I 
114TH CONGRESS 
1ST SESSION H. R. 3288 
To amend title XVIII of the Social Security Act to change the method 
of determining disproportionate share hospital (DSH) payments under 
the Medicare program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 29, 2015 
Mr. MARCHANT (for himself and Mr. BOUSTANY) introduced the following bill; 
which was referred to the Committee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to change 
the method of determining disproportionate share hos-
pital (DSH) payments under the Medicare program, and 
for other purposes. 
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 ‘‘Strengthening DSH 
and Medicare Through Subsidy Recapture and Payment 
Reform Act of 2015’’. 
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SEC. 2. CHANGE IN DETERMINATION OF MEDICARE DSH 
PAYMENTS. 
Paragraph (1) of section 1886(r) of the Social Secu-
rity Act (42 U.S.C. 1395ww(r)) is amended— 
(1) by striking so much of such paragraph as 
precedes ‘‘fiscal year 2014’’ and inserting the fol-
lowing: 
‘‘(1) DSH PAYMENTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), for’’; 
(2) by striking ‘‘(which represents’’ and all that 
follows through ‘‘Report to the Congress)’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(B) AGGREGATE LIMITATION BEGINNING 
WITH FISCAL YEAR 2017.—As part of the rule-
making to carry out subsection (d) for fiscal 
year 2017 and each subsequent fiscal year, the 
Secretary shall estimate the aggregate amount 
of payments to be made for such fiscal year 
under subparagraph (A) (determined without 
regard to this subparagraph) and, if the 
amount so estimated exceeds $3,300,000,000, 
then each amount paid under subparagraph (A) 
for that fiscal year shall be multiplied by the 
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ratio of $3,300,000,000 to the amount so esti-
mated.’’. 
SEC. 3. ADDITIONAL DSH PAYMENT FOR CERTAIN QUALI-
FYING HOSPITALS. 
Section 1886(r) of the Social Security Act (42 U.S.C. 
1395ww(r)) is amended— 
(1) by redesignating paragraph (3) as para-
graph (4); and 
(2) by inserting after paragraph (2) the fol-
lowing new paragraph: 
‘‘(3) ADDITIONAL
PAYMENT
FOR
CERTAIN 
QUALIFYING HOSPITALS.— 
‘‘(A) IN GENERAL.—For fiscal year 2017 
and each subsequent fiscal year, in addition to 
the payments made to a qualifying hospital 
under paragraphs (1) and (2), the Secretary 
shall pay to each qualifying hospital an amount 
equal to $1,000,000,000 multiplied by the fac-
tor that would be calculated under paragraph 
(2)(C) for such qualifying hospital if each ref-
erence in such paragraph to a subsection (d) 
hospital were treated as a reference to a quali-
fying hospital. 
‘‘(B) QUALIFYING HOSPITAL DEFINED.— 
In this paragraph, ‘qualifying hospital’ means a 
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subsection (d) hospital that is located in Ala-
bama, Florida, Georgia, Idaho, Kansas, Lou-
isiana, Maine, Mississippi, Missouri, Nebraska, 
North Carolina, Oklahoma, South Carolina, 
South Dakota, Tennessee, Texas, Utah, Vir-
ginia, Wisconsin, or Wyoming.’’. 
SEC. 4. RECAPTURE OF OVERPAYMENTS RESULTING FROM 
CERTAIN FEDERALLY SUBSIDIZED HEALTH 
INSURANCE. 
(a) IN GENERAL.—Paragraph (2) of section 36B(f) 
of the Internal Revenue Code of 1986 is amended by strik-
ing subparagraph (B). 
(b) CONFORMING AMENDMENT.—So much of para-
graph (2) of section 36B(f) of such Code, as amended by 
subsection (a), as precedes ‘‘advance payments’’ is amend-
ed to read as follows: 
‘‘(2) EXCESS ADVANCE PAYMENTS.—If the’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years ending after De-
cember 31, 2015. 
Æ 
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