II 

109TH CONGRESS 

2D SESSION S. 3606 

To amend title XVIII of the Social Security Act to provide fair payments 

for care provided in a hospital emergency department. 

IN THE SENATE OF THE UNITED STATES 

JUNE 29, 2006 

Mr. BINGAMAN 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 provide 

fair payments for care provided in a hospital emergency 

department. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Save Our Safety Net Act of 2005’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Ensuring adequate physician payment for emergency department visits. 

Sec. 3. Ensuring adequate hospital outpatient fee schedule amounts for clinic 

and emergency department visits. 


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Sec. 4. Permanent extension of adjustment to limit decline in payments for certain hospitals under hospital outpatient PPS. 

Sec. 5. Fairness in the Medicare disproportionate share hospital (DSH) adjustment for rural hospitals. 

1 SEC. 2. ENSURING ADEQUATE PHYSICIAN PAYMENT FOR 

2 EMERGENCY DEPARTMENT VISITS. 

3 Section 1833 of the Social Security Act (42 U.S.C. 

4 1395l) is amended by adding at the end the following new 

5 subsection: 

6 ‘‘(v) SAVE OUR SAFETY NET PAYMENTS FOR PHYSI7 CIANS’ SERVICES PROVIDED IN AN EMERGENCY DEPART8 MENT.—In the case of physicians’ services furnished to 

9 an individual covered under the insurance program estab10 lished by this part in an emergency department on or after 

11 January 1, 2006, in addition to the amount of payment 

12 that would otherwise be made for such services under this 

13 part, there also shall be paid to the physician or other 

14 person (or to an employer or entity in the cases described 

15 in clause (A) of section 1842(b)(6)) from the Federal Sup16 plementary Insurance Trust Fund an amount equal to 10 

17 percent of the payment amount for the service under this 

18 part.’’. 

19 SEC. 3. ENSURING ADEQUATE HOSPITAL OUTPATIENT FEE 

20 SCHEDULE AMOUNTS FOR CLINIC AND EMER21 GENCY DEPARTMENT VISITS. 

22 (a) IN GENERAL.—Section 1833(t) of the Social Se23 curity Act (42 U.S.C. 1395l(t)) is amended— 


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1 (1) in paragraph (3)(C)(ii), by striking ‘‘para2 graph (8)(B)’’ and inserting ‘‘paragraphs (8)(B), 

3 (11)(B), and (13)(A)(i)’’; 

4 (2) in paragraph (3)(C)(iii), by inserting ‘‘(but 

5 not the conversion factor computed under paragraph 

6 (13)(B))’’ after ‘‘this subparagraph’’; 

7 (3) in paragraph (3)(D)— 

8 (A) in clause (i), by striking ‘‘conversion 

9 factor computed under subparagraph (C) for 

10 the year’’ and inserting ‘‘applicable conversion 

11 factor computed under subparagraph (C), para12 graph (11)(B), or paragraph (13)(B) for the 

13 year’’; and 

14 (B) in clause (ii), by inserting ‘‘, para15 graph (9)(A), or paragraph (13)(C)’’ after 

16 ‘‘paragraph (2)(C)’’; 

17 (4) in paragraph (9), by amending subpara18 graph (B) to read as follows: 

19 ‘‘(B) BUDGET NEUTRALITY ADJUST20 MENT.— 

21 ‘‘(i) IN GENERAL.—If the Secretary 

22 makes revisions under subparagraph (A), 

23 then the revisions for a year may not cause 

24 the estimated amount of expenditures 

25 under this part for the year to increase or 


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1 decrease from the estimated amount of ex2 penditures under this part (including ex3 penditures attributable to the special rules 

4 specified in paragraph (13)) that would 

5 have been made if the revisions had not 

6 been made. 

7 ‘‘(ii) EXEMPTION FROM REDUC8 TION.—The relative payment weights de9 termined under paragraph (13)(C) and the 

10 conversion factor computed under para11 graph (13)(B) shall not be reduced by any 

12 budget neutrality adjustment made pursu13 ant to this subparagraph.’’; and 

14 (5) by redesignating paragraphs (13) through 

15 (16) as paragraphs (14) through (17), respectively, 

16 and by inserting after paragraph (12) the following 

17 new paragraph: 

18 ‘‘(13) SPECIAL RULES FOR CALCULATING MEDI19 CARE OPD FEE SCHEDULE AMOUNT FOR CLINIC AND

20 EMERGENCY VISITS.— 

21 ‘‘(A) IN GENERAL.—In computing the 

22 medicare OPD fee schedule amount under para23 graph (3)(D) for covered OPD services that are 

24 furnished on or after January 1, 2006, and 

25 classified within a group established or revised 


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1 under paragraph (2)(B) or (9)(A), respectively, 

2 for clinic and emergency visits (as described in 

3 subparagraph (D)), the Secretary shall— 

4 ‘‘(i) substitute for the conversion fac5 tor calculated under paragraph (3)(C) the 

6 conversion factor calculated under sub7 paragraph (B); and 

8 ‘‘(ii) substitute for the relative pay9 ment weight established or revised under 

10 paragraph (2)(C) or (9)(A), respectively, 

11 the relative payment weight determined 

12 under subparagraph (C) for such group. 

13 ‘‘(B) CALCULATION OF CONVERSION FAC14 TOR.—For purposes of subparagraph (A)(i), the 

15 conversion factor calculated under this subpara16 graph is— 

17 ‘‘(i) for services furnished during 

18 2006, an amount equal to the product of— 

19 ‘‘(I) the conversion factor speci20 fied for such year in the final rule 

21 published on November 10, 2005, in22 creased by the percentage by which 

23 such conversion factor is reduced for 

24 such year pursuant to paragraph 

25 (2)(E), and not taking into account 


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1 any subsequent amendments to such 

2 final rule; and 

3 ‘‘(II) 1.10; and 

4 ‘‘(ii) for services furnished in a year 

5 beginning on or after January 1, 2007, the 

6 conversion factor computed under this sub7 paragraph for the previous year increased 

8 by the OPD fee schedule increase factor 

9 specified under paragraph (3)(C)(iv) for 

10 the year involved. 

11 ‘‘(C) DETERMINATION OF RELATIVE PAY12 MENT WEIGHTS.—For purposes of subpara13 graph (A)(ii), the relative payment weight de14 termined under this subparagraph for a covered 

15 OPD service that is classified within such a 

16 group is— 

17 ‘‘(i) for services furnished during 

18 2006, the relative payment weight specified 

19 for such group for such period in the final 

20 rule published November 10, 2005, and 

21 not taking into account any subsequent 

22 amendments to such final rule; and 

23 ‘‘(ii) for services furnished in a year 

24 beginning on or after January 1, 2007— 


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1 ‘‘(I) for ambulatory patient clas2 sification group 0601 (relating to mid3 level clinic visits), or a successor to 

4 such group, the relative payment 

5 weight specified for such group in the 

6 final rule referred to in clause (i); and 

7 ‘‘(II) for other ambulatory pa8 tient classification groups described in 

9 subparagraph (D), the relative pay10 ment weight established or revised 

11 under paragraph (2)(C) or (9)(A), re12 spectively, for such group for such 

13 year (but without regard to any budg14 et neutrality adjustment under para15 graph (9)(B)). 

16 ‘‘(D) GROUPS FOR CLINIC AND EMER17 GENCY VISITS.—For purposes of this para18 graph, the groups established or revised under 

19 paragraph (2)(B) or (9)(A), respectively, for 

20 clinic and emergency visits are ambulatory pa21 tient classification groups 0600, 0601, 0602, 

22 0610, 0611, 0612, and 0620 as defined for pur23 poses of the final rule referred to in subpara24 graph (C)(i) (and any successors to such 

25 groups).’’. 


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1 (b) LIMITATION ON SECRETARIAL AUTHORITY.— 

2 Notwithstanding section 1833(t) of the Social Security 

3 Act (42 U.S.C. 1395l(t)), as amended by subsection (a), 

4 the Secretary of Health and Human Services may not 

5 make any adjustment under— 

6 (1) paragraph (2)(F), (3)(C)(iii), (9)(B), or 

7 (9)(C) of section 1833(t) of the Social Security Act 

8 (42 U.S.C. 1395l(t)); or 

9 (2) any other provision of such section; 

10 to ensure that the amendments made by subsection (a) 

11 do not cause the estimated amount of expenditures under 

12 part B of title XVIII of such Act (42 U.S.C. 1395j et 

13 seq.) to exceed the estimated amount of expenditures that 

14 would have been made under such part but for such 

15 amendments. 

16 SEC. 4. PERMANENT EXTENSION OF ADJUSTMENT TO 

17 LIMIT DECLINE IN PAYMENTS FOR CERTAIN 

18 HOSPITALS UNDER HOSPITAL OUTPATIENT 

19 PPS. 

20 (a) IN GENERAL.—Section 1833(t)(7)(D)(i) of the 

21 Social Security Act (42 U.S.C. 1395l(t)(7)(D)(i)), as 

22 amended by section 5105 of the Deficit Reduction Act of 

23 2005 (Public Law 109–171), is amended— 

24 (1) in the clause heading— 


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1 (A) by striking ‘‘TEMPORARY’’ and insert2 ing ‘‘PERMANENT’’; and 

3 (B) by striking ‘‘RURAL’’ 

4 (2) by striking subclause (II); 

5 (3) by striking ‘‘(I) In the case’’ and inserting 

6 ‘‘In the case’’; 

7 (4) by striking ‘‘located in a rural area, for’’ 

8 and inserting ‘‘, for’’; and 

9 (5) by striking ‘‘furnished before January 1, 

10 2006’’. 

11 (b) EFFECTIVE DATE.—The amendments made by 

12 subsection (a) shall apply to covered OPD services fur13 nished on or after January 1, 2006. 

14 SEC. 5. FAIRNESS IN THE MEDICARE DISPROPORTIONATE 

15 SHARE HOSPITAL (DSH) ADJUSTMENT FOR 

16 RURAL HOSPITALS. 

17 Section 1886(d)(5)(F)(xiv)(II) of the Social Security 

18 Act (42 U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended— 

19 (1) by striking ‘‘or, in the case’’ and all that 

20 follows through ‘‘subparagraph (G)(iv)’’; and 

21 (2) by inserting at the end the following new 

22 sentence: ‘‘The preceding sentence shall not apply to 

23 any hospital with respect to discharges occurring on 

24 or after October 1, 2006.’’. 

Æ 


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