,,ii  #aafth ,,congress  #b;d ,session  
,s4 #cffe  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #g1       
#bjbj,mr4 ,alexander 7for himself1 ,mr4 
,warner1 ,mr4 ,shelby1 ,mrs4 ,blackburn1
 ,mr4 ,cornyn1 ,mr4 ,jones1 ,mr4        
,perdue1 and ,mr4 ,kaine7 introduced the
 following bill2 which was read twice   
and referred to the ,committee on       
,finance  ,a ,,bill  ,to amend the title
 ,,xviii of the ,social ,security ,act  
to preserve access to rural health care 
by ensuring fairness in ,medicare       
hospital payments4  #a4 ,short title    
,this ,act may be cited as the ,save    
,rural ,hospitals ,act of #bjbj4  #b4   
,ensuring fairness in medicare hospital 
payments  7a7 ,hospital inpatient       
services  7#a7 ,in general ,section     
#ahhf7;d77#c77;,e77i7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#aciewww7d77#c77;,e77 is amended-- 7,a7 
in clause 7i71 in the first sentence1 by
 striking or 7iii7 and inserting 1      
7iii71 or 7iv72 and  7,b7 by adding at  

the end the following new clause3  7iv7 
,area wage index floor  7,i7 ,in general
 ,for discharges occurring on or after  
,october #a1 #bjbj1 the area wage index 
applicable under this subparagraph to   
any hospital which is not located in a  
frontier ,state 7as defined in clause   
7iii77,,ii77 may not be less than #j4he4
  7,,ii7 ,waiving budget neutrality     
,pursuant to the fifth sentence of      
clause 7i71 this clause shall not be    
applied in a budget neutral manner4  4  
7#b7 ,waiving budget neutrality  7,a7   
,technical amendatory correction        
,section #ajcbd7;a77#b7 of ,public ,law 
#aaa-adh is amended by striking third   
sentence and inserting fifth sentence4  
7,b7 ,waiver ,section                   
#ahhf7;d77#c77;,e77i7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#c77;,e77i77 is amended1 in  
the fifth sentence-- 7i7 by striking and
 the amendments and inserting 1 the     
amendments2 and  7ii7 by inserting 1 and
 the amendments made by section         

#b7;a77#a7 of the ,save ,rural          
,hospitals ,act of #bjbj after ,care    
,act4  7b7 ,hospital outpatient         
department services ,section #ahcc7t7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #aciel7t771 is amended-- 7#a7 
in paragraph 7#b77;,d71 by striking     
7#ai71 the ,secretaryand inserting 7#ai7
 and paragraph 7#bc71 the ,secretary2   
and  7#b7 by adding at the end the      
following new paragraph3  7#bc7 ,floor  
on area wage adjustment factor for      
hospital outpatient department services 
,with respect to covered ,,opd services 
furnished on or after ,january #a1      
#bjba1 the area wage adjustment factor  
applicable under the payment system     
established under this subsection to any
 hospital outpatient department which is
 not located in a frontier ,state 7as   
defined in section                      
#ahhf7;d77#c77;,e77iii77,,ii77 may not  
be less than #j4he4 ,the preceding      
sentence shall not be implemented in a  
budget neutral manner4  4