[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3635 Introduced in House (IH)]

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118th CONGRESS
  1st Session
                                H. R. 3635

 To amend title XVIII of the Social Security Act to ensure fairness in 
 Medicare hospital payments by establishing a floor for the area wage 
            index applied with respect to certain hospitals.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 24, 2023

Mr. Ferguson (for himself, Ms. Sewell, Mrs. Harshbarger, Mr. Mann, Mr. 
  Allen, Mr. Carter of Georgia, Mr. Thompson of Mississippi, and Mr. 
   Neguse) introduced the following bill; which was referred to the 
Committee on Ways and Means, and in addition to the Committee on Energy 
    and Commerce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to ensure fairness in 
 Medicare hospital payments by establishing a floor for the area wage 
            index applied with respect to certain hospitals.

    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 ``Save Rural Hospitals Act of 2023''.

SEC. 2. ENSURING FAIRNESS IN MEDICARE HOSPITAL PAYMENTS IN A BUDGET 
              NEUTRAL MANNER.

    (a) Hospital Inpatient Services.--Section 1886(d)(3)(E) of the 
Social Security Act (42 U.S.C. 1395www(d)(3)(E)) is amended--
            (1) in clause (i), by striking ``or (iv)'' and inserting 
        ``(iv), or (v)''; and
            (2) by adding at the end the following new clause:
                    ``(v) Floor on area wage index for hospitals in 
                certain other areas.--
                            ``(I) In general.--For discharges occurring 
                        on or after October 1, 2023, the area wage 
                        index applicable under this subparagraph to any 
                        hospital which is not located in a frontier 
                        State (as defined in clause (iii)(II)) may not 
                        be less than 0.85.
                            ``(II) Ensuring budget neutrality.--In 
                        order to ensure that the aggregate payments 
                        made under this subsection for a fiscal year 
                        (beginning with fiscal year 2024) are not 
                        greater than the aggregate payments that would 
                        have been made under this subsection for such 
                        fiscal year without the application of 
                        subclause (I), as estimated by the Secretary, 
                        the Secretary shall establish pursuant to 
                        rulemaking a maximum area wage index to apply 
                        under this subparagraph to any hospital which 
                        is not located in a frontier State (as defined 
                        in clause (iii)(II)).
                            ``(III) No impact for hospitals with an 
                        area wage index between the floor and the 
                        maximum index.--Subclauses (I) and (II) shall 
                        have no effect on the area wage index 
                        applicable in a fiscal year to a hospital with 
                        an area wage index that is greater than the 
                        floor under subclause (I) but less than the 
                        maximum area wage index established under 
                        subclause (II) for the fiscal year.''.
    (b) Hospital Outpatient Department Services.--Section 1833(t) of 
the Social Security Act (42 U.S.C. 1395l(t)), is amended--
            (1) in paragraph (2)(D), by striking ``paragraph (19), the 
        Secretary'' and inserting ``paragraphs (19) and (23), the 
        Secretary''; and
            (2) by adding at the end the following new paragraph:
            ``(23) Floor on area wage adjustment factor for hospital 
        outpatient department services in areas other than in frontier 
        states.--
                    ``(A) In general.--With respect to covered OPD 
                services furnished on or after January 1, 2024, the 
                area wage adjustment factor applicable under the 
                payment system established under this subsection to any 
                hospital outpatient department which is not located in 
                a frontier State (as defined in section 
                1886(d)(3)(E)(iii)(II)) may not be less than 0.85.
                    ``(B) Ensuring budget neutrality.--In order to 
                ensure that the aggregate payments made under this 
                subsection for a year (beginning with 2024) are not 
                greater than the aggregate payments that would have 
                been made under this subsection for such year without 
                the application of subparagraph (A), as estimated by 
                the Secretary, the Secretary shall establish pursuant 
                to rulemaking a maximum area wage adjustment factor to 
                apply under the payment system established under this 
                subsection to any hospital outpatient department which 
                is not located in a frontier State (as defined in 
                clause (iii)(II)).
                    ``(C) No impact for hospitals with an area wage 
                adjustment factor between the floor and the maximum 
                factor.--Subparagraphs (A) and (B) shall have no effect 
                on the area wage adjustment factor applicable in a year 
                to a hospital with an area wage adjustment factor that 
                is greater than the floor under subparagraph (A) but 
                less than the maximum area wage adjustment factor 
                established under subparagraph (B) for the year.''.
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