I 

111TH CONGRESS 

1ST SESSION H. R. 3422 

To amend title XVIII of the Social Security Act to make temporary improvements to the Medicare inpatient payment adjustment for low-volume 

hospitals, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 30, 2009 

Mr. KING of Iowa (for himself and Mr. LATHAM) 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 title XVIII of the Social Security Act to make 

temporary improvements to the Medicare inpatient payment adjustment for low-volume hospitals, and for other 

purposes. 

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 ‘‘Medicare Support for 

5 Rural Hospitals Act’’. 


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1 SEC. 2. TEMPORARY IMPROVEMENTS TO THE MEDICARE 

2 INPATIENT HOSPITAL PAYMENT ADJUST3 MENT FOR LOW-VOLUME HOSPITALS. 

4 (a) IN GENERAL.—Section 1886(d)(12) of the Social 

5 Security Act (42 U.S.C. 1395ww(d)(12)) is amended— 

6 (1) in subparagraph (A), by inserting ‘‘or (D) 

7 (for discharges occurring in fiscal year 2010)’’ after 

8 ‘‘subparagraph (B)’’; 

9 (2) in subparagraph (B), by striking ‘‘The Sec10 retary’’ and inserting ‘‘Except as provided in sub11 paragraph (D), the Secretary’’; 

12 (3) in subparagraph (C)(i)— 

13 (A) by inserting ‘‘(or, with respect to fiscal 

14 year 2010, 15 road miles)’’ after ‘‘25 road 

15 miles’’; and 

16 (B) by inserting ‘‘(or, with respect to fiscal 

17 year 2010, 1,500 discharges of individuals enti18 tled to, or enrolled for, benefits under part A)’’ 

19 after ‘‘800 discharges’’; and 

20 (4) by adding at the end the following new sub21 paragraph: 

22 ‘‘(D) TEMPORARY APPLICABLE PERCENT23 AGE INCREASE.—For discharges occurring in 

24 fiscal year 2010, the Secretary shall determine 

25 an applicable percentage increase for purposes 

26 of subparagraph (A) using a continuous linear 


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1 sliding scale ranging from 25 percent for low2 volume hospitals with 200 or fewer discharges 

3 of individuals entitled to, or enrolled for, bene4 fits under part A in the fiscal year to 0 percent 

5 for low-volume hospitals with greater than 

6 1,500 discharges of such individuals in the fis7 cal year.’’. 

8 (b) IMPLEMENTATION.—Notwithstanding any other 

9 provision of law, the Secretary of Health and Human 

10 Services may implement the amendments made by sub11 section (a) by program instruction or otherwise. 

12 SEC. 3. USE OF NON-WAGE ADJUSTED PPS RATE UNDER 

13 THE MEDICARE-DEPENDENT HOSPITAL 

14 (MDH) PROGRAM. 

15 (a) IN GENERAL.—Section 1886(d)(5)(G) of the So16 cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend17 ed by adding at the end the following new clause: 

18 ‘‘(v) In the case of discharges occurring on or after 

19 October 1, 2009, and before October 1, 2010, in deter20 mining the amount under paragraph (1)(A)(iii) for pur21 poses of clauses (i) and (ii)(II), such amount shall, if it 

22 results in greater payments to the hospital, be determined 

23 without regard to any adjustment for different area wage 

24 levels under paragraph (3)(E).’’. 


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1 (b) IMPLEMENTATION.—Notwithstanding any other 

2 provision of law, the Secretary of Health and Human 

3 Services may implement the amendment made by sub4 section (a) by program instruction or otherwise. 

5 SEC. 4. REPEAL OF SECTION 211 OF PUBLIC LAW 111–3. 

6 Section 211 of Public Law 111–3 is repealed. 

Æ 


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