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

[Q]: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Urban Medicare-Dependent Hospitals 
Preservation Act of 2011''.

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:
                    ``(M)(i) For cost reporting periods beginning on or 
                after October 1, 2011, and before October 1, 2014, in 
                the case of a subsection (d) hospital which is an urban 
                Medicare-dependent hospital, payment 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 a cost reporting period 
                that begins on or after October 1, 2011, and before 
                October 1, 2014, 50 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) For purposes of this subparagraph, 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 or 
                        reclassified to an urban area for wage index 
                        purposes;
                            ``(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);
                            ``(III) that is not a physician-owned 
                        hospital, as defined in section 489.3 of title 
                        42, Code of Federal Regulations (as in effect 
                        as of the date of the enactment of this 
                        subparagraph); and
                            ``(IV) for which not less than 60 percent 
                        of its inpatient days or discharges during the 
                        cost reporting period beginning in fiscal year 
                        2006, or two of the three most recently audited 
                        cost reporting periods for which the Secretary 
                        has a settled cost report, were attributable to 
                        inpatients entitled to benefits under part A 
                        and not enrolled in a Medicare Advantage plan 
                        under part C.''.
    (b) Target Payment Amount.--Section 1886(b)(3) of the Social 
Security Act (42 U.S.C. 1395ww(b)(3)) is amended--
            (1) in subparagraph (B)(iv), by striking ``and (D)'' and 
        inserting ``, (D), and (M)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(M) For cost reporting periods occurring on or 
                after October 1, 2011, and before October 1, 2014, 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--
                            ``(i) with respect to the first 12-month 
                        cost reporting period in which this 
                        subparagraph is applied to the hospital, the 
                        allowable operating costs of inpatient 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 or 2006 
                        (whichever results in a higher target amount), 
                        increased by the applicable percentage increase 
                        under subparagraph (B)(iv) for each of fiscal 
                        years 2003 through 2011 or 2007 through 2011, 
                        respectively; 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 target amount for the preceding 
                        year increased by the applicable percentage 
                        increase under subparagraph (B)(iv).''.
[A]: Urban Medicare-Dependent Hospitals Preservation Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act, with respect to cost reporting periods beginning on or after October 1, 2011, and before October 1, 2014, to revise the criteria and payment formula for "subsection (d) hospitals" which are urban Medicare-dependent hospitals.

(Generally a subsection (d) hospital is an acute care hospital particularly one that receives payments under Medicare's inpatient prospective payment system when providing covered inpatient services to eligible beneficiaries.)


[Q]: SECTION 1. AUTOMATIC INCREASE IN THE FEDERAL MEDICAL ASSISTANCE 
              PERCENTAGE DURING PERIODS OF NATIONAL ECONOMIC DOWNTURN.

    (a) National Economic Downturn Assistance FMAP.--
            (1) In general.--Section 1905 of the Social Security Act 
        (42 U.S.C. 1396d) is amended--
                    (A) in subsection (b), in the first sentence--
                            (i) by striking ``and (4)'' and inserting 
                        ``(4)''; and
                            (ii) by inserting ``and (5) with respect to 
                        each fiscal year quarter other than the first 
                        quarter of a national economic downturn 
                        assistance period described in subsection 
                        (y)(1), the Federal medical assistance 
                        percentage for any State described in 
                        subsection (y)(2) shall be equal to the 
                        national economic downturn assistance FMAP 
                        determined for the State for the quarter under 
                        subsection (y)(3)'' before the period; and
                    (B) by adding at the end the following:
    ``(y) National Economic Downturn Assistance FMAP.--For purposes of 
clause (5) of the first sentence of subsection (b):
            ``(1) National economic downturn assistance period.--A 
        national economic downturn assistance period described in this 
        paragraph--
                    ``(A) begins with the first fiscal year quarter for 
                which the Secretary determines that for at least 23 
                States, the rolling average unemployment rate for that 
                quarter has increased by at least 10 percent over the 
                corresponding quarter for the most recent preceding 12-
                month period for which data are available (in this 
                subsection referred to as the `trigger quarter'); and
                    ``(B) ends with the first succeeding fiscal year 
                quarter for which the Secretary determines that less 
                than 23 States have a rolling average unemployment rate 
                for that quarter with an increase of at least 10 
                percent over the corresponding quarter for the most 
                recent preceding 12-month period for which data are 
                available.
            ``(2) Eligible state.--A State described in this paragraph 
        is a State for which the Secretary determines that the rolling 
        average unemployment rate for the State for any quarter 
        occurring during a national economic downturn assistance period 
        described in paragraph (1) has increased over the corresponding 
        quarter for the most recent preceding 12-month period for which 
        data are available.
            ``(3) Determination of national economic downturn 
        assistance fmap.--
                    ``(A) In general.--The national economic downturn 
                assistance FMAP for a fiscal year quarter determined 
                with respect to a State under this paragraph is equal 
                to the Federal medical assistance percentage for the 
                State for that quarter increased by the number of 
                percentage points determined by--
                            ``(i) dividing--
                                    ``(I) the Medicaid additional 
                                unemployed increased cost amount 
                                determined under subparagraph (B) for 
                                the quarter; by
                                    ``(II) the State's total Medicaid 
                                quarterly spending amount determined 
                                under subparagraph (C) for the quarter; 
                                and
                            ``(ii) multiplying the quotient determined 
                        under clause (i) by 100.
                    ``(B) Medicaid additional unemployed increased cost 
                amount.--For purposes of subparagraph (A)(i)(I), the 
                Medicaid additional unemployed increased cost amount 
                determined under this subparagraph with respect to a 
                State and a quarter is the product of the following:
                            ``(i) State increase in rolling average 
                        number of unemployed individuals from the base 
                        quarter of unemployment.--
                                    ``(I) In general.--The amount 
                                determined by subtracting the rolling 
                                average number of unemployed 
                                individuals in the State for the base 
                                unemployment quarter for the State 
                                determined under subclause (II) from 
                                the rolling average number of 
                                unemployed individuals in the State for 
                                the quarter.
                                    ``(II) Base unemployment quarter 
                                defined.--
                                            ``(aa) In general.--For 
                                        purposes of subclause (I), 
                                        except as provided in item 
                                        (bb), the base quarter for a 
                                        State is the quarter with the 
                                        lowest rolling average number 
                                        of unemployed individuals in 
                                        the State in the 12-month 
                                        period preceding the trigger 
                                        quarter for a national economic 
                                        downturn assistance period 
                                        described in paragraph (1).
                                            ``(bb) Exception.--If the 
                                        rolling average number of 
                                        unemployed individuals in a 
                                        State for a quarter occurring 
                                        during a national economic 
                                        downturn assistance period 
                                        described in paragraph (1) is 
                                        less than the rolling average 
                                        number of unemployed 
                                        individuals in the State for 
                                        the base quarter determined 
                                        under item (aa), that quarter 
                                        shall be treated as the base 
                                        quarter for the State for such 
                                        national economic downturn 
                                        assistance period.
                            ``(ii) National average amount of 
                        additional federal medicaid spending per 
                        additional unemployed individual.--In the case 
                        of--
                                    ``(I) a calendar quarter occurring 
                                in fiscal year 2012, $350; and
                                    ``(II) a calendar quarter occurring 
                                in any succeeding fiscal year, the 
                                amount applicable under this clause for 
                                calendar quarters occurring during the 
                                preceding fiscal year, increased by the 
                                annual percentage increase in the 
                                medical care component of the consumer 
                                price index for all urban consumers 
                                (U.S. city average), as rounded up in 
                                an appropriate manner.
                            ``(iii) State nondisabled, nonelderly 
                        adults and children medicaid spending index.--
                                    ``(I) In general.--With respect to 
                                a State, the quotient (not to exceed 
                                1.00) of--
                                            ``(aa) the State 
                                        expenditure per person in 
                                        poverty amount determined under 
                                        subclause (II); divided by--
                                            ``(bb) the National 
                                        expenditure per person in 
                                        poverty amount determined under 
                                        subclause (III).
                                    ``(II) State expenditure per person 
                                in poverty amount.--For purposes of 
                                subclause (I)(aa), the State 
                                expenditure per person in poverty 
                                amount is the quotient of--
                                            ``(aa) the total amount of 
                                        annual expenditures by the 
                                        State for providing medical 
                                        assistance under the State plan 
                                        to nondisabled, nonelderly 
                                        adults and children; divided by
                                            ``(bb) the total number of 
                                        nonelderly adults and children 
                                        in poverty who reside in the 
                                        State, as determined under 
                                        paragraph (4)(A).
                                    ``(III) National expenditure per 
                                person in poverty amount.--For purposes 
                                of subclause (I)(bb), the National 
                                expenditure per person in poverty 
                                amount is the quotient of--
                                            ``(aa) the sum of the total 
                                        amounts determined under 
                                        subclause (II)(aa) for all 
                                        States; divided by
                                            ``(bb) the sum of the total 
                                        amounts determined under 
                                        subclause (II)(bb) for all 
                                        States.
                    ``(C) State's total medicaid quarterly spending 
                amount.--For purposes of subparagraph (A)(i)(II), the 
                State's total Medicaid quarterly spending amount 
                determined under this subparagraph with respect to a 
                State and a quarter is the amount equal to--
                            ``(i) the total amount of expenditures by 
                        the State for providing medical assistance 
                        under the State plan to all individuals 
                        enrolled in the plan for the most recent fiscal 
                        year for which data is available; divided by
                            ``(ii) 4.
            ``(4) Data.--In making the determinations required under 
        this subsection, the Secretary shall use, in addition to the 
        most recent available data from the Bureau of Labor Statistics 
        Local Area Unemployment Statistics for each State referred to 
        in paragraph (5), the most recently available--
                    ``(A) data from the Bureau of the Census with 
                respect to the number of nonelderly adults and children 
                who reside in a State described in paragraph (2) with 
                family income below the poverty line (as defined in 
                section 2110(c)(5)) applicable to a family of the size 
                involved (or, if the Secretary determines it 
                appropriate, a multiyear average of such data);
                    ``(B) data reported to the Secretary by a State 
                described in paragraph (2) with respect to expenditures 
                for medical assistance under the State plan under this 
                title for nondisabled, nonelderly adults and children; 
                and
                    ``(C) econometric studies of the responsiveness of 
                Medicaid enrollments and spending to changes in rolling 
                average unemployment rates and other factors, including 
                State spending on certain Medicaid populations.
            ``(5) Definition of `rolling average number of unemployed 
        individuals', `rolling average unemployment rate'.--In this 
        subsection, the term--
                    ``(A) `rolling average number of unemployed 
                individuals' means, with respect to a calendar quarter 
                and a State, the average of the 12 most recent months 
                of seasonally adjusted unemployment data for each 
                State;
                    ``(B) `rolling average unemployment rate' means, 
                with respect to a calendar quarter and a State, the 
                average of the 12 most recent monthly unemployment 
                rates for the State; and
                    ``(C) `monthly unemployment rate' means, with 
                respect to a State, the quotient of--
                            ``(i) the monthly seasonally adjusted 
                        number of unemployed individuals for the State; 
                        divided by
                            ``(ii) the monthly seasonally adjusted 
                        number of the labor force for the State,
        using the most recent data available from the Bureau of Labor 
        Statistics Local Area Unemployment Statistics for each State.
            ``(6) Increase in cap on payments to territories.--With 
        respect to any fiscal year quarter for which the national 
        economic downturn assistance Federal medical assistance 
        percentage applies to Puerto Rico, the Virgin Islands, Guam, 
        the Northern Mariana Islands, or American Samoa, the amounts 
        otherwise determined for such commonwealth or territory under 
        subsections (f) and (g) of section 1108 shall be increased by 
        such percentage of such amounts as the Secretary determines is 
        equal to twice the average increase in the national economic 
        downturn assistance FMAP determined for all States described in 
        paragraph (2) for the quarter.
            ``(7) Scope of application.--The national economic downturn 
        assistance FMAP shall only apply for purposes of payments under 
        section 1903 for a quarter and shall not apply with respect 
        to--
                    ``(A) disproportionate share hospital payments 
                described in section 1923;
                    ``(B) payments under title IV or XXI; or
                    ``(C) any payments under this title that are based 
                on the enhanced FMAP described in section 2105(b).
            ``(8) Additional requirement for certain states.--In the 
        case of a State described in paragraph (2) that requires 
        political subdivisions within the State to contribute toward 
        the non-Federal share of expenditures required under section 
        1902(a)(2), the State shall not require that such political 
        subdivisions pay for any fiscal year quarters occurring during 
        a national economic downturn assistance period a greater 
        percentage of the non-Federal share of such expenditures, or a 
        greater percentage of the non-Federal share of payments under 
        section 1923, than the respective percentage that would have 
        been required by the State under State law in effect on the 
        first day of the fiscal year quarter occurring immediately 
        prior to the trigger quarter for the period.''.
            (2) Effective date; no retroactive application.--The 
        amendments made by paragraph (1) take effect on January 1, 
        2012. In no event may a State receive a payment on the basis of 
        the national economic downturn assistance Federal medical 
        assistance percentage determined for the State under section 
        1905(y)(3) of the Social Security Act for amounts expended by 
        the State prior to January 1, 2012.
    (b) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        shall analyze the previous periods of national economic 
        downturn, including the most recent such period in effect as of 
        the date of enactment of this Act, and the past and projected 
        effects of temporary increases in the Federal medical 
        assistance percentage under the Medicaid program with respect 
        to such periods.
            (2) Report.--Not later than April 1, 2011, the Comptroller 
        General of the United States shall submit a report to Congress 
        on the results of the analysis conducted under paragraph (1). 
        Such report shall include such recommendations as the 
        Comptroller General determines appropriate for modifying the 
        national economic downturn assistance FMAP established under 
        section 1905(y) of the Social Security Act (as added by 
        subsection (a)) to improve the effectiveness of the application 
        of such percentage in addressing the needs of States during 
        periods of national economic downturn, including 
        recommendations for--
                    (A) improvements to the factors that begin and end 
                the application of such percentage;
                    (B) how the determination of such percentage could 
                be adjusted to address State and regional economic 
                variations during such periods; and
                    (C) how the determination of such percentage could 
                be adjusted to be more responsive to actual Medicaid 
                costs incurred by States during such periods, as well 
                as to the effects of any other specific economic 
                indicators that the Comptroller General determines 
                appropriate.
[A]: Amends title XIX (Medicaid) of the Social Security Act to authorize an automatic increase in the federal medical assistance percentage (FMAP) for any eligible state during periods of national economic downturn.

Directs the Comptroller General to analyze and report to Congress on previous periods of national economic downturn, including the most recent one, and the past and projected effects of temporary increases in the Medicaid FMAP with respect to them.


[Q]: SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Open Skies Treaty Compliance 
Assurance Act''.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Appropriate congressional committees.--The term 
        ``appropriate congressional committees'' means--
                    (A) the Committee on Armed Services, the Committee 
                on Foreign Relations, and the Select Committee on 
                Intelligence of the Senate; and
                    (B) the Committee on Armed Services, the Committee 
                on Foreign Affairs, and the Permanent Select Committee 
                on Intelligence of the House of Representatives.
            (2) Covered state party.--The term ``covered state party'' 
        means a foreign country that--
                    (A) is a state party to the Open Skies Treaty; and
                    (B) is a United States ally.
            (3) Intelligence community.--The term ``intelligence 
        community'' has the meaning given that term in section 3 of the 
        National Security Act of 1947 (50 U.S.C. 3003).
            (4) Observation aircraft, observation flight, and sensor.--
        The terms ``observation aircraft'', ``observation flight'', and 
        ``sensor'' have the meanings given such terms in Article II of 
        the Open Skies Treaty.
            (5) Open skies treaty.--The term ``Open Skies Treaty'' 
        means the Treaty on Open Skies, done at Helsinki March 24, 
        1992, and entered into force January 1, 2002.

SEC. 3. CERTIFICATION OF NEW SENSORS.

    (a) Limitation.--Notwithstanding any other provision of law, no 
funds may be obligated or expended to aid, support, permit, or 
facilitate the certification or approval of any new sensor, including 
to carry out an initial or exhibition observation flight of an 
observation aircraft, for use by the Russian Federation on observation 
flights under the Open Skies Treaty unless the President, in 
consultation with the Secretary of State, the Secretary of Defense, the 
Secretary of Homeland Security, and the Director of National 
Intelligence, submits to the appropriate committees of Congress the 
certification described in subsection (b)(1).
    (b) Certification.--
            (1) In general.--The certification described in this 
        subsection is a certification for a new sensor referred to in 
        subsection (a) that--
                    (A) the capabilities of the new sensor do not 
                exceed the capabilities imposed by the Open Skies 
                Treaty, and safeguards are in place to prevent the new 
                sensor, or any information obtained therefrom, from 
                being used in any way not permitted by the Open Skies 
                Treaty;
                    (B) the Secretary of Defense, the commanders of 
                relevant combatant commands, the directors of relevant 
                elements of the intelligence community, and the Federal 
                Bureau of Investigation have in place mitigation 
                measures with respect to collection against high-value 
                United States assets and critical infrastructure by the 
                new sensor;
                    (C) each covered state party has been notified and 
                briefed on concerns of the intelligence community 
                regarding upgraded sensors used under the Open Skies 
                Treaty, Russian Federation warfighting doctrine, and 
                intelligence collection in support thereof; and
                    (D) the Russian Federation is in compliance with 
                all of its obligations under the Open Skies treaty, 
                including the obligation to permit properly notified 
                covered state party observation flights over all of 
                Moscow, Chechnya, Abkhazia, South Ossetia, and 
                Kaliningrad.
            (2) Specific sensor approval.--The certification described 
        in paragraph (1) shall be required for each sensor and platform 
        for which the Russian Federation has requested approval under 
        to the Open Skies Treaty.
    (c) Waiver Authority.--
            (1) In general.--The President may waive the requirements 
        of subparagraph (D) of subsection (b)(1) if, not later than 30 
        days prior to certifying or approving a new sensor for use by 
        the Russian Federation on observation flights under the Open 
        Skies Treaty, the President submits a certification to the 
        appropriate committees of Congress that the certification or 
        approval of the new sensor is in the national security interest 
        of the United States that includes the following:
                    (A) A written explanation of the reasons it is in 
                the national security interest of the United States to 
                certify or approve the sensor.
                    (B) The date that the President expects the Russian 
                Federation to come into full compliance with all of its 
                Open Skies Treaty obligations, including the overflight 
                obligations described in subparagraph (D) of subsection 
                (b)(1).
                    (C) A detailed description of efforts made by the 
                United States Government to bring the Russian 
                Federation into full compliance with the Open Skies 
                Treaty.
            (2) Form.--Each certification submitted under paragraph (1) 
        shall be submitted in unclassified form, but may include a 
        classified annex.
[A]:
Open Skies Treaty Compliance Assurance Act This bill prohibits funds from being obligated or expended to aid the certification or approval of any new sensor, including to carry out an initial or exhibition observation flight of an observation aircraft, for use by the Russian Federation on observation flights under the Treaty on Open Skies unless the President certifies to Congress that:   the new sensor's capabilities do not exceed capabilities imposed by the treaty and safeguards are in place to prevent the sensor or any information obtained from being used in any way not permitted by the treaty;   mitigation measures are in place regarding collection by such sensor of high-value U.S. assets and critical infrastructure;  each covered state party has been briefed on intelligence concerns regarding upgraded sensors used under the treaty, Russian Federation war fighting doctrine, and related intelligence collection; and   the Russian Federation is in compliance with all of its treaty obligations, including the obligation to permit properly notified covered state party observation flights over all of Moscow, Chechnya, Abkhazia, South Ossetia, and Kaliningrad.  Certification is required for each sensor and platform for which the Russian Federation has requested approval under the treaty. The President may waive the requirement of Russian compliance with treaty obligations by certifying that sensor certification or approval is in U.S. national security interests. Such certification must include the date such compliance is expected and a description of U.S. efforts to achieve it. &quot;Covered state party&quot; means a foreign country that is a state party to the treaty and a U.S. ally.