,i  #aadth ,,congress  #b;d ,session    
,h4 ,r4 #fcii  ,,in ,,the ,,house ,,of  
,,representatives  ,november #bi1       
#bjaf,mr4 ,kelly of ,pennsylvania 7for  
himself and ,mr4 ,michael ,f4 ,doyle of 
,pennsylvania7 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 create a      
,medicare hospital wage index           
metropolitan floor1 and for other       
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,fixing ,medicare   
,hospital ,payments ,act of #bjaf4  #b4 
,creating a ,medicare hospital wage     
index metropolitan floor ,section       
#ahhf7;d77#c77;,e7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#c77;,e77 is amended by      
adding at the end the following new     
clause3  7iv7 ,floor on area wage index 
for hospitals in metropolitan areas     
7,i7 ,in general ,for discharges        
occurring on or after ,october #a1      

#bjag1 the area wage index applicable   
under this subparagraph to any hospital 
which is located in a metropolitan area 
7as defined in subclause 7,,ii77 may not
 be less than #j4id4  7,,ii7            
,metropolitan area defined ,for purposes
 of this clause1 the term metropolitan  
area means a large urban area 7as       
defined in paragraph 7#b77;,d77 that has
 a population of not less than          
#b1jjj1jjj individuals1 as determined by
 the ,secretary based on the most recent
 available population data published    
with respect to such area by the ,bureau
 of the ,census4  7,,iii7 ,no           
expenditures over otherwise-applicable  
fiscal year #bjah levels ,the ,secretary
 shall implement this clause in a manner
 that ensures that the aggregate        
payments made under this section to all 
hospitals located in metropolitan areas 
for discharges occurring in a fiscal    
year 7beginning with fiscal year #bjah7 
are not greater than the aggregate      
payments that would have been made under

 this section to such hospitals for such
 discharges if such discharges had      
occurred in fiscal year #bjah and if    
this clause had not applied with respect
 to such fiscal year #bjah4 ,the        
,secretary shall implement the preceding
 sentence by establishing1 pursuant to  
rulemaking and applicable with respect  
to discharges occurring on or after     
,october #a1 #bjag1 a maximum area wage 
index that shall be applicable under    
this subparagraph to any hospital       
located in a metropolitan area4  4