I 

108TH CONGRESS 

1ST SESSION H. R. 1351

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 

MARCH 19, 2003

Mr. ACEVEDO-VILA ́ 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 Fairness Act of 2003’’. 

6 SEC. 2. MODIFICATION OF PAYMENT RATE FOR PUERTO 

7 RICO HOSPITALS. 

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

9 U.S.C. 1395ww(d)(9)) is amended—

10 (1) in subparagraph (A)—
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1 (A) in clause (i), by striking ‘‘for dis2 charges beginning on or after October 1, 1997, 

3 50 percent (and for discharges between October 

4 1, 1987, and September 30, 1997, 75 percent)’’ 

5 and inserting ‘‘the applicable Puerto Rico per6 centage (specified in subparagraph (E))’’; and 

7 (B) in clause (ii), by striking ‘‘for dis8 charges beginning in a fiscal year beginning on 

9 or after October 1, 1997, 50 percent (and for 

10 discharges between October 1, 1987, and Sep11 tember 30, 1997, 25 percent)’’ and inserting 

12 ‘‘the applicable Federal percentage (specified in 

13 subparagraph (E))’’; and 

14 (2) by adding at the end the following new sub15 paragraph: 

16 ‘‘(E) For purposes of subparagraph (A), for dis17 charges occurring—

18 ‘‘(i) on or after October 1, 1987, and before Oc19 tober 1, 1997, the applicable Puerto Rico percentage 

20 is 75 percent and the applicable Federal percentage 

21 is 25 percent; 

22 ‘‘(ii) on or after October 1, 1997, and before 

23 October 1, 2003, the applicable Puerto Rico percent24 age is 50 percent and the applicable Federal per25 centage is 50 percent; 
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1 ‘‘(iii) on or after October 1, 2003, and before 

2 October 1, 2004, the applicable Puerto Rico percent3 age is 25 percent and the applicable Federal per4 centage is 75 percent; 

5 ‘‘(iv) on or after October 1, 2004, and before 

6 October 1, 2005, the applicable Puerto Rico percent7 age is 12.5 percent and the applicable Federal per8 centage is 87.5 percent; and 

9 ‘‘(v) on or after October 1, 2005, the applicable 

10 Puerto Rico percentage is 0 percent and the applica11 ble Federal percentage is 100 percent.’’. 

12 SEC. 3. CALCULATION OF MEDICARE DSH PAYMENTS FOR 

13 PPS HOSPITALS IN PUERTO RICO. 

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

15 Security Act (42 U.S.C. 1395ww(d)(9)), as amended by 

16 section 2, is amended—

17 (1) by striking subparagraph (D)(iii) and in18 serting the following: 

19 ‘‘(iii) Subparagraph (F) (relating to dispropor20 tionate share payments), except that for this pur21 pose—

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

23 subparagraph shall be substituted for the sum 

24 referred to in paragraph (5)(F)(ii)(I); and 
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1 ‘‘(II) the number of a subsection (d) Puer2 to Rico hospital’s SSI proxy patient days (as 

3 defined in subparagraph (F)) shall be sub4 stituted for the numerator referred to in para5 graph (5)(F)(vi)(I).’’; and 

6 (2) by adding at the end the following new sub7 paragraph: 

8 ‘‘(F)(i) For purposes of subparagraph (D)(iii)(II), 

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

10 patient days’ means the product of—

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

12 clause (ii)); and 

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

14 days for such period. 

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

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

17 Puerto Rico hospitals for cost reporting periods beginning 

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

19 (expressed as percentages) determined under paragraph 

20 (5)(F)(vi)(I) for all subsection (d) hospitals in the income21 equivalent proxy State (as defined in clause (iii)) for the 

22 most recent cost reporting period for which adequate data 

23 are available (other than hospitals for which such fraction 

24 or percentage is zero). 
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1 ‘‘(iii) For purposes of clause (ii), the term ‘income2 equivalent proxy State’ means, for cost reporting periods 

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

4 for which title XVI, as in effect without regard to the 

5 amendment made by section 301 of the Social Security 

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

7 income of which most closely approximates the per capita 

8 income of Puerto Rico (as determined by the Secretary 

9 based on the most recent period for which adequate data 

10 are available).’’. 

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

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

13 after October 1, 2003.

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