To amend title XVIII of the Social Security Act to increase payments under the medicare program to Puerto Rico hospitals.

March 18, 2003

Mr. SANTORUM (for himself and Mr. GRAHAM of Florida) introduced the following bill; which was read twice and referred to the Committee on Finance

To amend title XVIII of the Social Security Act to increase payments under the medicare program to Puerto Rico hospitals.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Medicare Puerto Rico Hospital Payment Parity Act of 2003'.

SEC. 2. MODIFICATION OF PAYMENT RATE FOR PUERTO RICO HOSPITALS.

Section 1886(d)(9) of the Social Security Act (42 U.S.C. 1395ww(d)(9)) is amended--

(1) in subparagraph (A)--

(A) in clause (i), by striking `for discharges beginning on or after October 1, 1997, 50 percent (and for discharges between October 1, 1987, and September 30, 1997, 75 percent)' and inserting `the applicable Puerto Rico percentage (specified in subparagraph (E))'; and

(B) in clause (ii), by striking `for discharges beginning in a fiscal year beginning on or after October 1, 1997, 50 percent (and for discharges between October 1, 1987, and September 30, 1997, 25 percent)' and inserting `the applicable Federal percentage (specified in subparagraph (E))'; and

(2) by adding at the end the following new subparagraph:

`(E) For purposes of subparagraph (A), for discharges occurring--

`(i) on or after October 1, 1987, and before October 1, 1997, the applicable Puerto Rico percentage is 75 percent and the applicable Federal percentage is 25 percent;

`(ii) on or after October 1, 1997, and before October 1, 2003, the applicable Puerto Rico percentage is 50 percent and the applicable Federal percentage is 50 percent; and

`(iii) on or after October 1, 2003, the applicable Puerto Rico percentage is 25 percent and the applicable Federal percentage is 75 percent.'.

SEC. 3. CALCULATION OF MEDICARE DSH PAYMENTS FOR PPS HOSPITALS IN PUERTO RICO.

(a) IN GENERAL- Section 1886(d)(9) of the Social Security Act (42 U.S.C. 1395ww(d)(9)), as amended by section 2, is amended--

(1) by striking subparagraph (D)(iii) and inserting the following:

`(iii) Subparagraph (F) (relating to disproportionate share payments), except that for this purpose--

`(I) the sum described in clause (ii) of this subparagraph shall be substituted for the sum referred to in paragraph (5)(F)(ii)(I); and

`(II) the number of a subsection (d) Puerto Rico hospital's SSI proxy patient days (as defined in subparagraph (F)) shall be substituted for the numerator referred to in paragraph (5)(F)(vi)(I).'; and

(2) by adding at the end the following new subparagraph:

`(F)(i) For purposes of subparagraph (D)(iii)(II), the term `subsection (d) Puerto Rico hospital's SSI proxy patient days' means the product of--

`(I) the SSI proxy percentage (as defined in clause (ii)); and

`(II) the total number of the hospital's patient days for such period.

`(ii) For purposes of clause (i)(I), the term `SSI proxy percentage' means, with respect to all subsection (d) Puerto Rico hospitals for cost reporting periods beginning in a fiscal year, the unweighted average of the fractions (expressed as percentages) determined under paragraph (5)(F)(vi)(I) for all subsection (d) hospitals in the income-equivalent proxy State (as defined in clause (iii)) for the most recent cost reporting period for which adequate data are available (other than hospitals for which such fraction or percentage is zero).

`(iii) For purposes of clause (ii), the term `income-equivalent proxy State' means, for cost reporting periods beginning in a fiscal year, the State (other than a State for which title XVI, as in effect without regard to the amendment made by section 301 of the Social Security Amendments of 1972, continues to apply) the per capita income of which most closely approximates the per capita income of Puerto Rico (as determined by the Secretary based on the most recent period for which adequate data are available).'.

(b) EFFECTIVE DATE- The amendments made by subsection (a) shall apply to discharges occurring on or after October 1, 2003.

END