I
103D CONGRESS
1ST SESSION
H. R. 953
To amend title XVIII of the Social Security Act to extend the period during
which medicare-dependent, small rural hospitals receive additional pay-
ments under the medicare program for the operating costs of inpatient
hospital services, to revise the criteria for determining whether hospitals
are eligible for such additional payments, and to provide additional pay-
ments under the medicare program to other medicare-dependent hos-
pitals.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 17, 1993
Mr. SHAW (for himself and Mr. SAXTON) 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 extend
the period during which medicare-dependent, small rural
hospitals receive additional payments under the medicare
program for the operating costs of inpatient hospital
services, to revise the criteria for determining whether
hospitals are eligible for such additional payments, and
to provide additional payments under the medicare pro-
gram to other medicare-dependent 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 Dependent
Hospital Relief Act of 1993’’.
SEC. 2. SPECIAL TREATMENT FOR MEDICARE-DEPENDENT,
SMALL RURAL HOSPITALS.
(a) EXTENSION OF SPECIAL TREATMENT.—
(1) DETERMINATION OF PAYMENT AMOUNT.—
Section 1886(b)(3)(D) of the Social Security Act (42
U.S.C. 1395ww(b)(3)(D)) is amended by striking
‘‘March 31, 1993,’’ and inserting ‘‘March 31,
1996,’’.
(2) ELIGIBILITY
FOR
DESIGNATION.—Section
1886(d)(5)(G)(i) 
of 
such 
Act 
(42 
U.S.C.
1395ww(d)(5)(G)(i)) is amended by striking ‘‘March
31, 1993,’’ and inserting ‘‘March 31, 1996,’’.
(3) EFFECTIVE DATE.—The amendments made
by paragraphs (1) and (2) shall take effect as if in-
cluded in the enactment of section 6003(f) of the
Omnibus Budget Reconciliation Act of 1989.
(b) REVISION OF CRITERIA FOR DESIGNATION.—
(1) 
IN
GENERAL.—Section
1886(d)(5)(G)(iii)(IV) of the Social Security Act (42
U.S.C. 1395ww(d)(5)(G)(iii)(IV)) is amended by
striking ‘‘during the cost reporting period beginning
during fiscal year 1987’’ and inserting ‘‘during at
least 2 of the cost reporting periods beginning on or
after October 1, 1986, and ending on or before Sep-
tember 30, 1990,’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to cost reporting peri-
ods beginning on or after April 1, 1993.
SEC. 3. ADDITIONAL PAYMENT FOR OTHER MEDICARE DE-
PENDENT HOSPITALS.
(a) IN GENERAL.—Section 1886(d)(5) of the Social
Security Act (42 U.S.C. 1395ww(d)(5)) is amended—
(1) by redesignating subparagraphs (H) and (I)
as subparagraphs (I) and (J); and
(2) by inserting after subparagraph (G) the fol-
lowing new subparagraph:
‘‘(G)(i) For discharges occurring on or after October
1, 1993, and on or before September 30, 1995, the Sec-
retary shall provide, in accordance with this subparagraph,
for an additional payment amount for each subsection (d)
hospital—
‘‘(I) that is not a medicare-dependent, small
rural hospital (as defined in subparagraph (G)(iii));
and
‘‘(II) for which not less than 65 percent of its
inpatient days or discharges during at least 2 of the
cost reporting periods beginning on or after October
1, 1986, and ending on or before September 30,
1990, were attributable to inpatients entitled to ben-
efits under part A.
‘‘(ii) The amount of the additional payment made
under this subparagraph for each discharge shall be equal
to 3 percent of the sum of—
‘‘(I) the amount determined under paragraph
(1)(A)(iii); and
‘‘(II) the amount paid to the hospital under
subparagraph (A) for that discharge.’’.
(b) APPLICABILITY
TO
HOSPITALS
IN
PUERTO
RICO.—Section 1886(d)(9)(D) of such Act (42 U.S.C.
1395ww(d)(9)(D)) is amended—
(1) in clause (iv), by striking ‘‘Subparagraph
(H)’’ and inserting ‘‘Subparagraph (I)’’;
(2) by redesignating clause (iv) as clause (v);
and
(3) by inserting after clause (iii) the following
new clause:
‘‘(iv) Subparagraph (G) (relating to additional
payments for medicare-dependent hospitals).’’.
(c) EFFECTIVE DATE.—The amendments made by
subsections (a) and (b) shall apply to discharges occurring
on or after October 1, 1993.
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