Save Rural Hospitals Act of 2021
This bill establishes an area wage adjustment floor for Medicare hospital payments in states that are not frontier states and excludes such adjustments from certain budget neutrality rules.
To amend the title XVIII of the Social Security Act to preserve access 
    to rural health care by ensuring fairness in Medicare hospital 
                               payments.

    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 2021''.

SEC. 2. ENSURING FAIRNESS IN MEDICARE HOSPITAL PAYMENTS.

    (a) Hospital Inpatient Services.--
            (1) In general.--Section 1886(d)(3)(E) of the Social 
        Security Act (42 U.S.C. 1395www(d)(3)(E)) is amended--
                    (A) in clause (i), in the first sentence, by 
                striking ``or (iii)'' and inserting ``, (iii), or 
                (iv)''; and
                    (B) by adding at the end the following new clause:
                            ``(iv) Area wage index floor.--
                                    ``(I) In general.--For discharges 
                                occurring on or after October 1, 2021, 
                                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) Waiving budget neutrality.--
                                Pursuant to the fifth sentence of 
                                clause (i), this clause shall not be 
                                applied in a budget neutral manner.''.
            (2) Waiving budget neutrality.--
                    (A) Technical amendatory correction.--Section 
                10324(a)(2) of Public Law 111-148 is amended by 
                striking ``third sentence'' and inserting ``fifth 
                sentence''.
                    (B) Waiver.--Section 1886(d)(3)(E)(i) of the Social 
                Security Act (42 U.S.C. 1395ww(d)(3)(E)(i)) is amended, 
                in the fifth sentence--
                            (i) by striking ``and the amendments'' and 
                        inserting ``, the amendments''; and
                            (ii) by inserting ``, and the amendments 
                        made by section 2(a)(1) of the Save Rural 
                        Hospitals Act of 2021'' after ``Care Act''.
    (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 ``(19), the 
        Secretary''and inserting ``(19) and paragraph (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.--With respect to covered OPD 
        services furnished on or after January 1, 2022, 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. 
        The preceding sentence shall not be implemented in a budget 
        neutral manner.''.
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Save Rural Hospitals Act of 2021
To amend the title XVIII of the Social Security Act to preserve access to rural health care by ensuring fairness in Medicare hospital payments.
Save Rural Hospitals Act of 2021
Rep. Sewell, Terri A.