I
103D CONGRESS
1ST SESSION
H. R. 2850
To amend title XVIII of the Social Security Act to provide an additional
payment under part A of the medicare program for the operating costs
of inpatient hospital services of hospitals with a high proportion of
patients who are medicare beneficiaries.
IN THE HOUSE OF REPRESENTATIVES
AUGUST 3, 1993
Mr. SMITH of New Jersey (for himself and Mr. SAXTON) 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 provide
an additional payment under part A of the medicare
program for the operating costs of inpatient hospital
services of hospitals with a high proportion of patients
who are medicare beneficiaries.
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 ‘‘High Medicare Hos-
pital Relief Act of 1993’’.
SEC. 2. ADDITIONAL MEDICARE PAYMENT FOR HIGH MEDI-
CARE HOSPITALS.
(a) IN GENERAL.—Section 1886(d)(5) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)) is amended—
(1) by redesignating subparagraphs (H) and (I)
as subparagraphs (I) and (J); and
(2) by inserting after subparagraph (G) the fol-
lowing new subparagraph:
‘‘(H)(i) For discharges occurring on or after October
1, 1993, and before October 1, 1995, the Secretary shall
provide, in accordance with this subparagraph, for an ad-
ditional payment for each high medicare hospital.
‘‘(ii) The amount of the additional payment under
this subparagraph for each discharge shall be determined
by multiplying (I) the sum of the amount determined
under paragraph (1)(A)(ii)(II) (or, if applicable, the
amount determined under paragraph (1)(A)(iii)) and the
amount paid to the hospital under subparagraph (A) for
that discharge, by (II) the applicable high medicare ad-
justment percentage established under clause (iii) for the
cost reporting period in which the discharge occurs.
‘‘(iii) The high medicare adjustment percentage for
a cost reporting period is equal to—
‘‘(I) for a hospital located in an urban area, the
difference (expressed as a percentage) between the
average of the medicare operating margins of all
subsection (d) hospitals located in urban areas that
are not high medicare hospitals and the average of
the medicare operating margins of all high medicare
hospitals located in urban areas, as determined for
the most recent cost reporting period for which such
medicare operating margins may be determined (ex-
cept that such percentage may not be less than 0
percent);
‘‘(II) for a hospital that is located in a rural
area and has 100 or more beds, the difference (ex-
pressed as a percentage) between the average of the
medicare operating margins of all subsection (d)
hospitals located in rural areas and having 100 or
more beds that are not high medicare hospitals and
the average of the medicare operating margins of all
high medicare hospitals located in rural areas and
having 100 or more beds, as determined for the
most recent cost reporting period for which such
medicare operating margins may be determined (ex-
cept that such percentage may not be less than 0
percent); and
‘‘(III) for a hospital that is located in a rural
area and has less than 100 beds, the difference (ex-
pressed as a percentage) between the average of the
medicare operating margins of all subsection (d)
hospitals located in rural areas and having less than
100 beds that are not high medicare hospitals and
the average of the medicare operating margins of all
high medicare hospitals located in rural areas and
having less than 100 beds, as determined for the
most recent cost reporting period for which such
medicare operating margins may be determined (ex-
cept that such percentage may not be less than 0
percent).
‘‘(iv) In this subparagraph, the term ‘high medicare
hospital’ means a subsection (d) hospital for which not
less than 65 percent of its inpatient days or discharges
during the cost reporting period beginning in fiscal year
1991 were attributable to inpatients entitled to benefits
under part A.
‘‘(v) In this subparagraph, a hospital’s ‘medicare op-
erating margin’ for a cost reporting period is equal to the
quotient of—
‘‘(I) the difference between the amount of the
payments received by the hospital under this title
during the cost reporting period for the operating
costs of inpatient hospital services and the costs to
the hospital of providing such services; divided by
‘‘(II) the amount of the payments received by
the hospital under this title during the cost report-
ing period for the operating costs of inpatient hos-
pital services.’’.
(b) 
CONFORMING
AMENDMENT.—Section
1886(d)(9)(D)(iv) 
of 
such 
Act 
(42 
U.S.C.
1395ww(d)(9)(D)(iv)) is amended by striking ‘‘Subpara-
graph (H)’’ and inserting ‘‘Subparagraph (I)’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall apply with respect to dis-
charges occurring on or after October 1, 1993.
Æ