II

106TH CONGRESS

2D SESSION S. 3187

To require the Secretary of Health and Human Services to apply aggregate

upper payment limits to non-State publicly owned or operated facilities

under the medicaid program.

IN THE SENATE OF THE UNITED STATES

OCTOBER 11 (legislative day, SEPTEMBER 22), 2000

Mr. ROTH introduced the following bill; which was read the first time

A BILL

To require the Secretary of Health and Human Services

to apply aggregate upper payment limits to non-State

publicly owned or operated facilities 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 ‘‘Medicaid Protection

5 Act’’.
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•S 3187 IS

1 SEC. 2. APPLICATION OF AGGREGATE UPPER PAYMENT

2 LIMITS TO NON-STATE PUBLICLY OWNED OR

3 OPERATED FACILITIES.

4 (a) ISSUANCE OF FINAL REGULATION.—Not later

5 than 30 days after the date of enactment of this Act, the

6 Secretary of Health and Human Services (in this section

7 referred to as the ‘‘Secretary’’), notwithstanding any re8 quirement of the Administrative Procedures Act under

9 chapter 5 of title 5, United States Code, or any other pro10 vision of law, shall issue a final regulation that provides

11 as follows (in addition to any other limitations established

12 under part 447 of title 42, Code of Federal Regulations):

13 (1) APPLICATION OF UPPER PAYMENT LIM14 ITS.—Except as provided in paragraph (3), aggre15 gate payments to each group of non-State publicly

16 owned or operated facilities described in paragraph

17 (2) under the medicaid program under title XIX of

18 the Social Security Act (42 U.S.C. 1396 et seq.) (in

19 this section referred to as the ‘‘medicaid program’’)

20 may not exceed the amount that can reasonably be

21 estimated would have been paid under medicare rea22 sonable cost payment principles under title XVIII of

23 such Act (42 U.S.C. 1395 et seq.).

24 (2) GROUPS DESCRIBED.—For purposes of this

25 subsection, each of the following is a group of facili26 ties:
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•S 3187 IS

1 (A) Hospitals with respect to their provi2 sion of inpatient hospital services (as such

3 terms are used for purposes of the medicaid

4 program).

5 (B) Hospitals with respect to their provi6 sion of outpatient hospital services (as so used).

7 (C) Nursing facilities (as so used).

8 (D) Intermediate care facilities for the

9 mentally retarded (as so used).

10 (3) DISPROPORTIONATE SHARE.—The upper

11 payment limitation established under paragraph (1)

12 does not apply to payment adjustments made under

13 a State plan to hospitals found to serve a dispropor14 tionate number of low-income patients with special

15 needs as provided in section 1923 of the Social Se16 curity Act (42 U.S.C.1396r–4).

17 (4) IMMEDIATE APPLICATION.—Except as pro18 vided in paragraph (5), the regulation is effective

19 upon publication, applies to services furnished on or

20 after that date, and requires States to immediately

21 apply payment rates under the medicaid program to

22 each group of non-State publicly owned or operated

23 facilities described in paragraph (2) in compliance

24 with the regulation.
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1 (5) TRANSITION PERIOD FOR PRIOR APPROVED

2 AMENDMENTS.—In the case of any State plan

3 amendment under the medicaid program that, as of

4 the date of enactment of this section, has been ap5 proved on a basis other than a deemed approval

6 basis as a result of an expired deadline for approval

7 by the Secretary, and that provides for payments

8 that are in excess of the payment limitation estab9 lished under the regulation, the regulation provides

10 that a State shall be considered to be in compliance

11 with the regulation so long as the State makes spe12 cific payment reductions on a timeline specified in

13 the regulation so that, for any period (or portion of

14 a period) that occurs on or after October 1, 2002,

15 payments made by the State under the medicaid

16 program comply with the regulation.

17 (b) DISAPPROVAL OF PLAN AMENDMENTS.—Upon

18 the publication of the final regulation under subsection

19 (a), the Secretary shall disapprove any pending proposed

20 State plan amendment under the medicaid program inso21 far as such amendment would permit payments under the

22 medicaid program in excess of payments permitted under

23 the final regulation required under subsection (a).

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