Title: Children's Hospital Protection Act
Policy area: Health

Summary:
Children's Hospital Protection Act
This bill specifically bases the methodology for determining limitations on Medicaid disproportionate-share hospital payments on the costs and payments for individuals for whom Medicaid is the primary payer.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 5077 Introduced in Senate (IS)]

<DOC>






116th CONGRESS
  2d Session
                                S. 5077

To amend title XIX of the Social Security Act to adjust the limitations 
         on Medicaid disproportionate share hospital payments.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           December 20, 2020

  Mr. Cornyn introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To amend title XIX of the Social Security Act to adjust the limitations 
         on Medicaid disproportionate share hospital payments.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Children's Hospital Protection 
Act''.

SEC. 2. MEDICAID SHORTFALL AND THIRD-PARTY PAYMENTS.

    (a) In General.--Subsection (g) of section 1923 of the Social 
Security Act (42 U.S.C. 1396r-4) is amended to read as follows:
    ``(g) Limit on Amount of Payment to Hospital.--
            ``(1) In general.--
                    ``(A) Amount of adjustment subject to uncompensated 
                costs.--A payment adjustment during a fiscal year shall 
                not be considered to be consistent with subsection (c) 
                with respect to a hospital (other than a hospital 
                described in paragraph (2)(B)) if the payment 
                adjustment exceeds an amount equal to--
                            ``(i) the costs incurred during the year of 
                        furnishing hospital services by the hospital to 
                        individuals described in subparagraph (B) 
                        minus--
                            ``(ii) the sum of--
                                    ``(I) payments under this title 
                                (other than under this section) for 
                                such services; and
                                    ``(II) payments by uninsured 
                                patients for such services.
                    ``(B) Individuals described.--For purposes of 
                subparagraph (A), the individuals described in this 
                clause are the following:
                            ``(i) Individuals who are eligible for 
                        medical assistance under the State plan or 
                        under a waiver of such plan and for whom the 
                        State plan or waiver is the primary payor for 
                        such services.
                            ``(ii) Subject to subparagraph (C), 
                        individuals who have no health insurance (or 
                        other source of third party coverage) for 
                        services provided during the year, as 
                        determined by the Secretary.
                    ``(C) Exclusion of certain payments.--For purposes 
                of subparagraph (B)(ii), payments made to a hospital 
                for services provided to indigent patients made by a 
                State or a unit of local government within a State 
                shall not be considered to be a source of third party 
                coverage.
            ``(2) Application of limits for certain hospitals.--
                    ``(A) In general.--A payment adjustment during a 
                fiscal year shall not be considered to be consistent 
                with subsection (c) with respect to a hospital 
                described in subparagraph (B) if the payment adjustment 
                exceeds the higher of--
                            ``(i) the amount determined for the 
                        hospital and fiscal year under paragraph 
                        (1)(A); and
                            ``(ii) the amount determined for the 
                        hospital under paragraph (1)(A) as in effect on 
                        January 1, 2020.
                    ``(B) Hospitals described.--A hospital is described 
                in this subparagraph for a fiscal year if, for the most 
                recent cost reporting period ending before such fiscal 
                year, the hospital is in at least the 98th percentile 
                of all hospitals with respect to the number of hospital 
                days for such period that were made up of patients who 
                (for such days) were entitled to benefits under part A 
                of title XVIII and were entitled to supplemental 
                security income benefits under title XVI (excluding any 
                State supplementary benefits paid with respect to such 
                patients).''.
    (b) Effective Date.--The amendment made by this section shall take 
effect on October 1, 2021, and shall apply to payment adjustments made 
under section 1923 of the Social Security Act (42 U.S.C. 1396r-4) 
during fiscal years beginning on or after such date.
                                 <all>