This legislation, known as the "Save Struggling Hospitals Act," aims to permanently establish the Medicare low-wage index hospital policy within the Social Security Act. It specifically amends Section 1886(d)(3)(E) to ensure that hospitals operating in areas with a low area wage index receive an upward adjustment. For discharges occurring on or after October 1, 2019, hospitals whose area wage index falls below the 25th percentile will see their index increased by half the difference between their current index and the 25th percentile. This adjustment is designed to provide financial relief to hospitals in areas with lower labor costs, which might otherwise receive lower Medicare reimbursements. Crucially, the bill mandates that these adjustments be applied in a budget-neutral manner . However, it includes important safeguards, prohibiting any budget neutrality adjustments from decreasing the wage index for hospitals below the 75th percentile or from reducing a hospital's wage index to less than 95 percent of its previous fiscal year's level.