1. Short title This Act may be cited as the Save Rural Hospitals Act of 2023 . 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. 1395ww(d)(3)(E) ) is amended— (A) in clause (i), in the first sentence, by striking or (iv) and inserting , (iv), or (v) ; and (B) by adding at the end the following new clause: (v) Area wage index floor (I) In general For discharges occurring on or after October 1, 2023, 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 2023 after Act of 2021 . (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