[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2850 Introduced in House (IH)]

103d CONGRESS
  1st Session
                                H. R. 2850

     To amend title XVIII of the Social Security Act to provide an 
    additional payment under part A of the medicare program for the 
operating costs of inpatient hospital services of hospitals with a high 
         proportion of patients who are medicare beneficiaries.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 3, 1993

  Mr. Smith of New Jersey (for himself and Mr. Saxton) introduced the 
 following bill; which was referred to the Committee on Ways and Means

_______________________________________________________________________

                                 A BILL


 
     To amend title XVIII of the Social Security Act to provide an 
    additional payment under part A of the medicare program for the 
operating costs of inpatient hospital services of hospitals with a high 
         proportion of patients who are medicare beneficiaries.

    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 ``High Medicare Hospital Relief Act of 
1993''.

SEC. 2. ADDITIONAL MEDICARE PAYMENT FOR HIGH MEDICARE HOSPITALS.

    (a) In General.--Section 1886(d)(5) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)) is amended--
            (1) by redesignating subparagraphs (H) and (I) as 
        subparagraphs (I) and (J); and
            (2) by inserting after subparagraph (G) the following new 
        subparagraph:
    ``(H)(i) For discharges occurring on or after October 1, 1993, and 
before October 1, 1995, the Secretary shall provide, in accordance with 
this subparagraph, for an additional payment for each high medicare 
hospital.
    ``(ii) The amount of the additional payment under this subparagraph 
for each discharge shall be determined by multiplying (I) the sum of 
the amount determined under paragraph (1)(A)(ii)(II) (or, if 
applicable, the amount determined under paragraph (1)(A)(iii)) and the 
amount paid to the hospital under subparagraph (A) for that discharge, 
by (II) the applicable high medicare adjustment percentage established 
under clause (iii) for the cost reporting period in which the discharge 
occurs.
    ``(iii) The high medicare adjustment percentage for a cost 
reporting period is equal to--
            ``(I) for a hospital located in an urban area, the 
        difference (expressed as a percentage) between the average of 
        the medicare operating margins of all subsection (d) hospitals 
        located in urban areas that are not high medicare hospitals and 
        the average of the medicare operating margins of all high 
        medicare hospitals located in urban areas, as determined for 
        the most recent cost reporting period for which such medicare 
        operating margins may be determined (except that such 
        percentage may not be less than 0 percent);
            ``(II) for a hospital that is located in a rural area and 
        has 100 or more beds, the difference (expressed as a 
        percentage) between the average of the medicare operating 
        margins of all subsection (d) hospitals located in rural areas 
        and having 100 or more beds that are not high medicare 
        hospitals and the average of the medicare operating margins of 
        all high medicare hospitals located in rural areas and having 
        100 or more beds, as determined for the most recent cost 
        reporting period for which such medicare operating margins may 
        be determined (except that such percentage may not be less than 
        0 percent); and
            ``(III) for a hospital that is located in a rural area and 
        has less than 100 beds, the difference (expressed as a 
        percentage) between the average of the medicare operating 
        margins of all subsection (d) hospitals located in rural areas 
        and having less than 100 beds that are not high medicare 
        hospitals and the average of the medicare operating margins of 
        all high medicare hospitals located in rural areas and having 
        less than 100 beds, as determined for the most recent cost 
        reporting period for which such medicare operating margins may 
        be determined (except that such percentage may not be less than 
        0 percent).
    ``(iv) In this subparagraph, the term `high medicare hospital' 
means a subsection (d) hospital for which not less than 65 percent of 
its inpatient days or discharges during the cost reporting period 
beginning in fiscal year 1991 were attributable to inpatients entitled 
to benefits under part A.
    ``(v) In this subparagraph, a hospital's `medicare operating 
margin' for a cost reporting period is equal to the quotient of--
            ``(I) the difference between the amount of the payments 
        received by the hospital under this title during the cost 
        reporting period for the operating costs of inpatient hospital 
        services and the costs to the hospital of providing such 
        services; divided by
            ``(II) the amount of the payments received by the hospital 
        under this title during the cost reporting period for the 
        operating costs of inpatient hospital services.''.
    (b) Conforming Amendment.--Section 1886(d)(9)(D)(iv) of such Act 
(42 U.S.C. 1395ww(d)(9)(D)(iv)) is amended by striking ``Subparagraph 
(H)'' and inserting ``Subparagraph (I)''.
    (c) Effective Date.--The amendments made by subsections (a) and (b) 
shall apply with respect to discharges occurring on or after October 1, 
1993.

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