S. 4233

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 4233 Introduced in Senate (IS)]

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119th CONGRESS
2d Session
S. 4233

To amend title XVIII of the Social Security Act to codify the Medicare 
low-wage index hospital policy.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

March 26, 2026

Mr. Warner (for himself, Mrs. Blackburn, Mrs. Hyde-Smith, and Mr. 
Tuberville) introduced the following bill; which was read twice and 
referred to the Committee on Finance

_______________________________________________________________________

A BILL

To amend title XVIII of the Social Security Act to codify the Medicare 
low-wage index hospital policy.

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 Struggling Hospitals Act''.

SEC. 2. CODIFICATION OF THE MEDICARE LOW-WAGE INDEX HOSPITAL POLICY.

Section 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 
1395ww(d)(3)(E)) is amended--
(1) in clause (i), in the first sentence, by striking ``or 
(iv)'' and inserting ``, (iv), or (v)''; and
(2) by adding at the end the following new clause:
``(v) Area wage index adjustment for low-
wage hospitals.--
``(I) In general.--For discharges 
occurring on or after October 1, 2019, 
the area wage index applicable under 
this subparagraph for a fiscal year to 
a hospital with an area wage index 
(determined without regard to this 
clause) below the 25th percentile area 
wage index shall be increased by \1/2\ 
of the difference between the otherwise 
applicable final area wage index for 
such fiscal year for such hospital and 
the 25th percentile area wage index for 
such fiscal year across all hospitals.
``(II) Budget neutrality.-- 
Pursuant to the fourth sentence of 
clause (i), this clause shall be 
applied in a budget neutral manner. Any 
adjustments made for the purposes of 
such application of budget neutrality 
may not--
``(aa) decrease the area 
wage index applicable under 
this subparagraph to a hospital 
with an area wage index 
(determined without regard to 
this clause) below the 75th 
percentile area wage index for 
the fiscal year; or
``(bb) result in an area 
wage index applicable under 
this subparagraph to a hospital 
for such fiscal year that is 
less than 95 percent of the 
area wage index applicable 
under this subparagraph to such 
hospital for the preceding 
fiscal year.''.
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