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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.''.
Output:
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.