I 
113TH CONGRESS 
1ST SESSION H. R. 1390 
To amend title XVIII of the Social Security Act to preserve access to urban 
Medicare-dependent hospitals. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 21, 2013 
Mr. SMITH of New Jersey (for himself, Mr. DEUTCH, Mr. LOBIONDO, Mr. 
RUNYAN, Mr. LARSON of Connecticut, Ms. FRANKEL of Florida, and Mr. 
COURTNEY) introduced the following bill; which was referred to the Com-
mittee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to preserve 
access to urban Medicare-dependent hospitals. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Urban Medicare-De-
pendent Hospitals Preservation Act of 2013’’. 
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SEC. 2. CRITERIA AND PAYMENT FOR CERTAIN URBAN 
MEDICARE-DEPENDENT HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(5) of the Social 
Security Act (42 U.S.C. 1395ww(d)(5)) is amended by 
adding at the end the following new subparagraph: 
‘‘(M)(i) For cost reporting periods begin-
ning on or after October 1, 2013, and before 
October 1, 2016, in the case of a subsection (d) 
hospital which is an urban Medicare-dependent 
hospital, payment under paragraph (1)(A) shall 
be equal to the sum of the amount determined 
under clause (ii) and the amount determined 
under paragraph (1)(A)(iii). 
‘‘(ii) The amount determined under this 
clause is, for discharges occurring during a cost 
reporting period that begins on or after October 
1, 2013, and before October 1, 2016, 50 per-
cent of the amount by which the hospital’s tar-
get amount for the cost reporting period (as de-
fined in subsection (b)(3)(L)) exceeds the 
amount determined under paragraph (1)(A)(iii). 
‘‘(iii) For purposes of this subparagraph, 
the term ‘urban Medicare-dependent hospital’ 
means, with respect to any cost reporting pe-
riod to which clause (i) applies, any hospital— 
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‘‘(I) located in an urban area or re-
classified to an urban area for wage index 
purposes; 
‘‘(II) that does not receive payment— 
‘‘(aa) under subparagraph (C) as 
a rural referral center; 
‘‘(bb) under subparagraph (D) as 
a sole community hospital; 
‘‘(cc) under subparagraph (B) or 
under subsection (h); or 
‘‘(dd) under subparagraph (F); 
‘‘(III) that is not a physician-owned 
hospital, as defined in section 489.3 of title 
42, Code of Federal Regulations (as in ef-
fect as of the date of the enactment of this 
subparagraph); and 
‘‘(IV) for which not less than 60 per-
cent of its inpatient days or discharges 
during the cost reporting period beginning 
in fiscal year 2006, or two of the three 
most recently audited cost reporting peri-
ods for which the Secretary has a settled 
cost report, were attributable to inpatients 
entitled to benefits under part A and not 
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