,in the ,senate of the ,united ,states1 
,march #be1 #bjba4  ,amendment3  ,that  
the bill from the ,house of             
,representatives 7,h4,r4 #ahfh7 entitled
 ,an ,act to prevent across-the-board   
direct spending cuts1 and for other     
purposes41 do pass with the following   
,strike all after the enacting clause   
and insert the following3 #a4 ,extension
 of temporary suspension of medicare    
sequestration  7a7 ,extension  7#a7 ,in 
general ,section #cgji7;a7 of division  
,a of the ,,cares ,act 7#b ,u4,s4,c4    
#ija;a note7 is amended by striking     
,march #ca1 #bjba and inserting         
,december #ca1 #bjba4  7#b7 ,effective  
date ,the amendment made by paragraph   
7#a7 shall take effect as if enacted as 
part of the ,,cares ,act 7,public ,law  
#aaf-acf74  7b7 ,offset ,section        
#bea;,a7#f77;,c7 of the ,balanced       
,budget and ,emergency ,deficit ,control
 ,act of #aihe 7#b ,u4,s4,c4            
#ija;a7#f77;,c77 is amended-- 7#a7 in   
clause 7i7-- 7,a7 by striking first #f  

months and inserting first #e #a_/b     
months2  7,b7 by striking #d4j percent  
and inserting #b4j percent2 and  7,c7 by
 striking and at the end2  7#b7 in      
clause 7ii7-- 7,a7 by striking second #f
 months and inserting #f-month period   
beginning on the day after the last day 
of the period described in clause 7i72  
and  7,b7 by striking #j4j percent4 and 
inserting #d4j percent2 and2 and  7#c7  
by adding at the end the following3     
7iii7 with respect to the remaining     
#a_/b month in which such order is so   
effective for such fiscal year1 the     
payment reduction shall be #j4j percent4
  4  #b4 ,technical corrections  7a7    
,rural health clinic payments  7#a7 ,in 
general ,section #ahcc7;f77#c7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7f77#c77 is amended-- 7,a7 in     
subparagraph 7,a7-- 7i7 in clause 7i71  
by striking subclauses 7,i7 and 7,,ii7  
and inserting the following3  7,i7 with 
respect to a rural health clinic that   
had a per visit payment amount          

established for services furnished in   
#bjbj-- 7aa7 the per visit payment      
amount applicable to such rural health  
clinic for rural health clinic services 
furnished in #bjbj1 increased by the    
percentage increase in the ,,mei        
applicable to primary care services     
furnished as of the first day of #bjba2 
or  7bb7 the limit described in         
paragraph 7#b77;,a72 and  7,,ii7 with   
respect to a rural health clinic that   
did not have a per visit payment amount 
established for services furnished in   
#bjbj-- 7aa7 the per visit payment      
amount applicable to such rural health  
clinic for rural health clinic services 
furnished in #bjba2 or  7bb7 the limit  
described in paragraph 7#b77;,a72 and  2
 and  7ii7 in clause 7ii77,i71 by       
striking under clause 7i77,i7 and       
inserting under subclause 7,i7 or 7,,ii7
 of clause 7i71 as applicable12 and     
7,b7 by striking subparagraph 7,b7 and  
inserting the following3  7,b7 ,a rural 
health clinic described in this         

subparagraph is a rural health clinic   
that-- 7i7 as of ,december #ca1 #bjbj1  
was in a hospital with less than #ej    
beds and after such date such hospital  
continues to have less than #ej beds    
7not taking into account any increase in
 the number of beds pursuant to a waiver
 under subsection 7b77#a77;,a7 of       
section #aace during the emergency      
period described in subsection          
7g77#a77;,b7 of such section72 and  7ii7
 7,i7 as of ,december #ca1 #bjbj1 was   
enrolled under section #ahff7;j7        
7including temporary enrollment during  
such emergency period for such emergency
 period72 or  7,,ii7 submitted an       
application for enrollment under section
 #ahff7;j7 7or a request for such a     
temporary enrollment for such emergency 
period7 that was received not later than
 ,december #ca1 #bjbj4  4  7#b7         
,effective date ,the amendments made by 
this subsection shall take effect as if 
included in the enactment of the        
,consolidated ,appropriations ,act1     

#bjba 7,public ,law #aaf-bfj74  7b7     
,additional amount for certain hospitals
 with high disproportionate share       
,effective as if included in the        
enactment of section #bjc7;a7 of title  
,,ii of division ,,cc of ,public ,law   
#aaf-bfj1 subsection 7g7 of section     
#aibc of the ,social ,security ,act 7#db
 ,u4,s4,c4 #acifr-#d71 as amended by    
such section1 is amended by adding at   
the end the following3  7#c7 ,continued 
application of grandfathered transition 
rule ,notwithstanding paragraph 7#b7 of 
this subsection 7as in effect on        
,october #a1 #bjba71 paragraph 7#b7 of  
this subsection 7as in effect on        
,september #cj1 #bjba1 and as applied   
under section #dgba7;e7 of the ,balanced
 ,budget ,act of #aiig1 and amended by  
section #fjg of the ,medicare1          
,medicaid1 and ,,schip ,balanced ,budget
 ,refinement ,act of #aiii 7,public ,law
 #ajf-aac77 shall apply in determining  
whether a payment adjustment for a      
hospital in a ,state referenced in      

section #dgba7;e7 of the ,balanced      
,budget ,act of #aiig during a ,state   
fiscal year shall be considered         
consistent with subsection 7c74  4      
,secretary