,i #aah? ,,congress #b;d ,session ,h4 ,r4 #gcbg ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,febru>y #ac1 #bjbd,ms4 ,de,gette introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce ,a ,,bill ,to am5d title ,,xix ( ! ,social ,security ,act to ensure adequate consid]ation ( paym5t rates = multimission hospitals "u ! ,m$icaid program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,protect+ ,front ,l9e ,multimission ,hospitals ,act ( #bjbd4 #b4 ,ensur+ appropriate paym5t rates = multimission hospitals "u ! ,m$icaid program ,section #aijb7;a77#ac77;,a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ac77;,a77 is am5d$-- 7#a7 9 clause 7iii71 by /rik+ & at ! end2 7#b7 9 clause 7iv71 by /rik+ ! semicolon & ins]t+ 2 &2 & 7#c7 by add+ at ! end ! foll[+ new clause3 7v7 9 ! case ( multimission hospitals 7z def9$ 9 section #aibc7k77 locat$ )9 ! ,/ate 7or locat$ )9 #ajj miles ( ! ,/ate1 9 ! case ( a hospital t provides t]ti>y s]vices "u ! ,/ate plan71 su* rates-- 7,i7 take into acc\nt ! %ort- & long-t]m f9ancial viability ( su* hospitals2 7,,ii7 provide /able1 pr$ictable1 & suffici5t reimbursem5t to improve or ma9ta9 ! f9ancial viability ( su* hospitals2 & 7,,iii7 ensure t items & s]vices are available to be furni%$ at su* hospitals "u ! ,/ate plan 7or waiv] ( su* plan7 to ! same ext5t t su* items & s]vices are available to be furni%$ at su* hospitals to ! g5]al population 9 a geographic region2 4 #c4 ,all[+ = increas$ disproportionate %>e hospital adju/m5ts = c]ta9 hospitals "u ! ,m$icaid program 7a7 ,9 g5]al ,section #aibc ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7k7 ,all[able increase 9 adju/m5ts = c]ta9 hospitals 7#a7 ,9 g5]al ,a paym5t adju/m5t "u ?is section dur+ a fiscal ye> ) respect to a hospital t is a multimission hospital = su* fiscal ye> t exce$s ! am\nt det]m9$ "u subsection 7g7 ) respect to su* hospital & fiscal ye> %all be deem$ to be consi/5t ) subsection 7c7 to ! ext5t t su* paym5t adju/m5t is less ?an or equal to ! am\nt t w\ld h be5 det]m9$ "u subsection 7g7 ) respect to su* hospital & fiscal ye> _h ! co/s incurr$ dur+ su* fiscal ye> by su* hospital 7z describ$ 9 p>agraph 7#a77;,a7 ( su* subsection 7or1 9 ! case ( a specifi$ hospital 7z def9$ 9 p>agraph 7#e771 z describ$ 9 p>agraph 7#a77;,a7 ( su* subsection z 9 effect on ,janu>y #a1 #bjbj77 to individuals describ$ 9 p>agraph 7#a77;,b7 ( su* subsection 7or1 9 ! case ( a specifi$ hospital1 individuals describ$ 9 p>agraph 7#a77;,a7 ( su* subsection z 9 effect on ,janu>y #a1 #bjbj7 includ$ co/s incurr$ by su* hospital dur+ su* fiscal ye> t are describ$ 9 p>agraph 7#b7 ) respect to individuals describ$ 9 p>agraph 7#c7 & t are s incurr$ = ! purpose 7z det]m9$ by ! ,/ate7 describ$ 9 p>agraph 7#d74 7#b7 ,co/s describ$ ,= purposes ( p>agraph 7#a71 ! co/s describ$ 9 ?is p>agraph are co/s = furni%+ or support+ ! furni%+ ( physicians' s]vices 7z def9$ 9 section #ahdh71 s]vices provid$ at ,f$]ally qualifi$ heal? c5t] or any o!r cl9ical outpati5t sett+1 & em]g5cy m$ical s]vices 7z def9$ 9 section #cjc7;j77#ac7 ( ! ,controll$ ,sub/ances ,act74 7#c7 ,individuals describ$ ,= purposes ( p>agraph 7#a71 ! individuals describ$ 9 ?is p>agraph are1 ) respect to co/s incurr$ by a hospital = a fiscal ye>-- 7,a7 except z provid$ 9 subp>agraph 7,b71 individuals describ$ 9 p>agraph 7#a77;,b7 ( subsection 7g72 & 7,b7 9 ! case ! am\nt det]m9$ "u su* subsection = su* hospital & su* ye> is s det]m9$ "u p>agraph 7#b77;,a77ii7 ( su* subsection1 individuals describ$ 9 p>agraph 7#a77;,a7 ( su* subsection z 9 effect on ,janu>y #a1 #bjbj4 7#d7 ,purpose describ$ ,= purposes ( p>agraph 7#a71 ! purpose describ$ 9 ?is p>agraph is to ensure t c>e & s]vices are available "u ! ,/ate plan 7or waiv] ( su* plan7 9 a geographic area at lea/ to ! ext5t t su* c>e & s]vices are available to ! g5]al population 9 su* area4 7#e7 ,def9itions ,9 ?is subsection3 7,a7 ,disproportionate pati5t b$ c\nt ,! t]m disproportionate pati5t b$ c\nt means1 ) respect to a hospital & a fiscal ye>1 ! product (-- 7i7 su* hospital's disproportionate pati5t p]c5tage = su* fiscal ye>2 & 7ii7 su* hospital's numb] ( b$s = su* fiscal ye>4 7,b7 ,multimission hospital ,! t]m multimission hospital means1 ) respect to a fiscal ye>-- 7i7 a public hospital ) #ajj or m b$s t has-- 7,i7 an av]age ,m$ic>e case mix index ( at lea/ #a4c2 7,,ii7 an int]n & resid5t to b$ ratio ( at lea/ #j4ag 7or at lea/ #abe resid5ts & fell[s72 & 7,,iii7 an av]age disproportionate pati5t p]c5tage ov] ! #c-ye> p]iod end+ on ! la/ day ( su* fiscal ye> ( at lea/ #dj p]c5t 7or a disproportionate pati5t p]c5tage = su* fiscal ye> ( at lea/ #dj p]c5t72 7ii7 a nonpr(it hospital ) m ?an #aii b few] ?an #a1jjj b$s t has an av]age disproportionate pati5t p]c5tage ov] ! #c-ye> p]iod end+ on ! la/ day ( su* fiscal ye> ( at lea/ #dj p]c5t 7or a disproportionate pati5t p]c5tage = su* fiscal ye> ( at lea/ #dj p]c5t7 & has-- 7,i7 9 ! case ( su* a hospital ) an av]age disproportionate pati5t p]c5tage ov] su* p]iod ( at lea/ #de p]c5t-- 7aa7 an av]age ,m$ic>e case mix index ( at lea/ #a4e2 & 7bb7 an int]n & resid5t to b$ ratio ( at lea/ #j4ai 7or at lea/ #aej resid5ts & fell[s72 or 7,,ii7 9 ! case ( su* a hospital n describ$ 9 subclause 7,i7-- 7aa7 a disproportionate pati5t b$ c\nt ( at lea/ #bej2 7bb7 an av]age ,m$ic>e case mix index ( at lea/ #b4j2 & 7cc7 an int]n & resid5t to b$ ratio ( at lea/ #j4b 7or at lea/ #age resid5ts & fell[s72 & 7iii7 a nonpr(it hospital ) #a1jjj or m b$s t has an av]age disproportionate pati5t p]c5tage ov] ! #c-ye> p]iod end+ on ! la/ day ( su* fiscal ye> ( at lea/ #ee p]c5t 7or a disproportionate pati5t p]c5tage = su* fiscal ye> ( at lea/ #ee p]c5t74 7,c7 ,specifi$ hospital ,! t]m specifi$ hospital means1 ) respect to a fiscal ye>1 a hospital ) an am\nt det]m9$ "u subsection 7g7 = su* ye> t is s det]m9$ "u p>agraph 7#b77;,a77ii7 ( su* subsection4 4 7b7 ,con=m+ am5dm5t ,section #aibc7;g77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;g77#a77 is am5d$ by /rik+ ,a paym5t adju/m5t & ins]t+ ,subject to subsection 7k71 a paym5t adju/m5t4 7c7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to fiscal ye> #bjbd & ea* subsequ5t fiscal ye>4