,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #bfaj  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #b1 #bjbe,ms4  
,t5ney 7= h]self1 ,mr4 ,langwor?y1 ,mr4 
,tonko1 ,mr4 ,lawl]1 & ,ms4 ,/efanik7   
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means1 & 9    
addition to ! ,committee on ,en]gy &    
,comm]ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xviii ( !     
,social ,security ,act to address       
significant "u projection ( ,,ma local  
area gr[? due to wage index             
reclassification4  #a4 ,%ort title ,?is 
,act may be cit$ z ! ,protect+ ,options 
= ,s5iors ,act ( #bjbe4  #b4 ,address+  
significant "u projection ( ,,ma local  
area gr[? due to wage index             
reclassification  7a7 ,local adju/m5t   
me?od & applicability ,section #ahec7;c7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #aciew-#bc7;c77 is am5d$--    

7#a7 9 p>agraph 7#a7-- 7,a7 9 ! text    
prec$+ subp>agraph 7,a71 by /rik+ & 7#g7
 & ins]t+ 1 7#f77;,d71 & 7#g72 &  7,b7 9
 subp>agraph 7,c77v77,,ii71 by ins]t+ 1 
tak+ into acc\nt any adju/m5t "u        
p>agraph 7#f77;,d7 be=e 1 b n2 &  7#b7 9
 p>agraph 7#f7-- 7,a7 9 ! head+1 by     
ins]t+ 2 local gr[? p]c5tage adju/m5t   
aft] def9$2 &  7,b7 by add+ at ! end !  
foll[+ new subp>agraph3  7,d7           
,additional adju/m5t = significant "u   
projection ( local area gr[?  7i7 ,9    
g5]al ,beg9n+ ) rates calculat$ = #bjbf1
 = purposes ( comput+ rates = an ,,ma   
paym5t area & a ye> z describ$ 9        
p>agraph 7#a71 if su* area is an        
applicable area describ$ 9 clause 7ii71 
! ,secret>y %all1 ) respect to su* area1
 increase ! national p] capita ,,ma gr[?
 p]c5tage det]m9$ "u ?is p>agraph = su* 
ye> by ! numb] ( p]c5tage po9ts specifi$
 9 clause 7iii77,i7 = su* area & ye>4   
7ii7 ,applicable area ,= purposes (     
clause 7i71 an applicable area describ$ 
9 ?is clause is an ,,ma local area )    

respect to :i* ! weight$ av]age hospital
 wage index 9 effect 9 su* area = #bjbe 
7or a subsequ5t ye>71 z calculat$ "u    
clause 7iv71 increas$ by m ?an #bj p]c5t
 z comp>$ to ! weight$ av]age hospital  
wage index 9 effect 9 su* area dur+ !   
prec$+ ye> 7z s calculat$74  7iii7      
,local gr[? p]c5tage  7,i7 ,9 g5]al ,=  
purposes ( clause 7i71 ) respect to an  
applicable area describ$ 9 clause 7ii7 &
 a ye>1 ! numb] ( p]c5tage po9ts        
specifi$ 9 ?is clause is equal to !     
product (-- 7aa7 ! p]c5tage calculat$ "u
 subclause 7,,ii7 = ! area & ye>1 &     
7bb7 ! weight+ factor calculat$ "u      
subclause 7,,iii7 = ! area & ye>4       
7,,ii7 ,p]c5tage ,= purposes ( subclause
 7,i71 ! p]c5tage calculat$ "u ?is      
subclause = an applicable area & a ye>  
is-- 7aa7 = #bjbf1 ! p]c5tage by :i* !  
weight$ av]age hospital wage index 9    
effect 9 ! applicable area = su* ye>1 z 
calculat$ "u clause 7iv71 increas$ z    
comp>$ to ! weight$ av]age hospital wage
 index 9 effect 9 su* area = #bjbd 7z s 

calculat$72 &  7bb7 = #bjbg & ea*       
subsequ5t ye>1 ! p]c5tage by :i* !      
weight$ av]age hospital wage index 9    
effect 9 ! applicable area = su* ye>1 z 
calculat$ "u clause 7iv71 increas$ z    
comp>$ to ! weight$ av]age hospital wage
 index 9 effect 9 su* area dur+ ! prec$+
 ye> 7z s calculat$74  7,,iii7 ,weight+ 
factor ,= purposes ( subclause 7,i71 !  
weight+ factor calculat$ "u ?is         
subclause = an applicable area & a ye>  
is equal to-- 7aa7 ! total am\nt (      
paym5ts made "u sections #ahcc7t7 &     
#ahhf to all area hospitals 9 su* area  
7includ+ disproportionate %>e paym5ts   
made "u section #ahhf7;d77#e77;,f77 t 7 
subject to adju/m5t = wage or labor     
co/s1 divid$ by  7bb7 ! total am\nt (   
paym5ts made "u p>ts ,a & ,b ( ?is title
 attributable to ! paym5t ( claims =    
items & s]vices furni%$ 9 su* area1     
exclud+ any su* paym5t attributable to a
 paym5t & s]vice deliv]y model be+ te/$ 
"u section #aaae;,a1  det]m9$ us+ paym5t
 in=mation ) respect to ! mo/ rec5t     

cal5d> ye> = :i* in=mation 0 comput$ &  
publi%$ "u subsection 7b77#d71 z ( !    
date on :i* ! advance notice "u         
subsection 7b77#b7 is provid$ = ! ye>4  
7iv7 ,weight$ av]age hospital wage index
 ,! weight$ av]age hospital wage index 9
 effect 9 an ,,ma local area = a ye> is 
equal to ! av]age area wage index       
applicable "u section #ahhf7;d77#c77;,e7
 = all area hospitals = su* area z ( !  
date on :i* ! advance notice "u         
subsection 7b77#b7 is provid$ = ! ye>1  
weight$ by ! total am\nt ( paym5ts made 
"u p>ts ,a & ,b ( ?is title to ea* su*  
area hospital1 det]m9$ us+ paym5t       
in=mation ) respect to ! mo/ rec5t      
cal5d> ye> = :i* in=mation 0 comput$ &  
publi%$ "u subsection 7b77#d71 z ( su*  
date4  7v7 ,area hospital def9$ ,9 ?is  
subp>agraph1 ! t]m area hospital means1 
) respect to an ,,ma local area & a ye>1
 a hospital t is geographically locat$ 9
 su* area at any po9t dur+ su* ye> 7)\t 
reg>d to :e!r su* hospital 0 reclassifi$
 to a new geographic area pursuant to   

section #ahhf7;d77#h77;,b71 a decision (
 ! ,m$ic>e ,geographic ,classification  
,review ,bo>d "u section #ahhf7;d77#aj71
 or a decision ( ! ,secret>y74  7vi7    
,requirem5t ( b5*m>k neutrality ,any    
adju/m5t made "u ?is subp>agraph = an   
,,ma paym5t area & a ye> %all be made 9 
a mann] t ensures t ! enrollm5t-weight$ 
av]age applicable am\nt "u subsection   
7k77#a77;,b7 = all ,,ma paym5t areas &  
su* ye> is n great] or less ?an :at x   
w\ld h be5 )\t su* adju/m5t4  4  7b7    
,adju/+ ! b5*m>k cap ,section           
#ahec7k77#a77;,b77i7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#bc7k77#a77;,b77i77 is am5d$ by  
ins]t+ 1 tak+ into acc\nt any adju/m5t  
"u subp>agraph 7,d7 ( su* subsection    
be=e 1 b n4  7c7 ,adju/+ ! base paym5t  
am\nt ,section #ahec7n77#b77;,e77ii7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#bc7n77#b77;,e77ii77 is am5d$--  
7#a7 9 subclause 7,i71 by ins]t+ 1 tak+ 
into acc\nt any adju/m5t "u subp>agraph 
7,d7 ( su* subsection be=e 1 b n2 &     

7#b7 9 subclause 7,,ii71 by ins]t+ or1 9
 ! case t ! area is an applicable area  
7z det]m9$ "u subsection 7c77#f77;,d771 
! am\nt specifi$ 9 subclause 7,i7 or !  
am\nt specifi$ 9 subsection 7c77#a77;,d7
 = ! area = ! ye>1 :i*ev] is great] be=e
 ! p]iod at ! end4  7d7 ,transp>5cy &   
data %>+  7#a7 ,9 g5]al ,section        
#ahec7;b77#d7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #aciew-#bc7;b77#d77 is  
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,e7 ,total am\nt paid to 
ea* area hospital 7z def9$ 9 subsection 
7c77#f77;,d77 = ! ye>1 comput$ sep>ately
 = "p ,a & = "p ,b4  4  7#b7 ,effective 
date ,! am5dm5ts made by p>agraph 7#a7  
%all apply beg9n+ ) ! computation &     
publication ( in=mation = ea* ,,ma      
paym5t area = #bjbf4