,i  #aadth ,,congress  #b;d ,session    
,h4 ,r4 #ddbh  ,,in ,,the ,,house ,,of  
,,representatives  ,february #b1 #bjaf  
,mrs4 ,black 7for herself1 ,ms4 ,sewell 
of ,alabama1 ,mr4 ,roe of ,tennessee1   
,mr4 ,duncan of ,tennessee1 ,mr4        
,fleischmann1 ,mr4 ,des,jarlais1 ,mr4   
,cooper1 ,mrs4 ,blackburn1 ,mr4         
,fincher1 ,mr4 ,cohen1 ,mr4 ,byrne1     
,mrs4 ,roby1 ,mr4 ,rogers of ,alabama1  
,mr4 ,aderholt1 ,mr4 ,brooks of         
,alabama1 ,mr4 ,david ,scott of         
,georgia1 ,mr4 ,griffith1 ,mr4          
,westerman1 ,mr4 ,crawford1 ,mr4 ,hill1 
,mr4 ,womack1 ,mr4 ,bishop of ,georgia1 
,mr4 ,palmer1 ,mr4 ,vela1 ,mr4          
,whitfield1 ,mr4 ,harper1 ,mr4          
,boustany1 ,mr4 ,richmond1 ,mr4 ,allen1 
,mr4 ,guthrie1 ,mr4 ,carter of ,georgia1
 and ,mr4 ,hinojosa7 introduced the     
following bill2 which was referred to   
the ,committee on ,ways and ,means1 and 
in addition to the ,committee on ,energy
 and ,commerce1 for a period to be      
subsequently determined by the ,speaker1

 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to amend title ,,xviii of   
the ,social ,security ,act to ensure    
fairness in ,medicare hospital payments 
by establishing a floor for the area    
wage index applied with respect to      
certain hospitals4  #a4 ,short title    
,this ,act may be cited as the ,the     
,fair ,medicare ,hospital ,payments ,act
 of #bjaf4  #b4 ,ensuring fairness in   
medicare hospital payments  7a7         
,hospital inpatient services ,section   
#ahhf7;d77#c77;,e7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#aciewww7d77#c77;,e77 is amended--  7#a7
 in clause 7i71 by striking clause 7ii7 
or 7iii7 and inserting clause 7ii71     
7iii71 or 7iv72 and  7#b7 by adding at  
the end the following new clause3  7iv7 
,area wage index floor  7,i7 ,in general
 ,subject to subclause 7,,ii71 for      
discharges occurring on or after        
,october #a1 #bjaf1 the area wage index 

applicable under this subparagraph to   
any hospital which is not located in a  
frontier ,state 7as defined in clause   
7iii77,,ii77 may not be less than       
#j4hgd4  7,,ii7 ,ensuring budget        
neutrality ,in order to ensure that the 
aggregate payments made under this      
subsection for a fiscal year 7beginning 
with fiscal year #bjag7 are not greater 
than the aggregate payments that would  
have been made under this subsection for
 such fiscal year without the           
application of subclause 7,i71 the      
,secretary shall establish pursuant to  
rulemaking a maximum area wage index to 
apply under this subparagraph to any    
hospital which is not located in a      
frontier ,state 7as defined in clause   
7iii77,,ii774  4  7b7 ,hospital         
outpatient department services ,section 
#ahcc7t7 of the ,social ,security ,act  
7#db ,u4,s4,c4 #aciel7t771 is amended-- 
7#a7 in paragraph 7#b77;,d71 by striking
 paragraph 7#ai71 the ,secretary and    
inserting paragraphs 7#ai7 and 7#bb71   

the ,secretary2 and  7#b7 by adding at  
the end the following new paragraph3    
7#bb7 ,floor on area wage adjustment    
factor for hospital outpatient          
department services  7,a7 ,in general   
,subject to subparagraph 7,b71 with     
respect to covered ,,opd services       
furnished on or after ,january #a1      
#bjag1 the area wage adjustment factor  
applicable under the payment system     
established under this subsection to any
 hospital outpatient department which is
 not located in a frontier ,state 7as   
defined in section                      
#ahhf7;d77#c77;,e77iii77,,ii77 may not  
be less than #j4hgd4  7,b7 ,ensuring    
budget neutrality ,in order to ensure   
that the aggregate payments made under  
this subsection for a year 7beginning   
with #bjag7 are not greater than the    
aggregate payments that would have been 
made under this subsection for such year
 without the application of subparagraph
 7,a71 the ,secretary shall establish   
pursuant to rulemaking a maximum area   

wage adjustment factor to apply under   
the payment system established under    
this subsection to any hospital         
outpatient department which is not      
located in a frontier ,state 7as defined
 in clause 7iii77,,ii774  4