I 

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. 

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 ‘‘Protecting Front Line 

5 Multimission Hospitals Act of 2024’’. 


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1 SEC. 2. ENSURING APPROPRIATE PAYMENT RATES FOR 

2 MULTIMISSION HOSPITALS UNDER THE MED3 ICAID PROGRAM. 

4 Section 1902(a)(13)(A) of the Social Security Act 

5 (42 U.S.C. 1396a(a)(13)(A)) is amended— 

6 (1) in clause (iii), by striking ‘‘and’’ at the end; 

7 (2) in clause (iv), by striking the semicolon and 

8 inserting ‘‘; and’’; and 

9 (3) by adding at the end the following new 

10 clause: 

11 ‘‘(v) in the case of multimission hos12 pitals (as defined in section 1923(k)) lo13 cated within the State (or located within 

14 100 miles of the State, in the case of a 

15 hospital that provides tertiary services 

16 under the State plan), such rates— 

17 ‘‘(I) take into account the short18 and long-term financial viability of 

19 such hospitals; 

20 ‘‘(II) provide stable, predictable, 

21 and sufficient reimbursement to im22 prove or maintain the financial viabil23 ity of such hospitals; and 

24 ‘‘(III) ensure that items and 

25 services are available to be furnished 

26 at such hospitals under the State plan 


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1 (or waiver of such plan) to the same 

2 extent that such items and services 

3 are available to be furnished at such 

4 hospitals to the general population in 

5 a geographic region;’’. 

6 SEC. 3. ALLOWING FOR INCREASED DISPROPORTIONATE 

7 SHARE HOSPITAL ADJUSTMENTS FOR CER8 TAIN HOSPITALS UNDER THE MEDICAID PRO9 GRAM. 

10 (a) IN GENERAL.—Section 1923 of the Social Secu11 rity Act (42 U.S.C. 1396r–4) is amended by adding at 

12 the end the following new subsection: 

13 ‘‘(k) ALLOWABLE INCREASE IN ADJUSTMENTS FOR

14 CERTAIN HOSPITALS.— 

15 ‘‘(1) IN GENERAL.—A payment adjustment 

16 under this section during a fiscal year with respect 

17 to a hospital that is a multimission hospital for such 

18 fiscal year that exceeds the amount determined 

19 under subsection (g) with respect to such hospital 

20 and fiscal year shall be deemed to be consistent with 

21 subsection (c) to the extent that such payment ad22 justment is less than or equal to the amount that 

23 would have been determined under subsection (g) 

24 with respect to such hospital and fiscal year had the 

25 costs incurred during such fiscal year by such hosVerDate Sep 11 2014 03:46 Feb 21, 2024 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7327.IH H7327

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1 pital (as described in paragraph (1)(A) of such sub2 section (or, in the case of a specified hospital (as de3 fined in paragraph (5)), as described in paragraph 

4 (1)(A) of such subsection as in effect on January 1, 

5 2020)) to individuals described in paragraph (1)(B) 

6 of such subsection (or, in the case of a specified hos7 pital, individuals described in paragraph (1)(A) of 

8 such subsection as in effect on January 1, 2020) in9 cluded costs incurred by such hospital during such 

10 fiscal year that are described in paragraph (2) with 

11 respect to individuals described in paragraph (3) and 

12 that are so incurred for the purpose (as determined 

13 by the State) described in paragraph (4). 

14 ‘‘(2) COSTS DESCRIBED.—For purposes of 

15 paragraph (1), the costs described in this paragraph 

16 are costs for furnishing or supporting the furnishing 

17 of physicians’ services (as defined in section 1848), 

18 services provided at Federally qualified health center 

19 or any other clinical outpatient setting, and emer20 gency medical services (as defined in section 

21 303(j)(13) of the Controlled Substances Act). 

22 ‘‘(3) INDIVIDUALS DESCRIBED.—For purposes 

23 of paragraph (1), the individuals described in this 

24 paragraph are, with respect to costs incurred by a 

25 hospital for a fiscal year— 


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1 ‘‘(A) except as provided in subparagraph 

2 (B), individuals described in paragraph (1)(B) 

3 of subsection (g); and 

4 ‘‘(B) in the case the amount determined 

5 under such subsection for such hospital and 

6 such year is so determined under paragraph 

7 (2)(A)(ii) of such subsection, individuals de8 scribed in paragraph (1)(A) of such subsection 

9 as in effect on January 1, 2020. 

10 ‘‘(4) PURPOSE DESCRIBED.—For purposes of 

11 paragraph (1), the purpose described in this para12 graph is to ensure that care and services are avail13 able under the State plan (or waiver of such plan) 

14 in a geographic area at least to the extent that such 

15 care and services are available to the general popu16 lation in such area. 

17 ‘‘(5) DEFINITIONS.—In this subsection: 

18 ‘‘(A) DISPROPORTIONATE PATIENT BED

19 COUNT.—The term ‘disproportionate patient 

20 bed count’ means, with respect to a hospital 

21 and a fiscal year, the product of— 

22 ‘‘(i) such hospital’s disproportionate 

23 patient percentage for such fiscal year; and 

24 ‘‘(ii) such hospital’s number of beds 

25 for such fiscal year. 


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1 ‘‘(B) MULTIMISSION HOSPITAL.—The term 

2 ‘multimission hospital’ means, with respect to a 

3 fiscal year— 

4 ‘‘(i) a public hospital with 100 or 

5 more beds that has— 

6 ‘‘(I) an average Medicare case 

7 mix index of at least 1.3; 

8 ‘‘(II) an intern and resident to 

9 bed ratio of at least 0.17 (or at least 

10 125 residents and fellows); and 

11 ‘‘(III) an average dispropor12 tionate patient percentage over the 3- 

13 year period ending on the last day of 

14 such fiscal year of at least 40 percent 

15 (or a disproportionate patient percent16 age for such fiscal year of at least 40 

17 percent); 

18 ‘‘(ii) a nonprofit hospital with more 

19 than 199 but fewer than 1,000 beds that 

20 has an average disproportionate patient 

21 percentage over the 3-year period ending 

22 on the last day of such fiscal year of at 

23 least 40 percent (or a disproportionate pa24 tient percentage for such fiscal year of at 

25 least 40 percent) and has— 


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1 ‘‘(I) in the case of such a hos2 pital with an average disproportionate 

3 patient percentage over such period of 

4 at least 45 percent— 

5 ‘‘(aa) an average Medicare 

6 case mix index of at least 1.5; 

7 and 

8 ‘‘(bb) an intern and resident 

9 to bed ratio of at least 0.19 (or 

10 at least 150 residents and fel11 lows); or 

12 ‘‘(II) in the case of such a hos13 pital not described in subclause (I)— 

14 ‘‘(aa) a disproportionate pa15 tient bed count of at least 250; 

16 ‘‘(bb) an average Medicare 

17 case mix index of at least 2.0; 

18 and 

19 ‘‘(cc) an intern and resident 

20 to bed ratio of at least 0.2 (or at 

21 least 175 residents and fellows); 

22 and 

23 ‘‘(iii) a nonprofit hospital with 1,000 

24 or more beds that has an average dis25 proportionate patient percentage over the 


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1 3-year period ending on the last day of 

2 such fiscal year of at least 55 percent (or 

3 a disproportionate patient percentage for 

4 such fiscal year of at least 55 percent). 

5 ‘‘(C) SPECIFIED HOSPITAL.—The term 

6 ‘specified hospital’ means, with respect to a fis7 cal year, a hospital with an amount determined 

8 under subsection (g) for such year that is so de9 termined under paragraph (2)(A)(ii) of such 

10 subsection.’’. 

11 (b) CONFORMING AMENDMENT.—Section 1923(g)(1) 

12 of the Social Security Act (42 U.S.C. 1396r–4(g)(1)) is 

13 amended by striking ‘‘A payment adjustment’’ and insert14 ing ‘‘Subject to subsection (k), a payment adjustment’’. 

15 (c) EFFECTIVE DATE.—The amendments made by 

16 this section shall apply with respect to fiscal year 2024 

17 and each subsequent fiscal year. 

Æ 


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