[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9034 Introduced in House (IH)]
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117th CONGRESS
2d Session
H. R. 9034
To amend title XVIII of the Social Security Act to provide for reform
to and a permanent extension of the Medicare-dependent hospital
program, and for other purposes.
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IN THE HOUSE OF REPRESENTATIVES
September 29, 2022
Mr. Arrington introduced the following bill; which was referred to the
Committee on Ways and Means
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A BILL
To amend title XVIII of the Social Security Act to provide for reform
to and a permanent extension of the Medicare-dependent hospital
program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Healthcare Enhancement for Americas
Rural Towns Act'' or the ``HEART Act''.
SEC. 2. REFORM AND PERMANENT EXTENSION OF THE MEDICARE-DEPENDENT
HOSPITAL (MDH) PROGRAM.
(a) Extension of Payment Methodology.--Section 1886(d)(5)(G) of the
Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking ``, and before October 1,
2022'' and inserting ``, and before October 1, 2023'';
(2) in clause (i), by adding at the end the following;
``For fiscal year 2024 and each subsequent fiscal year, in the
case of such a subsection (d) hospital, payment under paragraph
(1)(A) shall be equal to the sum of the amount determined under
paragraph (1)(A)(iii) and the amount determined by the increase
factor determined under clause (v) for such hospital and cost
reporting period.'';
(3) in clause (ii)(II), by striking ``, and before October
1, 2022'' and inserting ``, and before October 1, 2023''; and
(4) by adding at the end the following new clauses:
``(v)(I) Subject to subclause (II), for purposes of
clause (i), for fiscal year 2024 and each subsequent
fiscal year with respect to a subsection (d) hospital
which is a medicare-dependent, small rural hospital,
the Secretary shall determine an increase factor to
apply to such hospital with respect to discharges
occurring during such fiscal year. When determining
such increase factor, the Secretary may take into
account a methodology that results in a similar amount
of reimbursement to such hospital for such fiscal year
as such amount that would have been determined if the
first sentence of clause (i) applied with respect to
such fiscal year.
``(II) The aggregate amounts determined for all
subsection (d) hospitals which are medicare-dependent,
small rural hospitals by application of the increase
factors determined under this clause for such hospitals
shall not exceed a total of--
``(aa) for fiscal year 2024, $100,000,000;
and
``(bb) for each subsequent fiscal year, the
amount specified in this clause for the
previous fiscal year increased by the market
basket percentage increase (as defined in
subsection (b)(3)(B)(iii)) as determined
prospectively by the Secretary for such
subsequent fiscal year.''.
(b) Conforming Amendments.--
(1) Extension of target amount.--Section 1886(b)(3)(D) of
the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is
amended--
(A) in the matter preceding clause (i), by striking
``, and before October 1, 2022'';
(B) in clause (iii), by striking at the end
``and'';
(C) in clause (iv)--
(i) by striking ``through fiscal year
2022'' and inserting ``through fiscal year
2023''; and
(ii) by striking the period at the end and
inserting ``, and''; and
(D) by adding at the end the following new clause:
``(v) with respect to discharges occurring during
fiscal year 2024 or a subsequent fiscal year, the
target amount for the preceding year increased by the
applicable percentage increase under subparagraph
(B)(iv) and adjusted as determined necessary by the
Secretary to take into account the application of
subsection (d)(5)(G)(vi) for such fiscal year.''.
(2) Permitting hospitals to decline reclassification.--
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of
1993 (42 U.S.C. 1395ww note) is amended by striking ``through
fiscal year 2022'' and inserting ``or a subsequent fiscal
year''.
SEC. 3. TEMPORARY EXTENSION OF THE MEDICARE LOW-VOLUME ADJUSTMENT
PROGRAM.
Section 1886(d)(12) of the Social Security Act (42 U.S.C.
1395ww(d)(12)) is amended--
(1) in subparagraph (B), in the matter preceding clause
(i), by striking ``fiscal year 2023'' and inserting ``fiscal
year 2028'';
(2) in subparagraph (C)(i)--
(A) by striking ``fiscal years 2011 through 2022''
each place it appears and inserting ``fiscal years 2011
through 2027''; and
(B) by striking ``or portion of fiscal year''; and
(3) in subparagraph (D)--
(A) in the heading, by striking ``Temporary
applicable percentage increase'' and inserting
``Applicable percentage increase beginning with fiscal
year 2011'';
(B) in the matter preceding clause (i), by striking
``fiscal years 2011 through 2022,'' and inserting
``fiscal years 2011 through 2027''; and
(C) in clause (ii), by striking ``2022'' and
inserting ``2027''; and
(D) by striking ``or the portion of fiscal year''
each place it appears.
SEC. 4. BUDGET NEUTRAL PAY-FOR.
For fiscal year 2023 and each subsequent fiscal year, the Secretary
of Health and Human Services shall adjust payments under section
1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) in a manner
such that the estimated aggregate amount of expenditures under such
section for such fiscal year with application of the amendments made by
sections 2 and 3 of this Act is equal to the estimated aggregate amount
of expenditures under such section for such fiscal year without
application of such amendments.
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