicitation ,the ,secretary shall1     
notwithstanding subsection 7a77#b7 or   
paragraph 7#b7 of this subsection1 not  
later than #abj days after the date of  
the enactment of this clause1 issue a   
solicitation for applications to select 
up to the maximum number of additional  
rural community hospitals located in any
 ,state to participate in the           
demonstration program under this section
 for the third #e years of the #ae-year 
extension period without exceeding the  
limitation under paragraph 7#c7 of this 
subsection4  4  7b7 ,clarification of   
application of case mix adjustment      
,subsection 7b7 of such section #daj;,a 
is amended by adding at the end the     
following new paragraph3  7#c7 ,case mix
 adjustment ,the ,secretary shall       
provide for an appropriate adjustment   

under this paragraph to take into       
account variations in case mix of rural 
community hospitals1 using the most     
recent case-mix data available4  4  7c7 
,change in timing for report ,subsection
 7e7 of such section #daj;,a is amended 
by striking ,not later than ,august #a1 
#bjah and inserting ,not later than     
,august #a1 #bjbc4  7d7 ,clarifying     
technical amendments ,such section      
#daj;,a1 as amended by subsections 7a71 
7b71 and 7c71 is further amended-- 7#a7 
in subsection 7a77#a71 by inserting of  
,health and ,human ,services after      
,secretary2  7#b7 in subsection         
7f77#a77;,a77iv7 by inserting of the    
,social ,security ,act 7#db ,u4,s4,c4   
#acie;i-#d7 after section #ahbj2 and    
7#c7 in subsection 7g7-- 7,a7 in the    
heading of paragraph 7#d71 by striking  
,hospitals in demonstration program on  
date of enactment and inserting         
,hospitals participating in the         
demonstration program during the initial
 #e-,year period2 and  7,b7 in clause   

7i7 of paragraph 7#f77;,a71 as amended  
by subsection 7a77#b77;,c77i71 by       
striking not later than #abj days after 
the date of the enactment of this       
paragraph and inserting not later than  
,april #ab1 #bjag4