In this task, you are given text for US Congressional and California state bills, your task is to generate a summary for this bill.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``International Insurance Capital 
Standards Accountability Act of 2015''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) the Secretary of the Treasury, Board of Governors of 
        the Federal Reserve System, and Director of the Federal 
        Insurance Office shall support increasing transparency at any 
        global insurance or international standard-setting regulatory 
        or supervisory forum in which they participate, including 
        supporting and advocating for greater public observer access to 
        working groups and committee meetings of the International 
        Association of Insurance Supervisors; and
            (2) to the extent that the Secretary of the Treasury, Board 
        of Governors of the Federal Reserve System, and Director of the 
        Federal Insurance Office take a position or reasonably intend 
        to take a position on an insurance proposal by a global 
        insurance regulatory or supervisory forum, the Secretary of the 
        Treasury, Board of Governors of the Federal Reserve System, and 
        Director of the Federal Insurance Office shall achieve 
        consensus positions with State insurance regulators through the 
        National Association of Insurance Commissioners, when they are 
        United States participants in negotiations on insurance issues 
        before the International Association of Insurance Supervisors, 
        Financial Stability Board, or any other international forum of 
        financial regulators or supervisors that considers such issues.

SEC. 3. INSURANCE POLICY ADVISORY COMMITTEE.

    (a) Establishment.--There is established the Insurance Policy 
Advisory Committee on International Capital Standards and Other 
Insurance Issues at the Board of Governors of the Federal Reserve 
System.
    (b) Membership.--The Commission shall be composed of not more than 
21 members, all of whom represent a diverse set of expert perspectives 
from the various sectors of the United States insurance industry, 
including life insurance, property and casualty insurance and 
reinsurance, agents and brokers, academics, consumer advocates, or 
experts on issues facing underserved insurance communities and 
consumers.

SEC. 4. REPORTS.

    (a) In General.--
            (1) Reports and testimony by secretary of the treasury and 
        chairman of the federal reserve.--
                    (A) In general.--The Secretary of the Treasury and 
                the Chairman of the Federal Reserve, or their designee, 
                shall submit to the Banking, Housing, and Urban Affairs 
                Committee of the Senate, and the Financial Services 
                Committee of the House of Representatives, an annual 
                report and provide annual testimony to the Banking, 
                Housing, and Urban Affairs Committee of the Senate, and 
                the Financial Services Committee of the House of 
                Representatives on the efforts of the Secretary and the 
                Chairman with the National Association of Insurance 
                Commissioners with respect to global insurance 
                regulatory or supervisory forums, including--
                            (i) a description of the insurance 
                        regulatory or supervisory standard-setting 
                        issues under discussion at international 
                        standard-setting bodies, including the 
                        Financial Stability Board and the International 
                        Association of Insurance Supervisors;
                            (ii) a description of the effects that 
                        proposals discussed at international insurance 
                        regulatory or supervisory forums of insurance 
                        could have on consumer and insurance markets in 
                        the United States;
                            (iii) a description of any position taken 
                        by the Secretary of the Treasury, Board of 
                        Governors of the Federal Reserve System, and 
                        Director of the Federal Insurance Office in 
                        international insurance discussions; and
                            (iv) a description of the efforts by the 
                        Secretary of the Treasury, Director of the 
                        Federal Insurance Office, and the Board of 
                        Governors of the Federal Reserve System to 
                        increase transparency at the Financial 
                        Stability Board with respect to insurance 
                        proposals and the International Association of 
                        Insurance Supervisors, including efforts to 
                        provide additional public access to working 
                        groups and committees of the International 
                        Association of Insurance Supervisors.
                    (B) Termination.--This paragraph shall terminate on 
                December 31, 2018.
            (2) Reports and testimony by national association of 
        insurance commissioners.--The National Association of Insurance 
        Commissioners may provide testimony to Congress on the issues 
        described in paragraph (1)(A).
            (3) Joint report by the chairman of the federal reserve and 
        the director of the federal insurance office.--
                    (A) In general.--The Secretary of the Treasury, 
                Chairman of the Federal Reserve, and the Director of 
                the Federal Insurance Office shall, in consultation 
                with the National Association of Insurance 
                Commissioners, complete a study on, and submit to 
                Congress a report on the results of the study, the 
                impact on consumers and markets in the United States 
                before supporting or consenting to the adoption of any 
                key elements in any international insurance proposal or 
                international insurance capital standard.
                    (B) Notice and comment.--
                            (i) Notice.--The Secretary of the Treasury, 
                        Chairman of the Federal Reserve, and the 
                        Director of the Federal Insurance Office shall 
                        provide notice before the date on which 
                        drafting the report is commenced and after the 
                        date on which the draft of the report is 
                        completed.
                            (ii) Opportunity for comment.--There shall 
                        be an opportunity for public comment for a 
                        period beginning on the date on which the 
                        report is submitted under subparagraph (A) and 
                        ending on the date that is 60 days after the 
                        date on which the report is submitted.
                    (C) Review by comptroller general.--The Secretary 
                of the Treasury, Chairman of the Federal Reserve, and 
                the Director of the Federal Insurance Office shall 
                submit to the Comptroller General of the United States 
                the report described in subparagraph (A) for review.
            (4) Report on reduction in transparency.--Not later than 
        180 days after the date of enactment of this Act, the Chairman 
        of the Federal Reserve and the Secretary of the Treasury, or 
        their designees, shall submit to Congress a report and provide 
        testimony to Congress on the efforts of the Chairman and the 
        Secretary to increase transparency at meetings of the 
        International Association of Insurance Supervisors.
International Insurance Capital Standards Accountability Act of 2015 This bill establishes at the Board of Governors of the Federal Reserve System the Insurance Policy Advisory Committee on International Capital Standards and Other Insurance Issues, a 21-member committee representing diverse expert perspectives from the U.S. insurance industry (including life insurance, property and casualty insurance and reinsurance, agents and brokers, academics, consumer advocates, or experts on issues facing underserved insurance communities and consumers).  The Secretary of the Treasury and the Board Chairman shall report annually to certain congressional committees on their efforts with the National Association of Insurance Commissioners regarding global insurance regulatory or supervisory forums. The Secretary, the Board Chairman, and the Director of the Federal Insurance Office, before supporting or consenting to the adoption of any key element in any international insurance proposal or international insurance capital standard, must study its impact upon U.S. markets and consumers.  The Secretary and the Board Chairman must also report, as well as testify to Congress on their efforts to increase transparency at meetings of the International Association of Insurance Supervisors.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preservation of Antibiotics for 
Medical Treatment Act of 2011''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) In January 2001, a Federal interagency task force--
                    (A) released an action plan to address the 
                continuing decline in effectiveness of antibiotics 
                against common bacterial infections, referred to as 
                antibiotic resistance;
                    (B) determined that antibiotic resistance is a 
                growing menace to all people and poses a serious threat 
                to public health; and
                    (C) cautioned that if current trends continue, 
                treatments for common infections will become 
                increasingly limited and expensive, and, in some cases, 
                nonexistent.
            (2) Antibiotic resistance, resulting in a reduced number of 
        effective antibiotics, may significantly impair the ability of 
        the United States to respond to terrorist attacks involving 
        bacterial infections or a large influx of hospitalized 
        patients.
            (3)(A) Any overuse or misuse of antibiotics contributes to 
        the spread of antibiotic resistance, whether in human medicine 
        or in agriculture.
            (B) Recognizing the public health threat caused by 
        antibiotic resistance, Congress took several steps to curb 
        antibiotic overuse in human medicine through amendments to the 
        Public Health Service Act (42 U.S.C. 201 et seq.) made by 
        section 102 of the Public Health Threats and Emergencies Act 
        (Public Law 106-505, title I; 114 Stat. 2315), but has not yet 
        addressed antibiotic overuse in agriculture.
            (4) In a March 2003 report, the National Academy of 
        Sciences stated that--
                    (A) a decrease in antimicrobial use in human 
                medicine alone will have little effect on the current 
                situation; and
                    (B) substantial efforts must be made to decrease 
                inappropriate overuse in animals and agriculture.
            (5) In 2010, the FDA determined that--
                    (A) 13.1 million kilograms of antibacterial drugs 
                were sold for use on food animals in the United States 
                in 2009;
                    (B) 3.3 million kilograms of antibacterial drugs 
                were used for human health in 2009; and
                    (C) therefore, 80 percent of antibacterial drugs 
                disseminated in the United States in 2009 were sold for 
                use on food animals, rather than being used for human 
                health.
            (6)(A) Large-scale, voluntary surveys by the Department of 
        Agriculture's Animal and Plant Health Inspection Service in 
        1999, 2001, and 2006 revealed that--
                    (i) 84 percent of grower-finisher swine farms, 83 
                percent of cattle feedlots, and 84 percent of sheep 
                farms administer antimicrobials in the feed or water 
                for health or growth promotion reasons; and
                    (ii) many of the antimicrobials identified are 
                identical or closely related to drugs used in human 
                medicine, including tetracyclines, macrolides, 
                Bacitracin, penicillins, and sulfonamides; and
            (B) these drugs are used in people to treat serious 
        diseases such as pneumonia, scarlet fever, rheumatic fever, 
        venereal disease, skin infections, and even pandemics like 
        malaria and plague, as well as bioterrorism agents like 
        smallpox and anthrax.
            (7) Many scientific studies confirm that the nontherapeutic 
        use of antibiotics in agricultural animals contributes to the 
        development of antibiotic-resistant bacterial infections in 
        people.
            (8) The periodical entitled ``Clinical Infectious 
        Diseases'' published a report in June 2002, that--
                    (A) was based on a 2-year review by experts in 
                human and veterinary medicine, public health, 
                microbiology, biostatistics, and risk analysis, of more 
                than 500 scientific studies on the human health impacts 
                of antimicrobial use in agriculture; and
                    (B) recommended that antimicrobial agents should no 
                longer be used in agriculture in the absence of 
                disease, but should be limited to therapy for diseased 
                individual animals and prophylaxis when disease is 
                documented in a herd or flock.
            (9) The United States Geological Survey reported in March 
        2002 that--
                    (A) antibiotics were present in 48 percent of the 
                streams tested nationwide; and
                    (B) almost half of the tested streams were 
                downstream from agricultural operations.
            (10) An April 1999 study by the General Accounting Office 
        concluded that resistant strains of 3 microorganisms that cause 
        food-borne illness or disease in humans (Salmonella, 
        Campylobacter, and E. coli) are linked to the use of 
        antibiotics in animals.
            (11) Epidemiological research has shown that resistant 
        Salmonella and Campylobacter infections are associated with 
        increased numbers of ill patients and bloodstream infections, 
        and increased death.
            (12) In 2010, the peer-reviewed journal Molecular Cell 
        published a study demonstrating that low-dosage use of 
        antibiotics causes a dramatic increase in genetic mutation, 
        raising new concerns about the agricultural practice of using 
        low-dosage antibiotics in order to stimulate growth promotion 
        and routinely prevent disease in unhealthy conditions.
            (13)(A) In January 2003, Consumer Reports published test 
        results on poultry products bought in grocery stores nationwide 
        showing disturbingly high levels of Campylobacter and 
        Salmonella bacteria that were resistant to the antibiotics used 
        to treat food-borne illnesses.
            (B) The Food and Drug Administration's National 
        Antimicrobial Resistance Monitoring System routinely finds that 
        retail meat products are contaminated with bacteria (including 
        the foodborne pathogens Campylobacter and Salmonella) that are 
        resistant to antibiotics important in human medicine.
            (C) In December 2007, the USDA issued a fact sheet on the 
        recently recognized link between antimicrobial drug use in 
        animals and Methicillin Resistant Staphylococcus Aureas (MRSA) 
        infections in humans.
            (14) In October 2001, the New England Journal of Medicine 
        published an editorial urging a ban on nontherapeutic use of 
        medically important antibiotics in animals.
            (15)(A) In 1998, the National Academy of Sciences noted 
        that antibiotic-resistant bacteria generate a minimum of 
        $4,000,000,000 to $5,000,000,000 in costs to United States 
        society and individuals yearly.
            (B) In 2009, Cook County Hospital and the Alliance for 
        Prudent Use of Antibiotics estimated that the total health care 
        cost of antibiotic resistant infections in the United States 
        was between $16,600,000,000 and $26,000,000,000 annually.
            (16) The American Medical Association, the American Public 
        Health Association, the National Association of County and City 
        Health Officials, and the National Campaign for Sustainable 
        Agriculture are among the more than 300 organizations 
        representing health, consumer, agricultural, environmental, 
        humane, and other interests that have supported enactment of 
        legislation to phase out nontherapeutic use in farm animals of 
        medically important antibiotics.
            (17) In 2010, the Danish Veterinary and Food Administration 
        testified that the Danish ban of the non-therapeutic use of 
        antibiotics in food animal production resulted in a marked 
        reduction in antimicrobial resistance in multiple bacterial 
        species, including Campylobacter and Enterococci.
            (18) In 2009, the Congressional Research Service concluded 
        that restrictions overseas on the use of antimicrobial drugs in 
        the production of livestock could impact U.S. export markets 
        for livestock and poultry.
            (19) The Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
        301 et seq.)--
                    (A) requires that all drugs be shown to be safe 
                before the drugs are approved; and
                    (B) places the burden on manufacturers to account 
                for health consequences and prove safety.
            (20)(A) The Food and Drug Administration recently modified 
        the drug approval process for antibiotics to recognize the 
        development of resistant bacteria as an important aspect of 
        safety, but most antibiotics currently used in animal 
        production systems for nontherapeutic purposes were approved 
        before the Food and Drug Administration began considering 
        resistance during the drug-approval process.
            (B) The Food and Drug Administration has not established a 
        schedule for reviewing those existing approvals.
            (21) Certain non-routine uses of antibiotics in animal 
        agriculture are legitimate to prevent animal disease.
            (22) An April 2004 study by the General Accounting Office--
                    (A) concluded that Federal agencies do not collect 
                the critical data on antibiotic use in animals that 
                they need to support research on human health risks; 
                and
                    (B) recommends that the Department of Agriculture 
                and the Department of Health and Human Services develop 
                and implement a plan to collect data on antibiotic use 
                in animals.

SEC. 3. PURPOSE.

    The purpose of this Act is to preserve the effectiveness of 
medically important antibiotics used in the treatment of human and 
animal diseases by reviewing the safety of certain antibiotics for 
nontherapeutic purposes in food-producing animals.

SEC. 4. PROOF OF SAFETY OF CRITICAL ANTIMICROBIAL ANIMAL DRUGS.

    (a) Definitions.--Section 201 of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 321) is amended by adding at the end the 
following:
    ``(ss) Critical Antimicrobial Animal Drug.--The term `critical 
antimicrobial animal drug' means a drug that--
            ``(1) is intended for use in food-producing animals; and
            ``(2) is composed wholly or partly of--
                    ``(A) any kind of penicillin, tetracycline, 
                macrolide, lincosamide, streptogramin, aminoglycoside, 
                or sulfonamide; or
                    ``(B) any other drug or derivative of a drug that 
                is used in humans or intended for use in humans to 
                treat or prevent disease or infection caused by 
                microorganisms.
    ``(tt) Nontherapeutic Use.--The term `nontherapeutic use', with 
respect to a critical antimicrobial animal drug, means any use of the 
drug as a feed or water additive for an animal in the absence of any 
clinical sign of disease in the animal for growth promotion, feed 
efficiency, weight gain, routine disease prevention, or other routine 
purpose.''.
    (b) Applications Pending or Submitted After Enactment.--Section 
512(d)(1) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
360b(d)(1)) is amended--
            (1) in the first sentence--
                    (A) in subparagraph (H), by striking ``or'' at the 
                end;
                    (B) in subparagraph (I), by inserting ``or'' at the 
                end; and
                    (C) by inserting after subparagraph (I) the 
                following:
                    ``(J) with respect to a critical antimicrobial 
                animal drug or a drug of the same chemical class as a 
                critical antimicrobial animal drug, the applicant has 
                failed to demonstrate that there is a reasonable 
                certainty of no harm to human health due to the 
                development of antimicrobial resistance that is 
                attributable, in whole or in part, to the 
                nontherapeutic use of the drug; or''; and
            (2) in the second sentence, by striking ``(A) through (I)'' 
        and inserting ``(A) through (J)''.
    (c) Phased Elimination of Nontherapeutic Use in Animals of Critical 
Antimicrobial Animal Drugs Important for Human Health.--Section 512 of 
the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 360b) is amended by 
adding at the end the following:
    ``(q) Phased Elimination of Nontherapeutic Use in Animals of 
Critical Antimicrobial Animal Drugs Important for Human Health.--
            ``(1) Applicability.--This subsection applies to the 
        nontherapeutic use in a food-producing animal of a drug--
                    ``(A)(i) that is a critical antimicrobial animal 
                drug; or
                    ``(ii) that is of the same chemical class as a 
                critical antimicrobial animal drug; and
                    ``(B)(i) for which there is in effect an approval 
                of an application or an exemption under subsection (b), 
                (i), or (j) of section 505; or
                    ``(ii) that is otherwise marketed for use.
            ``(2) Withdrawal.--The Secretary shall withdraw the 
        approval of a nontherapeutic use in food-producing animals 
        described in paragraph (1) on the date that is 2 years after 
        the date of enactment of this subsection unless--
                    ``(A) before the date that is 2 years after the 
                date of the enactment of this subsection, the Secretary 
                makes a final written determination that the holder of 
                the approved application has demonstrated that there is 
                a reasonable certainty of no harm to human health due 
                to the development of antimicrobial resistance that is 
                attributable in whole or in part to the nontherapeutic 
                use of the drug; or
                    ``(B) before the date specified in subparagraph 
                (A), the Secretary makes a final written determination 
                under this subsection, with respect to a risk analysis 
                of the drug conducted by the Secretary and other 
                relevant information, that there is a reasonable 
                certainty of no harm to human health due to the 
                development of antimicrobial resistance that is 
                attributable in whole or in part to the nontherapeutic 
                use of the drug.
            ``(3) Exemptions.--Except as provided in paragraph (5), if 
        the Secretary grants an exemption under section 505(i) for a 
        drug that is a critical antimicrobial animal drug, the 
        Secretary shall rescind each approval of a nontherapeutic use 
        in a food-producing animal of the critical antimicrobial animal 
        drug, or of a drug in the same chemical class as the critical 
        antimicrobial animal drug, as of the date that is 2 years after 
        the date on which the Secretary grants the exemption.
            ``(4) Approvals.--Except as provided in paragraph (5), if 
        an application for a drug that is a critical antimicrobial 
        animal drug is submitted to the Secretary under section 505(b), 
        the Secretary shall rescind each approval of a nontherapeutic 
        use in a food-producing animal of the critical antimicrobial 
        animal drug, or of a drug in the same chemical class as the 
        critical antimicrobial animal drug, as of the date that is 2 
        years after the date on which the application is submitted to 
        the Secretary.
            ``(5) Exception.--Paragraph (3) or (4), as the case may be, 
        shall not apply if--
                    ``(A) before the date on which approval would be 
                rescinded under that paragraph, the Secretary makes a 
                final written determination that the holder of the 
                application for the approved nontherapeutic use has 
                demonstrated that there is a reasonable certainty of no 
                harm to human health due to the development of 
                antimicrobial resistance that is attributable in whole 
                or in part to the nontherapeutic use in the food-
                producing animal of the critical antimicrobial animal 
                drug; or
                    ``(B) before the date specified in subparagraph 
                (A), the Secretary makes a final written determination 
                under this subsection, with respect to a risk analysis 
                of the critical antimicrobial animal drug conducted by 
                the Secretary and any other relevant information, that 
                there is a reasonable certainty of no harm to human 
                health due to the development of antimicrobial 
                resistance that is attributable in whole or in part to 
                the nontherapeutic use of the drug.''.

SEC. 5. COMMITTEE HEARINGS ON IMPLEMENTATION.

    (a) In General.--The Committee on Energy and Commerce of the House 
of Representatives and the Committee on Energy of the Senate shall each 
hold a hearing on the implementation by the Commissioner of Food and 
Drugs of section 512(q) of the Federal Food, Drug, and Cosmetic Act, as 
added by section 4 of this Act.
    (b) Exercise of Rulemaking Authority.--Subsection (a) is enacted--
            (1) as an exercise of the rulemaking power of the House of 
        Representatives and Senate, and, as such, they shall be 
        considered as part of the rules of the House or Senate (as the 
        case may be), and such rules shall supersede any other rule of 
        the House or Senate only to the extent that rule is 
        inconsistent therewith; and
            (2) with full recognition of the constitutional right of 
        either House to change such rules (so far as relating to the 
        procedure in such House) at any time, in the same manner, and 
        to the same extent as in the case of any other rule of the 
        House or Senate.
Preservation of Antibiotics for Medical Treatment Act of 2011 - Amends the Federal Food, Drug, and Cosmetic Act to require the Secretary of Health and Human Services (HHS) to deny an application for a new animal drug that is a critical antimicrobial animal drug unless the applicant demonstrates that there is a reasonably certainty of no harm to human health due to the development of antimicrobial resistance attributable to the nontherapeutic use of the drug. Defines "critical antimicrobial animal drug" as a drug intended for use in food-producing animals that contains specified antibiotics or other drugs used in humans to treat or prevent disease or infection caused by microorganisms.

Requires the Secretary to withdraw approval of a nontherapeutic use of such drugs in food-producing animals two years after the date of enactment of this Act unless certain safety requirements are met. Directs specified congressional committees to hold hearings on the implementation of such a withdrawal of approval.

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Save Our Safety 
Net Act of 2005''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Ensuring adequate physician payment for emergency department 
                            visits.
Sec. 3. Ensuring adequate hospital outpatient fee schedule amounts for 
                            clinic and emergency department visits.
Sec. 4. Permanent extension of adjustment to limit decline in payments 
                            for certain hospitals under hospital 
                            outpatient PPS.
Sec. 5. Fairness in the Medicare disproportionate share hospital (DSH) 
                            adjustment for rural hospitals.

SEC. 2. ENSURING ADEQUATE PHYSICIAN PAYMENT FOR EMERGENCY DEPARTMENT 
              VISITS.

    Section 1833 of the Social Security Act (42 U.S.C. 1395l) is 
amended by adding at the end the following new subsection:
    ``(v) Save Our Safety Net Payments for Physicians' Services 
Provided in an Emergency Department.--In the case of physicians' 
services furnished to an individual covered under the insurance program 
established by this part in an emergency department on or after January 
1, 2006, in addition to the amount of payment that would otherwise be 
made for such services under this part, there also shall be paid to the 
physician or other person (or to an employer or entity in the cases 
described in clause (A) of section 1842(b)(6)) from the Federal 
Supplementary Insurance Trust Fund an amount equal to 10 percent of the 
payment amount for the service under this part.''.

SEC. 3. ENSURING ADEQUATE HOSPITAL OUTPATIENT FEE SCHEDULE AMOUNTS FOR 
              CLINIC AND EMERGENCY DEPARTMENT VISITS.

    (a) In General.--Section 1833(t) of the Social Security Act (42 
U.S.C. 1395l(t)) is amended--
            (1) in paragraph (3)(C)(ii), by striking ``paragraph 
        (8)(B)'' and inserting ``paragraphs (8)(B), (11)(B), and 
        (13)(A)(i)'';
            (2) in paragraph (3)(C)(iii), by inserting ``(but not the 
        conversion factor computed under paragraph (13)(B))'' after 
        ``this subparagraph'';
            (3) in paragraph (3)(D)--
                    (A) in clause (i), by striking ``conversion factor 
                computed under subparagraph (C) for the year'' and 
                inserting ``applicable conversion factor computed under 
                subparagraph (C), paragraph (11)(B), or paragraph 
                (13)(B) for the year''; and
                    (B) in clause (ii), by inserting ``, paragraph 
                (9)(A), or paragraph (13)(C)'' after ``paragraph 
                (2)(C)'';
            (4) in paragraph (9), by amending subparagraph (B) to read 
        as follows:
                    ``(B) Budget neutrality adjustment.--
                            ``(i) In general.--If the Secretary makes 
                        revisions under subparagraph (A), then the 
                        revisions for a year may not cause the 
                        estimated amount of expenditures under this 
                        part for the year to increase or decrease from 
                        the estimated amount of expenditures under this 
                        part (including expenditures attributable to 
                        the special rules specified in paragraph (13)) 
                        that would have been made if the revisions had 
                        not been made.
                            ``(ii) Exemption from reduction.--The 
                        relative payment weights determined under 
                        paragraph (13)(C) and the conversion factor 
                        computed under paragraph (13)(B) shall not be 
                        reduced by any budget neutrality adjustment 
                        made pursuant to this subparagraph.''; and
            (5) by redesignating paragraphs (13) through (16) as 
        paragraphs (14) through (17), respectively, and by inserting 
        after paragraph (12) the following new paragraph:
            ``(13) Special rules for calculating medicare opd fee 
        schedule amount for clinic and emergency visits.--
                    ``(A) In general.--In computing the medicare OPD 
                fee schedule amount under paragraph (3)(D) for covered 
                OPD services that are furnished on or after January 1, 
                2006, and classified within a group established or 
                revised under paragraph (2)(B) or (9)(A), respectively, 
                for clinic and emergency visits (as described in 
                subparagraph (D)), the Secretary shall--
                            ``(i) substitute for the conversion factor 
                        calculated under paragraph (3)(C) the 
                        conversion factor calculated under subparagraph 
                        (B); and
                            ``(ii) substitute for the relative payment 
                        weight established or revised under paragraph 
                        (2)(C) or (9)(A), respectively, the relative 
                        payment weight determined under subparagraph 
                        (C) for such group.
                    ``(B) Calculation of conversion factor.--For 
                purposes of subparagraph (A)(i), the conversion factor 
                calculated under this subparagraph is--
                            ``(i) for services furnished during 2006, 
                        an amount equal to the product of--
                                    ``(I) the conversion factor 
                                specified for such year in the final 
                                rule published on November 10, 2005, 
                                increased by the percentage by which 
                                such conversion factor is reduced for 
                                such year pursuant to paragraph (2)(E), 
                                and not taking into account any 
                                subsequent amendments to such final 
                                rule; and
                                    ``(II) 1.10; and
                            ``(ii) for services furnished in a year 
                        beginning on or after January 1, 2007, the 
                        conversion factor computed under this 
                        subparagraph for the previous year increased by 
                        the OPD fee schedule increase factor specified 
                        under paragraph (3)(C)(iv) for the year 
                        involved.
                    ``(C) Determination of relative payment weights.--
                For purposes of subparagraph (A)(ii), the relative 
                payment weight determined under this subparagraph for a 
                covered OPD service that is classified within such a 
                group is--
                            ``(i) for services furnished during 2006, 
                        the relative payment weight specified for such 
                        group for such period in the final rule 
                        published November 10, 2005, and not taking 
                        into account any subsequent amendments to such 
                        final rule; and
                            ``(ii) for services furnished in a year 
                        beginning on or after January 1, 2007--
                                    ``(I) for ambulatory patient 
                                classification group 0601 (relating to 
                                mid-level clinic visits), or a 
                                successor to such group, the relative 
                                payment weight specified for such group 
                                in the final rule referred to in clause 
                                (i); and
                                    ``(II) for other ambulatory patient 
                                classification groups described in 
                                subparagraph (D), the relative payment 
                                weight established or revised under 
                                paragraph (2)(C) or (9)(A), 
                                respectively, for such group for such 
                                year (but without regard to any budget 
                                neutrality adjustment under paragraph 
                                (9)(B)).
                    ``(D) Groups for clinic and emergency visits.--For 
                purposes of this paragraph, the groups established or 
                revised under paragraph (2)(B) or (9)(A), respectively, 
                for clinic and emergency visits are ambulatory patient 
                classification groups 0600, 0601, 0602, 0610, 0611, 
                0612, and 0620 as defined for purposes of the final 
                rule referred to in subparagraph (C)(i) (and any 
                successors to such groups).''.
    (b) Limitation on Secretarial Authority.--Notwithstanding section 
1833(t) of the Social Security Act (42 U.S.C. 1395l(t)), as amended by 
subsection (a), the Secretary of Health and Human Services may not make 
any adjustment under--
            (1) paragraph (2)(F), (3)(C)(iii), (9)(B), or (9)(C) of 
        section 1833(t) of the Social Security Act (42 U.S.C. 
        1395l(t)); or
            (2) any other provision of such section;
to ensure that the amendments made by subsection (a) do not cause the 
estimated amount of expenditures under part B of title XVIII of such 
Act (42 U.S.C. 1395j et seq.) to exceed the estimated amount of 
expenditures that would have been made under such part but for such 
amendments.

SEC. 4. PERMANENT EXTENSION OF ADJUSTMENT TO LIMIT DECLINE IN PAYMENTS 
              FOR CERTAIN HOSPITALS UNDER HOSPITAL OUTPATIENT PPS.

    (a) In General.--Section 1833(t)(7)(D)(i) of the Social Security 
Act (42 U.S.C. 1395l(t)(7)(D)(i)), as amended by section 5105 of the 
Deficit Reduction Act of 2005 (Public Law 109-171), is amended--
            (1) in the clause heading--
                    (A) by striking ``Temporary'' and inserting 
                ``Permanent''; and
                    (B) by striking ``Rural''
            (2) by striking subclause (II);
            (3) by striking ``(I) In the case'' and inserting ``In the 
        case'';
            (4) by striking ``located in a rural area, for'' and 
        inserting ``, for''; and
            (5) by striking ``furnished before January 1, 2006''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to covered OPD services furnished on or after January 1, 2006.

SEC. 5. FAIRNESS IN THE MEDICARE DISPROPORTIONATE SHARE HOSPITAL (DSH) 
              ADJUSTMENT FOR RURAL HOSPITALS.

    Section 1886(d)(5)(F)(xiv)(II) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(F)(xiv)(II)) is amended--
            (1) by striking ``or, in the case'' and all that follows 
        through ``subparagraph (G)(iv)''; and
            (2) by inserting at the end the following new sentence: 
        ``The preceding sentence shall not apply to any hospital with 
        respect to discharges occurring on or after October 1, 2006.''.

Save Our Safety Net Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act to require payment to a physician of an additional 10% for emergency department visits.

Prescribes special rules for calculating the Medicare hospital outpatient department (OPD) fee schedule amounts for clinic and emergency department visits.

Extends from temporary to permanent the current adjustment to payments (hold harmless provisions) for certain small rural and sole community hospitals under the OPD prospective payment system (PPS).

Eliminates the cap on the Medicare disproportionate share hospital (DSH) adjustment for payments to rural hospitals.