I 118th CONGRESS 2d Session H. R. 7327 IN THE HOUSE OF REPRESENTATIVES February 13, 2024 Ms. DeGette introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XIX of the Social Security Act to ensure adequate consideration of payment rates for multimission hospitals under the Medicaid program, and for other purposes.

1. Short title This Act may be cited as the Protecting Front Line Multimission Hospitals Act of 2024 . 2. Ensuring appropriate payment rates for multimission hospitals under the Medicaid program Section 1902(a)(13)(A) of the Social Security Act ( 42 U.S.C. 1396a(a)(13)(A) ) is amended— (1) in clause (iii), by striking and at the end; (2) in clause (iv), by striking the semicolon and inserting ; and ; and (3) by adding at the end the following new clause: (v) in the case of multimission hospitals (as defined in section 1923(k)) located within the State (or located within 100 miles of the State, in the case of a hospital that provides tertiary services under the State plan), such rates— (I) take into account the short- and long-term financial viability of such hospitals; (II) provide stable, predictable, and sufficient reimbursement to improve or maintain the financial viability of such hospitals; and (III) ensure that items and services are available to be furnished at such hospitals under the State plan (or waiver of such plan) to the same extent that such items and services are available to be furnished at such hospitals to the general population in a geographic region; . 3. Allowing for increased disproportionate share hospital adjustments for certain hospitals under the Medicaid program (a) In general Section 1923 of the Social Security Act ( 42 U.S.C. 1396r–4 ) is amended by adding at the end the following new subsection: (k) Allowable increase in adjustments for certain hospitals (1) In general A payment adjustment under this section during a fiscal year with respect to a hospital that is a multimission hospital for such fiscal year that exceeds the amount determined under subsection (g) with respect to such hospital and fiscal year shall be deemed to be consistent with subsection (c) to the extent that such payment adjustment is less than or equal to the amount that would have been determined under subsection (g) with respect to such hospital and fiscal year had the costs incurred during such fiscal year by such hospital (as described in paragraph (1)(A) of such subsection (or, in the case of a specified hospital (as defined in paragraph (5)), as described in paragraph (1)(A) of such subsection as in effect on January 1, 2020)) to individuals described in paragraph (1)(B) of such subsection (or, in the case of a specified hospital, individuals described in paragraph (1)(A) of such subsection as in effect on January 1, 2020) included costs incurred by such hospital during such fiscal year that are described in paragraph (2) with respect to individuals described in paragraph (3) and that are so incurred for the purpose (as determined by the State) described in paragraph (4). (2) Costs described For purposes of paragraph (1), the costs described in this paragraph are costs for furnishing or supporting the furnishing of physicians’ services (as defined in section 1848), services provided at Federally qualified health center or any other clinical outpatient setting, and emergency medical services (as defined in section 303(j)(13) of the Controlled Substances Act). (3) Individuals described For purposes of paragraph (1), the individuals described in this paragraph are, with respect to costs incurred by a hospital for a fiscal year— (A) except as provided in subparagraph (B), individuals described in paragraph (1)(B) of subsection (g); and (B) in the case the amount determined under such subsection for such hospital and such year is so determined under paragraph (2)(A)(ii) of such subsection, individuals described in paragraph (1)(A) of such subsection as in effect on January 1, 2020. (4) Purpose described For purposes of paragraph (1), the purpose described in this paragraph is to ensure that care and services are available under the State plan (or waiver of such plan) in a geographic area at least to the extent that such care and services are available to the general population in such area. (5) Definitions In this subsection: (A) Disproportionate patient bed count The term disproportionate patient bed count means, with respect to a hospital and a fiscal year, the product of— (i) such hospital’s disproportionate patient percentage for such fiscal year; and (ii) such hospital’s number of beds for such fiscal year. (B) Multimission hospital The term multimission hospital means, with respect to a fiscal year— (i) a public hospital with 100 or more beds that has— (I) an average Medicare case mix index of at least 1.3; (II) an intern and resident to bed ratio of at least 0.17 (or at least 125 residents and fellows); and (III) an average disproportionate patient percentage over the 3-year period ending on the last day of such fiscal year of at least 40 percent (or a disproportionate patient percentage for such fiscal year of at least 40 percent); (ii) a nonprofit hospital with more than 199 but fewer than 1,000 beds that has an average disproportionate patient percentage over the 3-year period ending on the last day of such fiscal year of at least 40 percent (or a disproportionate patient percentage for such fiscal year of at least 40 percent) and has— (I) in the case of such a hospital with an average disproportionate patient percentage over such period of at least 45 percent— (aa) an average Medicare case mix index of at least 1.5; and (bb) an intern and resident to bed ratio of at least 0.19 (or at least 150 residents and fellows); or (II) in the case of such a hospital not described in subclause (I)— (aa) a disproportionate patient bed count of at least 250; (bb) an average Medicare case mix index of at least 2.0; and (cc) an intern and resident to bed ratio of at least 0.2 (or at least 175 residents and fellows); and (iii) a nonprofit hospital with 1,000 or more beds that has an average disproportionate patient percentage over the 3-year period ending on the last day of such fiscal year of at least 55 percent (or a disproportionate patient percentage for such fiscal year of at least 55 percent). (C) Specified hospital The term specified hospital means, with respect to a fiscal year, a hospital with an amount determined under subsection (g) for such year that is so determined under paragraph (2)(A)(ii) of such subsection. . (b) Conforming amendment Section 1923(g)(1) of the Social Security Act ( 42 U.S.C. 1396r–4(g)(1) ) is amended by striking A payment adjustment and inserting Subject to subsection (k), a payment adjustment . (c) Effective date The amendments made by this section shall apply with respect to fiscal year 2024 and each subsequent fiscal year.