,,ii  #aaith ,,congress  #ast ,session  
,s4 #cce  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,january #cj1       
#bjbe,mr4 ,grassley 7for himself1 ,mr4  
,welch1 ,mrs4 ,capito1 ,mr4 ,kaine1 ,mr4
 ,wicker1 ,mrs4 ,shaheen1 ,mr4 ,moran1  
,ms4 ,smith1 ,mrs4 ,hyde-,smith1 ,mr4   
,fetterman1 ,mr4 ,boozman1 and ,mr4     
,kelly7 introduced the following bill2  
which was read twice and referred to the
 ,committee on ,finance  ,a ,,bill  ,to 
amend title ,,xviii of the ,social      
,security ,act to rebase the calculation
 of payments for sole community         
hospitals and ,medicare-dependent       
hospitals1 and for other purposes4  #a4 
,short title ,this ,act may be cited as 
the ,rural ,hospital ,support ,act4  #b4
 ,rebasing of the calculation of        
payments for sole community hospitals   
7a7 ,rebasing permitted ,section        
#ahhf7;b77#c7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acieww7b77#c77 is  
amended by adding at the end the        
following new subparagraph3  7,m7 7i7   

,for cost reporting periods beginning on
 or after ,october #a1 #bjbe1 in the    
case of a sole community hospital there 
shall be substituted for the amount     
otherwise determined under subsection   
7d77#e77;,d77i7 of this section1 if such
 substitution results in a greater      
amount of payment under this section for
 the hospital1 the subparagraph 7,m7    
rebased target amount4  7ii7 ,for       
purposes of this subparagraph1 the term 
subparagraph 7,m7 rebased target amount 
has the meaning given the term target   
amount in subparagraph 7,c71 except     
that-- 7,i7 there shall be substituted  
for the base cost reporting period the  
#ab-month cost reporting period         
beginning during fiscal year #bjaf2     
7,,ii7 any reference in subparagraph    
7,c77i7 to the first cost reporting     
period described in such subparagraph is
 deemed a reference to the first cost   
reporting period beginning on or after  
,october #a1 #bjbe2 and  7,,iii7 the    
applicable percentage increase shall    

only be applied under subparagraph      
7,c77iv7 for discharges occurring on or 
after ,october #a1 #bjbe4  4  7b7       
,conforming amendments ,section         
#ahhf7;b77#c7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acieww7b77#c77 is  
amended-- 7#a7 in subparagraph 7,c71 in 
the matter preceding clause 7i71 by     
striking subparagraphs 7,i7 and 7,l7 and
 inserting subparagraphs 7,i71 7,l71 and
 7,m72 and  7#b7 in subparagraph        
7,i77i71 in the matter preceding        
subclause 7,i71 by striking subparagraph
 7,l7 and inserting subparagraphs 7,l7  
and 7,m74  #c4 ,rebasing of the         
calculation of payments for             
,medicare-dependent hospitals ,section  
#ahhf7;b77#c7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acieww7b77#c771 as 
amended by section #b1 is amended-- 7#a7
 in subparagraph 7,d71 by striking      
subparagraph 7,k7 and inserting         
subparagraphs 7,k7 and 7,n72 and  7#b7  
by adding at the end the following new  
subparagraph3  7,n7 7i7 ,with respect to

 discharges occurring on or after       
,october #a1 #bjbe1 in the case of a    
medicare-dependent1 small rural         
hospital1 for purposes of applying      
subparagraph 7,d7-- 7,i7 there shall be 
substituted for the base cost reporting 
period described in subparagraph 7,d77i7
 the #ab-month cost reporting period    
beginning during fiscal year #bjaf2 and 
7,,ii7 any reference in such            
subparagraph to the first cost reporting
 period described in such subparagraph  
is deemed a reference to the first cost 
reporting period beginning on or after  
,october #a1 #bjbe4  7ii7 ,this         
subparagraph shall only apply to a      
hospital if the substitution described  
in clause 7i77,i7 results in an increase
 in the target amount under subparagraph
 7,d7 for the hospital4  4  #d4         
,prohibition of adjustments to          
classifications and weighting factors   
relating to the calculation of payments 
for sole community hospitals and        
,medicare-dependent hospitals ,section  

#ahhf7;d77#d77;,c7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#d77;,c77-- 7#a7 in clause   
7i71 by striking ,the ,secretary and    
inserting ,subject to clause 7v71 the   
,secretary2 and  7#b7 by adding at the  
end the following new clause3  7v7 ,for 
discharges using the rebased target     
amounts described in subparagraph 7,m7  
or 7,n7 of subsection 7b77#c71 the      
,secretary may not adjust such amounts  
for adjustments required by clause 7iii7
 prior to ,october #a1 #bjae4  4  #e4   
,extension of the medicare-dependent    
hospital 7,,mdh7 program  7a7 ,extension
 of payment methodology ,section        
#ahhf7;d77#e77;,g7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77;,g77 is amended-- 7#a7  
in clause 7i71 by striking 1 and before 
,april #a1 #bjbe2 and  7#b7 in clause   
7ii77,,ii71 by striking 1 and before    
,april #a1 #bjbe4  7b7 ,conforming      
amendments  7#a7 ,extension of target   
amount ,section #ahhf7;b77#c77;,d7 of   

the ,social ,security ,act 7#db         
,u4,s4,c4 #acieww7b77#c77;,d77 is       
amended-- 7,a7 in the matter preceding  
clause 7i71 by striking 1 and before    
,april #a1 #bjbe2 and  7,b7 in clause   
7iv71 by striking through fiscal year   
#bjbd and the portion of fiscal year    
#bjbe beginning on ,october #a1 #bjbd1  
and ending on ,march #ca1 #bjbe and     
inserting or a subsequent fiscal year4  
7#b7 ,permitting hospitals to decline   
reclassification ,section #aceja7;e77#b7
 of the ,omnibus ,budget ,reconciliation
 ,act of #aiic 7#db ,u4,s4,c4 #acieww   
note7 is amended by striking fiscal year
 #bjjj through fiscal year #bjbd1 or the
 portion of fiscal year #bjbe beginning 
on ,october #a1 #bjbd1 and ending on    
,march #ca1 #bjbe and inserting a       
subsequent fiscal year4  #f4 ,extension 
of the increased payments under the     
,medicare low-volume hospital program   
,section #ahhf7;d77#ab7 of the ,social  
,security ,act 7#db ,u4,s4,c4           
#acie7;d77#ab77 is amended-- 7#a7 in    

subparagraph 7,b7-- 7,a7 in the         
subparagraph heading1 by inserting for  
fiscal years #bjje through #bjaj after  
increase2 and  7,b7 in the matter       
preceding clause 7i71 by striking and   
for discharges occurring during the     
portion of fiscal year #bjbe beginning  
on ,april #a1 #bjbe1 and ending on      
,september #cj1 #bjbe1 and in fiscal    
year #bjbf and subsequent fiscal years2 
7#b7 in subparagraph 7,c77i7-- 7,a7 in  
the matter preceding subclause 7,i71 by 
striking fiscal years #bjaa through     
#bjbd and the portion of fiscal year    
#bjbe beginning on ,october #a1 #bjbd1  
and ending on ,march #ca1 #bjbe and     
inserting fiscal year #bjaa and         
subsequent fiscal years2  7,b7 in       
subclause 7,,iii7-- 7i7 by striking each
 of fiscal years #bjai through #bjbd and
 the portion of fiscal year #bjbe       
beginning on ,october #a1 #bjbd1 and    
ending on ,march #ca1 #bjbe and         
inserting fiscal year #bjai and each    
subsequent fiscal year2 and  7ii7 by    

striking 2 and at the end and inserting 
a period2 and  7,c7 by striking         
subclause 7,,iv72 and  7#c7 in          
subparagraph 7,d7-- 7,a7 by amending the
 subparagraph heading to reach as       
follows3 ,applicable percentage increase
 beginning with fiscal year #bjaa4--2   
7,b7 in the matter preceding clause 7i71
 by striking fiscal years #bjaa through 
#bjbd or during the portion of fiscal   
year #bjbe beginning on ,october #a1    
#bjbd1 and ending on ,march #ca1 #bjbe  
and inserting fiscal year #bjaa and     
subsequent fiscal years2 and  7,c7 in   
clause 7ii71 by striking each of fiscal 
years #bjai through #bjbd and the       
portion of fiscal year #bjbe beginning  
on ,october #a1 #bjbd1 and ending on    
,march #ca1 #bjbe and inserting fiscal  
year #bjai and each subsequent fiscal   
year4