,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #cffe  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #g1 #bjbj,mr4     
,alex&] 7= himself1 ,mr4 ,w>n]1 ,mr4    
,%elby1 ,mrs4 ,blackburn1 ,mr4 ,cornyn1 
,mr4 ,jones1 ,mr4 ,p]due1 & ,mr4 ,ka9e7 
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d ! title    
,,xviii ( ! ,social ,security ,act to   
pres]ve access to rural heal? c>e by    
ensur+ fairness 9 ,m$ic>e hospital      
paym5ts4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,save ,rural ,hospitals ,act
 ( #bjbj4  #b4 ,ensur+ fairness 9 m$ic>e
 hospital paym5ts  7a7 ,hospital        
inpati5t s]vices  7#a7 ,9 g5]al ,section
 #ahhf7;d77#c77;,e77i7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciewww7d77#c77;,e77 is am5d$-- 7,a7 9 
clause 7i71 9 ! fir/ s5t5ce1 by /rik+ or
 7iii7 & ins]t+ 1 7iii71 or 7iv72 &     
7,b7 by add+ at ! end ! foll[+ new      
clause3  7iv7 ,area wage index floor    
7,i7 ,9 g5]al ,= dis*>ges occurr+ on or 

aft] ,octob] #a1 #bjbj1 ! area wage     
index applicable "u ?is subp>agraph to  
any hospital :i* is n locat$ 9 a fronti]
 ,/ate 7z def9$ 9 clause 7iii77,,ii77   
may n be less ?an #j4he4  7,,ii7 ,waiv+ 
budget neutrality ,pursuant to ! fif?   
s5t5ce ( clause 7i71 ?is clause %all n  
be appli$ 9 a budget neutral mann]4  4  
7#b7 ,waiv+ budget neutrality  7,a7     
,te*nical am5datory correction ,section 
#ajcbd7;a77#b7 ( ,public ,law #aaa-adh  
is am5d$ by /rik+ ?ird s5t5ce & ins]t+  
fif? s5t5ce4  7,b7 ,waiv] ,section      
#ahhf7;d77#c77;,e77i7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#c77;,e77i77 is am5d$1 9 !   
fif? s5t5ce-- 7i7 by /rik+ & ! am5dm5ts 
& ins]t+ 1 ! am5dm5ts2 &  7ii7 by ins]t+
 1 & ! am5dm5ts made by section         
#b7;a77#a7 ( ! ,save ,rural ,hospitals  
,act ( #bjbj aft] ,c>e ,act4  7b7       
,hospital outpati5t dep>tm5t s]vices    
,section #ahcc7t7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciel7t771 is      
am5d$-- 7#a7 9 p>agraph 7#b77;,d71 by   

/rik+ 7#ai71 ! ,secret>y& ins]t+ 7#ai7 &
 p>agraph 7#bc71 ! ,secret>y2 &  7#b7 by
 add+ at ! end ! foll[+ new p>agraph3   
7#bc7 ,floor on area wage adju/m5t      
factor = hospital outpati5t dep>tm5t    
s]vices ,) respect to cov]$ ,,opd       
s]vices furni%$ on or aft] ,janu>y #a1  
#bjba1 ! area wage adju/m5t factor      
applicable "u ! paym5t sy/em e/abli%$ "u
 ?is subsection to any hospital         
outpati5t dep>tm5t :i* is n locat$ 9 a  
fronti] ,/ate 7z def9$ 9 section        
#ahhf7;d77#c77;,e77iii77,,ii77 may n be 
less ?an #j4he4 ,! prec$+ s5t5ce %all n 
be implem5t$ 9 a budget neutral mann]4  
4