,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #icea  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,augu/ #ac1 #bjbd,mr4 
,la,lota 7= himself1 ,ms4 ,cl>ke ( ,new 
,york1 ,mr4 ,buc%on1 ,ms4 ,matsui1 ,mr4 
,lawl]1 & ,mr4 ,mrvan7 introduc$ !      
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce  ,a     
,,bill  ,to am5d title ,,xix ( ! ,social
 ,security ,act to modify c]ta9         
limitations on disproportionate %>e     
hospital paym5t adju/m5ts "u ! ,m$icaid 
program4  #a4 ,%ort title ,?is ,act may 
be cit$ z ! ,save our ,safety-,net      
,hospitals ,act ( #bjbd4  #b4 ,modify+  
c]ta9 limitations on disproportionate   
%>e hospital paym5t adju/m5ts "u !      
,m$icaid program  7a7 ,9 g5]al ,section 
#aibc7;g7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acifr-#d7;g77 is am5d$--
 7#a7 9 p>agraph 7#a7-- 7,a7 9          
subp>agraph 7,a7-- 7i7 9 ! matt] prec$+ 
clause 7i71 by /rik+ 7o!r ?an a hospital
 describ$ 9 p>agraph 7#b77;,b772  7ii7 9
 clause 7i71 by ins]t+ ) respect to su* 

hospital & ye> aft] describ$ 9          
subp>agraph 7,b72 &  7iii7 9 clause     
7ii7-- 7,i7 9 subclause 7,i71 by /rik+ &
 at ! end2  7,,ii7 9 subclause 7,,ii71  
by /rik+ ! p]iod & ins]t+ 2 &2 &        
7,,iii7 by add+ at ! end ! foll[+ new   
subclause3  7,,iii7 paym5ts made "u     
title ,,xviii or by an applicable plan  
7z def9$ 9 section #ahfb7;b77#h77;,f77 =
 su* s]vices4  2 &  7,b7 9 subp>agraph  
7,b7-- 7i7 9 ! matt] prec$+ clause 7i71 
by /rik+ 9 ?is clause are & ins]t+ 9 ?is
 subp>agraph are1 ) respect to a        
hospital & a ye>12 &  7ii7 by add+ at ! 
end ! foll[+ new clause3  7iii7         
,individuals :o are eligible = m$ical   
assi/ance "u ! ,/ate plan or "u a waiv] 
( su* plan & = :om ! ,/ate plan or waiv]
 is ! second>y payor = su* s]vices aft] 
application ( b5efits "u title ,,xviii  
or "u an applicable plan 7z def9$ 9     
section #ahfb7;b77#h77;,f771 b only if !
 hospital has 9 ! aggregate incurr$ co/s
 exce$+ paym5ts "u su* ,/ate plan1      
waiv]1 title ,,xviii1 or applicable plan

 = su* s]vices furni%$ to su*           
individuals dur+ su* ye>4  2  7#b7 by   
/rik+ p>agraph 7#b72  7#c7 by r$esignat+
 p>agraph 7#c7 z p>agraph 7#b72 &  7#d7 
9 p>agraph 7#b71 z s r$esignat$1 by     
/rik+ ,not)/&+ p>agraph 7#b7 ( ?is      
subsection 7z 9 effect on ,octob] #a1   
#bjba71 p>agraph 7#b7 & ins]t+ ,p>agraph
 7#b74  7b7 ,effective date  7#a7 ,9    
g5]al ,! am5dm5ts made by ?is section   
%all apply to paym5t adju/m5ts made "u  
section #aibc ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr-#d7 dur+ fiscal  
ye>s beg9n+ on or aft] ,octob] #a1      
#bjba4  7#b7 ,no requir$ rec\pm5t bas$  
on *ange 9 cap am\nts ,9 ! case ( a     
paym5t adju/m5t made by a ,/ate "u      
section #aibc ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr-#d7 prior to !   
date ( ! enactm5t ( ?is ,act t 01 )\t   
application ( ! am5dm5ts made by ?is    
section1 consi/5t ) ! me?odology ( su*  
,/ate = mak+ su* adju/m5ts1 su* adju/m5t
 %all be deem$ to be consi/5t ) su*     
me?odology ) ! application ( su*        

am5dm5ts4