[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1103 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 1103

   To amend title XVIII of the Social Security Act to carve out from 
   payments to Medicare+Choice organizations amounts attributable to 
disproportionate share hospital payments and pay such amounts directly 
  to those disproportionate share hospitals in which their enrollees 
                             receive care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 11, 1999

Mr. Rangel (for himself, Mr. Stark, Mr. Quinn, Mr. Walsh, Mr. Ackerman, 
 Mrs. Christensen, Mr. Doyle, Mr. Fattah, Mr. Frost, Mr. Hinchey, Mr. 
Holden, Mr. Jenkins, Ms. Kilpatrick, Mr. Klink, Mr. LaFalce, Mr. Lewis 
  of Georgia, Mrs. Maloney of New York, Mr. Mascara, Mr. Matsui, Mrs. 
 McCarthy of New York, Mr. McDermott, Mr. McGovern, Ms. Slaughter, Mr. 
McNulty, Mr. Nadler, Mr. Pastor, Mr. Serrano, Mrs. Thurman, Mr. Towns, 
and Ms. Velazquez) introduced the following bill; which was referred to 
 the Committee on Ways and Means, and in addition to the Committee on 
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 title XVIII of the Social Security Act to carve out from 
   payments to Medicare+Choice organizations amounts attributable to 
disproportionate share hospital payments and pay such amounts directly 
  to those disproportionate share hospitals in which their enrollees 
                             receive care.

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

SECTION 1. CARVING OUT DSH PAYMENTS FROM PAYMENTS TO MEDICARE+CHOICE 
              ORGANIZATIONS AND PAYING THE AMOUNTS DIRECTLY TO DSH 
              HOSPITALS ENROLLING MEDICARE+CHOICE ENROLLEES.

    (A) In General.--Section 1853(c)(3) of the Social Security Act (42 
U.S.C. 1395w-23(c)(3)), as inserted by section 4001 of the Balanced 
Budget Act of 1997, is amended--
            (1) in subparagraph (A), by striking ``subparagraph (B)'' 
        and inserting ``subparagraphs (B) and (D)'',
            (2) by redesignating subparagraph (D) as subparagraph (E), 
        and
            (3) by inserting after subparagraph (C) the following new 
        subparagraph:
                    ``(D) Removal of payments attributable to 
                disproportionate share payments from calculation of 
                adjusted average per capita cost.--
                            ``(i) In general.--In determining the area-
                        specific Medicare+Choice capitation rate under 
                        subparagraph (A) for a year (beginning with 
                        2000), the annual per capita rate of payment 
                        for 1997 determined under section 1876(a)(1)(C) 
                        shall be adjusted, subject to clause (ii) to 
                        exclude from the rate the additional payments 
                        that the Secretary estimates were payment 
                        during 1997 for additional payments described 
                        in section 1886(d)(5)(F).
                            ``(ii) Treatment of payments covered under 
                        state hospital reimbursement system.--To the 
                        extent that the Secretary estimates that an 
                        annual per capita rate of payment for 1997 
                        described in clause (i) reflects payments to 
                        hospitals reimbursed under section 1814(b)(3), 
                        the Secretary shall estimate a payment 
                        adjustment that is comparable to the payment 
                        adjustment that would have been made under 
                        clause (i) if the hospitals had not been 
                        reimbursed under such section.''.
    (b) Additional Payments for Managed Care Enrollees.--Section 
1886(d)(5)(F) of such Act ((42 U.S.C. 1395ww(d)(5)(F)) is amended--
            (1) in clause (ii), by striking ``clause (ix)'' and 
        inserting ``clauses (ix) and (x)'', and
            (2) by adding at the end the following:
                            ``(ix)(I) For portions of cost reporting 
                        periods occurring on or after January 1, 2000, 
                        the Secretary shall provide for an additional 
                        payment amount for each applicable discharge of 
                        any subsection (d) hospital that is a 
                        disproportionate share hospital (as described 
                        in clause (i)).
                            ``(II) For purposes of this clause the term 
                        `applicable discharge' means the discharge of 
                        any individual who is enrolled under a risk-
                        sharing contract with a eligible organization 
                        under section 1876 and who is entitled to 
                        benefits under part A or any individual who is 
                        enrolled with a Medicare+Choice organization 
                        under part C.
                            ``(III) The amount of the payment under 
                        this clause with respect to any applicable 
                        discharge shall be equal to the estimated 
                        average per discharge amount that would 
                        otherwise have been paid under this 
                        subparagraph if the individuals had not been 
                        enrolled as described in subclause (II).
                            ``(IV) The Secretary shall establish rules 
                        for an additional payment amount, for any 
                        hospital reimbursed under a reimbursement 
                        system authorized under 1814(b)(3) if such 
                        hospital would qualify as a disproportionate 
                        share hospital under clause (i) were it not so 
                        reimbursed. Such payment shall be determined in 
                        the same manner as the amount of payment is 
                        determined under this clause for 
                        disproportionate share hospitals.''.
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