I 
111TH CONGRESS 
1ST SESSION H. R. 2574 
To amend title XVIII of the Social Security Act to preserve access to urban 
Medicare-dependent hospitals. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 21, 2009 
Mr. ADLER of New Jersey (for himself and Mr. PASCRELL) introduced the 
following bill; which was referred to the Committee 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 2009’’. 
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: 
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‘‘(M)(i) For cost reporting periods begin-
ning on or after October 1, 2009, 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 the 
cost reporting period that begins on or after 
October 1, 2009, and any subsequent cost re-
porting period, 75 percent of the amount by 
which the hospital’s target amount for the cost 
reporting period (as defined in subsection 
(b)(3)(L)) exceeds the amount determined 
under paragraph (1)(A)(iii). 
‘‘(iii) The term ‘urban Medicare-dependent 
hospital’ means, with respect to any cost report-
ing period to which clause (i) applies, any hos-
pital— 
‘‘(I) located in an urban area; 
‘‘(II) that does not receive payment— 
‘‘(aa) under subparagraph (C) as 
a rural referral center; 
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‘‘(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.’’. 
(b) 
TARGET
PAYMENT
AMOUNT.—Section 
1886(b)(3) of such Act (42 U.S.C. 1395ww(b)(3)) is 
amended— 
(1) in subparagraph (B)(iv), by striking ‘‘and 
(D)’’ and inserting ‘‘, (D), and (M)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
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‘‘(M) For cost reporting periods occurring 
on or after October 1, 2009, in the case of a 
hospital that is an urban Medicare-dependent 
hospital (as defined in subsection (d)(5)(M)), 
the term ‘target amount’ means— 
‘‘(i) with respect to the first 12-month 
cost reporting period in which this sub-
paragraph is applied to the hospital, the 
allowable operating costs of inpatient hos-
pital services (as defined in subsection 
(a)(4)) recognized under this title for the 
hospital for the 12-month cost reporting 
period beginning during fiscal year 2002 or 
2006 (whichever results in a higher target 
amount), increased by the applicable per-
centage 
increase 
under 
subparagraph 
(B)(iv) for each of fiscal years 2003 
through 2009 or 2007 through 2009, re-
spectively; and 
‘‘(ii) with respect to discharges occur-
ring after the first 12-month cost reporting 
period in which this subparagraph is ap-
plied to the hospital, the target amount for 
the preceding year increased by the appli-
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cable percentage increase under subpara-
graph (B)(iv).’’. 
Æ 
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