,,ii  #aai? ,,congress  #a/ ,session    
,s4 #bgdc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,septemb] #i1 #bjbe,mr4
 ,banks 7= himself & ,mrs4 ,gillibr&7   
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title ,,xix
 ( ! ,social ,security ,act to modify   
c]ta9 limitations on disproportionate   
%>e hospital paym5t adju/m5ts "u !      
,m$icaid program1 & = o!r purposes4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,save ,our ,safety-,net ,hospitals ,act 
( #bjbe4  #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 a 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$1 by     
/rik+ ,not)/&+ p>agraph 7#b7 ( ?is      
subsection 7z 9 effect on ,octob] #a1   
#bjba71 p>agraph 7#b7 & ins]t+ ,p>agraph
 7#b74  7b7 ,effective date  7#a7 ,9    
g5]al ,except z provid$ 9 p>agraph 7#b71
 ! 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 = ,m$icaid   
,/ate plan rate ye>s beg9n+ on or aft] !
 date ( enactm5t ( ?is ,act4  7#b7 ,/ate
 option to di/ribute unsp5t ,,d%        
allotm5ts f prior ye>s up to modifi$ cap
  7,a7 ,9 g5]al ,if1 = any ,m$icaid     
,/ate plan rate ye> t beg9s on or aft]  
,octob] #a1 #bjba1 & be=e ! date (      
enactm5t ( ?is ,act1 a ,/ate did n sp5d 
! full am\nt ( its ,f$]al fiscal ye>    
allotm5t "u section #aibc ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acifr-#d7
 applicable to t ,/ate plan rate ye>1 ! 
,/ate may use ! unsp5t portion ( su*    

allotm5t to increase ! am\nt ( any      
paym5t adju/m5t made to a hospital = su*
 rate ye>1 provid$ t-- 7i7 su* paym5t   
adju/m5t 7z s increas$7 is consi/5t )   
subsection 7g7 ( su* section 7z am5d$ by
 ?is section72 &  7ii7 ! total am\nt (  
all paym5t adju/m5ts = ! ,/ate plan rate
 ye> 7z s increas$7 does n exce$ !      
disproportionate %>e hospital allotm5t =
 ! ,/ate & applicable ,f$]al fiscal ye> 
"u subsection 7f7 ( su* section4  7,b7  
,no rec\pm5t ( paym5ts already made to  
hospitals ,a ,/ate %all n rec\p any     
paym5t adju/m5t made by ! ,/ate to a    
hospital = a ,m$icaid ,/ate plan rate   
ye> describ$ 9 subp>agraph 7,a7 if su*  
paym5t adju/m5t is consi/5t ) section   
#aibc7;g7 ( su* ,act 7#db ,u4,s4,c4     
#acifr-#d7;g77 z 9 effect on ,octob] #a1
 #bjba4  7,c7 ,au?ority to p]mit        
retroactive modification ( ,/ate plan   
am5dm5ts to all[ = increases  7i7 ,9    
g5]al ,subject to p>agraph 7#b71 solely 
= ! purpose ( all[+ a ,/ate to increase 
! am\nt ( a paym5t adju/m5t to a        

hospital = a ,m$icaid ,/ate plan rate   
ye> describ$ 9 subp>agraph 7,a7 pursuant
 to ?is p>agraph1 a ,/ate may           
retroactively modify a provision ( !    
,m$icaid ,/ate plan1 a waiv] ( su* plan1
 or a ,/ate plan am5dm5t t relates to   
su* rate ye> & ! ,secret>y may approve  
su* modification4  7ii7 ,deadl9e ,a     
,/ate may n submit a reque/ = approval (
 a retroactive modification to a        
provision ( ! ,m$icaid ,/ate plan1 a    
waiv] ( su* plan1 or a ,/ate plan       
am5dm5t = a ,m$icaid ,/ate plan rate ye>
 aft] ! date by :i* ! ,/ate is requir$  
to submit ! indep5d5t c]tifi$ audit = t 
,/ate plan rate ye> z requir$ "u section
 #aibc7;j77#b7 ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acifr-#d7;j77#b774 
7,d7 ,report+ ,if a ,/ate increases a   
paym5t adju/m5t made to a hospital = a  
,m$icaid ,/ate plan rate ye> pursuant to
 ?is p>agraph1 ! ,/ate %all include     
in=mation on su* increas$ paym5t        
adju/m5t z "p ( ! next annual report    
submitt$ by ! ,/ate "u section          

#aibc7;j77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acifr-#d7;j77#a774