[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[S. 817 Introduced in Senate (IS)]
105th CONGRESS
1st Session
S. 817
To amend title XVIII of the Social Security Act to permit
classification of certain hospitals as rural referral centers, to
permit reclassification of certain hospitals for disproportionate share
payments, and to permit sole community hospitals to rebase Medicare
payments based upon fiscal year 1994 and 1995 costs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 23, 1997
Mr. Grassley introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to permit
classification of certain hospitals as rural referral centers, to
permit reclassification of certain hospitals for disproportionate share
payments, and to permit sole community hospitals to rebase Medicare
payments based upon fiscal year 1994 and 1995 costs.
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 ``Rural Health Care Protection Act of
1997''.
SEC. 2. CLASSIFICATION AS RURAL REFERRAL CENTERS.
(a) Prohibiting Denial of Request for Reclassification on Basis of
Comparability of Wages.--
(1) In general.--Section 1886(d)(10)(D) of the Social
Security Act (42 U.S.C. 1395ww(d)(10)(D)) is amended--
(A) by redesignating clause (iii) as clause (iv);
and
(B) by inserting after clause (ii) the following
new clause:
``(iii) Under the guidelines published by the Secretary under
clause (i), in the case of a hospital which has ever been classified by
the Secretary as a rural referral center under paragraph (5)(C), the
Board may not reject the application of the hospital under this
paragraph on the basis of any comparison between the average hourly
wage of the hospital and the average hourly wage of hospitals in the
area in which it is located.''.
(2) Effective date.--Notwithstanding section
1886(d)(10)(C)(ii) of the Social Security Act (42 U.S.C.
1395ww(d)(10)(C)(ii)), a hospital may submit an application to
the Medicare Geographic Classification Review Board during the
60-day period beginning on the date of the enactment of this
Act requesting a change in its classification for purposes of
determining the area wage index applicable to the hospital
under section 1886(d)(3)(D) of such Act (42 U.S.C.
1395ww(d)(3)(D)) for fiscal year 1998 if the hospital would be
eligible for such a change in its classification under the
standards described in section 1886(d)(10)(D) of such Act (42
U.S.C. 1395ww(d)(10)(D)) (as amended by paragraph (1)) but for
its failure to meet the deadline for applications under section
1886(d)(10)(C)(ii) of such Act (42 U.S.C.
1395ww(d)(10)(C)(ii)).
(3) Reference to budget neutrality provision.--For a
requirement that the Secretary of Health and Human Services
make a proportional adjustment in the Medicare standardized
payment amounts for inpatient hospital services to ensure that
geographic reclassifications of hospitals resulting from this
subsection do not result in an increase in aggregate payments
under section 1886 of the Social Security Act, see subsection
(d)(8)(D) of such section (42 U.S.C. 1395ww(d)(8)(D)).
(b) Continuing Treatment of Previously Designated Centers.--
(1) In general.--Any hospital classified as a rural
referral center by the Secretary of Health and Human Services
under section 1886(d)(5)(C) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(C)) for fiscal year 1991 shall be
classified as such a rural referral center for fiscal year 1998
and each subsequent fiscal year.
(2) Budget neutrality.--The provisions of section
1886(d)(8)(D) of the Social Security Act (42 U.S.C.
1395ww(d)(8)(D)) shall apply to reclassifications made pursuant
to paragraph (1) in the same manner as such provisions apply to
a reclassification under section 1886(d)(10) of such Act (42
U.S.C. 1395ww(d)(10)).
SEC. 3. HOSPITAL GEOGRAPHIC RECLASSIFICATION PERMITTED FOR PURPOSES OF
DISPROPORTIONATE SHARE PAYMENT ADJUSTMENTS.
(a) In General.--Section 1886(d)(10)(C)(i) of the Social Security
Act (42 U.S.C. 1395ww(d)(10)(C)(i)) is amended--
(1) by striking ``or'' at the end of subclause (I);
(2) by striking the period at the end of subclause (II) and
inserting ``, or'';
(3) by inserting after subclause (II) the following:
``(III) eligibility for and amount of additional payment
amounts under paragraph (5)(F).''; and
(4) by adding at the end the following:
``Any application approved for purposes of subclause (I) for a fiscal
year is deemed to be approved for purposes of subclause (III) for that
fiscal year.''.
(b) Effective Date.--Notwithstanding section 1886(d)(10)(C)(ii) of
the Social Security Act (42 U.S.C. 1395ww(d)(10)(C)(ii)), a hospital
may submit an application to the Medicare Geographic Classification
Review Board during the 60-day period beginning on the date of the
enactment of this Act requesting a change in its classification for
purposes of determining the disproportionate share hospital payment
applicable to the hospital under section 1886(d)(5)(F) of such Act (42
U.S.C. 1395ww(d)(5)(F)) for fiscal year 1998 if the hospital would be
eligible for such a change in its classification under the guidelines
described in subsection (c) of this section but for its failure to meet
the deadline for applications under section 1886(d)(10(C)(ii) of such
Act (42 U.S.C. 1395ww(d)(10)(C)(ii)).
(c) Applicable Guidelines.--The Medicare Geographic Classification
Review Board shall apply the guidelines established for
reclassification under subclause (I) of section 1886(d)(10)(C)(i) of
the Social Security Act (42 U.S.C. 1395ww(d)(10)(C)(i)(I)) to
reclassification under subclause (III) of such section of such Act
until the Secretary of Health and Human Services promulgates separate
guidelines for reclassification under such subclause (III).
(d) Reference to Budget Neutrality Provision.--For a requirement
that the Secretary of Health and Human Services make a proportional
adjustment in the medicare standardized payment amounts for inpatient
hospital services to ensure that geographic reclassifications of
hospitals resulting from this section do not result in an increase in
aggregate payments under section 1886 of the Social Security Act, see
subsection (d)(8)(D) of such section of such Act (42 U.S.C.
1395ww(d)(8)(D)).
SEC. 4. PERMITTING REBASING OF PAYMENT FOR SOLE COMMUNITY HOSPITALS
USING FISCAL YEARS 1994 AND 1995 COSTS.
Section 1886(b)(3) of the Social Security Act (42 U.S.C.
1395ww(b)(3)) is amended--
(1) in subparagraph (C), by inserting ``subject to
subparagraph (F),'' after ``subsection (d)(5)(D)(iii)),''; and
(2) by adding at the end the following new subparagraph:
``(F) In applying subparagraph (C) with respect to discharges
occurring in fiscal year 1998 and each subsequent fiscal year, in no
case shall the target amount for a hospital for fiscal year 1998 be
less than the average of--
``(i) the allowable operating costs of inpatient hospital
services recognized under this title for the hospital's 12-
month cost reporting period (if any) beginning during fiscal
year 1994 increased (in a compounded manner) by the applicable
percentage increase under subparagraph (B)(iv) for each of
fiscal years 1995, 1996, 1997, and 1998, and
``(ii) the allowable operating costs of inpatient hospital
services recognized under this title for the hospital's 12-
month cost reporting period (if any) beginning during fiscal
year 1995 increased (in a compounded manner) by the applicable
percentage increase under subparagraph (B)(iv) for each of
fiscal years 1996, 1997, and 1998.''.
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