I
106TH CONGRESS
2D SESSION
H. R. 4997
To amend title XVIII of the Social Security Act to revise and improve
the Medicare-dependent, small rural hospital program.
IN THE HOUSE OF REPRESENTATIVES
JULY 27, 2000
Mr. PETERSON of Pennsylvania (for himself and Mrs. EMERSON) introduced
the following bill; which was referred to the Committee on Ways and
Means, and in addition to the Committee on Commerce, for a period to
be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee
concerned
A BILL
To amend title XVIII of the Social Security Act to revise
and improve the Medicare-dependent, small rural hospital
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 ‘‘Medicare-Dependent,
Small Rural Hospital Equity Act of 2000’’.
SEC. 2. APPLICATION OF THE MEDICARE PATIENT POPU-
LATION 
PERCENTAGE 
MEASUREMENT 
OF
MEDICARE-DEPENDENT, SMALL RURAL HOS-
PITALS TO THE THREE MOST RECENT COST
REPORTING PERIODS.
(a) IN GENERAL.—Section 1886(d)(5)(G)(iv)(IV) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1395ww(d)(5)(G)(iv)(IV)) is amended by inserting after
‘‘during the cost reporting period beginning in fiscal year
1987’’ ‘‘ or, at the election of the hospital (in a form and
manner determined by the Secretary), during any of the
three most recent 12-month cost reporting periods for
which the Secretary has the settled cost reports’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) applies with respect to discharges occurring
on or after October 1, 2000.
SEC. 3. REBASING FOR CERTAIN MEDICARE-DEPENDENT,
SMALL RURAL HOSPITALS.
Section 1886(b)(3) of the Social Security Act (42
U.S.C. 1395ww(b)(3)) is amended—
(1) in subparagraph (D), by inserting ‘‘subject
to subparagraph (J),’’ before ‘‘the term ‘target
amount’ means’’; and
(2) by adding at the end the following new sub-
paragraph:
‘‘(J)(i) For cost reporting periods beginning on or
after October 1, 2000, in the case of a medicare-depend-
ent, small rural hospital that elects (in a form and manner
determined by the Secretary) this subparagraph to apply
to the hospital, there shall be substituted for the target
amount applicable to the hospital under subparagraph
(D)—
‘‘(I) with respect to discharges occurring in fis-
cal year 2001, 75 percent of the target amount oth-
erwise applicable to the hospital under subparagraph
(D) (referred to in this clause as the ‘subparagraph
(D) target amount’) and 25 percent of the rebased
target amount (as defined in clause (ii));
‘‘(II) with respect to discharges occurring in fis-
cal year 2002, 50 percent of the subparagraph (D)
target amount and 50 percent of the rebased target
amount;
‘‘(III) with respect to discharges occurring in
fiscal year 2003, 25 percent of the subparagraph
(D) target amount and 75 percent of the rebased
target amount; and
‘‘(IV) with respect to discharges occurring after
fiscal year 2003, 100 percent of the rebased target
amount.
‘‘(ii) For purposes of this subparagraph, the term
‘rebased target amount’ has the meaning given the term
‘target amount’ in subparagraph (D) except that—
‘‘(I) there shall be substituted for the base cost
reporting period under subparagraph (D) any of the
three most recent 12-month cost reporting periods
for which the Secretary has the settled cost reports,
whichever results in the greatest increase in the tar-
get amount for the hospital;
‘‘(II) any reference in subparagraph (D)(i) to
the ‘first cost reporting period’ described in such
subparagraph is deemed a reference to the first cost
reporting period beginning on or after October 1,
2000; and
‘‘(III) applicable increase percentage shall only
be applied under subparagraph (D)(iv) for dis-
charges occurring in fiscal years beginning with fis-
cal year 2002.’’.
SEC. 4. MAKING THE MEDICARE DEPENDENT, SMALL
RURAL HOSPITAL PROGRAM PERMANENT.
(a) 
PAYMENT
METHODOLOGY.—Section
1886(d)(5)(G) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(G)) is amended—
(1) in clause (i), by striking ‘‘and before Octo-
ber 1, 2006,’’; and
(2) in clause (ii)(II), by striking ‘‘and before
October 1, 2006,’’.
(b) CONFORMING AMENDMENTS.—
(1) TARGET AMOUNT.—Section 1886(b)(3)(D)
of 
the 
Social 
Security 
Act 
(42 
U.S.C.
1395ww(b)(3)(D)) is amended—
(A) in the matter preceding clause (i), by
striking ‘‘and before October 1, 2006,’’; and
(B) in clause (iv), by striking ‘‘through fis-
cal year 2005,’’ and inserting ‘‘or any subse-
quent fiscal year,’’.
(2) PERMITTING HOSPITALS TO DECLINE RE-
CLASSIFICATION.—Section 13501(e)(2) of the Omni-
bus Budget Reconciliation Act of 1993 (42 U.S.C.
1395ww note) is amended by striking ‘‘or fiscal year
2000 through fiscal year 2005’’ and inserting ‘‘fiscal
year 2000, or any subsequent fiscal year,’’.
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