II 

111TH CONGRESS 

1ST SESSION S. 1218 

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

Medicare-dependent hospitals. 

IN THE SENATE OF THE UNITED STATES 

JUNE 9, 2009 

Mr. MENENDEZ (for himself 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 2009’’. 

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, 2009, in the case 

3 of a subsection (d) hospital which is an urban 

4 Medicare-dependent hospital, payment under 

5 paragraph (1)(A) shall be equal to the sum of 

6 the amount determined under clause (ii) and 

7 the amount determined under paragraph 

8 (1)(A)(iii). 

9 ‘‘(ii) The amount determined under this 

10 clause is, for discharges occurring during the 

11 cost reporting period that begins on or after 

12 October 1, 2009, and any subsequent cost re13 porting period, 75 percent of the amount by 

14 which the hospital’s target amount for the cost 

15 reporting period (as defined in subsection 

16 (b)(3)(L)) exceeds the amount determined 

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

18 ‘‘(iii) The term ‘urban Medicare-dependent 

19 hospital’ means, with respect to any cost report20 ing period to which clause (i) applies, any hos21 pital— 

22 ‘‘(I) located in an urban area; 

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

24 ‘‘(aa) under subparagraph (C) as 

25 a rural referral center; 


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1 ‘‘(bb) under subparagraph (D) as 

2 a sole community hospital; 

3 ‘‘(cc) under subparagraph (B) or 

4 under subsection (h); or 

5 ‘‘(dd) under subparagraph (F); 

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

7 hospital, as defined in section 489.3 of title 

8 42, Code of Federal Regulations (as in ef9 fect as of the date of the enactment of this 

10 subparagraph); and 

11 ‘‘(IV) for which not less than 60 per12 cent of its inpatient days or discharges 

13 during the cost reporting period beginning 

14 in fiscal year 2006, or two of the three 

15 most recently audited cost reporting peri16 ods for which the Secretary has a settled 

17 cost report, were attributable to inpatients 

18 entitled to benefits under part A.’’. 

19 (b) TARGET PAYMENT AMOUNT.—Section 

20 1886(b)(3) of such Act (42 U.S.C. 1395ww(b)(3)) is 

21 amended— 

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

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

24 (2) by adding at the end the following new sub25 paragraph: 


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1 ‘‘(M) For cost reporting periods occurring 

2 on or after October 1, 2009, in the case of a 

3 hospital that is an urban Medicare-dependent 

4 hospital (as defined in subsection (d)(5)(M)), 

5 the term ‘target amount’ means— 

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

7 cost reporting period in which this sub8 paragraph is applied to the hospital, the 

9 allowable operating costs of inpatient hos10 pital services (as defined in subsection 

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

12 hospital for the 12-month cost reporting 

13 period beginning during fiscal year 2002 or 

14 2006 (whichever results in a higher target 

15 amount), increased by the applicable per16 centage increase under subparagraph 

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

18 through 2009 or 2007 through 2009, re19 spectively; and 

20 ‘‘(ii) with respect to discharges occur21 ring after the first 12-month cost reporting 

22 period in which this subparagraph is ap23 plied to the hospital, the target amount for 

24 the preceding year increased by the appliVerDate Nov 24 2008 03:54 Jun 10, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1218.IS S1218

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1 cable percentage increase under subpara2 graph (B)(iv).’’. 

Æ 


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