This bill, known as the "Save Struggling Hospitals Act," seeks to codify a specific Medicare policy within the Social Security Act concerning hospital wage index adjustments. Its primary goal is to provide financial relief to hospitals operating in areas with lower wages by permanently embedding an existing policy into law. The legislation mandates an increase in the area wage index for hospitals whose current wage index falls below the 25th percentile across all hospitals. For these facilities, the wage index will be boosted by half the difference between their current index and the 25th percentile threshold, effective for discharges on or after October 1, 2019. Crucially, this adjustment must be implemented in a budget-neutral manner , meaning any increases for low-wage hospitals are offset by adjustments elsewhere. However, the bill includes important safeguards, prohibiting any budget neutrality adjustments from decreasing the wage index for hospitals already below the 75th percentile or causing any hospital's wage index to drop below 95 percent of its previous year's level.