,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #idfh  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,june #be1 #bjbf,mr4  
,h]n ( ,oklahoma 7= himself1 ,mrs4      
,mill] ( ,we/ ,virg9ia1 & ,mr4 ,smuck]7 
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,ways & ,means  ,a     
,,bill  ,to am5d title ,,xviii ( !      
,social ,security ,act to adju/ long-t]m
 c>e hospital paym5t rates "u ! ,m$ic>e 
program4  #a4 ,%ort title  ,?is ,act may
 be cit$ z ! ,sav+ ,today's ,acute-,c>e 
,res\rces ,act or ! ,,/> ,act4  #b4     
,adju/+ long-t]m c>e hospital paym5t    
rates "u ! ,m$ic>e program  7a7         
,ext5sion ( site neutral paym5t         
r$uctions ,section #ahhf7m77#f77;,b77iv7
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acieww7m77#f77;,b77iv77 is   
am5d$ by /rik+ #bjbf & ins]t+ #bjcb4    
7b7 ,modification ( crit]ia =           
nonapplication ( site neutral paym5t    
rate  7#a7 ,addition ( high acuity      
crit]ion ,section #ahhf7m77#f77;,a7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   

#acieww7m77#f77;,a77 is am5d$--  7,a7 9 
clause 7ii77,i71 by /rik+ or ! v5tilator
 crit]ion "u clause 7iv7 & ins]t+ 1 !   
v5tilator crit]ion "u clause 7iv71 or ! 
high acuity crit]ion describ$ 9 clause  
7v72 &  7,b7 by add+ at ! end ! foll[+  
new clause3  7v7 ,high acuity crit]ion  
7,i7 ,9 g5]al ,! crit]ion specifi$ 9 ?is
 clause 79 ?is p>agraph ref]r$ to z !   
high acuity crit]ion7 = a dis*>ge f a   
long-t]m c>e hospital 9 a fiscal ye> is 
t-- 7aa7 ! /ay 9 ! long-t]m c>e hospital
 end+ ) su* dis*>ge 0 imm$iately prec$$ 
by a dis*>ge f a /ay 9 a subsection 7d7 
hospital or a /ay 9 a critical access   
hospital2  7bb7 ! individual dis*>g$ 0  
assign$ to a                            
,m$ic>e-,sev]ity-,long-,t]m-,c>e-,diagno
sis-,relat$-,gr\p 7,,ms-,,ltc-,,drg7 t 0
 a specifi$ ,,ms-,,ltc-,,drg 7z describ$
 9 subclause 7,,ii77 ) respect to su*   
fiscal ye>2  7cc7 ! dis*>ge 0 f a       
long-t]m c>e hospital-- 7,,aa7 t enroll$
 "u ?is title z su* a hospital be=e !   
date ( ! enactm5t ( ?is clause2 7,,bb7  

^: qualify+ p]iod 7z describ$ 9 section 
#dab4bc7;e77#d77;iv7 ( title #db1 ,code 
( ,f$]al ,regulations 7or a successor   
regulation77 began be=e su* date2 7,,cc7
 t met ! mid-build requirem5ts describ$ 
9 subclause 7,,iii72 or 7,,dd7 t _h     
obta9$ an approv$ c]tificate ( ne$ f !  
,/ate 9 :i* su* hospital is locat$ be=e 
su* date1 if requir$ by ,/ate law2 &    
7dd7 ! dis*>ge occurr$ on or aft]       
,octob] #a1 #bjbf4  7,,ii7  ,specifi$   
,,ms-,,ltc-,,drg def9$  ,= purposes (   
subclause subclause 7,i77bb71 ! t]m     
specifi$ ,,ms-,,ltc-,,drg means1 )      
respect to a fiscal ye>1 an             
,,ms-,,ltc-,,drg--  7aa7 ) a relative   
weight ( #j4h or great]2 &  7bb7 t is n 
assign$ on ! basis ( ! receipt (        
v5tilator s]vices ( at lea/ #if h\rs4   
7,,iii7 ,mid-build requirem5ts describ$ 
,= purposes ( subclause 7,i77cc71 !     
mid-build requirem5ts describ$ 9 ?is    
clause are1 ) respect to a long-t]m c>e 
hospital1 t-- 7aa7 su* hospital _h a    
b9d+ writt5 agreem5t ) an outside1      

unrelat$ p>ty = ! actual con/ruction1   
r5ovation1 lease1 or demolition ( su*   
hospital 9 effect z ( ! date ( !        
enactm5t ( ?is clause &1 prior to su*   
date1 _h exp5d$ at lea/ #aj p]c5t 7or1  
if less1 #b1ejj1jjj7 ( ! e/imat$ co/ (  
su* con/ruction1 r5ovation1 lease1 or   
demolition2 &  7bb7 ! ,secret>y         
receives1 n lat] ?an #fj days aft] su*  
date1 f ! *ief executive (fic] or *ief  
op]at+ (fic] ( su* hospital a writt5    
c]tification t ! hospital met !         
requirem5t "u item 7aa74  4  7#b7       
,modification ( ,,icu & v5tilator       
crit]ia ,section #ahhf7m77#f77;,a7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7m77#f77;,a77 is am5d$--  7,a7 9 
clause 7iii77,i71 by ins]t+ or1 )       
respect to dis*>ges f a long-t]m c>e    
hospital occurr+ on or aft] ,octob] #a1 
#bjbf1 by a dis*>ge f a /ay 9 su* a     
hospital or a /ay 9 a critical access   
hospital1 aft] 9 a subsection 7d7       
hospital2 &  7,b7 9 clause 7iv77,i71 by 
ins]t+ or1 ) respect to dis*>ges f a    

long-t]m c>e hospital occurr+ on or aft]
 ,octob] #a1 #bjbf1 by a dis*>ge f a /ay
 9 su* a hospital or a /ay 9 a critical 
access hospital aft] 9 a subsection 7d7 
hospital4