I

103D CONGRESS

1ST SESSION H. R. 2850

To amend title XVIII of the Social Security Act to provide an additional

payment under part A of the medicare program for the operating costs

of inpatient hospital services of hospitals with a high proportion of

patients who are medicare beneficiaries.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 3, 1993

Mr. SMITH of New Jersey (for himself and Mr. SAXTON) introduced the

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

A BILL

To amend title XVIII of the Social Security Act to provide

an additional payment under part A of the medicare

program for the operating costs of inpatient hospital

services of hospitals with a high proportion of patients

who are medicare beneficiaries.

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 ‘‘High Medicare Hos5 pital Relief Act of 1993’’.
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1 SEC. 2. ADDITIONAL MEDICARE PAYMENT FOR HIGH MEDI2 CARE HOSPITALS.

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

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

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

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

7 (2) by inserting after subparagraph (G) the fol8 lowing new subparagraph:

9 ‘‘(H)(i) For discharges occurring on or after October

10 1, 1993, and before October 1, 1995, the Secretary shall

11 provide, in accordance with this subparagraph, for an ad12 ditional payment for each high medicare hospital.

13 ‘‘(ii) The amount of the additional payment under

14 this subparagraph for each discharge shall be determined

15 by multiplying (I) the sum of the amount determined

16 under paragraph (1)(A)(ii)(II) (or, if applicable, the

17 amount determined under paragraph (1)(A)(iii)) and the

18 amount paid to the hospital under subparagraph (A) for

19 that discharge, by (II) the applicable high medicare ad20 justment percentage established under clause (iii) for the

21 cost reporting period in which the discharge occurs.

22 ‘‘(iii) The high medicare adjustment percentage for

23 a cost reporting period is equal to—

24 ‘‘(I) for a hospital located in an urban area, the

25 difference (expressed as a percentage) between the

26 average of the medicare operating margins of all
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1 subsection (d) hospitals located in urban areas that

2 are not high medicare hospitals and the average of

3 the medicare operating margins of all high medicare

4 hospitals located in urban areas, as determined for

5 the most recent cost reporting period for which such

6 medicare operating margins may be determined (ex7 cept that such percentage may not be less than 0

8 percent);

9 ‘‘(II) for a hospital that is located in a rural

10 area and has 100 or more beds, the difference (ex11 pressed as a percentage) between the average of the

12 medicare operating margins of all subsection (d)

13 hospitals located in rural areas and having 100 or

14 more beds that are not high medicare hospitals and

15 the average of the medicare operating margins of all

16 high medicare hospitals located in rural areas and

17 having 100 or more beds, as determined for the

18 most recent cost reporting period for which such

19 medicare operating margins may be determined (ex20 cept that such percentage may not be less than 0

21 percent); and

22 ‘‘(III) for a hospital that is located in a rural

23 area and has less than 100 beds, the difference (ex24 pressed as a percentage) between the average of the

25 medicare operating margins of all subsection (d)
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1 hospitals located in rural areas and having less than

2 100 beds that are not high medicare hospitals and

3 the average of the medicare operating margins of all

4 high medicare hospitals located in rural areas and

5 having less than 100 beds, as determined for the

6 most recent cost reporting period for which such

7 medicare operating margins may be determined (ex8 cept that such percentage may not be less than 0

9 percent).

10 ‘‘(iv) In this subparagraph, the term ‘high medicare

11 hospital’ means a subsection (d) hospital for which not

12 less than 65 percent of its inpatient days or discharges

13 during the cost reporting period beginning in fiscal year

14 1991 were attributable to inpatients entitled to benefits

15 under part A.

16 ‘‘(v) In this subparagraph, a hospital’s ‘medicare op17 erating margin’ for a cost reporting period is equal to the

18 quotient of—

19 ‘‘(I) the difference between the amount of the

20 payments received by the hospital under this title

21 during the cost reporting period for the operating

22 costs of inpatient hospital services and the costs to

23 the hospital of providing such services; divided by

24 ‘‘(II) the amount of the payments received by

25 the hospital under this title during the cost report-
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1 ing period for the operating costs of inpatient hos2 pital services.’’.

3 (b) CONFORMING AMENDMENT.—Section

4 1886(d)(9)(D)(iv) of such Act (42 U.S.C.

5 1395ww(d)(9)(D)(iv)) is amended by striking ‘‘Subpara6 graph (H)’’ and inserting ‘‘Subparagraph (I)’’.

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

8 subsections (a) and (b) shall apply with respect to dis9 charges occurring on or after October 1, 1993.

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