I
106TH CONGRESS
2D SESSION
H. R. 5220
To amend title XVIII of the Social Security Act to preserve essential rural
hospitals.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 20, 2000
Mr. PAUL (for himself, Mr. EDWARDS, and Mr. SMITH of Texas) 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 preserve
essential rural 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 ‘‘Essential Rural Hos-
pital Preservation Act of 2000’’.
SEC. 2. REVISIONS IN THE MEDICARE PROGRAM TO PRE-
SERVE ESSENTIAL RURAL HOSPITALS.
(a) ESSENTIAL RURAL HOSPITAL DEFINED.—Sec-
tion 1861 of the Social Security Act (42 U.S.C. 1395x)
is amended by adding at the end the following new sub-
section:
‘‘Essential Rural Hospital
‘‘(uu) The term ‘essential rural hospital’ means a
subsection 
(d) 
hospital 
(as 
defined 
in 
section
1886(d)(1)(B)) that is located in a rural area (as defined
in section 1886(d)(2)(D)) and that has 50 or fewer beds.’’.
(b) FLOOR ON WAGE INDEX APPLIED UNDER INPA-
TIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM.—Sec-
tion 1886(d)(3)(E) of the Social Security Act (42 U.S.C.
1395ww(d)(3)(E)) is amended by adding at the end the
following: ‘‘In no case shall the wage index factor for an
essential rural hospital (as defined in section 1861(uu))
be less than 1.0.’’.
(c) TREATING AS ALLOWABLE COSTS 100 PERCENT
OF BAD DEBTS ATTRIBUTABLE TO MEDICARE COPAY-
MENTS
AND DEDUCTIONS.—Section 1861(v)(1)(T) of
such Act (42 U.S.C. 1395x(v)(1)(T)) is amended by in-
serting ‘‘(other than essential rural hospitals, as defined
in subsection (uu))’’ after ‘‘In determining such reason-
able costs for hospitals’’.
(d) EXEMPTION FROM HOSPITAL OUTPATIENT PRO-
SPECTIVE PAYMENT SYSTEM.—Section 1833(t)(13) of
such Act (42 U.S.C. 1395l(t)(13)) is amended by adding
at the end the following new subparagraph:
‘‘(B) EXEMPTION
OF
ESSENTIAL
RURAL
HOSPITALS.—The system under this subsection
shall not apply to covered OPD services fur-
nished in an essential rural hospital (as defined
in section 1861(uu)).’’.
(e) DSH PAYMENTS.—Section 1886(d)(5)(F) of such
Act (42 U.S.C. 1395ww(d)(5)(F)) is amended—
(1) in clause (i)—
(A) by striking ‘‘or’’ at the end of sub-
clause (I);
(B) by striking the period at the end of
subclause (II); and
(C) by adding at the end the following new
subclause:
‘‘(III) is an essential rural hospital (as defined
in section 1861(uu)).’’;
(2) in clause (ii), by striking ‘‘clause (ix)’’ and
inserting ‘‘clauses (ix) and (x)’’; and
(3) by adding at the end the following new
clause:
‘‘(x) In no case shall the disproportionate share ad-
justment percentage under this subparagraph for a hos-
pital described in clause (i)(III) be less than 20 percent.’’.
(f) EFFECTIVE DATES.—The amendments made
by—
(1) subsections (b) and (e) apply to discharges
occurring on or after October 1, 2000;
(2) subsection (c) applies to cost reporting peri-
ods beginning on or after October 1, 2000; and
(3) subsection (d) applies to covered OPD serv-
ices furnished on or after October 1, 2000.
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