,,ii  #aai? ,,congress  #a/ ,session    
,s4 #cce  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,janu>y #cj1 #bjbe,mr4 
,grassley 7= himself1 ,mr4 ,wel*1 ,mrs4 
,capito1 ,mr4 ,ka9e1 ,mr4 ,wick]1 ,mrs4 
,%ahe51 ,mr4 ,moran1 ,ms4 ,smi?1 ,mrs4  
,hyde-,smi?1 ,mr4 ,fett]man1 ,mr4       
,boozman1 & ,mr4 ,kelly7 introduc$ !    
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,f9ance  ,a ,,bill   
,to am5d title ,,xviii ( ! ,social      
,security ,act to rebase ! calculation (
 paym5ts = sole community hospitals &   
,m$ic>e-dep5d5t hospitals1 & = o!r      
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,rural ,hospital ,support  
,act4  #b4 ,rebas+ ( ! calculation (    
paym5ts = sole community hospitals  7a7 
,rebas+ p]mitt$ ,section #ahhf7;b77#c7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acieww7b77#c77 is am5d$ by add+ at !  
end ! foll[+ new subp>agraph3  7,m7 7i7 
,= co/ report+ p]iods beg9n+ on or aft] 
,octob] #a1 #bjbe1 9 ! case ( a sole    
community hospital !re %all be sub/itut$

 = ! am\nt o!rwise det]m9$ "u subsection
 7d77#e77;,d77i7 ( ?is section1 if su*  
sub/itution results 9 a great] am\nt (  
paym5t "u ?is section = ! hospital1 !   
subp>agraph 7,m7 rebas$ t>get am\nt4    
7ii7 ,= purposes ( ?is subp>agraph1 !   
t]m subp>agraph 7,m7 rebas$ t>get am\nt 
has ! mean+ giv5 ! t]m t>get am\nt 9    
subp>agraph 7,c71 except t-- 7,i7 !re   
%all be sub/itut$ = ! base co/ report+  
p]iod ! #ab-mon? co/ report+ p]iod      
beg9n+ dur+ fiscal ye> #bjaf2  7,,ii7   
any ref]5ce 9 subp>agraph 7,c77i7 to !  
fir/ co/ report+ p]iod describ$ 9 su*   
subp>agraph is deem$ a ref]5ce to ! fir/
 co/ report+ p]iod beg9n+ on or aft]    
,octob] #a1 #bjbe2 &  7,,iii7 !         
applicable p]c5tage increase %all only  
be appli$ "u subp>agraph 7,c77iv7 =     
dis*>ges occurr+ on or aft] ,octob] #a1 
#bjbe4  4  7b7 ,con=m+ am5dm5ts ,section
 #ahhf7;b77#c7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acieww7b77#c77 is  
am5d$-- 7#a7 9 subp>agraph 7,c71 9 !    
matt] prec$+ clause 7i71 by /rik+       

subp>agraphs 7,i7 & 7,l7 & ins]t+       
subp>agraphs 7,i71 7,l71 & 7,m72 &  7#b7
 9 subp>agraph 7,i77i71 9 ! matt] prec$+
 subclause 7,i71 by /rik+ subp>agraph   
7,l7 & ins]t+ subp>agraphs 7,l7 & 7,m74 
#c4 ,rebas+ ( ! calculation ( paym5ts = 
,m$ic>e-dep5d5t hospitals ,section      
#ahhf7;b77#c7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acieww7b77#c771 z am5d$
 by section #b1 is am5d$-- 7#a7 9       
subp>agraph 7,d71 by /rik+ subp>agraph  
7,k7 & ins]t+ subp>agraphs 7,k7 & 7,n72 
&  7#b7 by add+ at ! end ! foll[+ new   
subp>agraph3  7,n7 7i7 ,) respect to    
dis*>ges occurr+ on or aft] ,octob] #a1 
#bjbe1 9 ! case ( a m$ic>e-dep5d5t1     
small rural hospital1 = purposes (      
apply+ subp>agraph 7,d7-- 7,i7 !re %all 
be sub/itut$ = ! base co/ report+ p]iod 
describ$ 9 subp>agraph 7,d77i7 !        
#ab-mon? co/ report+ p]iod beg9n+ dur+  
fiscal ye> #bjaf2 &  7,,ii7 any ref]5ce 
9 su* subp>agraph to ! fir/ co/ report+ 
p]iod describ$ 9 su* subp>agraph is     
deem$ a ref]5ce to ! fir/ co/ report+   

p]iod beg9n+ on or aft] ,octob] #a1     
#bjbe4  7ii7 ,?is subp>agraph %all only 
apply to a hospital if ! sub/itution    
describ$ 9 clause 7i77,i7 results 9 an  
increase 9 ! t>get am\nt "u subp>agraph 
7,d7 = ! hospital4  4  #d4 ,prohibition 
( adju/m5ts to classifications & weight+
 factors relat+ to ! calculation (      
paym5ts = sole community hospitals &    
,m$ic>e-dep5d5t hospitals ,section      
#ahhf7;d77#d77;,c7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acieww7d77#d77;,c77-- 7#a7 9 clause    
7i71 by /rik+ ,! ,secret>y & ins]t+     
,subject to clause 7v71 ! ,secret>y2 &  
7#b7 by add+ at ! end ! foll[+ new      
clause3  7v7 ,= dis*>ges us+ ! rebas$   
t>get am\nts describ$ 9 subp>agraph 7,m7
 or 7,n7 ( subsection 7b77#c71 !        
,secret>y may n adju/ su* am\nts =      
adju/m5ts requir$ by clause 7iii7 prior 
to ,octob] #a1 #bjae4  4  #e4 ,ext5sion 
( ! m$ic>e-dep5d5t hospital 7,,mdh7     
program  7a7 ,ext5sion ( paym5t         
me?odology ,section #ahhf7;d77#e77;,g7 (

 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acieww7d77#e77;,g77 is am5d$-- 7#a7 9 
clause 7i71 by /rik+ 1 & be=e ,april #a1
 #bjbe2 &  7#b7 9 clause 7ii77,,ii71 by 
/rik+ 1 & be=e ,april #a1 #bjbe4  7b7   
,con=m+ am5dm5ts  7#a7 ,ext5sion ( t>get
 am\nt ,section #ahhf7;b77#c77;,d7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7b77#c77;,d77 is am5d$-- 7,a7 9 !
 matt] prec$+ clause 7i71 by /rik+ 1 &  
be=e ,april #a1 #bjbe2 &  7,b7 9 clause 
7iv71 by /rik+ ?r\gh fiscal ye> #bjbd & 
! portion ( fiscal ye> #bjbe beg9n+ on  
,octob] #a1 #bjbd1 & end+ on ,m>* #ca1  
#bjbe & ins]t+ or a subsequ5t fiscal    
ye>4  7#b7 ,p]mitt+ hospitals to decl9e 
reclassification ,section #aceja7;e77#b7
 ( ! ,omnibus ,budget ,reconciliation   
,act ( #aiic 7#db ,u4,s4,c4 #acieww     
note7 is am5d$ by /rik+ fiscal ye> #bjjj
 ?r\gh fiscal ye> #bjbd1 or ! portion ( 
fiscal ye> #bjbe beg9n+ on ,octob] #a1  
#bjbd1 & end+ on ,m>* #ca1 #bjbe &      
ins]t+ a subsequ5t fiscal ye>4  #f4     
,ext5sion ( ! increas$ paym5ts "u !     

,m$ic>e l[-volume hospital program      
,section #ahhf7;d77#ab7 ( ! ,social     
,security ,act 7#db ,u4,s4,c4           
#acie7;d77#ab77 is am5d$-- 7#a7 9       
subp>agraph 7,b7-- 7,a7 9 ! subp>agraph 
head+1 by ins]t+ = fiscal ye>s #bjje    
?r\gh #bjaj aft] increase2 &  7,b7 9 !  
matt] prec$+ clause 7i71 by /rik+ & =   
dis*>ges occurr+ dur+ ! portion ( fiscal
 ye> #bjbe beg9n+ on ,april #a1 #bjbe1 &
 end+ on ,septemb] #cj1 #bjbe1 & 9      
fiscal ye> #bjbf & subsequ5t fiscal     
ye>s2  7#b7 9 subp>agraph 7,c77i7-- 7,a7
 9 ! matt] prec$+ subclause 7,i71 by    
/rik+ fiscal ye>s #bjaa ?r\gh #bjbd & ! 
portion ( fiscal ye> #bjbe beg9n+ on    
,octob] #a1 #bjbd1 & end+ on ,m>* #ca1  
#bjbe & ins]t+ fiscal ye> #bjaa &       
subsequ5t fiscal ye>s2  7,b7 9 subclause
 7,,iii7-- 7i7 by /rik+ ea* ( fiscal    
ye>s #bjai ?r\gh #bjbd & ! portion (    
fiscal ye> #bjbe beg9n+ on ,octob] #a1  
#bjbd1 & end+ on ,m>* #ca1 #bjbe &      
ins]t+ fiscal ye> #bjai & ea* subsequ5t 
fiscal ye>2 &  7ii7 by /rik+ 2 & at !   

end & ins]t+ a p]iod2 &  7,c7 by /rik+  
subclause 7,,iv72 &  7#c7 9 subp>agraph 
7,d7-- 7,a7 by am5d+ ! subp>agraph head+
 to rea* z foll[s3 ,applicable p]c5tage 
increase beg9n+ ) fiscal ye> #bjaa4--2  
7,b7 9 ! matt] prec$+ clause 7i71 by    
/rik+ fiscal ye>s #bjaa ?r\gh #bjbd or  
dur+ ! portion ( fiscal ye> #bjbe beg9n+
 on ,octob] #a1 #bjbd1 & end+ on ,m>*   
#ca1 #bjbe & ins]t+ fiscal ye> #bjaa &  
subsequ5t fiscal ye>s2 &  7,c7 9 clause 
7ii71 by /rik+ ea* ( fiscal ye>s #bjai  
?r\gh #bjbd & ! portion ( fiscal ye>    
#bjbe beg9n+ on ,octob] #a1 #bjbd1 &    
end+ on ,m>* #ca1 #bjbe & ins]t+ fiscal 
ye> #bjai & ea* subsequ5t fiscal ye>4