,i  #aafth ,,congress  #b;d ,session    
,h4 ,r4 #gecd  ,,in ,,the ,,house ,,of  
,,representatives  ,july #i1 #bjbj,mr4  
,keller 7for himself1 ,mr4 ,kelly of    
,pennsylvania1 ,mr4 ,hagedorn1 ,mr4     
,crawford1 and ,mr4 ,thompson 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 direct the    
,secretary of ,health and ,human        
,services to conduct a study on         
potential disparities in incurred costs 
for rural and urban hospitals under the 
inpatient prospective payment system and
 to authorize appropriate payment       
adjustments4  #a4 ,short title ,this    
,act may be cited as the ,reviewing     
,urban and ,rural ,adjustments to ,level
 ,hospital ,expenses and ,lopsided      
,payments ,act of #bjbj or the ,,rural  
,,help ,act of #bjbj4  #b4 ,study on    
incurred costs disparities under ,,ipps2
 authorization of payment adjustments   

,section #ahhf7;d77#e7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acieww7d77#e77 is amended by adding at 
the end the following new subparagraph3 
7,n7 7i7 ,not later than #b years after 
the date of the enactment of this       
subparagraph1 the ,secretary shall      
conduct a study to determine if1 under  
the methodology for determining payments
 under paragraph 7#a77;,a71 and using   
both national and hospital-specific     
cost-to-charge ratios1 costs incurred by
 hospitals located in rural areas by    
diagnosis-related group exceed those    
costs incurred by hospitals located in  
urban areas4  7ii7 ,insofar as the      
,secretary determines through the study 
conducted under clause 7i7 that costs   
incurred by hospitals located in rural  
areas exceed those costs incurred by    
hospitals located in urban areas1 the   
,secretary shall provide for an         
appropriate adjustment to payments under
 paragraph 7#a77;,a7 to reflect those   
higher costs for discharges occurring on

 or after ,october #a of a year         
specified by the ,secretary 7but in no  
case later than #b years after the date 
of the enactment of this subparagraph74 
4