I 

118TH CONGRESS 

2D SESSION H. R. 9351 

To amend title XIX of the Social Security Act to modify certain limitations 

on disproportionate share hospital payment adjustments under the Medicaid program. 

IN THE HOUSE OF REPRESENTATIVES 

AUGUST 13, 2024 

Mr. LALOTA (for himself, Ms. CLARKE of New York, Mr. BUCSHON, Ms. 

MATSUI, Mr. LAWLER, and Mr. MRVAN) 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 modify 

certain limitations on disproportionate share hospital 

payment adjustments under the Medicaid program. 

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 ‘‘Save our Safety-Net 

5 Hospitals Act of 2024’’. 


ssavage on LAPJG3WLY3PROD with BILLS
2 

•HR 9351 IH

1 SEC. 2. MODIFYING CERTAIN LIMITATIONS ON DISPROPOR2 TIONATE SHARE HOSPITAL PAYMENT AD3 JUSTMENTS UNDER THE MEDICAID PRO4 GRAM. 

5 (a) IN GENERAL.—Section 1923(g) of the Social Se6 curity Act (42 U.S.C. 1396r–4(g)) is amended— 

7 (1) in paragraph (1)— 

8 (A) in subparagraph (A)— 

9 (i) in the matter preceding clause (i), 

10 by striking ‘‘(other than a hospital de11 scribed in paragraph (2)(B))’’; 

12 (ii) in clause (i), by inserting ‘‘with 

13 respect to such hospital and year’’ after 

14 ‘‘described in subparagraph (B)’’; and 

15 (iii) in clause (ii)— 

16 (I) in subclause (I), by striking 

17 ‘‘and’’ at the end; 

18 (II) in subclause (II), by striking 

19 the period and inserting ‘‘; and’’; and 

20 (III) by adding at the end the 

21 following new subclause: 

22 ‘‘(III) payments made under title 

23 XVIII or by an applicable plan (as de24 fined in section 1862(b)(8)(F)) for 

25 such services.’’; and 

26 (B) in subparagraph (B)— 


ssavage on LAPJG3WLY3PROD with BILLS
3 

•HR 9351 IH

1 (i) in the matter preceding clause (i), 

2 by striking ‘‘in this clause are’’ and insert3 ing ‘‘in this subparagraph are, with respect 

4 to a hospital and a year,’’; and 

5 (ii) by adding at the end the following 

6 new clause: 

7 ‘‘(iii) Individuals who are eligible for 

8 medical assistance under the State plan or 

9 under a waiver of such plan and for whom 

10 the State plan or waiver is the secondary 

11 payor for such services after application of 

12 benefits under title XVIII or under an ap13 plicable plan (as defined in section 

14 1862(b)(8)(F)), but only if the hospital 

15 has in the aggregate incurred costs exceed16 ing payments under such State plan, waiv17 er, title XVIII, or applicable plan for such 

18 services furnished to such individuals dur19 ing such year.’’; 

20 (2) by striking paragraph (2); 

21 (3) by redesignating paragraph (3) as para22 graph (2); and 

23 (4) in paragraph (2), as so redesignated, by 

24 striking ‘‘Notwithstanding paragraph (2) of this 


ssavage on LAPJG3WLY3PROD with BILLS
4 

•HR 9351 IH

1 subsection (as in effect on October 1, 2021), para2 graph (2)’’ and inserting ‘‘Paragraph (2)’’. 

3 (b) EFFECTIVE DATE.— 

4 (1) IN GENERAL.—The amendments made by 

5 this section shall apply to payment adjustments 

6 made under section 1923 of the Social Security Act 

7 (42 U.S.C. 1396r–4) during fiscal years beginning 

8 on or after October 1, 2021. 

9 (2) NO REQUIRED RECOUPMENT BASED ON

10 CHANGE IN CAP AMOUNTS.—In the case of a pay11 ment adjustment made by a State under section 

12 1923 of the Social Security Act (42 U.S.C. 1396r– 

13 4) prior to the date of the enactment of this Act 

14 that was, without application of the amendments 

15 made by this section, consistent with the method16 ology of such State for making such adjustments, 

17 such adjustment shall be deemed to be consistent 

18 with such methodology with the application of such 

19 amendments. 

Æ 


ssavage on LAPJG3WLY3PROD with BILLS