1.Short
title; table of contents
(a)This Act may be cited
as the Save Our Safety Net Act of
2005
.
(b)The table of contents of this Act is as follows:
Sec. 1. Short title; table of
contents.
Sec. 2. Ensuring adequate physician payment for emergency
department visits.
Sec. 3. Ensuring adequate hospital outpatient fee schedule
amounts for clinic and emergency department visits.
Sec. 4. Permanent extension of adjustment to limit decline in
payments for certain hospitals under hospital outpatient PPS.
Sec. 5. Fairness in the Medicare disproportionate share
hospital (DSH) adjustment for rural hospitals.
2.Ensuring
adequate physician payment for emergency department visitsSection 1833 of the Social Security Act
(42 U.S.C.
1395l) is amended by adding at the end the following new
subsection:
(v)Save our safety
net payments for physicians’ services provided in an emergency
departmentIn the case of
physicians’ services furnished to an individual covered under the insurance
program established by this part in an emergency department on or after January
1, 2006, in addition to the amount of payment that would otherwise be made for
such services under this part, there also shall be paid to the physician or
other person (or to an employer or entity in the cases described in clause (A)
of section 1842(b)(6)) from the Federal Supplementary Insurance Trust Fund an
amount equal to 10 percent of the payment amount for the service under this
part.
.
3.Ensuring
adequate hospital outpatient fee schedule amounts for clinic and emergency
department visits
(a)Section 1833(t) of the
Social Security Act (42 U.S.C. 1395l(t))
is amended—
(1)in paragraph
(3)(C)(ii), by striking paragraph (8)(B)
and inserting
paragraphs (8)(B), (11)(B), and (13)(A)(i)
;
(2)in paragraph
(3)(C)(iii), by inserting (but not the conversion factor computed under
paragraph (13)(B))
after this subparagraph
;
(3)in paragraph
(3)(D)—
(A)in clause (i), by
striking conversion factor computed under subparagraph (C) for the
year
and inserting applicable conversion factor computed under
subparagraph (C), paragraph (11)(B), or paragraph (13)(B) for the year
;
and
(B)in clause (ii),
by inserting , paragraph (9)(A), or paragraph (13)(C)
after
paragraph (2)(C)
;
(4)in paragraph (9),
by amending subparagraph (B) to read as follows:
(B)Budget
neutrality adjustment
(i)If the Secretary makes revisions under subparagraph (A),
then the revisions for a year may not cause the estimated amount of
expenditures under this part for the year to increase or decrease from the
estimated amount of expenditures under this part (including expenditures
attributable to the special rules specified in paragraph (13)) that would have
been made if the revisions had not been made.
(ii)The relative payment weights determined under paragraph
(13)(C) and the conversion factor computed under paragraph (13)(B) shall not be
reduced by any budget neutrality adjustment made pursuant to this
subparagraph.
;
and
(5)by redesignating
paragraphs (13) through (16) as paragraphs (14) through (17), respectively, and
by inserting after paragraph (12) the following new paragraph:
(13)Special rules
for calculating medicare OPD fee schedule amount for clinic and emergency
visits
(A)In computing the medicare OPD fee schedule amount under
paragraph (3)(D) for covered OPD services that are furnished on or after
January 1, 2006, and classified within a group established or revised under
paragraph (2)(B) or (9)(A), respectively, for clinic and emergency visits (as
described in subparagraph (D)), the Secretary shall—
(i)substitute for
the conversion factor calculated under paragraph (3)(C) the conversion factor
calculated under subparagraph (B); and
(ii)substitute for
the relative payment weight established or revised under paragraph (2)(C) or
(9)(A), respectively, the relative payment weight determined under subparagraph
(C) for such group.
(B)Calculation of
conversion factorFor purposes of subparagraph (A)(i), the
conversion factor calculated under this subparagraph is—
(i)for services
furnished during 2006, an amount equal to the product of—
(I)the conversion
factor specified for such year in the final rule published on November 10,
2005, increased by the percentage by which such conversion factor is reduced
for such year pursuant to paragraph (2)(E), and not taking into account any
subsequent amendments to such final rule; and
(II)1.10; and
(ii)for services
furnished in a year beginning on or after January 1, 2007, the conversion
factor computed under this subparagraph for the previous year increased by the
OPD fee schedule increase factor specified under paragraph (3)(C)(iv) for the
year involved.
(C)Determination
of relative payment weightsFor purposes of subparagraph (A)(ii),
the relative payment weight determined under this subparagraph for a covered
OPD service that is classified within such a group is—
(i)for services
furnished during 2006, the relative payment weight specified for such group for
such period in the final rule published November 10, 2005, and not taking into
account any subsequent amendments to such final rule; and
(ii)for services
furnished in a year beginning on or after January 1, 2007—
(I)for ambulatory
patient classification group 0601 (relating to mid-level clinic visits), or a
successor to such group, the relative payment weight specified for such group
in the final rule referred to in clause (i); and
(II)for other
ambulatory patient classification groups described in subparagraph (D), the
relative payment weight established or revised under paragraph (2)(C) or
(9)(A), respectively, for such group for such year (but without regard to any
budget neutrality adjustment under paragraph (9)(B)).
(D)Groups for
clinic and emergency visitsFor purposes of this paragraph, the
groups established or revised under paragraph (2)(B) or (9)(A), respectively,
for clinic and emergency visits are ambulatory patient classification groups
0600, 0601, 0602, 0610, 0611, 0612, and 0620 as defined for purposes of the
final rule referred to in subparagraph (C)(i) (and any successors to such
groups).
.
(b)Limitation on
secretarial authorityNotwithstanding
section
1833(t) of the Social Security
Act (42
U.S.C. 1395l(t)), as amended by subsection (a), the Secretary
of Health and Human Services may not make any adjustment under—
(1)paragraph (2)(F),
(3)(C)(iii), (9)(B), or (9)(C) of
section
1833(t) of the Social Security
Act (42
U.S.C. 1395l(t)); or
(2)any other
provision of such section;
to ensure that the amendments made
by subsection (a) do not cause the estimated amount of expenditures under part
B of title XVIII of such Act (42 U.S.C. 1395j et seq.) to exceed
the estimated amount of expenditures that would have been made under such part
but for such amendments.4.Permanent
extension of adjustment to limit decline in payments for certain hospitals
under hospital outpatient PPS
(a)Section 1833(t)(7)(D)(i) of the Social Security Act (42
U.S.C. 1395l(t)(7)(D)(i)), as amended by section 5105 of the Deficit Reduction
Act of 2005 (Public Law 109–171), is amended—
(1)in the clause
heading—
(A)by striking
Temporary
and inserting
Permanent
; and
(B)by striking
Rural
(2)by striking
subclause (II);
(3)by striking
(I) In the case
and inserting In the case
;
(4)by striking
located in a rural area, for
and inserting , for
;
and
(5)by striking
furnished before January 1, 2006
.
(b)The amendments made by subsection (a) shall apply to covered
OPD services furnished on or after January 1, 2006.
5.Fairness in the
Medicare disproportionate share hospital (DSH) adjustment for rural
hospitalsSection
1886(d)(5)(F)(xiv)(II) of the Social Security
Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended—
(1)by striking
or, in the case
and all that follows through subparagraph
(G)(iv)
; and
(2)by inserting at the end the following new
sentence: The preceding sentence shall not apply to any hospital with
respect to discharges occurring on or after October 1, 2006.
.