,,ii  #aaeth ,,congress  #ast ,session  
,s4 #cig  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,february #ae1      
#bjag,mr4 ,isakson 7for himself1 ,mr4   
,warner1 ,mr4 ,alexander1 ,mr4 ,brown1  
,mr4 ,shelby1 and ,mr4 ,kaine7          
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,finance  ,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 ,fair ,medicare     
,hospital ,payments ,act of #bjag4  #b4 
,ensuring fairness in ,medicare hospital
 payments in a budget neutral manner    
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 
,floor on area wage index for hospitals 
in certain other 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 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 #bjah7 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 as       
estimated by the ,secretary1 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  7,,iii7 ,no impact for   
hospitals with an area wage index       
between the floor and the maximum index 
,subclauses 7,i7 and 7,,ii7 shall have  
no affect on the area wage index        
applicable in a fiscal year to a        
hospital with an area wage index that is
 greater than the floor under subclause 
7,i7 but less than the maximum area wage
 index established under subclause      
7,,ii7 for the fiscal year4  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 in areas other than 
in frontier ,states  7,a7 ,in general   
,with respect to covered ,,opd services 

furnished on or after ,january #a1      
#bjah1 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 #bjah7 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 as estimated by the ,secretary1  
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  7,c7 ,no impact for      

hospitals with an area wage adjustment  
factor between the floor and the maximum
 factor ,subparagraphs 7,a7 and 7,b7    
shall have no affect on the area wage   
adjustment factor applicable in a year  
to a hospital with an area wage         
adjustment factor that is greater than  
the floor under subparagraph 7,a7 but   
less than the maximum area wage         
adjustment factor established under     
subparagraph 7,b7 for the year4  4