I 
118TH CONGRESS 
2D SESSION 
H. R. 9351 
To amend title XIX of the Social Security Act to modify certain limitations 
on disproportionate share hospital payment adjustments under the Med-
icaid program. 
IN THE HOUSE OF REPRESENTATIVES 
AUGUST 13, 2024 
Mr. LALOTA (for himself, Ms. CLARKE of New York, Mr. BUCSHON, Ms. 
MATSUI, Mr. LAWLER, and Mr. MRVAN) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title XIX of the Social Security Act to modify 
certain limitations on disproportionate share hospital 
payment adjustments under the Medicaid 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 ‘‘Save our Safety-Net 
Hospitals Act of 2024’’. 
VerDate Sep 11 2014 
15:28 Sep 07, 2024
Jkt 049200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H9351.IH
H9351
ssavage on LAPJG3WLY3PROD with BILLS
SEC. 2. MODIFYING CERTAIN LIMITATIONS ON DISPROPOR-
TIONATE SHARE HOSPITAL PAYMENT AD-
JUSTMENTS UNDER THE MEDICAID PRO-
GRAM. 
(a) IN GENERAL.—Section 1923(g) of the Social Se-
curity Act (42 U.S.C. 1396r–4(g)) is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (A)— 
(i) in the matter preceding clause (i), 
by striking ‘‘(other than a hospital de-
scribed in paragraph (2)(B))’’; 
(ii) in clause (i), by inserting ‘‘with 
respect to such hospital and year’’ after 
‘‘described in subparagraph (B)’’; and 
(iii) in clause (ii)— 
(I) in subclause (I), by striking 
‘‘and’’ at the end; 
(II) in subclause (II), by striking 
the period and inserting ‘‘; and’’; and 
(III) by adding at the end the 
following new subclause: 
‘‘(III) payments made under title 
XVIII or by an applicable plan (as de-
fined in section 1862(b)(8)(F)) for 
such services.’’; and 
(B) in subparagraph (B)— 
VerDate Sep 11 2014 
15:28 Sep 07, 2024
Jkt 049200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H9351.IH
H9351
ssavage on LAPJG3WLY3PROD with BILLS
(i) in the matter preceding clause (i), 
by striking ‘‘in this clause are’’ and insert-
ing ‘‘in this subparagraph are, with respect 
to a hospital and a year,’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(iii) Individuals who are eligible for 
medical assistance under the State plan or 
under a waiver of such plan and for whom 
the State plan or waiver is the secondary 
payor for such services after application of 
benefits under title XVIII or under an ap-
plicable 
plan 
(as 
defined 
in 
section 
1862(b)(8)(F)), but only if the hospital 
has in the aggregate incurred costs exceed-
ing payments under such State plan, waiv-
er, title XVIII, or applicable plan for such 
services furnished to such individuals dur-
ing such year.’’; 
(2) by striking paragraph (2); 
(3) by redesignating paragraph (3) as para-
graph (2); and 
(4) in paragraph (2), as so redesignated, by 
striking ‘‘Notwithstanding paragraph (2) of this 
VerDate Sep 11 2014 
15:28 Sep 07, 2024
Jkt 049200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H9351.IH
H9351
ssavage on LAPJG3WLY3PROD with BILLS
subsection (as in effect on October 1, 2021), para-
graph (2)’’ and inserting ‘‘Paragraph (2)’’. 
(b) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
this section shall apply to payment adjustments 
made under section 1923 of the Social Security Act 
(42 U.S.C. 1396r–4) during fiscal years beginning 
on or after October 1, 2021. 
(2) NO
REQUIRED
RECOUPMENT
BASED
ON 
CHANGE IN CAP AMOUNTS.—In the case of a pay-
ment adjustment made by a State under section 
1923 of the Social Security Act (42 U.S.C. 1396r– 
4) prior to the date of the enactment of this Act 
that was, without application of the amendments 
made by this section, consistent with the method-
ology of such State for making such adjustments, 
such adjustment shall be deemed to be consistent 
with such methodology with the application of such 
amendments. 
Æ 
VerDate Sep 11 2014 
15:28 Sep 07, 2024
Jkt 049200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H9351.IH
H9351
ssavage on LAPJG3WLY3PROD with BILLS