,,ii  #aae? ,,congress  #a/ ,session    
,s4 #cig  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,febru>y #ae1 #bjag,mr4
 ,isakson 7= himself1 ,mr4 ,w>n]1 ,mr4  
,alex&]1 ,mr4 ,br[n1 ,mr4 ,%elby1 & ,mr4
 ,ka9e7 introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
ensure fairness 9 ,m$ic>e hospital      
paym5ts by e/abli%+ a floor = ! area    
wage index appli$ ) respect to c]ta9    
hospitals4  #a4 ,%ort title ,?is ,act   
may be cit$ z ! ,fair ,m$ic>e ,hospital 
,paym5ts ,act ( #bjag4  #b4 ,ensur+     
fairness 9 ,m$ic>e hospital paym5ts 9 a 
budget neutral mann]  7a7 ,hospital     
inpati5t s]vices ,section               
#ahhf7;d77#c77;,e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#aciewww7d77#c77;,e77 is am5d$--  7#a7 9
 clause 7i71 by /rik+ clause 7ii7 or    
7iii7 & ins]t+ clause 7ii71 7iii71 or   
7iv72 &  7#b7 by add+ at ! end ! foll[+ 
new clause3  7iv7 ,floor on area wage   

index = hospitals 9 c]ta9 o!r 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 n locat$ 9 a fronti]
 ,/ate 7z def9$ 9 clause 7iii77,,ii77   
may n be less ?an #j4hgd4  7,,ii7       
,ensur+ budget neutrality ,9 ord] to    
ensure t ! aggregate paym5ts made "u ?is
 subsection = a fiscal ye> 7beg9n+ )    
fiscal ye> #bjah7 are n great] ?an !    
aggregate paym5ts t w\ld h be5 made "u  
?is subsection = su* fiscal ye> )\t !   
application ( subclause 7,i71 z e/imat$ 
by ! ,secret>y1 ! ,secret>y %all e/abli%
 pursuant to rulemak+ a maximum area    
wage index to apply "u ?is subp>agraph  
to any hospital :i* is n locat$ 9 a     
fronti] ,/ate 7z def9$ 9 clause         
7iii77,,ii774  7,,iii7 ,no impact =     
hospitals ) an area wage index betwe5 ! 
floor & ! maximum index ,subclauses 7,i7
 & 7,,ii7 %all h no affect on ! area    
wage index applicable 9 a fiscal ye> to 
a hospital ) an area wage index t is    

great] ?an ! floor "u subclause 7,i7 b  
less ?an ! maximum area wage index      
e/abli%$ "u subclause 7,,ii7 = ! fiscal 
ye>4  4  7b7 ,hospital outpati5t        
dep>tm5t s]vices ,section #ahcc7t7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#aciel7t771 is am5d$-- 7#a7 9 p>agraph  
7#b77;,d71 by /rik+ p>agraph 7#ai71 !   
,secret>y & ins]t+ p>agraphs 7#ai7 &    
7#bb71 ! ,secret>y2 &  7#b7 by add+ at !
 end ! foll[+ new p>agraph3  7#bb7      
,floor on area wage adju/m5t factor =   
hospital outpati5t dep>tm5t s]vices 9   
areas o!r ?an 9 fronti] ,/ates  7,a7 ,9 
g5]al ,) respect to cov]$ ,,opd s]vices 
furni%$ on or aft] ,janu>y #a1 #bjah1 ! 
area wage adju/m5t factor applicable "u 
! paym5t sy/em e/abli%$ "u ?is          
subsection to any hospital outpati5t    
dep>tm5t :i* is n locat$ 9 a fronti]    
,/ate 7z def9$ 9 section                
#ahhf7;d77#c77;,e77iii77,,ii77 may n be 
less ?an #j4hgd4  7,b7 ,ensur+ budget   
neutrality ,9 ord] to ensure t !        
aggregate paym5ts made "u ?is subsection

 = a ye> 7beg9n+ ) #bjah7 are n great]  
?an ! aggregate paym5ts t w\ld h be5    
made "u ?is subsection = su* ye> )\t !  
application ( subp>agraph 7,a71 z       
e/imat$ by ! ,secret>y1 ! ,secret>y %all
 e/abli% pursuant to rulemak+ a maximum 
area wage adju/m5t factor to apply "u ! 
paym5t sy/em e/abli%$ "u ?is subsection 
to any hospital outpati5t dep>tm5t :i*  
is n locat$ 9 a fronti] ,/ate 7z def9$ 9
 clause 7iii77,,ii774  7,c7 ,no impact =
 hospitals ) an area wage adju/m5t      
factor betwe5 ! floor & ! maximum factor
 ,subp>agraphs 7,a7 & 7,b7 %all h no    
affect on ! area wage adju/m5t factor   
applicable 9 a ye> to a hospital ) an   
area wage adju/m5t factor t is great]   
?an ! floor "u subp>agraph 7,a7 b less  
?an ! maximum area wage adju/m5t factor 
e/abli%$ "u subp>agraph 7,b7 = ! ye>4  4