< Back to H.R. 1651 (104th Congress, 1995–1996)

Text of the Medicare Dependent Hospital Relief Act of 1995

This bill was introduced on May 16, 1995, in a previous session of Congress, but was not enacted. The text of the bill below is as of May 16, 1995 (Introduced).

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HR 1651 IH

104th CONGRESS

1st Session

H. R. 1651

To require the Prospective Payment Assessment Commission to develop separate applicable percentage increases to ensure that medicare beneficiaries who receive services from medicare dependent hospitals receive the same quality of care and access to services as medicare beneficiaries in other hospitals, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

May 16, 1995

Mr. SHAW introduced the following bill; which was referred to the Committee on Ways and Means


A BILL

To require the Prospective Payment Assessment Commission to develop separate applicable percentage increases to ensure that medicare beneficiaries who receive services from medicare dependent hospitals receive the same quality of care and access to services as medicare beneficiaries in other hospitals, and for other purposes.

    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 ‘Medicare Dependent Hospital Relief Act of 1995’.

SEC. 2. DEVELOPMENT OF SEPARATE APPLICABLE PERCENTAGE INCREASES FOR MEDICARE DEPENDENT HOSPITALS AND OTHER HOSPITALS BY THE PROSPECTIVE PAYMENT ASSESSMENT COMMISSION.

    (a) DEVELOPMENT OF SEPARATE APPLICABLE PERCENTAGE INCREASES-

      (1) IN GENERAL- The Prospective Payment Assessment Commission established under section 1886(e)(2) of the Social Security Act (42 U.S.C. 1395ww(e)(2)) (in this section referred to as the ‘Commission’) shall, in accordance with paragraph (2), develop for fiscal year 1997 and each fiscal year thereafter separate applicable percentage increases described in section 1886(b)(3)(B) of such Act (42 U.S.C. 1395ww(b)(3)(B)) for medicare dependent hospitals and subsection (d) hospitals which are not medicare dependent hospitals.

      (2) EQUALIZATION OF MEDICARE MARGINS- The Commission shall develop separate applicable percentage increases under paragraph (1) such that, if such factors were in effect, the estimated average annual medicare margins of all medicare dependent hospitals in furnishing inpatient hospital services to medicare beneficiaries in such fiscal year would be equal to the average annual medicare margins of all subsection (d) hospitals which are not medicare dependent hospitals in furnishing inpatient hospital services to medicare beneficiaries in such fiscal year.

      (3) BUDGET NEUTRALITY- The Commission shall provide that the separate applicable percentage increases developed under paragraph (1) would, if in effect, not result in aggregate payments under section 1886 of the Social Security Act (42 U.S.C. 1395ww) to medicare dependent hospitals and subsection (d) hospitals which are not medicare dependent hospitals for the furnishing of inpatient hospital services in a fiscal year in excess of the aggregate payments under such section to such hospitals in such fiscal year if such factors were not in effect.

    (b) REPORTS-

      (1) IN GENERAL- Beginning in March 1996, the Commission shall, in each of the Commission’s March reports to the Congress required under section 1886(e)(3) of the Social Security Act (42 U.S.C. 1395ww(e)(3)) include--

        (A) the separate applicable percentage increases developed by the Commission under subsection (a)(1) for the upcoming fiscal year; and

        (B) recommendations on methods to ensure that medicare beneficiaries who receive services furnished by medicare dependent hospitals have the same access and quality of care as medicare beneficiaries who are furnished services by subsection (d) hospitals which are not medicare dependent hospitals.

      (2) ANNUAL REVIEW OF MEDICARE MARGINS- The Commission shall develop the recommended methods under paragraph (1)(B) after annually reviewing the average medicare margins in medicare dependent hospitals and the impact of such medicare margins on the medicare dependent hospitals’ overall profit margins.

SEC. 3. DEFINITIONS.

    In this Act, the following definitions apply:

      (1) MEDICARE BENEFICIARY- The term ‘medicare beneficiary’ means an individual who is entitled to benefits under part A of title XVIII of the Social Security Act (42 U.S.C. 1395c et seq.).

      (2) MEDICARE DEPENDENT HOSPITAL- The term ‘medicare dependent hospital’ means any subsection (d) hospital--

        (A) that is not classified as a sole community hospital under section 1886(d)(5)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(D)); and

        (B) for which not less than 60 percent of its inpatient days were attributable to medicare beneficiaries during 2 of the last 3 preceding fiscal years for which data is available.

      (3) MEDICARE MARGIN-

        (A) IN GENERAL- The term ‘medicare margin’ means for a fiscal year the ratio expressed as a percentage equal to--

          (i) the difference between all medicare revenues paid to a hospital for the operating costs of inpatient hospital services in a fiscal year and all medicare program eligible expenses for such operating costs for such fiscal year (as shown by each hospital’s HCFA 2552 report submitted annually to the Health Care Financing Administration); divided by

          (ii) all medicare revenues paid to the hospital for the operating costs of inpatient hospital services for such fiscal year.

        (B) OPERATING COSTS OF INPATIENT HOSPITAL SERVICES- The term ‘operating costs of inpatient hospital services’ has the meaning given such term in section 1886(a)(4) of the Social Security Act (42 U.S.C. 1395ww(a)(4)).

      (4) SUBSECTION (d) HOSPITAL- The term ‘subsection (d) hospital’ has the meaning given such term in section 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)).