II 

112TH CONGRESS 

1ST SESSION S. 1900 

To amend title XVIII of the Social Security Act to preserve access to urban 

Medicare-dependent hospitals. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 17, 2011 

Mr. MENENDEZ (for himself, Mr. NELSON of Florida, and Mr. LAUTENBERG) 

introduced the following bill; which was read twice and referred to the 

Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to preserve 

access to urban Medicare-dependent 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 ‘‘Urban Medicare-De5 pendent Hospitals Preservation Act of 2011’’. 

6 SEC. 2. CRITERIA AND PAYMENT FOR CERTAIN URBAN 

7 MEDICARE-DEPENDENT HOSPITALS. 

8 (a) IN GENERAL.—Section 1886(d)(5) of the Social 

9 Security Act (42 U.S.C. 1395ww(d)(5)) is amended by 

10 adding at the end the following new subparagraph: 


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1 ‘‘(M)(i) For cost reporting periods begin2 ning on or after October 1, 2011, and before 

3 October 1, 2014, in the case of a subsection (d) 

4 hospital which is an urban Medicare-dependent 

5 hospital, payment under paragraph (1)(A) shall 

6 be equal to the sum of the amount determined 

7 under clause (ii) and the amount determined 

8 under paragraph (1)(A)(iii). 

9 ‘‘(ii) The amount determined under this 

10 clause is, for discharges occurring during a cost 

11 reporting period that begins on or after October 

12 1, 2011, and before October 1, 2014, 50 per13 cent of the amount by which the hospital’s tar14 get amount for the cost reporting period (as de15 fined in subsection (b)(3)(L)) exceeds the 

16 amount determined under paragraph (1)(A)(iii). 

17 ‘‘(iii) For purposes of this subparagraph, 

18 the term ‘urban Medicare-dependent hospital’ 

19 means, with respect to any cost reporting pe20 riod to which clause (i) applies, any hospital— 

21 ‘‘(I) located in an urban area or re22 classified to an urban area for wage index 

23 purposes; 

24 ‘‘(II) that does not receive payment— 


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1 ‘‘(aa) under subparagraph (C) as 

2 a rural referral center; 

3 ‘‘(bb) under subparagraph (D) as 

4 a sole community hospital; 

5 ‘‘(cc) under subparagraph (B) or 

6 under subsection (h); or 

7 ‘‘(dd) under subparagraph (F); 

8 ‘‘(III) that is not a physician-owned 

9 hospital, as defined in section 489.3 of title 

10 42, Code of Federal Regulations (as in ef11 fect as of the date of the enactment of this 

12 subparagraph); and 

13 ‘‘(IV) for which not less than 60 per14 cent of its inpatient days or discharges 

15 during the cost reporting period beginning 

16 in fiscal year 2006, or two of the three 

17 most recently audited cost reporting peri18 ods for which the Secretary has a settled 

19 cost report, were attributable to inpatients 

20 entitled to benefits under part A and not 

21 enrolled in a Medicare Advantage plan 

22 under part C.’’. 

23 (b) TARGET PAYMENT AMOUNT.—Section 

24 1886(b)(3) of the Social Security Act (42 U.S.C. 

25 1395ww(b)(3)) is amended— 


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1 (1) in subparagraph (B)(iv), by striking ‘‘and 

2 (D)’’ and inserting ‘‘, (D), and (M)’’; and 

3 (2) by adding at the end the following new sub4 paragraph: 

5 ‘‘(M) For cost reporting periods occurring 

6 on or after October 1, 2011, and before October 

7 1, 2014, in the case of a hospital that is an 

8 urban Medicare-dependent hospital (as defined 

9 in subsection (d)(5)(M)), the term ‘target 

10 amount’ means— 

11 ‘‘(i) with respect to the first 12-month 

12 cost reporting period in which this sub13 paragraph is applied to the hospital, the 

14 allowable operating costs of inpatient hos15 pital services (as defined in subsection 

16 (a)(4)) recognized under this title for the 

17 hospital for the 12-month cost reporting 

18 period beginning during fiscal year 2002 or 

19 2006 (whichever results in a higher target 

20 amount), increased by the applicable per21 centage increase under subparagraph 

22 (B)(iv) for each of fiscal years 2003 

23 through 2011 or 2007 through 2011, re24 spectively; and 


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1 ‘‘(ii) with respect to discharges occur2 ring after the first 12-month cost reporting 

3 period in which this subparagraph is ap4 plied to the hospital, the target amount for 

5 the preceding year increased by the appli6 cable percentage increase under subpara7 graph (B)(iv).’’. 

Æ 


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