S.Amdt. 2992

SA 2992. Mr. MENENDEZ submitted an amendment intended to be proposed
to amendment SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr.
Dodd, and Mr. Harkin) to the bill H.R. 3590, to amend the Internal
Revenue Code of 1986 to modify the first-time homebuyers credit in the
case of members of the Armed Forces and certain other Federal
employees, and for other purposes; which was ordered to lie on the
table; as follows:

Beginning on page 867, strike line 15 and all that follows
through page 869, line 14, and insert the following:

SEC. 3142. TREATMENT OF URBAN MEDICARE-DEPENDENT HOSPITALS.

Section 1886(d)(5) of the Social Security Act (42 U.S.C.
1395ww(d)(5)) is amended by adding at the end the following
new subparagraph:
``(M) Authorization of adjustment in amount of payment for
urban medicare-dependent hospitals.--
``(i) Study.--The Secretary shall conduct a study on the
need for a payment adjustment under the prospective payment
system under this section for urban Medicare-dependent
hospitals similar to the adjustment available (as of the date
of enactment of this subparagraph) to medicare-dependent,
small rural hospitals under subparagraph (G). Such study
shall compare the Medicare inpatient operating margins of
urban Medicare-dependent hospitals to the Medicare inpatient
operating margins of subsection (d) hospitals that receive
one or more additional payments or adjustments (as defined in
clause (iv)). The Secretary shall finish conducting such
study by not later than June 1, 2010.
``(ii) Authorization of adjustment.--If the Secretary
determines under clause (i) that the average Medicare
inpatient operating margin of urban Medicare-dependent
hospitals is materially lower than the average Medicare
inpatient operating margin of subsection (d) hospitals that
receive one or more additional payments or adjustments (as so
defined), the Secretary shall provide for an adjustment to
the payment amounts to urban Medicare-dependent hospitals
under this section similar to the adjustment available to
medicare-dependent, small rural hospitals under subparagraph
(G). Any such adjustment shall be effective for discharges
occurring on or after October 1, 2010.
``(iii) Definition or urban medicare-dependent hospital.--
In this subparagraph, the term `urban Medicare-dependent
hospital' means a subsection (d) hospital--

``(I) located in an urban area;
``(II) that does not receive any additional payments or
adjustments (as so defined);
``(III) that is not a physician-owned hospital, as defined
in section 489.3 of title 42, Code of Federal Regulations (as
in effect as of the date of the enactment of this
subparagraph); and
``(IV) for which not less than 60 percent of its inpatient
days or discharges during the cost reporting period beginning
in fiscal year 2006, or 2 of the 3 most recently audited cost
reporting periods for which the Secretary has a settled cost
report, were attributable to inpatients entitled to benefits
under part A.

``(iv) Additional payments or adjustments defined.--The
term `additional payments or adjustments' means payments or
adjustments--

``(I) under subparagraph (C) as a rural referral center;
``(II) under subparagraph (D) as a sole community hospital;
``(III) under subparagraph (B) for indirect medical
education costs;
``(IV) under subsection (h) for direct graduate medical
education costs;
``(V) under subparagraph (F) for disproportionate share
hospital payments; or
``(VI) under subparagraph (G) as a medicare-dependent,
small rural hospital.''.

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