I 

108TH CONGRESS 

1ST SESSION H. R. 1739

To amend title XVIII of the Social Security Act to increase payments under 

the Medicare Program to Puerto Rico hospitals. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 10, 2003

Mr. GREENWOOD (for himself, Mr. RANGEL, Mr. MCCRERY, Mr. CRANE, and 

Mr. GUTIERREZ) introduced the following bill; which was referred to the 

Committee on Ways and Means 

A BILL

To amend title XVIII of the Social Security Act to increase 

payments under the Medicare Program to Puerto Rico 

hospitals.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Medicare Puerto Rico 

5 Hospital Payment Parity Act of 2003’’. 

6 SEC. 2. MODIFICATION OF PAYMENT RATE FOR PUERTO 

7 RICO HOSPITALS. 

8 Section 1886(d)(9)(A) of the Social Security Act (42 

9 U.S.C. 1395ww(d)(9)(A)) is amended—
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1 (1) in clause (i), by striking ‘‘October 1, 1997, 

2 50 percent (’’ and inserting ‘‘October 1, 2003, 25 

3 percent (for discharges between October 1, 1997, 

4 and September 30, 2003, 50 percent,’’; and 

5 (2) in clause (ii), in the matter preceding sub6 clause (I), by striking ‘‘after October 1, 1997, 50 

7 percent (’’ and inserting ‘‘after October 1, 2003, 75 

8 percent (for discharges between October 1, 1997, 

9 and September 30, 2003, 50 percent,’’. 

10 SEC. 3. CALCULATION OF MEDICARE DSH PAYMENTS FOR 

11 PPS HOSPITALS IN PUERTO RICO. 

12 (a) IN GENERAL.—Section 1886(d)(9) of the Social 

13 Security Act (42 U.S.C. 1395ww(d)(9)) is amended—

14 (1) by striking subparagraph (D)(iii) and in15 serting the following: 

16 ‘‘(iii) Subparagraph (F) (relating to dispropor17 tionate share payments), except that for this pur18 pose—

19 ‘‘(I) the sum described in clause (ii) of this 

20 subparagraph shall be substituted for the sum 

21 referred to in paragraph (5)(F)(ii)(I); and 

22 ‘‘(II) the number of a subsection (d) Puer23 to Rico hospital’s SSI proxy patient days (as 

24 defined in subparagraph (E)) shall be sub-
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1 stituted for the numerator referred to in para2 graph (5)(F)(vi)(I).’’; and 

3 (2) by adding at the end the following new sub4 paragraph: 

5 ‘‘(E)(i) For purposes of subparagraph (D)(iii)(II), 

6 the term ‘subsection (d) Puerto Rico hospital’s SSI proxy 

7 patient days’ means the product obtained by multiplying—

8 ‘‘(I) the SSI proxy percentage (as defined in 

9 clause (ii)); by 

10 ‘‘(II) the total number of the hospital’s patient 

11 days for such period. 

12 ‘‘(ii) For purposes of clause (i)(I), the term ‘SSI 

13 proxy percentage’ means, with respect to all subsection (d) 

14 Puerto Rico hospitals for cost reporting periods beginning 

15 in a fiscal year, the unweighted average of the fractions 

16 (expressed as percentages) determined under paragraph 

17 (5)(F)(vi)(I) for all subsection (d) hospitals in the income18 equivalent proxy State (as defined in clause (iii)) for the 

19 most recent cost reporting period for which adequate data 

20 are available (other than hospitals for which such fraction 

21 or percentage is zero). 

22 ‘‘(iii) For purposes of clause (ii), the term ‘income23 equivalent proxy State’ means, for cost reporting periods 

24 beginning in a fiscal year, the State (other than a State 

25 for which title XVI, as in effect without regard to the 
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1 amendment made by section 301 of the Social Security 

2 Amendments of 1972, continues to apply) the per capita 

3 income of which most closely approximates the per capita 

4 income of Puerto Rico (as determined by the Secretary 

5 based on the most recent period for which adequate data 

6 are available).’’. 

7 (b) EFFECTIVE DATE.—The amendments made by 

8 subsection (a) shall apply to discharges occurring on or 

9 after October 1, 2003.

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