,,ii  #aaith ,,congress  #ast ,session  
,s4 #eea  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,february #ab1      
#bjbe,mr4 ,sullivan 7for himself1 ,mr4  
,schatz1 and ,ms4 ,murkowski7 introduced
 the following bill2 which was read     
twice and referred to the ,committee on 
,finance  ,a ,,bill  ,to amend title    
,,xviii of the ,social ,security ,act to
 provide for the application of a       
cost-of-living adjustment to the        
non-labor related portion for hospital  
outpatient department services furnished
 in ,alaska and ,hawaii4  #a4 ,short    
title ,this ,act may be cited as the    
,ensuring ,outpatient ,quality for      
,rural ,states ,act4  #b4 ,application  
of cost-of-living adjustment to         
non-labor related portion for hospital  
outpatient department services furnished
 in ,alaska and ,hawaii ,section        
#ahcc7t7 of the ,social ,security ,act  
7#db ,u4,s4,c4 #aciel7t77 is amended by 
adding at the end the following new     
paragraph3  7#bc7 ,application of       

cost-of-living adjustment to non-labor  
related portion for hospital outpatient 
department services furnished in ,alaska
 and ,hawaii ,with respect to covered   
,,opd services furnished on or after    
,january #a1 #bjbf1 the ,secretary may  
provide for adjustments to the payment  
amounts under this subsection for such  
services in the same manner that is     
provided under section                  
#ahhf7;d77#e77;,h7 with respect to the  
application of the cost-of-living       
adjustment to the non-labor related     
portion of such payment amounts to take 
into account the unique circumstances of
 hospitals located in ,alaska or        
,hawaii4 ,the preceding sentence shall  
not be applied in a budget neutral      
manner4  4