249 
which no more than $481,140,000,000 shall be for 
the nondefense category; 
‘‘(2) 
with 
respect 
to 
fiscal 
year 
2012, 
$1,096,439,000,000 in new budget authority of 
which no more than $476,329,000,000 shall be for 
the nondefense category; 
‘‘(3) 
with 
respect 
to 
fiscal 
year 
2013, 
$1,100,705,000 in new budget authority of which no 
more than $471,565,000,000 shall be for the non-
defense category; 
‘‘(4) 
with 
respect 
to 
fiscal 
year 
2014, 
$1,106,750,000,000 in new budget authority of 
which no more than $466,850,000,000 shall be for 
the nondefense category; 
‘‘(5) 
with 
respect 
to 
fiscal 
year 
2015, 
$1,116,011,000,000 in new budget authority of 
which no more than $462,181,000,000 shall be for 
the nondefense category; 
‘‘(6) 
with 
respect 
to 
fiscal 
year 
2016, 
$1,117,559,000,000 in new budget authority of 
which no more than $457,559,000,000 shall be for 
the nondefense category; 
‘‘(7) 
with 
respect 
to 
fiscal 
year 
2017, 
$1,117,984,000,000 in new budget authority of 
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which no more than $452,984,000,000 shall be for 
the nondefense category; 
‘‘(8) 
with 
respect 
to 
fiscal 
year 
2018, 
$1,118,454,000,000 in new budget authority of 
which no more than $448,454,000,000 shall be for 
the nondefense category; 
‘‘(9) 
with 
respect 
to 
fiscal 
year 
2019, 
$1,118,969,000,000 in new budget authority of 
which no more than 443,969,000,000 shall be for 
the nondefense category; and 
‘‘(10) with respect to fiscal year 2020, 
$1,127,530,000,000 in new budget authority of 
which no more than $439,530,000,000 shall be for 
the nondefense category.’’. 
(b) DISCRETIONARY SPENDING LIMIT POINT
OF 
ORDER.—Section 312 of the Congressional Budget Act of 
1974 (as amended by section 214(a)) is further amended 
by adding at the end the following new subsection: 
‘‘(h) DISCRETIONARY SPENDING LIMIT POINT OF 
ORDER.—It shall not be in order in the House of Rep-
resentatives or the Senate to consider any bill, joint resolu-
tion, amendment, or conference report that— 
‘‘(1) increases the discretionary spending limits 
for any ensuing fiscal year after the budget year; or 
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251 
‘‘(2) would cause the discretionary spending 
limits for the budget year to be breached.’’. 
(c) ADVANCE APPROPRIATION POINT OF ORDER.— 
Section 312 of the Congressional Budget Act of 1974 (as 
amended by this section) is further amended by adding 
at the end the following new subsection: 
‘‘(i) ADVANCE APPROPRIATION POINT OF ORDER.— 
It shall not be in order in the House of Representatives 
or the Senate to consider any appropriation bill or joint 
resolution, or amendment thereto or conference report 
thereon, that provides advance discretionary new budget 
authority that first becomes available for any fiscal year 
after the budget year at an amount for any program, 
project, or activity above the amount of appropriations for 
fiscal year 2008 for such program, project, or activity.’’. 
(d) TECHNICAL CHANGES.—(1) Section 275(b) of 
the Balanced Budget and Emergency Deficit Control Act 
of 1985 is repealed. 
(2) Section 254(c)(2) of such Act is amended by 
striking ‘‘2002’’ and inserting ‘‘2020’’. 
(3) Section 254(f)(2)(A) of such Act is amended by 
striking ‘‘2002’’ and inserting ‘‘2020’’. 
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252 
Subtitle B—Repeal of Unused 
Stimulus Funds 
SEC. 1211. RESCISSION AND REPEAL IN ARRA. 
(a) RESCISSION.—Of the discretionary appropria-
tions made available in division A of the American Recov-
ery and Reinvestment Act of 2009 (Public Law 111–5), 
all unobligated balances are rescinded. 
(b) REPEAL.—Subtitles B and C of title II and titles 
III through VII of division B of the American Recovery 
and Reinvestment Act of 2009 (Public Law 111–5) are 
repealed. 
Subtitle C—Savings From Health 
Care Efficiencies 
SEC. 1221. MEDICARE DSH REPORT AND PAYMENT ADJUST-
MENTS IN RESPONSE TO COVERAGE EXPAN-
SION. 
(a) DSH REPORT.— 
(1) IN GENERAL.—Not later than January 1, 
2015, the Secretary of Health and Human Services 
shall submit to Congress a report on Medicare DSH 
taking into account the impact of the health care re-
forms carried out under this Act in reducing the 
number of uninsured individuals. The report shall 
include recommendations relating to the following: 
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(A) The appropriate amount, targeting, 
and distribution of Medicare DSH to com-
pensate for higher Medicare costs associated 
with serving low-income beneficiaries (taking 
into account variations in the empirical jus-
tification for Medicare DSH attributable to hos-
pital characteristics, including bed size), con-
sistent with the original intent of Medicare 
DSH. 
(B) The appropriate amount, targeting, 
and distribution of Medicare DSH to hospitals 
given their continued uncompensated care costs, 
to the extent such costs remain. 
(2) COORDINATION WITH MEDICAID DSH RE-
PORT.—The Secretary shall coordinate the report 
under this subsection with the report on Medicaid 
DSH under section 1222(a). 
(b) PAYMENT ADJUSTMENTS IN RESPONSE TO COV-
ERAGE EXPANSION.— 
(1) IN GENERAL.—If there is a significant de-
crease in the national rate of uninsurance as a result 
of this Act (as determined under paragraph (2)(A)), 
then the Secretary of Health and Human Services 
shall, beginning in fiscal year 2016, implement the 
following adjustments to Medicare DSH: 
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254 
(A) In lieu of the amount of Medicare 
DSH payment that would otherwise be made 
under section 1886(d)(5)(F) of the Social Secu-
rity Act, the amount of Medicare DSH payment 
shall be an amount based on the recommenda-
tions of the report under subsection (a)(1)(A) 
and shall take into account variations in the 
empirical justification for Medicare DSH attrib-
utable to hospital characteristics, including bed 
size. 
(B) Subject to paragraph (3), make an ad-
ditional payment to a hospital by an amount 
that is estimated based on the amount of un-
compensated care provided by the hospital 
based on criteria for uncompensated care as de-
termined by the Secretary, which shall exclude 
bad debt. 
(2) SIGNIFICANT DECREASE IN NATIONAL RATE 
OF UNINSURANCE AS A RESULT OF THIS ACT.—For 
purposes of this subsection— 
(A) IN GENERAL.—There is a ‘‘significant 
decrease in the national rate of uninsurance as 
a result of this Act’’ if there is a decrease in 
the national rate of uninsurance (as defined in 
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255 
subparagraph (B)) from 2011 to 2013 that ex-
ceeds 8 percentage points. 
(B) NATIONAL
RATE
OF
UNINSURANCE 
DEFINED.—The 
term 
‘‘national 
rate 
of 
uninsurance’’ means, for a year, such rate for 
the under-65 population for the year as deter-
mined and published by the Bureau of the Cen-
sus in its Current Population Survey in or 
about September of the succeeding year. 
(3) UNCOMPENSATED CARE INCREASE.— 
(A) COMPUTATION OF DSH SAVINGS.—For 
each fiscal year (beginning with fiscal year 
2016), the Secretary shall estimate the aggre-
gate reduction in Medicare DSH that will result 
from the adjustment under paragraph (1)(A). 
(B) 
STRUCTURE
OF
PAYMENT
IN-
CREASE.—The Secretary shall compute the in-
crease in Medicare DSH under paragraph 
(1)(B) for a fiscal year in accordance with a 
formula established by the Secretary that pro-
vides that— 
(i) the aggregate amount of such in-
crease for the fiscal year does not exceed 
50 percent of the aggregate reduction in 
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256 
Medicare DSH estimated by the Secretary 
for such fiscal year; and 
(ii) hospitals with higher levels of un-
compensated care receive a greater in-
crease. 
(c) MEDICARE DSH.—In this section, the term 
‘‘Medicare DSH’’ means adjustments in payments under 
section 1886(d)(5)(F) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(F)) for inpatient hospital services 
furnished by disproportionate share hospitals. 
SEC. 1222. REDUCTION IN MEDICAID DSH. 
(a) REPORT.— 
(1) IN GENERAL.—Not later than January 1, 
2015, the Secretary of Health and Human Services 
(in this title referred to as the ‘‘Secretary’’) shall 
submit to Congress a report concerning the extent to 
which, based upon the impact of the health care re-
forms carried out under this Act in reducing the 
number of uninsured individuals, there is a contin-
ued role for Medicaid DSH. In preparing the report, 
the Secretary shall consult with community-based 
health care networks serving low-income bene-
ficiaries. 
(2) MATTERS TO BE INCLUDED.—The report 
shall include the following: 
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(A) 
RECOMMENDATIONS.—Recommenda-
tions regarding— 
(i) the appropriate targeting of Med-
icaid DSH within States; and 
(ii) the distribution of Medicaid DSH 
among the States. 
(B) SPECIFICATION OF DSH HEALTH RE-
FORM METHODOLOGY.—The DSH Health Re-
form methodology described in paragraph (2) of 
subsection (b) for purposes of implementing the 
requirements of such subsection. 
(3) COORDINATION WITH MEDICARE DSH RE-
PORT.—The Secretary shall coordinate the report 
under this subsection with the report on Medicare 
DSH under section 1221. 
(4) MEDICAID DSH.—In this section, the term 
‘‘Medicaid DSH’’ means adjustments in payments 
under section 1923 of the Social Security Act for in-
patient hospital services furnished by dispropor-
tionate share hospitals. 
(b) MEDICAID DSH REDUCTIONS.— 
(1) IN GENERAL.—If there is a significant de-
crease in the national rate of uninsurance as a result 
of 
this 
Act 
(as 
determined 
under 
section 
1221(a)(2)(A)), then the Secretary of Health and 
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258 
Human Services shall reduce Medicaid DSH so as to 
reduce total Federal payments to all States for such 
purpose by $1,500,000,000 in fiscal year 2016, 
$2,500,000,000 
in 
fiscal 
year 
2017, 
and 
$6,000,000,000 in fiscal year 2018. 
(2) DSH HEALTH REFORM METHODOLOGY.— 
The Secretary shall carry out paragraph (1) through 
use of a DSH Health Reform methodology issued by 
the Secretary that imposes the largest percentage re-
ductions on the States that— 
(A) have the lowest percentages of unin-
sured individuals (determined on the basis of 
audited hospital cost reports) during the most 
recent year for which such data are available; 
or 
(B) do not target their DSH payments 
on— 
(i) hospitals with high volumes of 
Medicaid inpatients (as defined in section 
1923(b)(1)(A) of the Social Security Act 
(42 U.S.C. 1396r–4(b)(1)(A)); and 
(ii) hospitals that have high levels of 
uncompensated care (excluding bad debt). 
(3) DSH ALLOTMENT PUBLICATIONS.— 
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(A) IN GENERAL.—Not later than the pub-
lication deadline specified in subparagraph (B), 
the Secretary shall publish in the Federal Reg-
ister a notice specifying the DSH allotment to 
each State under 1923(f) of the Social Security 
Act for the respective fiscal year specified in 
such subparagraph, consistent with the applica-
tion of the DSH Health Reform methodology 
described in paragraph (2). 
(B) PUBLICATION DEADLINE.—The publi-
cation deadline specified in this subparagraph 
is— 
(i) January 1, 2015, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2016; 
(ii) January 1, 2016, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2017; and 
(iii) January 1, 2017, with respect to 
DSH allotments described in subparagraph 
(A) for fiscal year 2018. 
(c) CONFORMING AMENDMENTS.— 
(1) Section 1923(f) of the Social Security Act 
(42 U.S.C. 1396r–4(f)) is amended— 
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260 
(A) by redesignating paragraph (7) as 
paragraph (8); and 
(B) by inserting after paragraph (6) the 
following new paragraph: 
‘‘(7) SPECIAL RULE FOR FISCAL YEARS 2016, 
2017, AND 2018.—Notwithstanding paragraph (2), if 
the Secretary makes a reduction under section 
1222(b)(1) of the Empowering Patients First Act, 
the total DSH allotments for all States for— 
‘‘(A) fiscal year 2016, shall be the total 
DSH allotments that would otherwise be deter-
mined under this subsection for such fiscal year 
decreased by $1,500,000,000; 
‘‘(B) fiscal year 2017, shall be the total 
DSH allotments that would otherwise be deter-
mined under this subsection for such fiscal year 
decreased by $2,500,000,000; and 
‘‘(C) fiscal year 2018, shall be the total 
DSH allotments that would otherwise be deter-
mined under this subsection for such fiscal year 
decreased by $6,000,000,000.’’. 
(2) Section 1923(b)(4) of such Act (42 U.S.C. 
1396r–4(b)(4)) is amended by adding before the pe-
riod the following: ‘‘or to affect the authority of the 
Secretary to issue and implement the DSH Health 
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