,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #acij  ,,in ,,the ,,house ,,of  
,,representatives  ,march #ba1 #bjac    
,mr4 ,smith of ,new ,jersey 7for        
himself1 ,mr4 ,deutch1 ,mr4 ,lo,biondo1 
,mr4 ,runyan1 ,mr4 ,larson of           
,connecticut1 ,ms4 ,frankel of ,florida1
 and ,mr4 ,courtney7 introduced the     
following bill2 which was referred to   
the ,committee on ,ways and ,means  ,a  
,,bill  ,to amend title ,,xviii of the  
,social ,security ,act to preserve      
access to urban ,medicare-dependent     
hospitals4  #a4 ,short title ,this ,act 
may be cited as the ,urban              
,medicare-,dependent ,hospitals         
,preservation ,act of #bjac4  #b4       
,criteria and payment for certain urban 
,medicare-dependent hospitals  7a7 ,in  
general ,section #ahhf7;d77#e7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7d77#e77 is amended by adding at 
the end the following new subparagraph3 
7,m7 7i7 ,for cost reporting periods    
beginning on or after ,october #a1      

#bjac1 and before ,october #a1 #bjaf1 in
 the case of a subsection 7d7 hospital  
which is an urban ,medicare-dependent   
hospital1 payment under paragraph       
7#a77;,a7 shall be equal to the sum of  
the amount determined under clause 7ii7 
and the amount determined under         
paragraph 7#a77;,a77iii74  7ii7 ,the    
amount determined under this clause is1 
for discharges occurring during a cost  
reporting period that begins on or after
 ,october #a1 #bjac1 and before ,october
 #a1 #bjaf1 #ej percent of the amount by
 which the hospital's target amount for 
the cost reporting period 7as defined in
 subsection 7b77#c77,l77 exceeds the    
amount determined under paragraph       
7#a77;,a77iii74  7iii7 ,for purposes of 
this subparagraph1 the term urban       
,medicare-dependent hospital means1 with
 respect to any cost reporting period to
 which clause 7i7 applies1 any          
hospital--  7,i7 located in an urban    
area or reclassified to an urban area   
for wage index purposes2  7,,ii7 that   

does not receive payment--  7aa7 under  
subparagraph 7,c7 as a rural referral   
center2  7bb7 under subparagraph 7,d7 as
 a sole community hospital2  7cc7 under 
subparagraph 7,b7 or under subsection   
7h72 or  7dd7 under subparagraph 7,f72  
7,,iii7 that is not a physician-owned   
hospital1 as defined in section #dhi4c  
of title #db1 ,code of ,federal         
,regulations 7as in effect as of the    
date of the enactment of this           
subparagraph72 and  7,,iv7 for which not
 less than #fj percent of its inpatient 
days or discharges during the cost      
reporting period beginning in fiscal    
year #bjjf1 or two of the three most    
recently audited cost reporting periods 
for which the ,secretary has a settled  
cost report1 were attributable to       
inpatients entitled to benefits under   
part ,a and not enrolled in a ,medicare 
,advantage plan under part ,c4  4  7b7  
,target payment amount ,section         
#ahhf7;b77#c7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acieww7b77#c77 is  

amended--  7#a7 in subparagraph         
7,b77iv71 by striking and 7,d7 and      
inserting 1 7,d71 and 7,m72 and  7#b7 by
 adding at the end the following new    
subparagraph3  7,m7 ,for cost reporting 
periods occurring on or after ,october  
#a1 #bjac1 and before ,october #a1      
#bjaf1 in the case of a hospital that is
 an urban ,medicare-dependent hospital  
7as defined in subsection 7d77#e77,m771 
the term target amount means--  7i7 with
 respect to the first #ab-month cost    
reporting period in which this          
subparagraph is applied to the hospital1
 the allowable operating costs of       
inpatient hospital services 7as defined 
in subsection 7a77#d77 recognized under 
this title for the hospital for the     
#ab-month cost reporting period         
beginning during fiscal year #bjjb or   
#bjjf 7whichever results in a higher    
target amount71 increased by the        
applicable percentage increase under    
subparagraph 7,b77iv7 for each of fiscal
 years #bjjc through #bjac or #bjjg     

through #bjac1 respectively2 and  7ii7  
with respect to discharges occurring    
after the first #ab-month cost reporting
 period in which this subparagraph is   
applied to the hospital1 the target     
amount for the preceding year increased 
by the applicable percentage increase   
under subparagraph 7,b77iv74  4