I
106TH CONGRESS
1ST SESSION
H. R. 1529
To require the Secretary of Health and Human Services to modify the
treatment of certain patient days for purposes of determining the amount
of disproportionate share adjustment payments to hospitals under the
Medicare Program.
IN THE HOUSE OF REPRESENTATIVES
APRIL 22, 1999
Mr. ENGLISH (for himself, Mr. COYNE, Mr. WELDON of Pennsylvania, Mr.
BRADY of Pennsylvania, Mr. PETERSON of Pennsylvania, Mr. BORSKI,
Mr. GEKAS, Mr. DOYLE, Mr. GOODLING, Mr. FATTAH, Mr. GREENWOOD,
Mr. HOEFFEL, Mr. PITTS, Mr. HOLDEN, Mr. SHERWOOD, Mr. KAN-
JORSKI, Mr. SHUSTER, Mr. KLINK, Mr. MURTHA, Mr. TOOMEY, and Mr.
MASCARA) introduced the following bill; which was referred to the Com-
mittee on Ways and Means
A BILL
To require the Secretary of Health and Human Services
to modify the treatment of certain patient days for pur-
poses of determining the amount of disproportionate
share adjustment payments to hospitals under the Medi-
care Program.
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 ‘‘Indigent Care Reim-
bursement Act of 1999’’.
SEC. 2. TREATMENT OF CERTAIN PATIENT DAYS IN DETER-
MINING DSH PAYMENTS UNDER MEDICARE.
(a) LIMIT ON DISALLOWANCES.—The Secretary of
Health and Human Services (in this section referred to
as the ‘‘Secretary’’) may not—
(1) in calculating the disproportionate patient
percentage (as defined in section 1886(d)(5)(F)(vi)
of 
the 
Social 
Security 
Act 
(42 
U.S.C.
1395ww(d)(5)(F)(vi))) of a hospital that is located
in a subsection (c) State for discharges occurring be-
fore October 1, 1998, treat patient days for individ-
uals eligible for general assistance under the laws of
such State, for purposes of subclause (II) of such
section, as not consisting of patients who (for such
days) were eligible for medical assistance under a
State plan approved under title XIX of such Act; or
(2) recoup payments from (or otherwise reduce,
disallow, or adjust payments under title XVIII of
such Act to) such a hospital for discharges occurring
before such date based on the treatment of patient
days for general assistance in the manner prohibited
by paragraph (1).
(b) REFUNDS OF RECOUPED AMOUNTS.—If, before
the date of the enactment of this section, the Secretary
has recouped payments from (or otherwise reduced, dis-
allowed, or adjusted payments under title XVIII of such
Act to) a hospital that is located in a subsection (c) State
based on the treatment of patient days for general assist-
ance in the manner prohibited by subsection (a)(1), the
Secretary shall refund to the hospital the portion of the
amount recouped, reduced, disallowed, or adjusted that is
attributable to discharges occurring before October 1,
1998.
(c) SUBSECTION (c) STATE DEFINED.—For purposes
of this section, the term ‘‘subsection (c) State’’ means a
State that meets the following requirements:
(1) No subsection (d) hospital (as defined in
section 1886(d)(1)(B) of such Act (42 U.S.C.
1395ww(d)(1)(B))) located in the State is owned
and operated by a unit of State or local government.
(2) The total amount of payments under section
1886(d)(5)(F) 
of 
such 
Act 
(42 
U.S.C.
1395ww(d)(5)(F)) 
(relating 
to 
disproportionate
share payments) for hospitals located in the State
that were included in a medicare public use file enti-
tled ‘‘PPS XIII Hospital Data Set’’ is not less than
$150,000,000 nor more than $170,000,000.
(3) The total number of individuals residing in
the State and enrolled in an insurance program es-
tablished under title XVIII of such Act during cal-
endar year 1996 was more than 2,000,000, but less
than 2,200,000.
(4) More than 15.8 percent of the individuals
residing in the State during 1995 had attained age
65.
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