[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 653 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                 S. 653

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


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             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

_______________________________________________________________________

                                 A BILL


 
 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.
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