1. Short title This Act may be cited as the Healthcare Enhancement for Americas Rural Towns Act or the HEART Act . 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, 2017 and inserting before October 1, 2018 ; (2) in clause (i), by adding at the end the following; For fiscal year 2018 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, 2017 and inserting before October 1, 2018 ; and (4) by adding at the end the following new clauses: (v) Subject to subclause (II), for purposes of clause (i), for fiscal year 2019 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. (vi) The aggregate amounts determined for all subsection (d) hospitals which are medicare-dependent, small rural hospitals by application of the increase factors determined under clause (v) for such hospitals shall not exceed a total of— (I) for fiscal year 2019, $100,000,000