I
106TH CONGRESS
1ST SESSION
H. R. 1103
To amend title XVIII of the Social Security Act to carve out from payments
to Medicare+Choice organizations amounts attributable to disproportion-
ate share hospital payments and pay such amounts directly to those
disproportionate share hospitals in which their enrollees receive care.
IN THE HOUSE OF REPRESENTATIVES
MARCH 11, 1999
Mr. RANGEL (for himself, Mr. STARK, Mr. QUINN, Mr. WALSH, Mr. ACKER-
MAN, Mrs. CHRISTENSEN, Mr. DOYLE, Mr. FATTAH, Mr. FROST, Mr.
HINCHEY, Mr. HOLDEN, Mr. JENKINS, Ms. KILPATRICK, Mr. KLINK, Mr.
LAFALCE, Mr. LEWIS of Georgia, Mrs. MALONEY of New York, Mr. MAS-
CARA, Mr. MATSUI, Mrs. MCCARTHY of New York, Mr. MCDERMOTT,
Mr. MCGOVERN, Ms. SLAUGHTER, Mr. MCNULTY, Mr. NADLER, Mr.
PASTOR, Mr. SERRANO, Mrs. THURMAN, Mr. TOWNS, and Ms.
VELA´ZQUEZ) 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 consideration of such provisions as fall within the juris-
diction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to carve
out from payments to Medicare+Choice organizations
amounts attributable to disproportionate share hospital
payments and pay such amounts directly to those dis-
proportionate share hospitals in which their enrollees re-
ceive care.
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. CARVING OUT DSH PAYMENTS FROM PAY-
MENTS TO MEDICARE+CHOICE ORGANIZA-
TIONS AND PAYING THE AMOUNTS DIRECTLY
TO 
DSH 
HOSPITALS 
ENROLLING
MEDICARE+CHOICE ENROLLEES.
(A) IN GENERAL.—Section 1853(c)(3) of the Social
Security Act (42 U.S.C. 1395w–23(c)(3)), as inserted by
section 4001 of the Balanced Budget Act of 1997, is
amended—
(1) in subparagraph (A), by striking ‘‘subpara-
graph (B)’’ and inserting ‘‘subparagraphs (B) and
(D)’’,
(2) by redesignating subparagraph (D) as sub-
paragraph (E), and
(3) by inserting after subparagraph (C) the fol-
lowing new subparagraph:
‘‘(D) REMOVAL
OF
PAYMENTS
ATTRIB-
UTABLE
TO
DISPROPORTIONATE
SHARE
PAY-
MENTS FROM CALCULATION OF ADJUSTED AV-
ERAGE PER CAPITA COST.—
‘‘(i) IN
GENERAL.—In determining
the area-specific Medicare+Choice capita-
tion rate under subparagraph (A) for a
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year (beginning with 2000), the annual per
capita rate of payment for 1997 deter-
mined under section 1876(a)(1)(C) shall be
adjusted, subject to clause (ii) to exclude
from the rate the additional payments that
the Secretary estimates were payment dur-
ing 1997 for additional payments described
in section 1886(d)(5)(F).
‘‘(ii) TREATMENT OF PAYMENTS COV-
ERED
UNDER
STATE
HOSPITAL
REIM-
BURSEMENT SYSTEM.—To the extent that
the Secretary estimates that an annual per
capita rate of payment for 1997 described
in clause (i) reflects payments to hospitals
reimbursed under section 1814(b)(3), the
Secretary shall estimate a payment adjust-
ment that is comparable to the payment
adjustment that would have been made
under clause (i) if the hospitals had not
been reimbursed under such section.’’.
(b) ADDITIONAL PAYMENTS FOR MANAGED CARE
ENROLLEES.—Section 1886(d)(5)(F) of such Act ((42
U.S.C. 1395ww(d)(5)(F)) is amended—
(1) in clause (ii), by striking ‘‘clause (ix)’’ and
inserting ‘‘clauses (ix) and (x)’’, and
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(2) by adding at the end the following:
‘‘(ix)(I) For portions of cost reporting
periods occurring on or after January 1,
2000, the Secretary shall provide for an
additional payment amount for each appli-
cable discharge of any subsection (d) hos-
pital that is a disproportionate share hos-
pital (as described in clause (i)).
‘‘(II) For purposes of this clause the
term ‘applicable discharge’ means the dis-
charge of any individual who is enrolled
under a risk-sharing contract with a eligi-
ble organization under section 1876 and
who is entitled to benefits under part A or
any individual who is enrolled with a
Medicare+Choice organization under part
C.
‘‘(III) The amount of the payment
under this clause with respect to any appli-
cable discharge shall be equal to the esti-
mated average per discharge amount that
would otherwise have been paid under this
subparagraph if the individuals had not
been enrolled as described in subclause
(II).
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‘‘(IV) The Secretary shall establish
rules for an additional payment amount,
for any hospital reimbursed under a reim-
bursement 
system 
authorized 
under
1814(b)(3) if such hospital would qualify
as a disproportionate share hospital under
clause (i) were it not so reimbursed. Such
payment shall be determined in the same
manner as the amount of payment is de-
termined under this clause for dispropor-
tionate share hospitals.’’.
Æ