A bill to amend title XVIII of the Social Security Act to provide fair payments for care provided in a hospital emergency department.

Summary: Save Our Safety Net Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act to require payment to a physician of an additional 10% for emergency department visits.

Prescribes special rules for calculating the Medicare hospital outpatient department (OPD) fee schedule amounts for clinic and emergency department visits.

Extends from temporary to permanent the current adjustment to payments (hold harmless provisions) for certain small rural and sole community hospitals under the OPD prospective payment system (PPS).

Eliminates the cap on the Medicare disproportionate share hospital (DSH) adjustment for payments to rural hospitals.

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Save Our Safety 
Net Act of 2005''.
    (b) Table of Contents.--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.

SEC. 2. ENSURING ADEQUATE PHYSICIAN PAYMENT FOR EMERGENCY DEPARTMENT 
              VISITS.

    Section 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 Department.--In 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.''.

SEC. 3. ENSURING ADEQUATE HOSPITAL OUTPATIENT FEE SCHEDULE AMOUNTS FOR 
              CLINIC AND EMERGENCY DEPARTMENT VISITS.

    (a) In General.--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) In general.--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) Exemption from reduction.--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 general.--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 factor.--For 
                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 weights.--
                For 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 visits.--For 
                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 Authority.--Notwithstanding 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.

SEC. 4. PERMANENT EXTENSION OF ADJUSTMENT TO LIMIT DECLINE IN PAYMENTS 
              FOR CERTAIN HOSPITALS UNDER HOSPITAL OUTPATIENT PPS.

    (a) In General.--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) Effective Date.--The amendments made by subsection (a) shall 
apply to covered OPD services furnished on or after January 1, 2006.

SEC. 5. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE HOSPITAL (DSH) 
              ADJUSTMENT FOR RURAL HOSPITALS.

    Section 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.''.