H.R. 1868House117th Congress (2021-2023)Enacted

To prevent across-the-board direct spending cuts, and for other purposes.

Introduced March 12, 2021

AI-Generated Summary

Updated February 8, 2026 at 12:20 AM UTC

The bill aims to stop broad direct spending cuts by extending the temporary suspension of Medicare sequestration and fixing technical issues in health‑care payment rules. It pushes the end date for the sequestration pause to Dec. 31, 2021, and adjusts related budget offset formulas. It also updates how rural health clinics receive per‑visit payments and clarifies eligibility, and it preserves a grandfathered rule for extra payments to certain high‑disproportionate‑share hospitals.

Key Provisions

  • Extends the Medicare sequestration suspension from March 31, 2021 to Dec 31, 2021, treating the change as if part of the original CARES Act.
  • Modifies offset calculations in the Balanced Budget and Emergency Deficit Control Act, changing the timing and percentage reductions applied to spending cuts.
  • Revises rural health clinic payment rules, setting payment amounts based on 2020 or 2021 rates and defining eligibility criteria for clinics tied to hospital size and enrollment status.
  • Adds a clarification that a previously grandfathered transition rule continues to apply when determining payment adjustments for certain high‑disproportionate‑share hospitals.

Legislative Activity

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26 earlier actions
Became Law Latest Action

Became Public Law No: 117-7.

April 14, 2021

View full timeline
HouseIntro Referral

Introduced in House

March 12, 2021

HouseIntro Referral

Referred to the Committee on the Budget, and in addition to the Committees on Energy and Commerce, and Ways and Means, 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.

March 12, 2021

HouseCommittee

Referred to the Subcommittee on Health.

March 16, 2021

HouseFloor

Rules Committee Resolution H. Res. 233 Reported to House. Rule provides for consideration of H.R. 1620, H.R. 6, H.R. 1603, H.R. 1868 and H.J. Res. 17. The resolution provides for one hour of general debate on H.R. 1620, H.R. 6, H.R. 1603, H.R. 1868, and H.J.Res. 17. The resolution provides that H.Res. 232 is hereby adopted.

March 16, 2021 • 3:49 PM

HouseFloor

Considered under the provisions of rule H. Res. 233. (consideration: CR H1589-1601)

March 19, 2021 • 9:17 AM

HouseFloor

Rule provides for consideration of H.R. 1620, H.R. 6, H.R. 1603, H.R. 1868 and H.J. Res. 17. The resolution provides for one hour of general debate on H.R. 1620, H.R. 6, H.R. 1603, H.R. 1868, and H.J.Res. 17. The resolution provides that H.Res. 232 is hereby adopted.

March 19, 2021 • 9:17 AM

HouseFloor

DEBATE - The House proceeded with one hour of debate on H.R. 1868.

March 19, 2021 • 9:17 AM

HouseFloor

The previous question was ordered pursuant to the rule.

March 19, 2021 • 9:17 AM

HouseFloor

Mr. Smith (MO) moved to recommit to the Committee on the Budget. (text: CR H1598-1600)

March 19, 2021 • 10:27 AM

HouseFloor

On motion to recommit Failed by the Yeas and Nays: 202 - 216 (Roll no. 95).

March 19, 2021 • 11:17 AM

HouseFloor

Passed/agreed to in House: On passage Passed by the Yeas and Nays: 246 - 175 (Roll no. 96).(text: CR H1589-1590)

March 19, 2021 • 12:03 PM

HouseFloor

On passage Passed by the Yeas and Nays: 246 - 175 (Roll no. 96). (text: CR H1589-1590)

March 19, 2021 • 12:03 PM

HouseFloor

Motion to reconsider laid on the table Agreed to without objection.

March 19, 2021 • 12:03 PM

SenateIntro Referral

Received in the Senate.

March 22, 2021

SenateCalendars

Read the first time. Placed on Senate Legislative Calendar under Read the First Time.

March 24, 2021

SenateCalendars

Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 31.

March 25, 2021

SenateFloor

Measure laid before Senate by unanimous consent. (consideration: CR S1800-1804)

March 25, 2021

SenateFloor

Passed Senate, having achieved 60 votes in the affirmative, with an amendment by Yea-Nay Vote. 90 - 2. Record Vote Number: 142. (text of amendment in the nature of a substitute: CR S1801-1802)

March 25, 2021

SenateFloor

Message on Senate action sent to the House.

March 26, 2021

HouseResolving Differences

Mr. Yarmuth moved that the House suspend the rules and concur in the Senate amendment. (consideration: CR H1729-1733)

April 13, 2021 • 7:04 PM

HouseFloor

DEBATE - The House proceeded with forty minutes of debate on the motion to suspend the rules and concur in the Senate amendment to H.R. 1868.

April 13, 2021 • 7:05 PM

HouseNot Used

Resolving differences -- House actions: On motion that the House suspend the rules and agree to the Senate amendment Agreed to by the Yeas and Nays: (2/3 required): 384 - 38 (Roll no. 98).(text: CR H1729-1730)

April 13, 2021

HouseResolving Differences

On motion that the House suspend the rules and agree to the Senate amendment Agreed to by the Yeas and Nays: (2/3 required): 384 - 38 (Roll no. 98). (text: CR H1729-1730)

April 13, 2021 • 7:49 PM

HouseResolving Differences

Motion to reconsider laid on the table Agreed to without objection.

April 13, 2021 • 7:50 PM

President

Presented to President.

April 14, 2021

Became Law

Signed by President.

April 14, 2021

Became Law

Became Public Law No: 117-7.

April 14, 2021

Floor Debate

20 members

What members said about H.R. 1868 on the floor

12 Republicans8 Democrats
Norma J. Torres
Rep. Norma J. TorresD-CA-35 · Mar 16, 2021

Madam Speaker, by direction of the Committee on Rules, I call up House Resolution 233 and ask for its immediate consideration. Madam Speaker, for the purpose of debate only, I yield the customary 30…

Sheila Jackson Lee
Rep. Sheila Jackson LeeD-TX-18 · Mar 19, 2021

Mr. Speaker, I thank our distinguished chairman for yielding. Mr. Speaker, whenever you hear the words of Speaker Pelosi, you know that the gentlewoman is leading us on the fight to protect our…

John A. Yarmuth
Rep. John A. YarmuthD-KY-3 · Mar 19, 2021

Mr. Speaker, pursuant to House Resolution 233, I call up the bill (H.R. 1868) to prevent across-the-board direct spending cuts, and for other purposes, and ask for its immediate consideration. Mr.…

Sheila Jackson Lee
Rep. Sheila Jackson LeeD-TX-18 · Apr 13, 2021

Madam Speaker, I thank the chairman very much for yielding, and I rise in support of the Senate amendment to H.R. 1868, an act to prevent direct across-the-board spending cuts, which would include…

Christopher H. Smith
Rep. Christopher H. SmithR-NJ-4 · Mar 16, 2021

Madam Speaker, the most recent Marist poll found that 7 in 10 Americans, including nearly half who identify as pro-choice, want significant restrictions on abortion. Yet, the ERA as written will be…

Show 8 more
Jason Smith
Rep. Jason SmithR-MO-8 · Mar 19, 2021

Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, this week, the President has been traveling across the country telling Americans how appreciative they should be that Washington…

Michelle Fischbach
Rep. Michelle FischbachR-MN-7 · Mar 16, 2021

Madam Speaker, I thank my colleague from the Rules Committee, the Representative from California, for yielding me the customary 30 minutes, and I yield myself such time as I may consume. Madam…

Sheila Jackson Lee
Rep. Sheila Jackson LeeD-TX-18 · Mar 16, 2021

Madam Speaker, I thank the manager of the bill for her leadership and the rule. Let me, first of all, rise in support of H.R. 6 because there are millions of young people waiting for this relief in…

Jeanne Shaheen
Sen. Jeanne ShaheenD-NH · Mar 25, 2021

If we are quiet, we will be quick. I urge my colleagues on both sides of the aisle to come together and help ensure that our Nation's hospitals, nursing homes, physicians, and other healthcare…

Bob Good
Rep. Bob GoodR-VA-5 · Mar 19, 2021

Mr. Speaker, I thank the distinguished ranking member from Missouri for yielding this time. Mr. Speaker, I rise today in strong opposition to H.R. 1868, the Democrats' attempt to put a Band-Aid on…

Tom McClintock
Rep. Tom McClintockR-CA-4 · Mar 19, 2021

Mr. Speaker, this bill is just the first taste of a bitter brew concocted by those who pushed through $1.9 trillion of pure deficit spending last week. Now, this measure involves our paygo rules. You…

Jodey C. Arrington
Rep. Jodey C. ArringtonR-TX-19 · Mar 19, 2021

Mr. Speaker, I thank the gentleman for yielding. Mr. Speaker, to the gentlewoman's point about working together, Democrats did not offer a hand of bipartisanship in this ram-and-jam job on the $2…

John Barrasso
Sen. John BarrassoR-WY · Mar 23, 2021

Mr. President, reserving the right to object. Mr. President, the Democrats have just passed a $1.9 trillion spending package. They filled the bill with lots of partisan priorities. They refused to…

Show 11 more
Joe Manchin III
Sen. Joe Manchin IIID-WV · Mar 25, 2021

Mr. President, I reserve the right to object. I have a statement to make. Last week, my friend from Indiana and I were last down here discussing this issue. There seemed to be a lot of confusion…

John A. Yarmuth
Rep. John A. YarmuthD-KY-3 · Apr 13, 2021

Madam Speaker, I move to suspend the rules and concur in the Senate amendment to the bill (H.R. 1868) to prevent across-the- board direct spending cuts, and for other purposes. Madam Speaker, I ask…

Mariannette Miller-Meeks
Rep. Mariannette Miller-MeeksR-IA-2 · Mar 16, 2021

Madam Speaker, I thank my good friend, Congresswoman Fischbach, for yielding me time. I urge my colleagues to defeat the previous question so we can take up my bill, H.R. 1897, the REACT Act. My bill…

Michael C. Burgess
Rep. Michael C. BurgessR-TX-26 · Mar 19, 2021

Mr. Speaker, I thank the gentleman for yielding. Mr. Speaker, I am going to speak in opposition to H.R. 1868, but I also feel obligated to point out that you may say that the inflation rate is zero,…

John Katko
Rep. John KatkoR-NY-24 · Mar 16, 2021

Madam Speaker, I will note, in response to my colleagues across the aisle, that there is nothing wrong with enforcing the immigration laws that are on the books. That is all we are talking about…

Jason Smith
Rep. Jason SmithR-MO-8 · Apr 13, 2021

Madam Speaker, I yield myself such time as I may consume. Madam Speaker, the legislation before us today is clearly a wiser course of action than that which my House Democrat colleagues pursued just…

Earl L. "Buddy" Carter
Rep. Earl L. "Buddy" CarterR-GA-1 · Mar 19, 2021

Mr. Speaker, today, we are addressing a problem that didn't even exist a week ago. It did not even exist last week. The Republicans stood on this floor and argued against the $1.9 trillion partisan…

Lloyd Doggett
Rep. Lloyd DoggettD-TX-35 · Mar 19, 2021

Mr. Speaker, 55 years ago, President Lyndon B. Johnson overcame sustained Republican opposition to enact Medicare. It has been a literal lifeline for millions. Those who suffered without healthcare…

Jimmy Panetta
Rep. Jimmy PanettaD-CA-20 · Mar 19, 2021

Mr. Speaker, today, I rise in support of H.R. 1868 to prevent these harmful budget cuts to vital agricultural programs that are relied on by farmers, farmworkers, and food-insecure families in all of…

Ann Wagner
Rep. Ann WagnerR-MO-2 · Mar 16, 2021

Madam Speaker, I rise in stark opposition to H.J. Res. 17, which would retroactively and unconstitutionally remove the deadline to ratify the equal rights amendment. Ratification of the equal rights…

Joe Courtney
Rep. Joe CourtneyD-CT-2 · Mar 19, 2021

Mr. Speaker, I thank the chairman of the Budget Committee for his and his committee staff's steady hand over the last couple of months to make sure that the American Rescue Plan was enacted last…

Bill Text

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One Hundred Seventeenth Congress of the United States of America

At the First Session

Begun and held at the City of Washington on Sunday, the third day of January, two thousand and twenty-one

H. R. 1868

AN ACT

To prevent across-the-board direct spending cuts, and for other purposes.

1.

Extension of temporary suspension of medicare sequestration

(a)

Extension

(1)

In general

Section 3709(a) of division A of the CARES Act (2 U.S.C. 901a note) is amended by striking March 31, 2021 and inserting December 31, 2021.

(2)

Effective date

The amendment made by paragraph (1) shall take effect as if enacted as part of the CARES Act (Public Law 116–136).

(b)

Offset

Section 251A(6)(C) of the Balanced Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 901a(6)(C)) is amended—

(1)

in clause (i)—

(A)

by striking first 6 months and inserting first 5 1/2 months;

(B)

by striking 4.0 percent and inserting 2.0 percent; and

(C)

by striking and at the end;

(2)

in clause (ii)—

(A)

by striking second 6 months and inserting 6-month period beginning on the day after the last day of the period described in clause (i); and

(B)

by striking 0.0 percent. and inserting 4.0 percent; and; and

(3)

by adding at the end the following:

(iii)

with respect to the remaining 1/2 month in which such order is so effective for such fiscal year, the payment reduction shall be 0.0 percent.

.

2.

Technical corrections

(a)

Rural health clinic payments

(1)

In general

Section 1833(f)(3) of the Social Security Act (42 U.S.C. 1395l(f)(3)) is amended—

(A)

in subparagraph (A)—

(i)

in clause (i), by striking subclauses (I) and (II) and inserting the following:

(I)

with respect to a rural health clinic that had a per visit payment amount established for services furnished in 2020—

(aa)

the per visit payment amount applicable to such rural health clinic for rural health clinic services furnished in 2020, increased by the percentage increase in the MEI applicable to primary care services furnished as of the first day of 2021; or

(bb)

the limit described in paragraph (2)(A); and

(II)

with respect to a rural health clinic that did not have a per visit payment amount established for services furnished in 2020—

(aa)

the per visit payment amount applicable to such rural health clinic for rural health clinic services furnished in 2021; or

(bb)

the limit described in paragraph (2)(A); and

; and

(ii)

in clause (ii)(I), by striking under clause (i)(I) and inserting under subclause (I) or (II) of clause (i), as applicable,; and

(B)

by striking subparagraph (B) and inserting the following:

(B)

A rural health clinic described in this subparagraph is a rural health clinic that—

(i)

as of December 31, 2020, was in a hospital with less than 50 beds and after such date such hospital continues to have less than 50 beds (not taking into account any increase in the number of beds pursuant to a waiver under subsection (b)(1)(A) of section 1135 during the emergency period described in subsection (g)(1)(B) of such section); and

(ii)
(I)

as of December 31, 2020, was enrolled under section 1866(j) (including temporary enrollment during such emergency period for such emergency period); or

(II)

submitted an application for enrollment under section 1866(j) (or a request for such a temporary enrollment for such emergency period) that was received not later than December 31, 2020.

.

(2)

Effective date

The amendments made by this subsection shall take effect as if included in the enactment of the Consolidated Appropriations Act, 2021 (Public Law 116–260).

(b)

Additional amount for certain hospitals with high disproportionate share

Effective as if included in the enactment of section 203(a) of title II of division CC of Public Law 116–260, subsection (g) of section 1923 of the Social Security Act (42 U.S.C. 1396r–4), as amended by such section, is amended by adding at the end the following:

(3)

Continued application of grandfathered transition rule

Notwithstanding paragraph (2) of this subsection (as in effect on October 1, 2021), paragraph (2) of this subsection (as in effect on September 30, 2021, and as applied under section 4721(e) of the Balanced Budget Act of 1997, and amended by section 607 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106–113)) shall apply in determining whether a payment adjustment for a hospital in a State referenced in section 4721(e) of the Balanced Budget Act of 1997 during a State fiscal year shall be considered consistent with subsection (c).

.

Speaker of the House of Representatives.

Vice President of the United States and President of the Senate.