[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7327 Introduced in House (IH)]

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118th CONGRESS
  2d Session
                                H. R. 7327

   To amend title XIX of the Social Security Act to ensure adequate 
  consideration of payment rates for multimission hospitals under the 
               Medicaid program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 13, 2024

 Ms. DeGette introduced the following bill; which was referred to the 
                    Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
   To amend title XIX of the Social Security Act to ensure adequate 
  consideration of payment rates for multimission hospitals under the 
               Medicaid program, and for other purposes.

    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 ``Protecting Front Line Multimission 
Hospitals Act of 2024''.

SEC. 2. ENSURING APPROPRIATE PAYMENT RATES FOR MULTIMISSION HOSPITALS 
              UNDER THE MEDICAID PROGRAM.

    Section 1902(a)(13)(A) of the Social Security Act (42 U.S.C. 
1396a(a)(13)(A)) is amended--
            (1) in clause (iii), by striking ``and'' at the end;
            (2) in clause (iv), by striking the semicolon and inserting 
        ``; and''; and
            (3) by adding at the end the following new clause:
                            ``(v) in the case of multimission hospitals 
                        (as defined in section 1923(k)) located within 
                        the State (or located within 100 miles of the 
                        State, in the case of a hospital that provides 
                        tertiary services under the State plan), such 
                        rates--
                                    ``(I) take into account the short- 
                                and long-term financial viability of 
                                such hospitals;
                                    ``(II) provide stable, predictable, 
                                and sufficient reimbursement to improve 
                                or maintain the financial viability of 
                                such hospitals; and
                                    ``(III) ensure that items and 
                                services are available to be furnished 
                                at such hospitals under the State plan 
                                (or waiver of such plan) to the same 
                                extent that such items and services are 
                                available to be furnished at such 
                                hospitals to the general population in 
                                a geographic region;''.

SEC. 3. ALLOWING FOR INCREASED DISPROPORTIONATE SHARE HOSPITAL 
              ADJUSTMENTS FOR CERTAIN HOSPITALS UNDER THE MEDICAID 
              PROGRAM.

    (a) In General.--Section 1923 of the Social Security Act (42 U.S.C. 
1396r-4) is amended by adding at the end the following new subsection:
    ``(k) Allowable Increase in Adjustments for Certain Hospitals.--
            ``(1) In general.--A payment adjustment under this section 
        during a fiscal year with respect to a hospital that is a 
        multimission hospital for such fiscal year that exceeds the 
        amount determined under subsection (g) with respect to such 
        hospital and fiscal year shall be deemed to be consistent with 
        subsection (c) to the extent that such payment adjustment is 
        less than or equal to the amount that would have been 
        determined under subsection (g) with respect to such hospital 
        and fiscal year had the costs incurred during such fiscal year 
        by such hospital (as described in paragraph (1)(A) of such 
        subsection (or, in the case of a specified hospital (as defined 
        in paragraph (5)), as described in paragraph (1)(A) of such 
        subsection as in effect on January 1, 2020)) to individuals 
        described in paragraph (1)(B) of such subsection (or, in the 
        case of a specified hospital, individuals described in 
        paragraph (1)(A) of such subsection as in effect on January 1, 
        2020) included costs incurred by such hospital during such 
        fiscal year that are described in paragraph (2) with respect to 
        individuals described in paragraph (3) and that are so incurred 
        for the purpose (as determined by the State) described in 
        paragraph (4).
            ``(2) Costs described.--For purposes of paragraph (1), the 
        costs described in this paragraph are costs for furnishing or 
        supporting the furnishing of physicians' services (as defined 
        in section 1848), services provided at Federally qualified 
        health center or any other clinical outpatient setting, and 
        emergency medical services (as defined in section 303(j)(13) of 
        the Controlled Substances Act).
            ``(3) Individuals described.--For purposes of paragraph 
        (1), the individuals described in this paragraph are, with 
        respect to costs incurred by a hospital for a fiscal year--
                    ``(A) except as provided in subparagraph (B), 
                individuals described in paragraph (1)(B) of subsection 
                (g); and
                    ``(B) in the case the amount determined under such 
                subsection for such hospital and such year is so 
                determined under paragraph (2)(A)(ii) of such 
                subsection, individuals described in paragraph (1)(A) 
                of such subsection as in effect on January 1, 2020.
            ``(4) Purpose described.--For purposes of paragraph (1), 
        the purpose described in this paragraph is to ensure that care 
        and services are available under the State plan (or waiver of 
        such plan) in a geographic area at least to the extent that 
        such care and services are available to the general population 
        in such area.
            ``(5) Definitions.--In this subsection:
                    ``(A) Disproportionate patient bed count.--The term 
                `disproportionate patient bed count' means, with 
                respect to a hospital and a fiscal year, the product 
                of--
                            ``(i) such hospital's disproportionate 
                        patient percentage for such fiscal year; and
                            ``(ii) such hospital's number of beds for 
                        such fiscal year.
                    ``(B) Multimission hospital.--The term 
                `multimission hospital' means, with respect to a fiscal 
                year--
                            ``(i) a public hospital with 100 or more 
                        beds that has--
                                    ``(I) an average Medicare case mix 
                                index of at least 1.3;
                                    ``(II) an intern and resident to 
                                bed ratio of at least 0.17 (or at least 
                                125 residents and fellows); and
                                    ``(III) an average disproportionate 
                                patient percentage over the 3-year 
                                period ending on the last day of such 
                                fiscal year of at least 40 percent (or 
                                a disproportionate patient percentage 
                                for such fiscal year of at least 40 
                                percent);
                            ``(ii) a nonprofit hospital with more than 
                        199 but fewer than 1,000 beds that has an 
                        average disproportionate patient percentage 
                        over the 3-year period ending on the last day 
                        of such fiscal year of at least 40 percent (or 
                        a disproportionate patient percentage for such 
                        fiscal year of at least 40 percent) and has--
                                    ``(I) in the case of such a 
                                hospital with an average 
                                disproportionate patient percentage 
                                over such period of at least 45 
                                percent--
                                            ``(aa) an average Medicare 
                                        case mix index of at least 1.5; 
                                        and
                                            ``(bb) an intern and 
                                        resident to bed ratio of at 
                                        least 0.19 (or at least 150 
                                        residents and fellows); or
                                    ``(II) in the case of such a 
                                hospital not described in subclause 
                                (I)--
                                            ``(aa) a disproportionate 
                                        patient bed count of at least 
                                        250;
                                            ``(bb) an average Medicare 
                                        case mix index of at least 2.0; 
                                        and
                                            ``(cc) an intern and 
                                        resident to bed ratio of at 
                                        least 0.2 (or at least 175 
                                        residents and fellows); and
                            ``(iii) a nonprofit hospital with 1,000 or 
                        more beds that has an average disproportionate 
                        patient percentage over the 3-year period 
                        ending on the last day of such fiscal year of 
                        at least 55 percent (or a disproportionate 
                        patient percentage for such fiscal year of at 
                        least 55 percent).
                    ``(C) Specified hospital.--The term `specified 
                hospital' means, with respect to a fiscal year, a 
                hospital with an amount determined under subsection (g) 
                for such year that is so determined under paragraph 
                (2)(A)(ii) of such subsection.''.
    (b) Conforming Amendment.--Section 1923(g)(1) of the Social 
Security Act (42 U.S.C. 1396r-4(g)(1)) is amended by striking ``A 
payment adjustment'' and inserting ``Subject to subsection (k), a 
payment adjustment''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to fiscal year 2024 and each subsequent fiscal year.
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