[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5621 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5621

    To amend the Balanced Budget Act of 1997 to apply the Medicaid 
   disproportionate share hospital payment transition rule to public 
                        hospitals in all States.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 1, 2000

   Mr. Rush introduced the following bill; which was referred to the 
                         Committee on Commerce

_______________________________________________________________________

                                 A BILL


 
    To amend the Balanced Budget Act of 1997 to apply the Medicaid 
   disproportionate share hospital payment transition rule to public 
                        hospitals in all States.

    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 ``Medicaid DSH Fairness Act of 2000''.

SEC. 2. EXPANSION OF APPLICATION OF MEDICAID DSH TRANSITION RULE TO 
              PUBLIC HOSPITALS IN ALL STATES.

    (a) Application to Public Hospitals in All States.--
            (1) In general.--Section 4721(e) of the Balanced Budget Act 
        of 1997 (Public Law 105-33; 111 Stat. 514), as amended by 
        section 607 of the Medicare, Medicaid, and SCHIP Balanced 
        Budget Refinement Act of 1999 (Appendix F, 113 Stat. 1501A-
        321), as enacted into law by section 1000(a)(6) of Public Law 
        106-113, is amended--
                    (A) by striking ``July 1, 1997'' each place it 
                appears and inserting ``October 1, 2000'';
                    (B) by striking ``the State of California'' and 
                inserting ``hospitals owned or operated by a State (as 
                defined for purposes of title XIX of such Act), or by 
                an instrumentality or a unit of government within a 
                State (as so defined)'';
                    (C) by redesignating paragraph (3) as paragraph 
                (4);
                    (D) by striking ``and'' at the end of paragraph 
                (2); and
                    (E) by inserting after paragraph (2), the following 
                new paragraph:
            ``(3) `(as defined in subparagraph (B) but without regard 
        to clause (ii) of that subparagraph and subject to subsection 
        (d))' were substituted for `(as defined in subparagraph (B))' 
        in subparagraph (A) of such section; and''.
            (2) Special rule.--With respect to California, section 
        4721(e) of the Balanced Budget Act of 1997 (Public Law 105-33; 
        111 Stat. 514) as amended by section 607 of BBRA (113 Stat. 
        1501A-321) shall be applied without regard to the amendments 
        made by paragraph (1).
            (3) Effective date.--The amendments made by paragraph (1) 
        take effect on July 1, 2002.
    (b) Application To Certain States.--
            (1) In general.--Beginning with fiscal year 2002, 
        notwithstanding section 1923(f) of the Social Security Act (42 
        U.S.C. 1396r-4(f)) and subject to paragraph (3), with respect 
        to a State, payment adjustments made under title XIX of such 
        Act (42 U.S.C. 1396 et seq.) after the application of section 
        4721(e) of the Balanced Budget Act of 1997 (as amended by 
        subsection (a)(1)) to any hospital described in paragraph (2) 
        located in the State shall be made without regard to the DSH 
        allotment limitation for the State determined under section 
        1923(f) of that Act (42 U.S.C. 1396r-4(f)).
            (2) Hospital described.--A hospital is described in this 
        paragraph if the hospital--
                    (A) is described in section 4721(e) of the Balanced 
                Budget Act of 1997 (as amended by subsection (a)(1));
                    (B) as of October 1, 2000--
                            (i) is in existence and operating as a 
                        hospital described in such section (as so 
                        amended); and
                            (ii) is not receiving disproportionate 
                        share hospital payments from the State in which 
                        it is located under title XIX of such Act; and
                    (C) has a low-income utilization rate (as defined 
                in section 1923(b)(3) of the Social Security Act (42 
                U.S.C. 1396r-4(b)(3))) in excess of 65 percent.
            (3) Limitation on expenditures.--
                    (A) In general.--With respect to any fiscal year, 
                the aggregate amount of Federal financial participation 
                that may be provided for payment adjustments described 
                in paragraph (1) for that fiscal year may not exceed 
                the amount described in subparagraph (B) for the fiscal 
                year.
                    (B) Amount described.--The amount described in this 
                subparagraph for a fiscal year is as follows:
                            (i) For fiscal year 2002, $15,000,000.
                            (ii) For fiscal year 2003, $176,000,000.
                            (iii) For fiscal year 2004, $270,000,000.
                            (iv) For fiscal year 2005, $330,000,000.
                            (v) For fiscal year 2006 and each fiscal 
                        year thereafter, $375,000,000.
    (c) Application To Waivers.--With respect to a State medicaid 
program operating under a Statewide waiver of the requirements of title 
XIX of the Social Security Act (42 U.S.C. 1396 et seq.) under section 
1115 of such Act (42 U.S.C. 1315), to the extent that the amendment 
made by subsection (a)(1) would modify the total amount that the State 
would expend under such title in a fiscal year if the State were not 
operating under such a waiver, the Secretary of Health and Human 
Services shall revise the budget neutrality baseline expenditure limit 
applicable to the waiver to reflect the increase in State expenditures 
under the medicaid program for such fiscal year that would be incurred 
in the absence of the waiver as a result of such amendment. Such 
modified budget neutrality baseline expenditure limit shall take effect 
on the effective date described in subsection (a)(3).
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