To permanently and fully equalize the standardized payment rate beginning in fiscal year 2004.

1. 1

   Change 1: Rewrites section 401

   Replaces

   In S. 1 · Reported to Senate

   SEC. 401. EQUALIZING URBAN AND RURAL STANDARDIZED PAYMENT AMOUNTS UNDER THE MEDICARE INPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM.

   (a) In General.--Section 1886(d)(3)(A)(iv) (42 U.S.C. 1395ww(d)(3)(A)(iv)) is amended--

   (1) by striking "(iv) For discharges" and inserting "(iv)(I) Subject to [struck: the succeeding provisions of this clause][inserted: subclause (II)], for discharges"; and

   (2) by adding at the end the following new [struck: subclauses][inserted: subclause]:

   "(II) For discharges occurring [struck: during the last 3 quarters of][inserted: in a fiscal year beginning with] fiscal year 2004, the [struck: operating ][inserted: Secretary shall compute a ]standardized amount for hospitals located [struck: other than in a large urban area shall be increased by \1/2\ of][inserted: in any area within the United States and within each region equal to] the [struck: difference between the operating standardized amount determined ][inserted: standardized amount computed for the previous fiscal year ]under [struck: subclause (I)][inserted: this subparagraph] for hospitals located in [inserted: a ]large urban [struck: areas for such ][inserted: area (or, beginning with ]fiscal year [struck: and such amount determined (without regard to this subclause) for other hospitals ][inserted: 2005, for hospitals located in any area) increased by the applicable percentage increase under subsection (b)(3)(B)(i) ]for [struck: such][inserted: the] fiscal year[inserted: involved].[inserted: ".]

   Struck: "(III) For discharges occurring in a fiscal year beginning with fiscal year 2005, the Secretary shall compute an operating standardized amount for hospitals located in any area within the United States and within each region equal to the operating standardized amount computed for the previous fiscal year under this subparagraph for hospitals located in a large urban area (or, beginning with fiscal year 2006, applicable for all hospitals in the previous fiscal year) increased by the applicable percentage increase under subsection (b)(3)(B)(i) for the fiscal year involved.".

   (b) Conforming Amendments.--

   (1) Computing drg-specific rates.--Section 1886(d)(3)(D) (42 U.S.C. 1395ww(d)(3)(D)) is amended--

   (A) in the heading, by striking "in different areas";

   (B) in the matter preceding clause (i), by striking "[inserted: , ]each of[struck: which is]";

   (C) in clause (i)--

   (i) in the matter preceding subclause (I), by inserting "for fiscal years before fiscal year [struck: 2005][inserted: 2004]," before "for hospitals"; and

   (ii) in subclause (II), by striking "and" after the semicolon at the end;

   (D) in clause (ii)--

   (i) in the matter preceding subclause (I), by inserting "for fiscal years before fiscal year [struck: 2005][inserted: 2004]," before "for hospitals"; and

   (ii) in subclause (II), by striking the period at the end and inserting "; and"; and

   (E) by adding at the end the following new clause:

   "(iii) for a fiscal year beginning after fiscal year [struck: 2004][inserted: 2003], for hospitals located in all areas, to the product of--

   "(I) the applicable [struck: operating ]standardized amount (computed under subparagraph (A)), reduced under subparagraph (B), and adjusted or reduced under subparagraph (C) for the fiscal year; and

   "(II) the weighting factor (determined under paragraph (4)(B)) for that [struck: diagnosis- related ][inserted: diagnosis-related ]group.".

   (2) Technical conforming sunset.--Section 1886(d)(3) (42 U.S.C. 1395ww(d)(3)) is amended--

   (A) in the matter preceding subparagraph (A), by inserting ", for fiscal years before fiscal year 1997," before "a regional adjusted DRG prospective payment rate"; and

   1 unchanged paragraphHide unchanged text

   (B) in subparagraph (D), in the matter preceding clause (i), by inserting ", for fiscal years before fiscal year 1997," before "a regional DRG prospective payment rate for each region,".

   Original wording

   Strike section 401 and insert the following:

2. 2

   Change 2: Adds SEC. ____. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS at the end of title VI

   Adds a section

   In S. 1 · Reported to Senate

   Section 13031(j)(3) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is amended by striking "September 30, 2003" and inserting "September 30, 2013". Amend the title so as to read: "A bill to amend title XVIII of the Social Security Act to provide for a voluntary prescription drug benefit under the medicare program and to strengthen and improve the medicare program, and for other purposes.".

   Inserted: SEC. ____. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.

   Inserted: (a) Technical Amendment Concerning Secretary's Authority To Make Conditional Payment When Certain Primary Plans Do Not Pay Promptly.--

   Inserted: (1) In general.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is amended--

   Inserted: (A) in subparagraph (A)(ii), by striking "promptly (as determined in accordance with regulations)"; and

   Inserted: (B) in subparagraph (B)--

   Inserted: (i) by redesignating clauses (i) through (iii) as clauses (ii) through (iv), respectively; and

   Inserted: (ii) by inserting before clause (ii), as so redesignated, the following new clause:

   Inserted: "(i) Authority to make conditional payment.--The Secretary may make payment under this title with respect to an item or service if a primary plan described in subparagraph (A)(ii) has not made or cannot reasonably be expected to make payment with respect to such item or service promptly (as determined in accordance with regulations). Any such payment by the Secretary shall be conditioned on reimbursement to the appropriate Trust Fund in accordance with the succeeding provisions of this subsection.".

   Inserted: (2) Effective date.--The amendments made by paragraph (1) shall be effective as if included in the enactment of title III of the Medicare and Medicaid Budget Reconciliation Amendments of 1984 (Public Law 98-369).

   Inserted: (b) Clarifying Amendments to Conditional Payment Provisions.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further amended--

   Inserted: (1) in subparagraph (A), in the matter following clause (ii), by inserting the following sentence at the end: "An entity that engages in a business, trade, or profession shall be deemed to have a self-insured plan if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part.";

   Inserted: (2) in subparagraph (B)(ii), as redesignated by subsection (a)(2)(B)--

   Show 6 more inserted paragraphsShow less

   Inserted: (A) by striking the first sentence and inserting the following: "A primary plan, and an entity that receives payment from a primary plan, shall reimburse the appropriate Trust Fund for any payment made by the Secretary under this title with respect to an item or service if it is demonstrated that such primary plan has or had a responsibility to make payment with respect to such item or service. A primary plan's responsibility for such payment may be demonstrated by a judgment, a payment conditioned upon the recipient's compromise, waiver, or release (whether or not there is a determination or admission of liability) of payment for items or services included in a claim against the primary plan or the primary plan's insured, or by other means."; and

   Inserted: (B) in the final sentence, by striking "on the date such notice or other information is received" and inserting "on the date notice of, or information related to, a primary plan's responsibility for such payment or other information is received"; and

   Inserted: (3) in subparagraph (B)(iii), as redesignated by subsection (a)(2)(B), by striking the first sentence and inserting the following: "In order to recover payment made under this title for an item or service, the United States may bring an action against any or all entities that are or were required or responsible (directly, as an insurer or self-insurer, as a third-party administrator, as an employer that sponsors or contributes to a group health plan, or large group health plan, or otherwise) to make payment with respect to the same item or service (or any portion thereof) under a primary plan. The United States may, in accordance with paragraph (3)(A) collect double damages against any such entity. In addition, the United States may recover under this clause from any entity that has received payment from a primary plan or from the proceeds of a primary plan's payment to any entity.".

   Inserted: (c) Clerical Amendments.--Section 1862(b) (42 U.S.C. 1395y(b)) is amended--

   Inserted: (1) in paragraph (1)(A), by moving the indentation of clauses (ii) through (v) 2 ems to the left; and

   Inserted: (2) in paragraph (3)(A), by striking "such" before "paragraphs".

   Original wording

   At the end of title VI, add the following:

Read automatically from the Congressional Record. Check the original before relying on it.

As printed