I 
112TH CONGRESS 
1ST SESSION H. R. 1273 
To amend title XVIII of the Social Security Act to apply the additional 
Medicare HITECH payment provisions to hospitals in Puerto Rico. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 30, 2011 
Mr. PIERLUISI (for himself, Mr. ANDREWS, Mr. RANGEL, Mr. SERRANO, Mr. 
CONYERS, Mrs. CHRISTENSEN, Mr. GRIJALVA, Ms. ROYBAL-ALLARD, 
Mrs. NAPOLITANO, Mr. FALEOMAVAEGA, and Mr. SABLAN) 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 apply 
the additional Medicare HITECH payment provisions 
to hospitals in Puerto Rico. 
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 ‘‘Puerto Rico Hospital 
HITECH Amendments of 2011’’. 
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SEC. 2. APPLICATION OF MEDICARE HITECH PAYMENTS TO 
HOSPITALS IN PUERTO RICO. 
(a) IN GENERAL.—Subsection (n)(6)(B) of section 
1886 of the Social Security Act (42 U.S.C. 1395ww) is 
amended by striking ‘‘subsection (d) hospital’’ and insert-
ing ‘‘hospital that is a subsection (d) hospital or a sub-
section (d) Puerto Rico hospital’’. 
(b) OFFSETTING REDUCTION.—Subsection (n)(2) of 
such section is amended by adding at the end the following 
new subparagraph: 
‘‘(H) 
BUDGET
NEUTRALITY
ADJUST-
MENT.—The Secretary shall reduce the applica-
ble amounts that would otherwise be deter-
mined under this subsection with respect to— 
‘‘(i) fiscal year 2012 by an amount 
that the Secretary estimates would ensure 
that estimated aggregate payments under 
this subsection for fiscal years 2011 and 
2012 are not increased as a result of the 
amendment made by subsection (a) of sec-
tion 2 of the Puerto Rico Hospital 
HITECH Amendments of 2011; or 
‘‘(ii) a succeeding fiscal year by an 
amount that the Secretary estimates would 
ensure that estimated aggregate payments 
under this subsection for such fiscal year 
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are not increased as a result of the amend-
ments made by subsections (a) and (c) of 
such section.’’. 
(c) CONFORMING
AMENDMENTS.—(1) Subsection 
(b)(3)(B)(ix) of such section is amended— 
(A) in subclause (I), by striking ‘‘(n)(6)(A)’’ 
and inserting ‘‘(n)(6)(B)’’; and 
(B) in subclause (II), by striking ‘‘subsection 
(d) hospital’’ and inserting ‘‘an eligible hospital’’. 
(2) Paragraphs (2) and (4)(A) of section 1853(m) of 
the Social Security Act (42 U.S.C. 1395w–23(m)) are 
each amended by striking ‘‘1886(n)(6)(A)’’ and inserting 
‘‘1886(n)(6)(B)’’. 
(d) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by sub-
sections (a), (b) and (c) by program instruction or other-
wise. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply as if included in the enactment 
of the American Recovery and Reinvestment Act of 2009 
(Public Law 111–3). 
Æ 
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