S.Amdt. 634

1. Adds Subtitle D--Medicare Improvements SEC. 531. EQUALIZING URBAN AND RURAL STANDARDIZED PAYMENT AMOUNTS UNDER THE MEDICARE INPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM on page 281, between lines 2 and 3

   Adds a sectionPrinted page

   Inserted: Subtitle D--Medicare Improvements SEC. 531. EQUALIZING URBAN AND RURAL STANDARDIZED PAYMENT AMOUNTS UNDER THE MEDICARE INPATIENT HOSPITAL PROSPECTIVE PAYMENT SYSTEM.

   Inserted: (a) In General.--Section 1886(d)(3)(A)(iv) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(A)(iv)) is amended--

   Inserted: (1) by striking "(iv) For discharges" and inserting "(iv)(I) Subject to subclause (II), for discharges"; and

   Inserted: (2) by adding at the end the following new subclause:

   Inserted: "(II) For discharges occurring in a fiscal year beginning with fiscal year 2004, the Secretary shall compute a standardized amount for hospitals located in any area within the United States and within each region equal to the standardized amount computed for the previous fiscal year under this subparagraph for hospitals located in a large urban area (or, beginning with fiscal year 2005, for hospitals located in any area) increased by the applicable percentage increase under subsection (b)(3)(B)(i) for the fiscal year involved.".

   Inserted: (b) Conforming Amendments.--

   Inserted: (1) Computing drg-specific rates.--Section 1886(d)(3)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(D)) is amended--

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

   Inserted: (B) in the matter preceding clause (i), by striking ", each of";

   Inserted: (C) in clause (i)--

   Inserted: (i) in the matter preceding subclause (I), by inserting "for fiscal years before fiscal year 2004," before "for hospitals"; and

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

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   Inserted: (D) in clause (ii)--

   Inserted: (i) in the matter preceding subclause (I), by inserting "for fiscal years before fiscal year 2004," before "for hospitals"; and

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

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

   Inserted: "(iii) for a fiscal year beginning after fiscal year 2003, for hospitals located in all areas, to the product of--

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

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

   Inserted: (2) Technical conforming sunset.--Section 1886(d)(3) of the Social Security Act (42 U.S.C. 1395ww(d)(3)) is amended--

   Inserted: (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

   Inserted: (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,".

   Inserted: SEC. 532. INCREASE IN LEVEL OF ADJUSTMENT FOR INDIRECT COSTS OF MEDICAL EDUCATION (IME).

   Inserted: (a) In General.--Section 1886(d)(5)(B)(ii) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)(ii)) is amended--

   Inserted: (1) in subclause (VI), by striking "and" at the end; and

   Inserted: (2) by striking subclause (VII) and inserting the following new subclauses:

   Inserted: "(VII) during fiscal year 2003, "c" is equal to 1.35.

   Inserted: "(VIII) during fiscal year 2004, "c" is equal to 1.85; and

   Inserted: "(IX) on or after October 1, 2004, 'c' is equal to 1.6.".

   Inserted: (b) Conforming Amendment Relating to Determination of Standardized Amount.--Section 1886(d)(2)(C)(i) of the Social Security Act (42 U.S.C. 1395ww(d)(2)(C)(i)) is amended--

   Inserted: (1) by striking "1999 or" and inserting "1999,"; and

   Inserted: (2) by inserting ", or of section 532(a) of the Jobs and Growth Tax Relief Reconciliation Act of 2003" after "2000".

   Inserted: SEC. 533. PERMANENT INCREASE IN MEDICARE PAYMENT FOR HOME HEALTH SERVICES FURNISHED IN A RURAL AREA.

   Inserted: (a) In General.--Section 1895 of the Social Security Act (42 U.S.C. 1395fff) is amended by adding at the end the following new subsection:

   Inserted: "(f) Increase in Payment for Services Furnished in a Rural Area.--

   Inserted: "(1) In general.--In the case of home health services furnished in a rural area (as defined in section 1886(d)(2)(D)) on or after April 1, 2003, the Secretary shall increase the payment amount otherwise made under this section for such services by 10 percent.

   Inserted: "(2) Waiver of budget neutrality.--The Secretary shall not reduce the standard prospective payment amount (or amounts) under this section applicable to home health services furnished during a period to offset the increase in payments resulting from the application of paragraph (1).".

   Inserted: (b) Effective Date.--The amendments made by this section shall apply to services furnished on or after April 1, 2003.

   Inserted: SEC. 534. 3-YEAR EXTENSION OF CERTAIN PAYMENT PROVISIONS FOR SKILLED NURSING FACILITY SERVICES UNDER THE MEDICARE PROGRAM.

   Inserted: (a) 3-Year Extension of Temporary Increase in Nursing Component of PPS Federal Rate.--Section 312(a) of Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (114 Stat. 2763A-498), as enacted into law by section 1(a)(6) of Public Law 106-554, is amended by striking ", and before October 1, 2002" and inserting "and before October 1, 2005".

   Inserted: (b) 3-Year Extension of Increase for Skilled Nursing Facility Adjusted Federal Per Diem Rate Through Fiscal Year 2005.--Section 101(d) of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (113 Stat. 1501A-325), as enacted into law by section 1000(a)(6) of Public Law 106-113, is amended--

   Inserted: (1) in the heading, by striking "and 2002" and inserting "through 2005"; and

   Inserted: (2) in paragraph (1), by striking "and 2002" and inserting "through 2005".

   Inserted: (c) Effective Date.--The amendments made by this section shall be effective as if this section had been enacted before October 1, 2002. The Secretary of Health and Human Services shall promptly provide for such adjustments in payments as may be required based on such amendments for services furnished during periods before the date of implementation of such amendments.

   Inserted: SEC. 535. TWO-YEAR EXTENSION OF MORATORIUM ON THERAPY CAPS.

   Inserted: Section 1833(g)(4) of the Social Security Act (42 U.S.C. 1395l(g)(4)) is amended by striking "and 2002" and inserting "2002, 2003, and 2004".

   Inserted: SEC. 536. COVERAGE OF IMMUNOSUPPRESSIVE DRUGS FOR ALL MEDICARE BENEFICIARIES.

   Inserted: (a) In General.--Section 1861(s)(2)(J) (42 U.S.C. 1395x(s)(2)(J)) is amended by striking ", to an individual who receives" and all that follows before the semicolon at the end and inserting "to an individual who has received an organ transplant".

   Inserted: (b) Effective Date.--The amendments made by this section shall apply to drugs furnished on or after the date of the enactment of this Act.

   Inserted: SEC. 537. BUDGET PROVISIONS.

   Inserted: (a) Inapplicability of Sunset.--The provisions of section 601(a) shall not apply to the provisions of, and amendments made by, this subtitle.

   Inserted: (b) Elimination of Acceleration of Top Rate Reduction In Individual Income Tax Rates.--Notwithstanding the amendment made by section 102(a) of this Act, in lieu of the percent specified in the last column of the table in paragraph (2) of section 1(i) of the Internal Revenue Code of 1986, as amended by such section 102(a), for taxable years beginning during calendar years 2003 and 2004, the following percentages shall be substituted for such years:

   Inserted: (1) For 2003, 38.6%.

   Inserted: (2) For 2004, 37.6%.

   Original wording

   On page 281, between lines 2 and 3, insert the following:

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As printed