I 
110TH CONGRESS 
2D SESSION 
H. R. 7105 
To amend title XVIII of the Social Security Act to preserve access to urban 
Medicare-dependent hospitals. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 25, 2008 
Mr. SAXTON (for himself and Mr. SMITH of New Jersey) 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 preserve 
access to urban 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 ‘‘Urban Medicare-De-
pendent Hospitals Preservation Act of 2008’’. 
SEC. 2. CRITERIA AND PAYMENT FOR CERTAIN URBAN 
MEDICARE-DEPENDENT HOSPITALS. 
(a) IN GENERAL.—Section 1886(d)(5) of the Social 
Security Act (42 U.S.C. 1395ww(d)(5)) is amended by 
adding at the end the following new subparagraph: 
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‘‘(M)(i) For cost reporting periods beginning on or 
after October 1, 2008, in the case of a subsection (d) hos-
pital which is an urban Medicare-dependent hospital, pay-
ment under paragraph (1)(A) shall be equal to the sum 
of the amount determined under clause (ii) and the 
amount determined under paragraph (1)(A)(iii). 
‘‘(ii) The amount determined under this clause is, for 
discharges occurring during the cost reporting period that 
begins on or after October 1, 2008, and any subsequent 
cost reporting period, 75 percent of the amount by which 
the hospital’s target amount for the cost reporting period 
(as defined in subsection (b)(3)(L)) exceeds the amount 
determined under paragraph (1)(A)(iii). 
‘‘(iii) The term ‘urban Medicare-dependent hospital’ 
means, with respect to any cost reporting period to which 
clause (i) applies, any hospital— 
‘‘(I) located in an urban area; 
‘‘(II) that does not receive payment— 
‘‘(aa) under subparagraph (C) as a rural 
referral center; 
‘‘(bb) under subparagraph (D) as a sole 
community hospital; 
‘‘(cc) under subparagraph (B) or under 
subsection (h); or 
‘‘(dd) under subparagraph (F); and 
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‘‘(III) for which not less than 60 percent of its 
inpatient days or discharges during the cost report-
ing period beginning in fiscal year 2006, or two of 
the three most recently audited cost reporting peri-
ods for which the Secretary has a settled cost report, 
were attributable to inpatients entitled to benefits 
under part A. 
‘‘(iv) The Secretary shall for each fiscal year make 
an appropriate adjustment in the national standardized 
amount under paragraph (3) to ensure that any payments 
made under this subparagraph are made in a manner that 
assures that the aggregate payments under this subsection 
are not greater or less than those that would have been 
made without such additional payments.’’. 
(b) 
TARGET
PAYMENT
AMOUNT.—Section 
1886(b)(3) of such Act (42 U.S.C. 1395ww(b)(3)) is 
amended— 
(1) in subparagraph (B)(iv), by striking ‘‘and 
(D)’’ and inserting ‘‘, (D), and (L)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(L) For cost reporting periods occurring on or after 
October 1, 2008, in the case of a hospital that is an urban 
Medicare-dependent hospital (as defined in subsection 
(d)(5)(M)), the term ‘target amount’ means— 
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‘‘(i) with respect to the first 12-month cost re-
porting period in which this subparagraph is applied 
to the hospital, the allowable operating costs of inpa-
tient hospital services (as defined in subsection 
(a)(4)) recognized under this title for the hospital 
for the 12-month cost reporting period beginning 
during fiscal year 2002, increased by the applicable 
percentage increase under subparagraph (B)(iv) for 
each of fiscal years 2003 through 2008; and 
‘‘(ii) with respect to discharges occurring after 
the first 12-month cost reporting period in which 
this subparagraph is applied to the hospital, the tar-
get amount for the preceding year increased by the 
applicable percentage increase under subparagraph 
(B)(iv).’’. 
Æ 
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