S335-119

1. Short title This Act may be cited as the Rural Hospital Support Act.

2. Rebasing of the calculation of payments for sole community hospitals Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)) is amended by adding at the end the following new subparagraph: For cost reporting periods beginning on or after October 1, 2025, in the case of a sole community hospital there shall be substituted for the amount otherwise determined under subsection (d)(5)(D)(i) of this section, if such substitution results in a greater amount of payment under this section for the hospital, the subparagraph (M) rebased target amount. For purposes of this subparagraph, the term subparagraph (M) rebased target amount has the meaning given the term target amount in subparagraph (C), except that— there shall be substituted for the base cost reporting period the 12-month cost reporting period beginning during fiscal year 2016; any reference in subparagraph (C)(i) 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 1, 2025; and the applicable percentage increase shall only be applied under subparagraph (C)(iv) for discharges occurring on or after October 1, 2025. Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)) is amended— in subparagraph (C), in the matter preceding clause (i), by striking subparagraphs (I) and (L) and inserting subparagraphs (I), (L), and (M); and in subparagraph (I)(i), in the matter preceding subclause (I), by striking subparagraph (L) and inserting subparagraphs (L) and (M). (M)(i)For cost reporting periods beginning on or after October 1, 2025, in the case of a sole community hospital there shall be substituted for the amount otherwise determined under subsection (d)(5)(D)(i) of this section, if such substitution results in a greater amount of payment under this section for the hospital, the subparagraph (M) rebased target amount.(ii)For purposes of this subparagraph, the term subparagraph (M) rebased target amount has the meaning given the term target amount in subparagraph (C), except that—(I)there shall be substituted for the base cost reporting period the 12-month cost reporting period beginning during fiscal year 2016;(II)any reference in subparagraph (C)(i) 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 1, 2025; and(III)the applicable percentage increase shall only be applied under subparagraph (C)(iv) for discharges occurring on or after October 1, 2025..

3. Rebasing of the calculation of payments for Medicare-dependent hospitals Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)), as amended by section 2, is amended— in subparagraph (D), by striking subparagraph (K) and inserting subparagraphs (K) and (N); and by adding at the end the following new subparagraph: With respect to discharges occurring on or after October 1, 2025, in the case of a medicare-dependent, small rural hospital, for purposes of applying subparagraph (D)— there shall be substituted for the base cost reporting period described in subparagraph (D)(i) the 12-month cost reporting period beginning during fiscal year 2016; and 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 1, 2025. This subparagraph shall only apply to a hospital if the substitution described in clause (i)(I) results in an increase in the target amount under subparagraph (D) for the hospital. (N)(i)With respect to discharges occurring on or after October 1, 2025, in the case of a medicare-dependent, small rural hospital, for purposes of applying subparagraph (D)—(I)there shall be substituted for the base cost reporting period described in subparagraph (D)(i) the 12-month cost reporting period beginning during fiscal year 2016; and(II)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 1, 2025.(ii)This subparagraph shall only apply to a hospital if the substitution described in clause (i)(I) results in an increase in the target amount under subparagraph (D) for the hospital..

4. Prohibition of adjustments to classifications and weighting factors relating to the calculation of payments for sole community hospitals and Medicare-dependent hospitals Section 1886(d)(4)(C) of the Social Security Act (42 U.S.C. 1395ww(d)(4)(C))— in clause (i), by striking The Secretary and inserting Subject to clause (v), the Secretary; and by adding at the end the following new clause: For discharges using the rebased target amounts described in subparagraph (M) or (N) of subsection (b)(3), the Secretary may not adjust such amounts for adjustments required by clause (iii) prior to October 1, 2015. (v)For discharges using the rebased target amounts described in subparagraph (M) or (N) of subsection (b)(3), the Secretary may not adjust such amounts for adjustments required by clause (iii) prior to October 1, 2015..

5. Extension of the medicare-dependent hospital (MDH) program Section 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended— in clause (i), by striking , and before April 1, 2025; and in clause (ii)(II), by striking , and before April 1, 2025. Section 1886(b)(3)(D) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is amended— in the matter preceding clause (i), by striking , and before April 1, 2025; and in clause (iv), by striking through fiscal year 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting or a subsequent fiscal year. Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 (42 U.S.C. 1395ww note) is amended by striking fiscal year 2000 through fiscal year 2024, or the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting a subsequent fiscal year.

6. Extension of the increased payments under the Medicare low-volume hospital program Section 1886(d)(12) of the Social Security Act (42 U.S.C. 1395(d)(12)) is amended— in subparagraph (B)— in the subparagraph heading, by inserting for fiscal years 2005 through 2010 after increase; and in the matter preceding clause (i), by striking and for discharges occurring during the portion of fiscal year 2025 beginning on April 1, 2025, and ending on September 30, 2025, and in fiscal year 2026 and subsequent fiscal years; in subparagraph (C)(i)— in the matter preceding subclause (I), by striking fiscal years 2011 through 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting fiscal year 2011 and subsequent fiscal years; in subclause (III)— by striking each of fiscal years 2019 through 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting fiscal year 2019 and each subsequent fiscal year; and by striking ; and at the end and inserting a period; and by striking subclause (IV); and in subparagraph (D)— by amending the subparagraph heading to reach as follows: Applicable percentage increase beginning with fiscal year 2011.—; in the matter preceding clause (i), by striking fiscal years 2011 through 2024 or during the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting fiscal year 2011 and subsequent fiscal years; and in clause (ii), by striking each of fiscal years 2019 through 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on March 31, 2025 and inserting fiscal year 2019 and each subsequent fiscal year.