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106TH CONGRESS

1ST SESSION H. R. 1103

To amend title XVIII of the Social Security Act to carve out from payments

to Medicare+Choice organizations amounts attributable to disproportionate share hospital payments and pay such amounts directly to those

disproportionate share hospitals in which their enrollees receive care.

IN THE HOUSE OF REPRESENTATIVES

MARCH 11, 1999

Mr. RANGEL (for himself, Mr. STARK, Mr. QUINN, Mr. WALSH, Mr. ACKERMAN, Mrs. CHRISTENSEN, Mr. DOYLE, Mr. FATTAH, Mr. FROST, Mr.

HINCHEY, Mr. HOLDEN, Mr. JENKINS, Ms. KILPATRICK, Mr. KLINK, Mr.

LAFALCE, Mr. LEWIS of Georgia, Mrs. MALONEY of New York, Mr. MASCARA, Mr. MATSUI, Mrs. MCCARTHY of New York, Mr. MCDERMOTT,

Mr. MCGOVERN, Ms. SLAUGHTER, Mr. MCNULTY, Mr. NADLER, Mr.

PASTOR, Mr. SERRANO, Mrs. THURMAN, Mr. TOWNS, and Ms.

VELA ́ZQUEZ) 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 carve

out from payments to Medicare+Choice organizations

amounts attributable to disproportionate share hospital

payments and pay such amounts directly to those disproportionate share hospitals in which their enrollees receive care.
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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. CARVING OUT DSH PAYMENTS FROM PAY4 MENTS TO MEDICARE+CHOICE ORGANIZA5 TIONS AND PAYING THE AMOUNTS DIRECTLY

6 TO DSH HOSPITALS ENROLLING

7 MEDICARE+CHOICE ENROLLEES.

8 (A) IN GENERAL.—Section 1853(c)(3) of the Social

9 Security Act (42 U.S.C. 1395w–23(c)(3)), as inserted by

10 section 4001 of the Balanced Budget Act of 1997, is

11 amended—

12 (1) in subparagraph (A), by striking ‘‘subpara13 graph (B)’’ and inserting ‘‘subparagraphs (B) and

14 (D)’’,

15 (2) by redesignating subparagraph (D) as sub16 paragraph (E), and

17 (3) by inserting after subparagraph (C) the fol18 lowing new subparagraph:

19 ‘‘(D) REMOVAL OF PAYMENTS ATTRIB20 UTABLE TO DISPROPORTIONATE SHARE PAY21 MENTS FROM CALCULATION OF ADJUSTED AV22 ERAGE PER CAPITA COST.—

23 ‘‘(i) IN GENERAL.—In determining

24 the area-specific Medicare+Choice capita25 tion rate under subparagraph (A) for a
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1 year (beginning with 2000), the annual per

2 capita rate of payment for 1997 deter3 mined under section 1876(a)(1)(C) shall be

4 adjusted, subject to clause (ii) to exclude

5 from the rate the additional payments that

6 the Secretary estimates were payment dur7 ing 1997 for additional payments described

8 in section 1886(d)(5)(F).

9 ‘‘(ii) TREATMENT OF PAYMENTS COV10 ERED UNDER STATE HOSPITAL REIM11 BURSEMENT SYSTEM.—To the extent that

12 the Secretary estimates that an annual per

13 capita rate of payment for 1997 described

14 in clause (i) reflects payments to hospitals

15 reimbursed under section 1814(b)(3), the

16 Secretary shall estimate a payment adjust17 ment that is comparable to the payment

18 adjustment that would have been made

19 under clause (i) if the hospitals had not

20 been reimbursed under such section.’’.

21 (b) ADDITIONAL PAYMENTS FOR MANAGED CARE

22 ENROLLEES.—Section 1886(d)(5)(F) of such Act ((42

23 U.S.C. 1395ww(d)(5)(F)) is amended—

24 (1) in clause (ii), by striking ‘‘clause (ix)’’ and

25 inserting ‘‘clauses (ix) and (x)’’, and
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1 (2) by adding at the end the following:

2 ‘‘(ix)(I) For portions of cost reporting

3 periods occurring on or after January 1,

4 2000, the Secretary shall provide for an

5 additional payment amount for each appli6 cable discharge of any subsection (d) hos7 pital that is a disproportionate share hos8 pital (as described in clause (i)).

9 ‘‘(II) For purposes of this clause the

10 term ‘applicable discharge’ means the dis11 charge of any individual who is enrolled

12 under a risk-sharing contract with a eligi13 ble organization under section 1876 and

14 who is entitled to benefits under part A or

15 any individual who is enrolled with a

16 Medicare+Choice organization under part

17 C.

18 ‘‘(III) The amount of the payment

19 under this clause with respect to any appli20 cable discharge shall be equal to the esti21 mated average per discharge amount that

22 would otherwise have been paid under this

23 subparagraph if the individuals had not

24 been enrolled as described in subclause

25 (II).
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1 ‘‘(IV) The Secretary shall establish

2 rules for an additional payment amount,

3 for any hospital reimbursed under a reim4 bursement system authorized under

5 1814(b)(3) if such hospital would qualify

6 as a disproportionate share hospital under

7 clause (i) were it not so reimbursed. Such

8 payment shall be determined in the same

9 manner as the amount of payment is de10 termined under this clause for dispropor11 tionate share hospitals.’’.

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