I 
108TH CONGRESS 
1ST SESSION H. R. 1351
To amend title XVIII of the Social Security Act to increase payments under 
the Medicare Program to Puerto Rico hospitals. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 19, 2003
Mr. ACEVEDO-VILA´ 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 increase 
payments under the Medicare Program to Puerto Rico 
hospitals.
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 Puerto Rico 
Hospital Payment Fairness Act of 2003’’. 
SEC. 2. MODIFICATION OF PAYMENT RATE FOR PUERTO 
RICO HOSPITALS. 
Section 1886(d)(9) of the Social Security Act (42 
U.S.C. 1395ww(d)(9)) is amended—
(1) in subparagraph (A)—
(A) in clause (i), by striking ‘‘for dis-
charges beginning on or after October 1, 1997, 
50 percent (and for discharges between October 
1, 1987, and September 30, 1997, 75 percent)’’ 
and inserting ‘‘the applicable Puerto Rico per-
centage (specified in subparagraph (E))’’; and 
(B) in clause (ii), by striking ‘‘for dis-
charges beginning in a fiscal year beginning on 
or after October 1, 1997, 50 percent (and for 
discharges between October 1, 1987, and Sep-
tember 30, 1997, 25 percent)’’ and inserting 
‘‘the applicable Federal percentage (specified in 
subparagraph (E))’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(E) For purposes of subparagraph (A), for dis-
charges occurring—
‘‘(i) on or after October 1, 1987, and before Oc-
tober 1, 1997, the applicable Puerto Rico percentage 
is 75 percent and the applicable Federal percentage 
is 25 percent; 
‘‘(ii) on or after October 1, 1997, and before 
October 1, 2003, the applicable Puerto Rico percent-
age is 50 percent and the applicable Federal per-
centage is 50 percent;
‘‘(iii) on or after October 1, 2003, and before 
October 1, 2004, the applicable Puerto Rico percent-
age is 25 percent and the applicable Federal per-
centage is 75 percent; 
‘‘(iv) on or after October 1, 2004, and before 
October 1, 2005, the applicable Puerto Rico percent-
age is 12.5 percent and the applicable Federal per-
centage is 87.5 percent; and 
‘‘(v) on or after October 1, 2005, the applicable 
Puerto Rico percentage is 0 percent and the applica-
ble Federal percentage is 100 percent.’’. 
SEC. 3. CALCULATION OF MEDICARE DSH PAYMENTS FOR 
PPS HOSPITALS IN PUERTO RICO. 
(a) IN GENERAL.—Section 1886(d)(9) of the Social 
Security Act (42 U.S.C. 1395ww(d)(9)), as amended by 
section 2, is amended—
(1) by striking subparagraph (D)(iii) and in-
serting the following: 
‘‘(iii) Subparagraph (F) (relating to dispropor-
tionate share payments), except that for this pur-
pose—
‘‘(I) the sum described in clause (ii) of this 
subparagraph shall be substituted for the sum 
referred to in paragraph (5)(F)(ii)(I); and
‘‘(II) the number of a subsection (d) Puer-
to Rico hospital’s SSI proxy patient days (as 
defined in subparagraph (F)) shall be sub-
stituted for the numerator referred to in para-
graph (5)(F)(vi)(I).’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F)(i) For purposes of subparagraph (D)(iii)(II), 
the term ‘subsection (d) Puerto Rico hospital’s SSI proxy 
patient days’ means the product of—
‘‘(I) the SSI proxy percentage (as defined in 
clause (ii)); and 
‘‘(II) the total number of the hospital’s patient 
days for such period. 
‘‘(ii) For purposes of clause (i)(I), the term ‘SSI 
proxy percentage’ means, with respect to all subsection (d) 
Puerto Rico hospitals for cost reporting periods beginning 
in a fiscal year, the unweighted average of the fractions 
(expressed as percentages) determined under paragraph 
(5)(F)(vi)(I) for all subsection (d) hospitals in the income-
equivalent proxy State (as defined in clause (iii)) for the 
most recent cost reporting period for which adequate data 
are available (other than hospitals for which such fraction 
or percentage is zero).
‘‘(iii) For purposes of clause (ii), the term ‘income-
equivalent proxy State’ means, for cost reporting periods 
beginning in a fiscal year, the State (other than a State 
for which title XVI, as in effect without regard to the 
amendment made by section 301 of the Social Security 
Amendments of 1972, continues to apply) the per capita 
income of which most closely approximates the per capita 
income of Puerto Rico (as determined by the Secretary 
based on the most recent period for which adequate data 
are available).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to discharges occurring on or 
after October 1, 2003.
Æ