I

106TH CONGRESS

2D SESSION H. R. 5220

To amend title XVIII of the Social Security Act to preserve essential rural

hospitals.

IN THE HOUSE OF REPRESENTATIVES

SEPTEMBER 20, 2000

Mr. PAUL (for himself, Mr. EDWARDS, and Mr. SMITH of Texas) introduced

the following bill; which was referred to the Committee on Ways and

Means, and in addition to the Committee on Commerce, for a period to

be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee

concerned

A BILL

To amend title XVIII of the Social Security Act to preserve

essential rural 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 ‘‘Essential Rural Hos5 pital Preservation Act of 2000’’.
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1 SEC. 2. REVISIONS IN THE MEDICARE PROGRAM TO PRE2 SERVE ESSENTIAL RURAL HOSPITALS.

3 (a) ESSENTIAL RURAL HOSPITAL DEFINED.—Sec4 tion 1861 of the Social Security Act (42 U.S.C. 1395x)

5 is amended by adding at the end the following new sub6 section:

7 ‘‘Essential Rural Hospital

8 ‘‘(uu) The term ‘essential rural hospital’ means a

9 subsection (d) hospital (as defined in section

10 1886(d)(1)(B)) that is located in a rural area (as defined

11 in section 1886(d)(2)(D)) and that has 50 or fewer beds.’’.

12 (b) FLOOR ON WAGE INDEX APPLIED UNDER INPA13 TIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM.—Sec14 tion 1886(d)(3)(E) of the Social Security Act (42 U.S.C.

15 1395ww(d)(3)(E)) is amended by adding at the end the

16 following: ‘‘In no case shall the wage index factor for an

17 essential rural hospital (as defined in section 1861(uu))

18 be less than 1.0.’’.

19 (c) TREATING AS ALLOWABLE COSTS 100 PERCENT

20 OF BAD DEBTS ATTRIBUTABLE TO MEDICARE COPAY21 MENTS AND DEDUCTIONS.—Section 1861(v)(1)(T) of

22 such Act (42 U.S.C. 1395x(v)(1)(T)) is amended by in23 serting ‘‘(other than essential rural hospitals, as defined

24 in subsection (uu))’’ after ‘‘In determining such reason25 able costs for hospitals’’.
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1 (d) EXEMPTION FROM HOSPITAL OUTPATIENT PRO2 SPECTIVE PAYMENT SYSTEM.—Section 1833(t)(13) of

3 such Act (42 U.S.C. 1395l(t)(13)) is amended by adding

4 at the end the following new subparagraph:

5 ‘‘(B) EXEMPTION OF ESSENTIAL RURAL

6 HOSPITALS.—The system under this subsection

7 shall not apply to covered OPD services fur8 nished in an essential rural hospital (as defined

9 in section 1861(uu)).’’.

10 (e) DSH PAYMENTS.—Section 1886(d)(5)(F) of such

11 Act (42 U.S.C. 1395ww(d)(5)(F)) is amended—

12 (1) in clause (i)—

13 (A) by striking ‘‘or’’ at the end of sub14 clause (I);

15 (B) by striking the period at the end of

16 subclause (II); and

17 (C) by adding at the end the following new

18 subclause:

19 ‘‘(III) is an essential rural hospital (as defined

20 in section 1861(uu)).’’;

21 (2) in clause (ii), by striking ‘‘clause (ix)’’ and

22 inserting ‘‘clauses (ix) and (x)’’; and

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

24 clause:
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1 ‘‘(x) In no case shall the disproportionate share ad2 justment percentage under this subparagraph for a hos3 pital described in clause (i)(III) be less than 20 percent.’’.

4 (f) EFFECTIVE DATES.—The amendments made

5 by—

6 (1) subsections (b) and (e) apply to discharges

7 occurring on or after October 1, 2000;

8 (2) subsection (c) applies to cost reporting peri9 ods beginning on or after October 1, 2000; and

10 (3) subsection (d) applies to covered OPD serv11 ices furnished on or after October 1, 2000.

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