Healthcare Enhancement for Americas Rural Towns Act or the HEART Act
This bill permanently extends and otherwise revises the Medicare-Dependent Hospital program, which provides additional payments to certain small rural hospitals that have a high proportion of Medicare patients. The bill also temporarily extends certain increased payment adjustments for low-volume hospitals under Medicare's inpatient prospective payment system.
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.
                                 <all>
HEART Act
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.
HEART Act
Healthcare Enhancement for Americas Rural Towns Act
Rep. Arrington, Jodey C.