,,ii #aaith ,,congress #ast ,session ,s4 #bgdc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #i1 #bjbe,mr4 ,banks 7for himself and ,mrs4 ,gillibrand7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to modify certain limitations on disproportionate share hospital payment adjustments under the ,medicaid program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,save ,our ,safety-,net ,hospitals ,act of #bjbe4 #b4 ,modifying certain limitations on disproportionate share hospital payment adjustments under the ,medicaid program 7a7 ,in general ,section #aibc7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;g77 is amended-- 7#a7 in paragraph 7#a7-- 7,a7 in subparagraph 7,a7-- 7i7 in the matter preceding clause 7i71 by striking 7other than a hospital described in paragraph 7#b77;,b772 7ii7 in clause 7i71 by inserting with respect to such hospital and year after described in subparagraph 7,b72 and 7iii7 in clause 7ii7-- 7,i7 in subclause 7,i71 by striking and at the end2 7,,ii7 in subclause 7,,ii71 by striking the period and inserting 2 and2 and 7,,iii7 by adding at the end the following new subclause3 7,,iii7 payments made under title ,,xviii or by an applicable plan 7as defined in section #ahfb7;b77#h77;,f77 for such services4 2 and 7,b7 in subparagraph 7,b7-- 7i7 in the matter preceding clause 7i71 by striking in this clause are and inserting in this subparagraph are1 with respect to a hospital and a year12 and 7ii7 by adding at the end the following new clause3 7iii7 ,individuals who are eligible for medical assistance under the ,state plan or under a waiver of such plan and for whom the ,state plan or waiver is a payor for such services after application of benefits under title ,,xviii or under an applicable plan 7as defined in section #ahfb7;b77#h77;,f771 but only if the hospital has in the aggregate incurred costs exceeding payments under such ,state plan1 waiver1 title ,,xviii1 or applicable plan for such services furnished to such individuals during such year4 2 7#b7 by striking paragraph 7#b72 7#c7 by redesignating paragraph 7#c7 as paragraph 7#b72 and 7#d7 in paragraph 7#b71 as so redesignated1 by striking ,notwithstanding paragraph 7#b7 of this subsection 7as in effect on ,october #a1 #bjba71 paragraph 7#b7 and inserting ,paragraph 7#b74 7b7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments made by this section shall apply to payment adjustments made under section #aibc of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7 for ,medicaid ,state plan rate years beginning on or after the date of enactment of this ,act4 7#b7 ,state option to distribute unspent ,,dsh allotments from prior years up to modified cap 7,a7 ,in general ,if1 for any ,medicaid ,state plan rate year that begins on or after ,october #a1 #bjba1 and before the date of enactment of this ,act1 a ,state did not spend the full amount of its ,federal fiscal year allotment under section #aibc of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7 applicable to that ,state plan rate year1 the ,state may use the unspent portion of such allotment to increase the amount of any payment adjustment made to a hospital for such rate year1 provided that-- 7i7 such payment adjustment 7as so increased7 is consistent with subsection 7g7 of such section 7as amended by this section72 and 7ii7 the total amount of all payment adjustments for the ,state plan rate year 7as so increased7 does not exceed the disproportionate share hospital allotment for the ,state and applicable ,federal fiscal year under subsection 7f7 of such section4 7,b7 ,no recoupment of payments already made to hospitals ,a ,state shall not recoup any payment adjustment made by the ,state to a hospital for a ,medicaid ,state plan rate year described in subparagraph 7,a7 if such payment adjustment is consistent with section #aibc7;g7 of such ,act 7#db ,u4,s4,c4 #acifr-#d7;g77 as in effect on ,october #a1 #bjba4 7,c7 ,authority to permit retroactive modification of ,state plan amendments to allow for increases 7i7 ,in general ,subject to paragraph 7#b71 solely for the purpose of allowing a ,state to increase the amount of a payment adjustment to a hospital for a ,medicaid ,state plan rate year described in subparagraph 7,a7 pursuant to this paragraph1 a ,state may retroactively modify a provision of the ,medicaid ,state plan1 a waiver of such plan1 or a ,state plan amendment that relates to such rate year and the ,secretary may approve such modification4 7ii7 ,deadline ,a ,state may not submit a request for approval of a retroactive modification to a provision of the ,medicaid ,state plan1 a waiver of such plan1 or a ,state plan amendment for a ,medicaid ,state plan rate year after the date by which the ,state is required to submit the independent certified audit for that ,state plan rate year as required under section #aibc7;j77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;j77#b774 7,d7 ,reporting ,if a ,state increases a payment adjustment made to a hospital for a ,medicaid ,state plan rate year pursuant to this paragraph1 the ,state shall include information on such increased payment adjustment as part of the next annual report submitted by the ,state under section #aibc7;j77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#d7;j77#a774