,i  #aad? ,,congress  #b;d ,session  ,h4
 ,r4 #fcii  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,novemb] #bi1         
#bjaf,mr4 ,kelly ( ,p5nsylvania 7=      
himself & ,mr4 ,mi*ael ,f4 ,doyle (     
,p5nsylvania7 introduc$ ! foll[+ bill2  
:i* 0 ref]r$ to ! ,committee on ,ways & 
,means  ,a ,,bill  ,to am5d title       
,,xviii ( ! ,social ,security ,act to   
create a ,m$ic>e hospital wage index    
metropolitan floor1 & = o!r purposes4   
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,fix+ ,m$ic>e ,hospital ,paym5ts ,act 
( #bjaf4  #b4 ,creat+ a ,m$ic>e hospital
 wage index metropolitan floor ,section 
#ahhf7;d77#c77;,e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acieww7d77#c77;,e77 is am5d$ by add+ at
 ! end ! foll[+ new clause3  7iv7 ,floor
 on area wage index = hospitals 9       
metropolitan areas  7,i7 ,9 g5]al ,=    
dis*>ges occurr+ on or aft] ,octob] #a1 
#bjag1 ! area wage index applicable "u  
?is subp>agraph to any hospital :i* is  
locat$ 9 a metropolitan area 7z def9$ 9 

subclause 7,,ii77 may n be less ?an     
#j4id4  7,,ii7 ,metropolitan area def9$ 
,= purposes ( ?is clause1 ! t]m         
metropolitan area means a l>ge urban    
area 7z def9$ 9 p>agraph 7#b77;,d77 t   
has a population ( n less ?an #b1jjj1jjj
 individuals1 z det]m9$ by ! ,secret>y  
bas$ on ! mo/ rec5t available population
 data publi%$ ) respect to su* area by !
 ,bureau ( ! ,c5sus4  7,,iii7 ,no       
exp5ditures ov] o!rwise-applicable      
fiscal ye> #bjah levels ,! ,secret>y    
%all implem5t ?is clause 9 a mann] t    
ensures t ! aggregate paym5ts made "u   
?is section to all hospitals locat$ 9   
metropolitan areas = dis*>ges occurr+ 9 
a fiscal ye> 7beg9n+ ) fiscal ye> #bjah7
 are n great] ?an ! aggregate paym5ts t 
w\ld h be5 made "u ?is section to su*   
hospitals = su* dis*>ges if su* dis*>ges
 _h occurr$ 9 fiscal ye> #bjah & if ?is 
clause _h n appli$ ) respect to su*     
fiscal ye> #bjah4 ,! ,secret>y %all     
implem5t ! prec$+ s5t5ce by e/abli%+1   
pursuant to rulemak+ & applicable )     

respect to dis*>ges occurr+ on or aft]  
,octob] #a1 #bjag1 a maximum area wage  
index t %all be applicable "u ?is       
subp>agraph to any hospital locat$ 9 a  
metropolitan area4  4