I 
108TH CONGRESS 
1ST SESSION H. R. 1580
To amend title XVIII of the Social Security Act to provide for national 
standardized payment amounts for inpatient hospital services furnished 
under the Medicare Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 3, 2003
Mr. ENGLISH (for himself, Mr. TANNER, Mr. SHERWOOD, Mr. MCNULTY, Mr. 
BERRY, Mr. MURTHA, Mr. MCHUGH, Mr. FARR, Mr. UDALL of Colorado, 
Mrs. EMERSON, Mr. ALLEN, Mr. REYNOLDS, Mr. PETERSON of Pennsyl-
vania, Mr. KANJORSKI, Mr. HOLDEN, Mr. ORTIZ, Mr. TURNER of Texas, 
Mr. DAVIS of Tennessee, Mr. PLATTS, Mr. DOYLE, Mr. LATHAM, Mr. 
POMEROY, Mr. BOSWELL, Mr. COOPER, and Mr. ROGERS of Alabama) 
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 
for national standardized payment amounts for inpatient 
hospital services furnished under the Medicare Program, 
and for other purposes.
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 ‘‘Medicare Area Wage 
Index and Standardized Rate Act of 2003’’.
SEC. 2. ESTABLISHING A SINGLE STANDARDIZED AMOUNT 
UNDER 
MEDICARE 
INPATIENT 
HOSPITAL 
PPS. 
(a) IN GENERAL.—Section 1886(d)(3)(A) of the So-
cial Security Act (42 U.S.C. 1395ww(d)(3)(A)) is amend-
ed—
(1) in clause (iv), by inserting ‘‘and ending on 
or before September 30, 2003,’’ after ‘‘October 1, 
1995,’’; and 
(2) by redesignating clauses (v) and (vi) as 
clauses (vii) and (viii), respectively, and inserting 
after clause (iv) the following new clauses: 
‘‘(v) For discharges occurring in the fiscal year 
beginning on October 1, 2003, the average standard-
ized amount for hospitals located in areas other than 
a large urban area shall be equal to the average 
standardized amount for hospitals located in a large 
urban area. 
‘‘(vi) For discharges occurring in a fiscal year 
beginning on or after October 1, 2004, the Secretary 
shall compute an average standardized amount for 
hospitals located in all areas within the United 
States equal to the average standardized amount 
computed under clause (v) or this clause for the pre-
vious fiscal year increased by the applicable percent-
age increase under subsection (b)(3)(B)(i) for the 
fiscal year involved.’’. 
(b) COMPUTING DRG-SPECIFIC RATES.—
(1) IN
GENERAL.—Section 1886(d)(3)(D) of 
such Act (42 U.S.C. 1395ww(d)(3)(D)) is amend-
ed—
(A) in the heading by striking ‘‘IN DIF-
FERENT AREAS’’; 
(B) in the matter preceding clause (i)—
(i) by inserting ‘‘for fiscal years before 
fiscal year 1997’’ before ‘‘a regional DRG 
prospective payment rate for each region,’’; 
and 
(ii) by striking ‘‘each of which is’’; 
(C) in clause (i)—
(i) by inserting ‘‘for fiscal years before 
fiscal year 2004,’’ after ‘‘(i)’’; and 
(ii) by striking ‘‘and’’ at the end; 
(D) in clause (ii)—
(i) by inserting ‘‘for fiscal years before 
fiscal year 2004,’’ after ‘‘(ii)’’; and 
(ii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(E) by adding at the end the following new 
clause:
‘‘(iii) for a fiscal year beginning after fiscal 
year 2003, for hospitals located in all areas, to 
the product of—
‘‘(I) the applicable average standard-
ized amount (computed under subpara-
graph (A)), reduced under subparagraph 
(B), and adjusted or reduced under sub-
paragraph (C) for the fiscal year; and 
‘‘(II) the weighting factor (determined 
under paragraph (4)(B)) for that diag-
nosis-related group.’’. 
(2) TECHNICAL CONFORMING SUNSET.—Section 
1886(d)(3) of such Act (42 U.S.C. 1395ww(d)(3)) is 
amended in the matter preceding subparagraph (A) 
by inserting ‘‘for fiscal years before fiscal year 
1997’’ before ‘‘a regional DRG prospective payment 
rate’’. 
SEC. 3. ADJUSTMENT TO WAGE INDEX. 
Section 1886(d)(3)(E) of the Social Security Act (42 
U.S.C. 1395ww(d)(3)(E)) is amended—
(1) in the fourth sentence, by inserting ‘‘, ex-
cept that this sentence shall not apply to the substi-
tution required by the succeeding sentence’’; and 
(2) by adding at the end the following: ‘‘For 
discharges occurring during fiscal years beginning
on or after October 1, 2003, in the case of a sub-
section (d) hospital for which the factor established 
by the Secretary under the first sentence for the fis-
cal year is less than 1.0, the Secretary shall sub-
stitute for the proportion otherwise estimated under 
such sentence but for this sentence a proportion of 
62 percent.’’.
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