[Congressional Record Volume 145, Number 139 (Thursday, October 14, 1999)]
[Senate]
[Page S12641]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. VOINOVICH (for himself and Mr. DeWine):
  S. 1728. A bill to amend title XIX of the Social Security Act to 
remove the limit on amount of medicaid disproportionate share hospital 
payment for hospitals in Ohio; to the Committee on Finance.


            medicaid hospital payment for hospitals in ohio

  Mr. VOINOVICH. Mr. President, I rise today with my good friend and 
colleague from Ohio, Senator Mike DeWine, to introduce legislation that 
will remove the limit on the amount of federal Medicaid 
disproportionate share (DSH) payments for hospitals in Ohio. In 1993, 
Congress passed the Omnibus Budget Reconciliation Act (OBRA) in an 
effort to curb the rate of growth of federal Medicaid DSH spending to 
hospitals. Section 1923(g) of that bill placed maximum payment caps on 
hospitals. Subsequently, Congress passed the Balanced Budget Act (BBA) 
in 1997, in which Section 1923(f) placed funding caps on states. With 
the implementation of the aggregate state DSH spending limits, 
hospital-specific caps are no longer needed to assure the financial 
integrity of the program.
  I have often spoken on the floor of the Senate in support of 
federalism. When the federal government makes overly prescriptive laws 
and regulations, it can erode the ability of state governments to 
protect consumers, promote economic development, and generate the 
revenue streams that fund education, public safety, infrastructure and 
other vital services. This is especially true in the case of Medicaid. 
Hospitals that provide care to indigent patients provide an invaluable 
service to their communities, often at great expense. DSH payments are 
intended to help reimburse those expenses. Congress should allow 
individual states to administer their DSH program in a way that 
provides the most funding for the most hospitals as possible. Without 
such leeway, we are imposing what is effectively an unfunded mandate on 
the private sector--telling these hospitals to treat Medicaid and 
uninsured patients without helping them pay for it. This is not good 
policy.
  This legislation is federalism at its best. Section 1923(g) fails to 
recognize that each state implements its DSH program differently, and 
thus fails to recognize that the hospital-specific caps adversely 
affect Ohio hospitals. This legislation is budget neutral, yet it gives 
my state the flexibility to implement the Medicaid DSH program in the 
fairest and most equitable manner.
  Under Ohio's DSH program, the Hospital Care Assurance Program (HCAP), 
all necessary hospital services are provided free of charge to persons 
below the federal poverty line. Generally, under HCAP, hospitals are 
taxed and those funds are used as the state's share to draw matching 
federal Medicaid DSH funds. The total pool is then distributed back to 
hospitals based on the level of each hospital's indigent care. Ideally, 
the DSH dollars should follow the indigent patients. However, partly 
because of the hospital-specific caps that were enacted in 1993, there 
are many HCAP hospitals that are reimbursed far less than the amount 
that would actually cover their indigent care expenses. The bill will 
give Ohio the ability to implement a new formula to correct this 
inequity within Ohio's overall spending limit.
  Mr. President, Ohio deserves the authority to make health care 
decisions that are in the best interest of her citizens and their local 
hospitals. Ohio is not seeking additional federal dollars, merely the 
flexibility to allocate reimbursement funds under the DSH program where 
the funds are needed most. I urge passage of this legislation that will 
give relief to our hospitals and allow them to continue to provide 
quality care to each and every citizen in my state.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1728

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. REMOVAL OF LIMIT ON AMOUNT OF MEDICAID 
                   DISPROPORTIONATE SHARE HOSPITAL PAYMENT FOR 
                   HOSPITALS IN OHIO.

       (a) In General.--Section 1923(g)(1) of the Social Security 
     Act (42 U.S.C. 1396r-4(g)(1)) is amended--
  (1) in subparagraph (A), by striking ``A'' and inserting ``Except as 
provided in subparagraph (D), a''; and
  (2) by adding at the end the following new subparagraph:
  ``(D) Exception.--The limitations in subparagraphs (A) and (C) shall 
not apply to payments made to hospitals (other than institutions for 
mental diseases or other mental health facilities) located in Ohio.''.
  (b) Effective Date.--The amendments made by subsection (a) shall 
apply to payments and payment adjustments made to hospitals on or after 
July 1, 1999.
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