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H.R.5324
Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 2000
(Introduced in the House)
SEC. 111. REVISION OF REDUCTION OF INDIRECT GRADUATE MEDICAL EDUCATION PAYMENTS.
(1) IN GENERAL- Section 1886(d)(5)(B)(ii) (42 U.S.C.
1395ww(d)(5)(B)(ii)) is amended--
(A) in subclause (IV), by adding `and' at the end; and
(B) by striking subclauses (V) and (VI) and inserting the following
new subclause:
`(V) on or after October 1, 2000, `c' is equal to 1.6.'.
(2) TECHNICAL AMENDMENTS- Section 1886(d)(5)(B) (42 U.S.C.
1395ww(d)(5)(B)), as amended by paragraph (1), is amended--
(A) by realigning the left margins of clauses (ii) and (v) so as to
align with the left margin of clause (i); and
(B) by realigning the left margins of subclauses (I) through (V) of
clause (ii) appropriately.
(b) SPECIAL ADJUSTMENT FOR PURPOSES OF MAINTAINING 6.5 PERCENT IME PAYMENT
FOR FISCAL YEAR 2001- Notwithstanding paragraph (5)(B)(ii)(V) of section
1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(ii)(V)), as
amended by subsection (a), for purposes of making payments for subsection (d)
hospitals (as defined in paragraph (1)(B) of such section) with indirect costs
of medical education , the indirect
teaching adjustment factor referred to in paragraph (5)(B)(ii) of such
section shall be determined--
(1) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, pursuant to such paragraph as in effect on the day before the
date of enactment of this Act; and
(2) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, by substituting `1.66' for `1.6' in subclause (V) of such
paragraph (as so amended).
(c) CONFORMING AMENDMENT RELATING TO DETERMINATION OF STANDARDIZED AMOUNT-
Section 1886(d)(2)(C)(i) (42 U.S.C. 1395ww(d)(2)(C)(i)) is amended--
(1) by inserting a comma after `Balanced Budget Act of 1997'; and
(2) by inserting `, or any payment under such paragraph resulting from
the application of section 111(b) of the Medicare, Medicaid, and SCHIP
Balanced Budget Refinement Act of 2000' after `Balanced Budget Refinement
Act of 1999'.
SEC. 112. ELIMINATING REDUCTION IN PPS HOSPITAL PAYMENT UPDATE.
(a) IN GENERAL- Section 1886(b)(3)(B)(i) (42 U.S.C. 1395ww(b)(3)(B)(i)) is
amended--
(1) in subclause (XV), by adding `and' at the end;
(2) by striking subclauses (XVI) and (XVII);
(3) by redesignating subclause (XVIII) as subclause (XVI); and
(4) in subclause (XVI), as so redesignated, by striking `fiscal year
2003' and inserting `fiscal year 2001'.
(b) SPECIAL RULE FOR PAYMENT FOR INPATIENT HOSPITAL SERVICES FOR FISCAL
YEAR 2001- Notwithstanding the amendments made by subsection (a), for purposes
of making payments for fiscal year 2001 for inpatient hospital services
furnished by subsection (d) hospitals (as defined in section 1886(d)(1)(B) of
the Social Security Act (42 U.S.C. 1395ww(d)(1)(B))), the `applicable
percentage increase' referred to in section 1886(b)(3)(B)(i) of such Act (42
U.S.C. 1395ww(b)(3)(B)(i))--
(1) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, shall be determined in accordance with subclause (XVI) of
such section as in effect on the day before the date of enactment of this
Act; and
(2) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, shall be equal to--
(A) the market basket percentage increase plus 1.1 percentage points
for hospitals (other than sole community hospitals) in all areas;
and
(B) the market basket percentage increase for sole community
hospitals.
SEC. 113. ELIMINATING REDUCTION IN DISPROPORTIONATE SHARE HOSPITAL (DSH)
PAYMENTS.
(a) ELIMINATION OF REDUCTION-
(1) IN GENERAL- Section 1886(d)(5)(F)(ix) (42 U.S.C.
1395ww(d)(5)(F)(ix)) is amended--
(A) in subclause (III), by striking `during each of fiscal years 2000
and 2001' and inserting `during fiscal year 2000';
(B) by striking subclause (IV);
(C) by redesignating subclause (V) as subclause (IV); and
(D) in subclause (IV), as so redesignated, by striking `during fiscal
year 2003' and inserting `during fiscal year 2001'.
(2) EFFECTIVE DATE- The amendments made by this subsection shall apply
to discharges occurring on or after October 1, 2000.
(b) SPECIAL RULE FOR DSH PAYMENT FOR FISCAL YEAR 2001- Notwithstanding the
amendments made by subsection (a)(1), for purposes of making disproportionate
share payments for subsection (d) hospitals (as defined in section
1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B))) for
fiscal year 2001, the additional payment amount otherwise determined under
clause (ii) of section 1886(d)(5)(F) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(F))--
(1) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, shall be adjusted as provided by clause (ix)(III) of such
section as in effect on the day before the date of enactment of this Act;
and
(2) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, shall be increased by 3 percent.
(c) CONFORMING AMENDMENTS RELATING TO DETERMINATION OF STANDARDIZED
AMOUNT- Section 1886(d)(2)(C)(iv) (42 U.S.C. 1395ww(d)(2)(C)(iv)), is
amended--
(1) by striking `Act of 1989 or' and inserting `Act of 1989,'; and
(2) by inserting `, or the enactment of section 113(b) of the Medicare,
Medicaid, and SCHIP Balanced Budget Refinement Act of 2000' after `Omnibus
Budget Reconciliation Act of 1990'.
SEC. 114. EQUALIZING THE THRESHOLD AND UPDATING PAYMENT FORMULAS FOR
DISPROPORTIONATE SHARE HOSPITALS.
(a) APPLICATION OF UNIFORM 15 PERCENT THRESHOLD- Section 1886(d)(5)(F)(v)
(42 U.S.C. 1395ww(d)(5)(F)(v)) is amended by striking `exceeds--' and all that
follows and inserting `exceeds 15 percent.'.
(b) CHANGE IN PAYMENT PERCENTAGE FORMULAS- Section 1886(d)(5)(F)(viii) (42
U.S.C. 1395ww(d)(5)(F)(viii)) is amended to read as follows:
`(viii) The formula used to determine the disproportionate share
adjustment percentage for a cost reporting period for a hospital described in
subclause (II), (III), or (IV) of clause (iv) is--
`(I) in the case of such a hospital with a disproportionate patient
percentage (as defined in clause (vi)) that does not exceed 20.2,
(P-15)(.65) + 2.5;
`(II) in the case of such a hospital with a disproportionate patient
percentage (as so defined) that exceeds 20.2 but does not exceed 25.2,
(P-20.2)(.825) + 5.88;
`(III) except as provided in subclause (IV), in the case of such a
hospital with a disproportionate patient percentage (as so defined) that
exceeds 25.2, the disproportionate share adjustment percentage = 10;
and
`(IV) in the case of such a hospital with a disproportionate patient
percentage (as so defined) that exceeds 30.0 and that is described in clause
(iv)(III), (P-30)(.6) + 10;
where `P' is the hospital's disproportionate patient percentage (as so
defined).'.
(c) CONFORMING AMENDMENTS- Section 1886(d)(5)(F)(iv) (42 U.S.C.
1395ww(d)(5)(F)(iv)) is amended--
(1) in subclause (I), by striking `is described in the second sentence
of clause (v)' and inserting `is located in a rural area and has 500 or more
beds';
(2) by amending subclause (II) to read as follows:
`(II) is located in an urban area and has less than 100 beds, or is
located in a rural area and has less than 500 beds and is not described in
subclause (III) or (IV), is equal to the percent determined in accordance
with the applicable formula described in clause (viii);';
(3) by striking subclauses (III) and (IV);
(4) by redesignating subclauses (V) and (VI) as subclauses (III) and
(IV), respectively;
(5) in subclause (III) (as so redesignated), by striking `and is not
classified as a sole community hospital under subparagraph (D),'; and
(6) in subclause (IV) (as so redesignated), by striking `10 percent' and
inserting `equal to the percent determined in accordance with the applicable
formula described in clause (viii)'.
(d) EFFECTIVE DATE- The amendments made by this section shall apply to
discharges occurring on or after April 1, 2001.
SEC. 115. CARE FOR LOW-INCOME PATIENTS.
(a) FREEZE IN MEDICAID DSH ALLOTMENTS-
(1) IN GENERAL- Section 1923(f) (42 U.S.C. 1396r-4(f)) is
amended--
(A) by redesignating paragraph (4) as paragraph (5); and
(B) by inserting after paragraph (3), the following new
paragraph:
`(4) SPECIAL RULE FOR FISCAL YEARS 2001 THROUGH 2008- With respect to
each of fiscal years 2001 through 2008--
`(A) paragraph (2) shall be applied--
`(I) in the heading, `2001' for `2002';
`(II) in the matter preceding the table, `2001 (and the DSH
allotment for a State for fiscal year 2001 is the same as the DSH
allotment for the State for fiscal year 2000, as determined under the
following table)' for `2002'; and
`(ii) without regard to the columns in the table relating to FY 01
and FY 02 (fiscal years 2001 and 2002); and
`(B) paragraph (3) shall be applied by substituting--
`(i) in the heading, `2002' for `2003';
`(ii) in subparagraph (A), `2002' for `2003'.'.
(2) REPEAL; APPLICABILITY- Effective October 1, 2008, the amendments
made by paragraph (1) are repealed and section 1923(f) of the Social
Security Act (42 U.S.C. 1396r-4(f)) shall be applied and administered as if
such amendments had not been enacted.
(b) INCREASE IN DSH ALLOTMENTS FOR THE DISTRICT OF COLUMBIA-
(1) IN GENERAL- Each of the entries in the table in section 1923(f)(2)
(42 U.S.C. 1396r-4(f)(2)) relating to the District of Columbia for FY 98
(fiscal year 1998), for FY 99 (fiscal year 1999), for FY 00 (fiscal year
2000), for FY 01 (fiscal year 2001), and for FY 02 (fiscal year 2002) are
amended by striking the amount otherwise specified and inserting
`43.4'.
(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall take
effect as if included in the enactment of section 4721(a) of BBA (111 Stat.
511).
(c) OPTIONAL ELIGIBILITY OF CERTAIN ALIEN PREGNANT WOMEN AND CHILDREN FOR
MEDICAID AND SCHIP-
(1) MEDICAID- Section 1903(v) (42 U.S.C. 1396b(v)) is amended--
(A) in paragraph (1), by striking `paragraph (2)' and inserting
`paragraphs (2) and (4)'; and
(B) by adding at the end the following new paragraph:
`(4)(A) A State may elect (in a plan amendment under this title) to
provide medical assistance under
this title, notwithstanding sections 401(a), 402(b), 403, and 421 of the
Personal Responsibility and Work Opportunity Reconciliation Act of 1996, for
aliens who are lawfully residing in the United States (including battered
aliens described in section 431(c) of such Act) and who are otherwise eligible
for such assistance, within any of the following eligibility categories:
`(i) PREGNANT WOMEN- Women during pregnancy (and during the 60-day
period beginning on the last day of the pregnancy).
`(ii) CHILDREN- Children (as defined under such plan), including
optional targeted low-income children described in section
1905(u)(2)(B).
`(B) In the case of a State that has elected to provide medical assistance to a category of
aliens under subparagraph (A), no action may be brought under an affidavit of
support against any sponsor of such an alien on the basis of provision of
assistance to such category.'.
(2) SCHIP- Section 2107(e)(1) (42 U.S.C. 1397gg(e)(1)) is amended by
adding at the end the following new subparagraph:
`(D) Section 1903(v)(4)(A)(ii) (relating to optional coverage of
permanent resident alien children), but only if the State has in effect an
election under that same eligibility category for purposes of title
XIX.'.
(3) EFFECTIVE DATE- The amendments made by this section take effect on
October 1, 2000, and apply to medical assistance and child health
assistance furnished on or after such date.
SEC. 116. MODIFICATION OF PAYMENT RATE FOR PUERTO RICO HOSPITALS.
(a) MODIFICATION OF PAYMENT RATE- Section 1886(d)(9)(A) (42 U.S.C.
1395ww(d)(9)(A)) is amended--
(1) in clause (i), by striking `October 1, 1997, 50 percent (' and
inserting `October 1, 2000, 25 percent (for discharges between October 1,
1997, and September 30, 2000, 50 percent,'; and
(2) in clause (ii), in the matter preceding subclause (I), by striking
`after October 1, 1997, 50 percent (' and inserting `after October 1, 2000,
75 percent (for discharges between October 1, 1997, and September 30, 2000,
50 percent,'.
(b) SPECIAL RULE FOR PAYMENT FOR FISCAL YEAR 2001-
(1) IN GENERAL- Notwithstanding the amendment made by subsection (a),
for purposes of making payments for the operating costs of inpatient
hospital services of a section 1886(d) Puerto Rico hospital for fiscal year
2001, the amount referred to in the matter preceding clause (i) of section
1886(d)(9)(A) of the Social Security Act (42 U.S.C. 1395ww(d)(9)(A))--
(A) for discharges occurring on or after October 1, 2000, and before
April 1, 2001, shall be determined in accordance with such section as in
effect on the day before the date of enactment of this Act; and
(B) for discharges occurring on or after April 1, 2001, and before
October 1, 2001, shall be determined--
(i) using 0 percent of the Puerto Rico adjusted DRG prospective
payment rate referred to in clause (i) of such section; and
(ii) using 100 percent of the discharge-weighted average referred to
in clause (ii) of such section.
(2) SECTION 1886(d) PUERTO RICO HOSPITAL- For purposes of this
subsection, the term `section 1886(d) Puerto Rico hospital' has the meaning
given the term `subsection (d) Puerto Rico hospital' in the last sentence of
section 1886(d)(9)(A) of the Social Security Act (42 U.S.C.
1395ww(d)(9)(A)).
SEC. 117. MEDPAC STUDY ON HOSPITAL AREA WAGE INDEXES.
(1) IN GENERAL- The Medicare Payment Advisory Commission established
under section 1805 of the Social Security Act (42 U.S.C. 1395b-6) (in this
section referred to as `MedPAC') shall conduct a study on the hospital area
wage indexes used in making payments to hospitals under section 1886(d) of
the Social Security Act (42 U.S.C. 1395ww(d)), including an assessment of
the accuracy of those indexes in reflecting geographic differences in wage
and wage-related costs of hospitals.
(2) CONSIDERATIONS- In conducting the study under paragraph (1), MedPAC
shall consider--
(A) the appropriate method for determining hospital area wage
indexes;
(B) the appropriate portion of hospital payments that should be
adjusted by the applicable area wage index;
(C) the appropriate method for adjusting the wage index by
occupational mix; and
(D) the feasibility and impact of making changes (as determined
appropriate by MedPAC) to the methods used to determine such indexes,
including the need for a data system required to implement such
changes.
(b) REPORT- Not later than 18 months after the date of enactment of this
Act, MedPAC shall submit a report to the Secretary of Health and Human
Services and Congress on the study conducted under subsection (a) together
with such recommendations for legislation and administrative action as MedPAC
determines appropriate.
Subtitle C--PPS Exempt Hospitals
SEC. 121. TREATMENT OF CERTAIN CANCER HOSPITALS.
(a) IN GENERAL- Section 1886(d)(1)(B)(v) of the Social Security Act (42
U.S.C. 1395ww(d)(1)(B)(v)) is amended--
(1) in subclause (I), by striking `or' at the end;
(2) in subclause (II), by striking the semicolon at the end and
inserting `, or'; and
(3) by adding at the end the following:
`(III) a hospital that was recognized as a clinical cancer research
center by the National Cancer Institute of the National Institutes of Health
as of February 18, 1998, that has never been reimbursed for inpatient
hospital services pursuant to a reimbursement system under a demonstration
project under section 1814(b), that is a freestanding facility organized
primarily for treatment of and research on cancer and is not a unit of
another hospital, that as of the date of enactment of this subclause, is
licensed for 162 acute care beds, and that demonstrates for the 4-year
period ending on June 30, 1999, that at least 50 percent of its total
discharges have a principal finding of neoplastic disease, as defined in
subparagraph (E);'.
(b) CONFORMING AMENDMENT- Section 1886(d)(1)(E) of the Social Security Act
(42 U.S.C. 1395ww(d)(1)(E)) is amended by striking `For purposes of
subparagraph (B)(v)(II)' and inserting `For purposes of subclauses (II) and
(III) of subparagraph (B)(v)'.
(1) APPLICATION TO COST REPORTING PERIODS- Any classification by reason
of section 1886(d)(1)(B)(v)(III) of the Social Security Act (as added by
subsection (a)) shall apply to 12-month cost reporting periods beginning on
or after July 1, 1999.
(2) BASE YEAR- Notwithstanding the provisions of section 1886(b)(3)(E)
of such Act (42 U.S.C. 1395ww(b)(3)(E)) or other provisions to the contrary,
the base cost reporting period for purposes of determining the target amount
for any hospital classified by reason of section 1886(d)(1)(B)(v)(III) of
such Act (as added by subsection (a)) shall be the 12-month cost reporting
period beginning on July 1, 1995.
(3) DEADLINE FOR PAYMENTS- Any payments owed to a hospital by reason of
this subsection shall be made expeditiously, but in no event later than 1
year after the date of enactment of this Act.
SEC. 122. PAYMENT ADJUSTMENT FOR INPATIENT SERVICES IN REHABILITATION
HOSPITALS.
(a) OPTION TO APPLY PROSPECTIVE PAYMENT SYSTEM DURING TRANSITION PERIOD-
Section 1886(j)(1)(A) (42 U.S.C. 1395ww(j)(1)(A)) is amended in the matter
preceding subclause (i) by inserting `the greater of the prospective payment
rate determined in paragraph (3)(A) or' after `is equal to'.
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