I 

111TH CONGRESS 

2D SESSION H. R. 5417 

To amend titles XIX and XVIII of the Social Security Act, as amended 

by the Patient Protection and Affordable Care Act and the Health 

Care and Education Reconciliation Act of 2010, with respect to payment 

of disproportionate share hospitals (DSH) under the Medicare and Medicaid programs. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 26, 2010 

Ms. EDDIE BERNICE JOHNSON of Texas introduced the following bill; which 

was referred to the Committee on Ways and Means, and in addition to 

the Committee on Energy and Commerce, for a period to be subsequently 

determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend titles XIX and XVIII of the Social Security Act, 

as amended by the Patient Protection and Affordable 

Care Act and the Health Care and Education Reconciliation Act of 2010, with respect to payment of disproportionate share hospitals (DSH) under the Medicare and 

Medicaid programs. 

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. MEDICARE DSH REPORT AND PAYMENT AD2 JUSTMENTS IN RESPONSE TO COVERAGE EX3 PANSION INSTEAD OF PPACA AND HCERA RE4 VISIONS. 

5 (a) DSH REPORT.—Not later than January 1, 2016, 

6 the Secretary of Health and Human Services shall submit 

7 to Congress a report on Medicare DSH taking into ac8 count the impact of the health care reforms carried out 

9 under the Patient Protection and Affordable Care Act, as 

10 amended by the Health Care and Education Reconciliation 

11 Act of 2010, in reducing the number of uninsured individ12 uals. The report shall include recommendations relating 

13 to the following: 

14 (1) The appropriate amount, targeting, and dis15 tribution of Medicare DSH to compensate for higher 

16 Medicare costs, Medicaid reimbursement shortfalls, 

17 and uncompensated care associated with serving low18 income beneficiaries (taking into account variations 

19 in the empirical justification for Medicare DSH at20 tributable to hospital characteristics, including bed 

21 size), consistent with the original intent of Medicare 

22 DSH. 

23 (2) The appropriate amount, targeting, and dis24 tribution of Medicare DSH to hospitals given their 

25 continued uncompensated care costs, to the extent 

26 such costs remain. 


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1 (b) PAYMENT ADJUSTMENTS IN RESPONSE TO COV2 ERAGE EXPANSION.— 

3 (1) IN GENERAL.—If there is a significant de4 crease in the national rate of uninsurance as a result 

5 of corrected PPACA (as determined under para6 graph (2)(A)), then the Secretary of Health and 

7 Human Services shall, beginning no earlier than fis8 cal year 2018, implement the following adjustments 

9 to Medicare DSH: 

10 (A) In lieu of the amount of Medicare 

11 DSH payment that would otherwise be made 

12 under section 1886(d)(5)(F) of the Social Secu13 rity Act, the amount of Medicare DSH payment 

14 shall be an amount based on the recommenda15 tions of the report under subsection (a)(1) and 

16 shall take into account variations in the empir17 ical justification for Medicare DSH attributable 

18 to hospital characteristics, including bed size. 

19 (B) Subject to paragraph (3), make an ad20 ditional payment to a hospital by an amount 

21 that is estimated based on the amount of un22 compensated care provided by the hospital 

23 based on criteria for uncompensated care as de24 termined by the Secretary, which shall exclude 

25 bad debt. 


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1 (2) SIGNIFICANT DECREASE IN NATIONAL RATE

2 OF UNINSURANCE AS A RESULT OF THIS ACT.—For 

3 purposes of this subsection— 

4 (A) IN GENERAL.—There is a ‘‘significant 

5 decrease in the national rate of uninsurance as 

6 a result of corrected PPACA’’ if there is a de7 crease in the national rate of uninsurance (as 

8 defined in subparagraph (B)) from 2012 to 

9 2014 that exceeds 8 percentage points. 

10 (B) NATIONAL RATE OF UNINSURANCE

11 DEFINED.—The term ‘‘national rate of 

12 uninsurance’’ means, for a year, such rate for 

13 the under-65 population for the year as deter14 mined and published by the Bureau of the Cen15 sus in its Current Population Survey in or 

16 about September of the succeeding year. 

17 (3) UNCOMPENSATED CARE INCREASE.— 

18 (A) COMPUTATION OF DSH SAVINGS.—For 

19 each fiscal year (beginning with fiscal year 

20 2018), the Secretary shall estimate the aggre21 gate reduction in the amount of Medicare DSH 

22 payment that would be expected to result from 

23 the adjustment under paragraph (1)(A). 

24 (B) STRUCTURE OF PAYMENT IN25 CREASE.—The Secretary shall compute the adVerDate Mar 15 2010 22:40 May 27, 2010 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5417.IH H5417

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1 ditional payment to a hospital as described in 

2 paragraph (1)(B) for a fiscal year in accordance 

3 with a formula established by the Secretary 

4 that provides that— 

5 (i) the estimated aggregate amount of 

6 such increase for the fiscal year does not 

7 exceed 50 percent of the aggregate reduc8 tion in Medicare DSH estimated by the 

9 Secretary for such fiscal year; and 

10 (ii) hospitals with higher levels of un11 compensated care receive a greater in12 crease. 

13 (c) DEFINITIONS.—In this section: 

14 (1) The term ‘‘Medicare DSH’’ means adjust15 ments in payments under section 1886(d)(5)(F) of 

16 the Social Security Act (42 U.S.C. 

17 1395ww(d)(5)(F)) for inpatient hospital services fur18 nished by disproportionate share hospitals. 

19 (2) The term ‘‘corrected PPACA’’ means the 

20 Patient Protection and Affordable Care Act, as 

21 amended by the Health Care and Education Rec22 onciliation Act of 2010. 

23 (d) ELIMINATION OF HCERA PROVISION.—Section 

24 1886 of the Social Security Act (42 U.S.C. 1395ww), as 

25 amended by sections 3133 and 10316 of the Patient ProVerDate Mar 15 2010 22:40 May 27, 2010 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5417.IH H5417

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1 tection and Affordable Care Act and section 1104 of the 

2 Health Care and Education Reconciliation Act of 2010, 

3 is amended— 

4 (1) in subsection (d)(5)(F)(i), by striking ‘‘Sub5 ject to subsection (r), for’’ and inserting ‘‘For’’; and 

6 (2) by striking subsection (r). 

7 SEC. 2. MEDICAID DSH REVISIONS. 

8 Section 1923(f)(7)(A) of the Social Security Act (42 

9 U.S.C. 1396r–4(f)(7)(A)), as amended by sections 

10 2551(a)(4) and 10201(e)(1) of the Patient Protection and 

11 Affordable Care Act and section 1203(a) of the Health 

12 Care and Education Reconciliation Act of 2010, is amend13 ed— 

14 (1) clause (i), by striking ‘‘2014 through 2020’’ 

15 and inserting ‘‘2018 through 2024’’; and 

16 (2) in subclauses (I) through (VII) of clause 

17 (ii), by striking ‘‘2014’’, ‘‘2015’’, ‘‘2016’’, ‘‘2017’’, 

18 ‘‘2018’’, ‘‘2019’’, and ‘‘2020’’ and inserting ‘‘2018’’, 

19 ‘‘2019’’, ‘‘2020’’, ‘‘2021’’, ‘‘2022’’, ‘‘2023’’, and 

20 ‘‘2024’’, respectively. 

Æ 


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