I 111th CONGRESS 2d Session H. R. 5417 IN THE HOUSE OF REPRESENTATIVES May 26, 2010 Ms. Eddie Bernice Johnson of Texas introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and 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 titles XIX and XVIII of the Social Security Act, as amended by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, with respect to payment of disproportionate share hospitals (DSH) under the Medicare and Medicaid programs.

1.

Medicare DSH report and payment adjustments in response to coverage expansion instead of PPACA and HCERA revisions

(a)

DSH report

Not later than January 1, 2016, the Secretary of Health and Human Services shall submit to Congress a report on Medicare DSH taking into account the impact of the health care reforms carried out under the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, in reducing the number of uninsured individuals. The report shall include recommendations relating to the following: (1)The appropriate amount, targeting, and distribution of Medicare DSH to compensate for higher Medicare costs, Medicaid reimbursement shortfalls, and uncompensated care associated with serving low-income beneficiaries (taking into account variations in the empirical justification for Medicare DSH attributable to hospital characteristics, including bed size), consistent with the original intent of Medicare DSH. (2)The appropriate amount, targeting, and distribution of Medicare DSH to hospitals given their continued uncompensated care costs, to the extent such costs remain. (b)

Payment adjustments in response to coverage expansion

(1)

In general

If there is a significant decrease in the national rate of uninsurance as a result of corrected PPACA (as determined under paragraph (2)(A)), then the Secretary of Health and Human Services shall, beginning no earlier than fiscal year 2018, implement the following adjustments to Medicare DSH: (A)In lieu of the amount of Medicare DSH payment that would otherwise be made under section 1886(d)(5)(F) of the Social Security Act, the amount of Medicare DSH payment shall be an amount based on the recommendations of the report under subsection (a)(1) and shall take into account variations in the empirical justification for Medicare DSH attributable to hospital characteristics, including bed size. (B)Subject to paragraph (3), make an additional payment to a hospital by an amount that is estimated based on the amount of uncompensated care provided by the hospital based on criteria for uncompensated care as determined by the Secretary, which shall exclude bad debt. (2)

Significant decrease in national rate of uninsurance as a result of this Act

For purposes of this subsection— (A)

In general

There is a significant decrease in the national rate of uninsurance as a result of corrected PPACA if there is a decrease in the national rate of uninsurance (as defined in subparagraph (B)) from 2012 to 2014 that exceeds 8 percentage points. (B)

National rate of uninsurance defined

The term national rate of uninsurance means, for a year, such rate for the under-65 population for the year as determined and published by the Bureau of the Census in its Current Population Survey in or about September of the succeeding year. (3)

Uncompensated care increase

(A)

Computation of DSH savings

For each fiscal year (beginning with fiscal year 2018), the Secretary shall estimate the aggregate reduction in the amount of Medicare DSH payment that would be expected to result from the adjustment under paragraph (1)(A). (B)

Structure of payment increase

The Secretary shall compute the additional payment to a hospital as described in paragraph (1)(B) for a fiscal year in accordance with a formula established by the Secretary that provides that— (i)the estimated aggregate amount of such increase for the fiscal year does not exceed 50 percent of the aggregate reduction in Medicare DSH estimated by the Secretary for such fiscal year; and (ii)hospitals with higher levels of uncompensated care receive a greater increase. (c)

Definitions

In this section: (1)The term Medicare DSH means adjustments in payments under section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(F)) for inpatient hospital services furnished by disproportionate share hospitals. (2)The term corrected PPACA means the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010. (d)

Elimination of HCERA provision

Section 1886 of the Social Security Act (42 U.S.C. 1395ww), as amended by sections 3133 and 10316 of the Patient Protection and Affordable Care Act and section 1104 of the Health Care and Education Reconciliation Act of 2010, is amended— (1)in subsection (d)(5)(F)(i), by striking Subject to subsection (r), for and inserting For; and (2)by striking subsection (r).

2.

Medicaid DSH revisions

Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r–4(f)(7)(A)), as amended by sections 2551(a)(4) and 10201(e)(1) of the Patient Protection and Affordable Care Act and section 1203(a) of the Health Care and Education Reconciliation Act of 2010, is amended— (1)clause (i), by striking 2014 through 2020 and inserting 2018 through 2024; and (2)in subclauses (I) through (VII) of clause (ii), by striking 2014, 2015, 2016, 2017, 2018, 2019, and 2020 and inserting 2018, 2019, 2020, 2021, 2022, 2023, and 2024, respectively.