II

103D CONGRESS

1ST SESSION S. 1051

To amend title XVIII of the Social Security Act to extend the period during

which medicare-dependent, small rural hospitals receive additional payments under the medicare program for the operating costs of inpatient

hospital services, to revise the criteria for determining whether hospitals

are eligible for such additional payments, and to provide additional

payments under the medicare program to other medicare-dependent

±hospitals.

IN THE SENATE OF THE UNITED STATES

MAY 27 (legislative day, APRIL 19), 1993

Mr. MACK (for himself and Mr. GRAHAM) 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 extend

the period during which medicare-dependent, small rural

hospitals receive additional payments under the medicare

program for the operating costs of inpatient hospital

services, to revise the criteria for determining whether

hospitals are eligible for such additional payments, and

to provide additional payments under the medicare program to other medicare-dependent hospitals.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Medicare Dependent

3 Hospital Relief Act of 1993’’.

4 SEC. 2. SPECIAL TREATMENT FOR MEDICARE-DEPENDENT,

5 SMALL RURAL HOSPITALS.

6 (a) EXTENSION OF SPECIAL TREATMENT.—

7 (1) DETERMINATION OF PAYMENT AMOUNT.—

8 Section 1886(b)(3)(D) of the Social Security Act (42

9 U.S.C. 1395ww(b)(3)(D)) is amended by striking

10 ‘‘March 31, 1993,’’ and inserting ‘‘March 31,

11 1996,’’.

12 (2) ELIGIBILITY FOR DESIGNATION.—Section

13 1886(d)(5)(G)(i) of such Act (42 U.S.C.

14 1395ww(d)(5)(G)(i)) is amended by striking ‘‘March

15 31, 1993,’’ and inserting ‘‘March 31, 1996,’’.

16 (3) EFFECTIVE DATE.—The amendments made

17 by paragraphs (1) and (2) shall take effect as if in18 cluded in the enactment of section 6003(f) of the

19 Omnibus Budget Reconciliation Act of 1989.

20 (b) REVISION OF CRITERIA FOR DESIGNATION.—

21 (1) IN GENERAL.—Section

22 1886(d)(5)(G)(iii)(IV) of the Social Security Act (42

23 U.S.C. 1395ww(d)(5)(G)(iii)(IV)) is amended by

24 striking ‘‘during the cost reporting period beginning

25 during fiscal year 1987’’ and inserting ‘‘during at

26 least 2 of the cost reporting periods beginning on or
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1 after October 1, 1986, and ending on or before Sep2 tember 30, 1990,’’.

3 (2) EFFECTIVE DATE.—The amendment made

4 by paragraph (1) shall apply to cost reporting peri5 ods beginning on or after April 1, 1993.

6 SEC. 3. ADDITIONAL PAYMENT FOR OTHER MEDICARE DE7 PENDENT HOSPITALS.

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

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

10 (1) by redesignating subparagraphs (H) and (I)

11 as subparagraphs (I) and (J); and

12 (2) by inserting after subparagraph (G) the fol13 lowing new subparagraph:

14 ‘‘(G)(i) For discharges occurring on or after October

15 1, 1993, and on or before September 30, 1995, the Sec16 retary shall provide, in accordance with this subparagraph,

17 for an additional payment amount for each subsection (d)

18 hospital—

19 ‘‘(I) that is not a medicare-dependent, small

20 rural hospital (as defined in subparagraph (G)(iii));

21 and

22 ‘‘(II) for which not less than 65 percent of its

23 inpatient days or discharges during at least 2 of the

24 cost reporting periods beginning on or after October

25 1, 1986, and ending on or before September 30,
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1 1990, were attributable to inpatients entitled to ben2 efits under part A.

3 ‘‘(ii) The amount of the additional payment made

4 under this subparagraph for each discharge shall be equal

5 to 3 percent of the sum of—

6 ‘‘(I) the amount determined under paragraph

7 (1)(A)(iii); and

8 ‘‘(II) the amount paid to the hospital under

9 subparagraph (A) for that discharge.’’.

10 (b) APPLICABILITY TO HOSPITALS IN PUERTO

11 RICO.—Section 1886(d)(9)(D) of such Act (42 U.S.C.

12 1395ww(d)(9)(D)) is amended—

13 (1) in clause (iv), by striking ‘‘Subparagraph

14 (H)’’ and inserting ‘‘Subparagraph (I)’’;

15 (2) by redesignating clause (iv) as clause (v);

16 and

17 (3) by inserting after clause (iii) the following

18 new clause:

19 ‘‘(iv) Subparagraph (G) (relating to additional

20 payments for medicare-dependent hospitals).’’.

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

22 subsections (a) and (b) shall apply to discharges occurring

23 on or after October 1, 1993.

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