HR 342
112th CONGRESS
1st Session
H. R. 342
To amend titles XIX and XVIII of the Social Security Act, as amended
by the Patient Protection and Affordable Care Act and the Health Care and
Education Reconciliation Act of 2010, with respect to payment of disproportionate
share hospitals (DSH) under the Medicare and Medicaid programs.
IN THE HOUSE OF REPRESENTATIVES
January 19, 2011
Ms. EDDIE BERNICE JOHNSON of Texas introduced the following bill; which was
referred to the Committee on Ways and Means, and in addition to the Committee
on Energy and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall within
the jurisdiction of the committee concerned
A BILL
To amend titles XIX and XVIII of the Social Security Act, as amended
by the Patient Protection and Affordable Care Act and the Health Care and
Education Reconciliation Act of 2010, with respect to payment of disproportionate
share hospitals (DSH) under the Medicare and Medicaid programs.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. MEDICARE DSH REPORT AND PAYMENT ADJUSTMENTS IN RESPONSE TO COVERAGE
EXPANSION INSTEAD OF PPACA AND HCERA REVISIONS.
(a) DSH Report- Not later than January 1, 2016, the Secretary of Health and
Human Services shall submit to Congress a report on Medicare DSH taking into
account the impact of the health care reforms carried out under the Patient
Protection and Affordable Care Act, as amended by the Health Care and Education
Reconciliation Act of 2010, in reducing the number of uninsured individuals.
The report shall include recommendations relating to the following:
(1) The appropriate amount, targeting, and distribution of Medicare DSH
to compensate for higher Medicare costs, Medicaid reimbursement shortfalls,
and uncompensated care associated with serving low-income beneficiaries
(taking into account variations in the empirical justification for Medicare
DSH attributable to hospital characteristics, including bed size), consistent
with the original intent of Medicare DSH.
(2) The appropriate amount, targeting, and distribution of Medicare DSH
to hospitals given their continued uncompensated care costs, to the extent
such costs remain.
(b) Payment Adjustments in Response to Coverage Expansion-
(1) IN GENERAL- If there is a significant decrease in the national rate
of uninsurance as a result of corrected PPACA (as determined under paragraph
(2)(A)), then the Secretary of Health and Human Services shall, beginning
no earlier than fiscal year 2018, implement the following adjustments to
Medicare DSH:
(A) In lieu of the amount of Medicare DSH payment that would otherwise
be made under section 1886(d)(5)(F) of the Social Security Act, the amount
of Medicare DSH payment shall be an amount based on the recommendations
of the report under subsection (a)(1) and shall take into account variations
in the empirical justification for Medicare DSH attributable to hospital
characteristics, including bed size.
(B) Subject to paragraph (3), make an additional payment to a hospital
by an amount that is estimated based on the amount of uncompensated care
provided by the hospital based on criteria for uncompensated care as determined
by the Secretary, which shall exclude bad debt.
(2) SIGNIFICANT DECREASE IN NATIONAL RATE OF UNINSURANCE AS A RESULT OF
THIS ACT- For purposes of this subsection--
(A) IN GENERAL- There is a `significant decrease in the national rate
of uninsurance as a result of corrected PPACA' if there is a decrease
in the national rate of uninsurance (as defined in subparagraph (B)) from
2012 to 2014 that exceeds 8 percentage points.
(B) NATIONAL RATE OF UNINSURANCE DEFINED- The term `national rate of uninsurance'
means, for a year, such rate for the under-65 population for the year
as determined and published by the Bureau of the Census in its Current
Population Survey in or about September of the succeeding year.
(3) UNCOMPENSATED CARE INCREASE-
(A) COMPUTATION OF DSH SAVINGS- For each fiscal year (beginning with fiscal
year 2018), the Secretary shall estimate the aggregate reduction in the
amount of Medicare DSH payment that would be expected to result from the
adjustment under paragraph (1)(A).
(B) STRUCTURE OF PAYMENT INCREASE- The Secretary shall compute the additional
payment to a hospital as described in paragraph (1)(B) for a fiscal year
in accordance with a formula established by the Secretary that provides
that--
(i) the estimated aggregate amount of such increase for the fiscal year
does not exceed 50 percent of the aggregate reduction in Medicare DSH
estimated by the Secretary for such fiscal year; and
(ii) hospitals with higher levels of uncompensated care receive a greater
increase.
(c) Definitions- In this section:
(1) The term `Medicare DSH' means adjustments in payments under section
1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) for
inpatient hospital services furnished by disproportionate share hospitals.
(2) The term `corrected PPACA' means the Patient Protection and Affordable
Care Act, as amended by the Health Care and Education Reconciliation Act
of 2010.
(d) Elimination of HCERA Provision- Section 1886 of the Social Security Act
(42 U.S.C. 1395ww), as amended by sections 3133 and 10316 of the Patient Protection
and Affordable Care Act and section 1104 of the Health Care and Education
Reconciliation Act of 2010, is amended--
(1) in subsection (d)(5)(F)(i), by striking `Subject to subsection (r),
for' and inserting `For'; and
(2) by striking subsection (r).
SEC. 2. MEDICAID DSH REVISIONS.
Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r-4(f)(7)(A)),
as amended by sections 2551(a)(4) and 10201(e)(1) of the Patient Protection
and Affordable Care Act and section 1203(a) of the Health Care and Education
Reconciliation Act of 2010, is amended--
(1) clause (i), by striking `2014 through 2020' and inserting `2018 through
2024'; and
(2) in subclauses (I) through (VII) of clause (ii), by striking `2014',
`2015', `2016', `2017', `2018', `2019', and `2020' and inserting `2018',
`2019', `2020', `2021', `2022', `2023', and `2024', respectively.
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