S. 1563Senate109th Congress (2005-2007)In Committee

ABCs for Children's Health Act of 2005

Introduced July 29, 2005

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SenateIntro Referral Latest Action

Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S9478-9480)

July 29, 2005

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SenateIntro Referral

Introduced in Senate

July 29, 2005

SenateIntro Referral

Sponsor introductory remarks on measure. (CR S9477-9478)

July 29, 2005

SenateIntro Referral

Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S9478-9480)

July 29, 2005

Floor Debate

23 members

What members said about S. 1563 on the floor

12 Republicans11 Democrats
Jon Kyl
Sen. Jon KylR-AZ · Jul 29, 2005

Mr. President, I rise today to introduce the Law Enforcement Officers' Protection Act of 2005. This act will guarantee tough, mandatory punishment for criminals who murder or assault police officers,…

Carl Levin
Sen. Carl LevinD-MI · Jul 29, 2005

Mr. President, tax shelter and tax haven abuses are undermining the integrity of our tax system, robbing the Treasury of tens of billions of dollars each year, and shifting the tax burden from high…

Olympia J. Snowe
Sen. Olympia J. SnoweR-ME · Jul 29, 2005

Mr. President, I rise today to introduce the Medicaid Emergency Psychiatric Care Act of 2005, which will serve to improve access to mental health treatment and remove an unfunded mandate on our…

Jon S. Corzine
Sen. Jon S. CorzineD-NJ · Jul 29, 2005

Mr. President, today I am proud to introduce a bill, along with Senators Lautenberg and Landrieu, to grant a Federal Charter to the Irish American Cultural Institute, an organization that promotes…

Maria Cantwell
Sen. Maria CantwellD-WA · Jul 29, 2005

Mr. President, I am proud to rise today with my colleagues Senators Collins, Bingaman, Murray, Mikulski, Kohl and Corzine, to introduce bipartisan legislation enhancing the Seniors Farmers' Market…

Show 8 more
Jeff Bingaman
Sen. Jeff BingamanD-NM · Jul 29, 2005

Mr. President, today I introduce legislation that will help address the critical nurse faculty shortage facing our Nation today. The Bureau of Labor statistics estimates that 1,000,000 new and…

Gordon H. Smith
Sen. Gordon H. SmithR-OR · Jul 29, 2005

Mr. President, I rise today with Senators Dorgan and Pryor to introduce the ``Universal Service for the 21st Century Act.'' For more than 70 years, the preservation and advancement of universal…

Michael B. Enzi
Sen. Michael B. EnziR-WY · Jul 29, 2005

Mr. President, today I rise to introduce the Safe and Fair Deposit Insurance Act of 2005. As many of us in this chamber know, reforming the operations of the Federal Deposit Insurance Corporation has…

Daniel K. Akaka
Sen. Daniel K. AkakaD-HI · Jul 29, 2005

Mr. President, I am proud to introduce the Healthcare Equality and Accountability Act, along with my colleagues Senators Reid, Durbin, Bingaman, Corzine, Murray, Kennedy, Landrieu, Lautenberg,…

Chuck Grassley
Sen. Chuck GrassleyR-IA · Jul 29, 2005

Mr. President, I am pleased to join my colleagues Senator Bayh and Senator Clinton in introducing the Improving Long-term Care Choices Act. This legislation sets forth a series of proposals aimed at…

Conrad R. Burns
Sen. Conrad R. BurnsR-MT · Jul 29, 2005

Mr. President, today I am introducing, along with my colleague Senator Dorgan, a bill that addresses a persistent inequity in the agriculture industry. Since the passage of the North American Free…

Frank R. Lautenberg
Sen. Frank R. LautenbergD-NJ · Jul 29, 2005

Mr. President, I rise to introduce legislation to address a serious problem in New Jersey and across the nation--the unregulated sorting and processing of garbage at rail facilities in our…

Byron L. Dorgan
Sen. Byron L. DorganD-ND · Jul 29, 2005

Mr. President, today I am reintroducing bipartisan legislation to remedy a long-standing and glaring inequity in our so- called free-trade system. There are significant and costly differences in…

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Mike DeWine
Sen. Mike DeWineR-OH · Jul 29, 2005

Mr. President, today I join my friend and colleague from Arkansas, Senator Lincoln, to introduce a bill called the Advancing Better Coverage and Care for Children's Health Act or the ABCs for…

Mike DeWine
Sen. Mike DeWineR-OH · Jul 29, 2005

Mr. President, today I join my friend and colleague from Arkansas, Senator Lincoln, to introduce a bill called the Advancing Better Coverage and Care for Children's Health Act or the ABCs for…

Christopher S. Bond
Sen. Christopher S. BondR-MO · Jul 29, 2005

Mr. President, I rise today to introduce a bill that addresses an inequity and helps clarify a tax exemption that exists for small property and casualty (P&C) insurance companies under the Internal…

John McCain
Sen. John McCainR-AZ · Jul 29, 2005

Mr. President, I am pleased to be joined by Senators Ensign and Kyl in introducing the Abolishing Aviation Barriers Act of 2005. This bill would remove the arbitrary restrictions that prevent…

Orrin G. Hatch
Sen. Orrin G. HatchR-UT · Jul 29, 2005

Mr. President, if I may, I would like to speak very briefly on another topic. I am an unqualified supporter of the ``Protection of Lawful Commerce in Arms Act,'' on which we will be voting later…

Ron Wyden
Sen. Ron WydenD-OR · Jul 29, 2005

Mr. President, today I introduce legislation that will safeguard and promote specialty crops and value-added agriculture in Oregon and in the United States. The great farmers and ranchers of Oregon…

Max Baucus
Sen. Max BaucusD-MT · Jul 29, 2005

Mr. President, last year, the Senate passed significant legislation aimed at shutting down tax shelters. We ramped up disclosure requirements that make it easier for IRS to find those who promoted…

Susan M. Collins
Sen. Susan M. CollinsR-ME · Jul 29, 2005

Mr. President, I rise today to introduce legislation that would preserve an important means of protecting the safety of those who work in the Federal judiciary system. This legislation, which I am…

Norm Coleman
Sen. Norm ColemanR-MN · Jul 29, 2005

Mr. President, today I rise to join Senator Levin in introducing the Tax Shelter and Tax Haven Reform Act of 2005. This bill addresses abusive tax shelters and offshore tax havens which allow tax…

Barack Obama
Sen. Barack ObamaD-IL · Jul 29, 2005

Mr. President, I rise today to speak about the ``Tax Shelter and Tax Haven Reform Act of 2005,'' of which I am a cosponsor. This bill seeks to improve the fairness of our tax system by deterring the…

Harry Reid
Sen. Harry ReidD-NV · Jul 29, 2005

Mr. President, I rise to express my support for the Healthcare Equality and Accountability Act that Senator Akaka and I are introducing today. We are pleased that Congressman Honda, Chair of the…

Bill Text

Latest available legislative text

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Introduced in SenateIssued July 29, 2005

II

109th CONGRESS

1st Session

S. 1563

IN THE SENATE OF THE UNITED STATES

July 29, 2005

Mr. DeWine (for himself and Mrs. Lincoln) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend title XIX of the Social Security Act to protect and strengthen the safety net of children's public health coverage by extending the enhanced Federal matching rate under the State children's health insurance program to children covered by medicaid at State option and by encouraging innovations in children's enrollment and retention, to advance quality and performance in children's public health insurance programs, to provide payments for children's hospitals to reward quality and performance, and for other purposes.

1.

Short title

This Act may be cited as the Advancing Better Coverage and Care for Children's Health Act of 2005 or the ABCs for Children's Health Act of 2005.

2.

Table of contents

The table of contents for this Act is as follows:

Sec. 1. Short title.

Sec. 2. Table of contents.

TITLE I—Covering Children

Sec. 101. Phased-in application of enhanced FMAP for children whose eligibility is optional under medicaid.

Sec. 102. Enhanced matching rate for the effective enrollment and retention of children under medicaid.

Sec. 103. Preserving comprehensive benefits appropriate to children's needs.

TITLE II—Advancing Quality and Performance: Innovations in Care

Sec. 201. Purpose.

Sec. 202. National quality forum; advancing consensus-based pediatric quality and performance measures.

Sec. 203. Research grant program; developing new pediatric quality and performance measures.

Sec. 204. Medicaid demonstration program; evaluating evidence-based quality and performance measures for children's health services.

Sec. 205. Funding.

TITLE III—Ensuring Access to Care

Sec. 301. Pay for performance for children's critical access hospitals.

Sec. 302. Inclusion of children's hospitals as covered entities for purposes of limitation of purchased drug price.

I

Covering Children

101.

Phased-in application of enhanced fmap for children whose eligibility is optional under medicaid

(a)

In general

The first sentence of section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—

(1)

in subsection (b)—

(A)

by striking and (4) and inserting (4); and

(B)

by inserting before the period the following: , and (5) the Federal medical assistance percentage shall be equal to the applicable percentage determined under subsection (y) with respect to medical assistance provided to children who are eligible for such assistance on the basis of subsection (a)(10)(A)(ii), (a)(10)(C), (e)(3), or (e)(9) of section 1902, or a waiver under subsection (c) or (e) of section 1915, or who are eligible for such assistance during a presumptive eligibility period under section 1920A (but only if the child is not eligible for medical assistance on the basis of section 1902(a)(10)(A)(i)); and

(2)

by adding at the end the following:

(y)

For purposes of the fifth clause of the first sentence of subsection (b), the applicable percentage determined under this subsection is—

(1)

in the case of fiscal year 2006, the enhanced FMAP determined under section 2105(b) by substituting 6 percent for 30 percent in such section;

(2)

in the case of fiscal year 2007, the enhanced FMAP determined under section 2105(b) by substituting 12 percent for 30 percent in such section;

(3)

in the case of fiscal year 2008, the enhanced FMAP determined under section 2105(b) by substituting 18 percent for 30 percent in such section;

(4)

in the case of fiscal year 2009, the enhanced FMAP determined under section 2105(b) by substituting 24 percent for 30 percent in such section; and

(5)

in the case of fiscal year 2010 or any fiscal year thereafter, the enhanced FMAP determined under section 2105(b).

.

(b)

Effective date

The amendments made by subsection (a) take effect on October 1, 2005.

102.

Enhanced matching rate for the effective enrollment and retention of children under medicaid

(a)

In general

Section 1903(a)(3) of the Social Security Act (42 U.S.C. 1396b(a)(3)) is amended—

(1)

in subparagraph (E), by striking plus at the end and inserting and; and

(2)

by adding at the end the following:

(F)

90 percent of the sums expended during such quarter which are attributable to the design, development, implementation, and evaluation of such enrollment systems as the Secretary determines are likely to provide more efficient and effective administration of the plan’s enrollment and retention of eligible children, including—

(i)

express lane enrollment for children through procedures to ensure that children's eligibility for medical assistance is determined and expedited through the use of technology and shared information with other public benefit programs, such as the school lunch program under the Richard B. Russell National School Lunch Act and the food stamp program under the Food Stamp Act of 1977;

(ii)

a single, simplified application form for medical assistance under this title and for children's health assistance under title XXI;

(iii)

procedures which allow for the enrollment of children by mail or through the Internet;

(iv)

the timely evaluation, assistance, and determination of presumptive eligibility under section 1920A;

(v)

procedures which allow for passive reenrollment of children to protect against the loss of coverage among eligible children; and

(vi)

such other enrollment system changes as the Secretary determines are likely to provide more efficient and effective administration of the plan's enrollment and retention of eligible children; plus

.

(b)

Exclusion from erroneous excess payment determination

Section 1903(u)(1)(D) of such Act (42 U.S.C. 1396a(u)(1)(D)) is amended by adding at the end the following:

(vi)
(I)

Notwithstanding clauses (ii) and (iii), and subject to subclause (II), in determining the amount of erroneous excess payments, there shall not be included any erroneous payments made with respect to medical assistance provided to children who are erroneously enrolled or erroneously provided with continued enrollment under this title as a result of the application of enrollment systems described in subsection (a)(3)(F).

(II)

Subclause (I) shall only apply with respect to erroneous payments made during the first 5 fiscal years that begin on or after the date of enactment of this clause.

.

103.

Preserving comprehensive benefits appropriate to children's needs

(a)

In general

Title XIX of the Social Security Act is amended by inserting after section 1925 the following:

1926.

Clarification of authority under section 1115

The Secretary may not impose or approve under the authority of section 1115 an elimination or modification of the amount, duration, or scope of the services described in section 1905(a)(4)(B) (relating to early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r))) or of the requirements of subparagraphs (A) through (C) of section 1902(a)(43).

.

(b)

Effective date

(1)

In general

Except as provided in paragraph (2), section 1926 of the Social Security Act, as added by subsection (a), shall apply to the approval on or after the date of enactment of this Act of—

(A)

a waiver, experimental, pilot, or demonstration project under section 1115 of the Social Security Act (42 U.S.C. 1315); and

(B)

an amendment or extension of such a project.

(2)

Exception

Section 1926 of the Social Security Act, as so added, shall not apply with respect to any extension of approval of a waiver, experimental, pilot, or demonstration project with respect to title XIX of the Social Security Act that was first approved before 1994 and that provides a comprehensive and preventive child health program under such project that includes screening, diagnosis, and treatment of children who have not attained age 21.

II

Advancing Quality and Performance: Innovations in Care

201.

Purpose

The purpose of this title is to increase the quality of the health care furnished to children under the health insurance programs under titles XIX and XXI of the Social Security Act.

202.

National quality forum; advancing consensus-based pediatric quality and performance measures

(a)

In general

The Secretary of Health and Human Services (in this title referred to as the Secretary), acting through the Director of the Center for Medicaid and State Operations of the Centers for Medicare & Medicaid Services, shall enter into agreements with the National Quality Forum to facilitate the development of consensus-based pediatric quality and performance measures.

(b)

Consultation

In carrying out agreements under subsection (a), the Director of the Center for Medicaid and State Operations shall consult with—

(1)

the Agency for Healthcare Research and Quality; and

(2)

national pediatric provider groups.

203.

Research grant program; developing new pediatric quality and performance measures

(a)

In general

The Secretary, acting through the Administrator of the Agency for Healthcare Research and Quality, shall award grants to eligible entities for the development and evaluation of pediatric quality and performance measures.

(b)

Eligible entity defined

In this section, the term eligible entity means—

(1)

an institution or multiple institutions with demonstrated expertise and capacity to evaluate pediatric quality and performance measures;

(2)

a National nonprofit association of pediatric academic medical centers with demonstrated experience in working with other pediatric provider and accrediting organizations in developing quality and performance measures for children’s inpatient and outpatient care; and

(3)

a collaboration of national pediatric organizations working to improve quality and performance in pediatric critical care.

(c)

Application

Each eligible entity desiring a grant under this section shall submit an application to the Secretary at such time, in such manner, and accompanied by such information as the Secretary may require.

204.

Medicaid demonstration program; evaluating evidence-based quality and performance measures for children's health services

(a)

In general

Not later than 1 year after the date of enactment of this Act, the Secretary, acting through the Director of the Center for Medicaid and State Operations of the Centers for Medicare & Medicaid Services, shall establish demonstration projects in each of the 3 categories described in subsection (c) to advance quality and performance in the delivery of medical assistance provided to children under the medicaid program established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

(b)

Authority

(1)

In general

The Secretary is authorized to award grants to States or providers to conduct such projects.

(2)

Use of funds

Funds provided under a grant awarded under this section may be used for administrative costs, including costs associated with the design, data collection, and evaluation of the demonstration project conducted with such funds, and other expenditures that are not otherwise eligible for reimbursement under the medicaid program.

(3)

Evidence of organizational commitment required for award of grants

A State or provider shall not be eligible to receive a grant to conduct a demonstration project under this section unless the State or provider demonstrates a commitment to the concept of change and transformation in the delivery of children's health services. Dedication of financial resources of the State or provider to the project may be deemed to demonstrate evidence of such a commitment.

(c)

Project categories described

The 3 demonstration project categories described in this subsection are the following:

(1)

Projects that adopt and use health information technology and evidenced-based outcome measures for pediatric inpatient and sub-specialty physician care and evaluate the impact of such technology and measures on the quality, safety, and costs of such care.

(2)

Projects that demonstrate and evaluate care management for children with chronic conditions to determine the extent to which such management promotes continuity of care, stabilization of medical conditions, and functional outcomes, prevents or minimizes acute exacerbations of chronic conditions, and reduces adverse health outcomes and avoidable hospitalizations.

(3)

Projects that implement evidenced-based approaches to improving efficiency, safety, and effectiveness in the delivery of hospital care for children across hospital services and evaluate the impact of such changes on the quality and costs of such care.

(d)

Sites

To the extent practicable, the Secretary shall use multiple sites in different geographical locations in conducting each of the 3 demonstration project categories described in subsection (c).

(e)

Uniform measures, data, project evaluations

Working in consultation with experts described in subsection (f) and with participating States or providers, the Secretary shall establish uniform measures (adjusted for patient acuity), collect data, and conduct evaluations with respect to the 3 demonstration project categories described in subsection (c).

(f)

Consultation

In developing and implementing demonstration projects under this section, the Secretary shall consult with national pediatric provider organizations, consumers, and such other entities or individuals with relevant expertise as the Secretary deems necessary.

(g)

Report

Not later than 6 months after the completion of all demonstration projects conducted under this section, the Secretary shall evaluate such projects and submit a report to Congress that includes the findings of the evaluation and recommendations with respect to—

(1)

expanding the projects to additional sites; and

(2)

the broad implementation of identified successful approaches in advancing quality and performance in the delivery of medical assistance provided to children under the medicaid program.

205.

Funding

In order to carry out the provisions of this title, out of funds in the Treasury not otherwise appropriated, there are appropriated to the Secretary—

(1)

$25,000,000 for fiscal year 2006;

(2)

$30,000,000 for fiscal year 2007; and

(3)

$35,000,000 for each of the fiscal years 2008, 2009, and 2010.

III

Ensuring Access to Care

301.

Pay for performance for children's critical access hospitals

(a)

In general

The Secretary of Health and Human Services (in this section referred to as the Secretary), acting through the Administrator of the Centers for Medicare & Medicaid Services (in this section referred to as the Administrator), shall implement a 4-year program to develop, implement, and evaluate a pay-for-performance program for eligible children’s hospitals providing critical access to children eligible for medical assistance under the medicaid program established under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.).

(b)

Consultation

Measures of quality and performance utilized in the program will be determined by the Administrator in collaboration with participating eligible children's hospitals and in consultation with States, the National Association of Children’s Hospitals and Related Institutions, the Agency for Healthcare Research and Quality, the National Quality Forum, and such other entities or individuals with expertise in pediatric quality and performance measures as the Administrator deems appropriate.

(c)

Eligible children's hospitals

For purposes of this section, an eligible children's hospital is a children's hospital that, not later than January 1, 2006, has submitted an application to the Secretary to participate in the program established under this section and has been certified by the Secretary as—

(1)

meeting the criteria described in subsection (d);

(2)

agreeing to report data on quality and performance measures; and

(3)

meeting or exceeding such measures as are established by the Secretary with respect to the provision of care by the hospital.

(d)

Criteria described

In order to be certified as meeting the criteria described in this subsection, a hospital shall be a general acute care children’s hospital or a specialty children’s hospital as defined under 1886(d)(1)(B)(iii) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)(iii)), or a non-freestanding general acute care children’s hospital which shares a provider number with another hospital or hospital system that—

(1)

has 62 or more total pediatric beds;

(2)

has 38 or more total combined pediatric general medical or surgical and pediatric intensive care beds;

(3)

has at least 4 pediatric intensive care beds;

(4)

has a pediatric emergency room in the hospital or access to an emergency room with pediatric services through the hospital system; and

(5)

provides a minimum of 25 percent of its days of care to patients eligible for medical assistance under the medicaid program.

(e)

Payment methodology

(1)

In general

An eligible children's hospital that participates in the program established under this section shall receive supplemental Federal payments for inpatient and outpatient care (which shall be in addition to any other payments the hospitals receive for such care under the medicaid program) for cost reporting periods or portions of such reporting periods occurring during fiscal years 2007 through 2010 in accordance with the following:

(A)

Fiscal years 2007 and 2008

(i)

In general

For hospital cost reporting periods or portions of such reporting periods occurring during fiscal year 2007 or 2008, hospitals reporting data for quality and performance measures established under the program and participating in the development of pay-for-performance methodology under this section, subject to clause (ii), shall receive with respect to inpatient or outpatient care that is determined to meet such measures, a Federal supplemental payment increase equal to the amount received under the medicaid program for such care multiplied by the market basket percentage increase for the year (as defined under section 1886(b)(3)(B)(iii) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(iii)).

(ii)

Limitation

The total amount of all Federal supplemental payments made with respect to cost reporting periods or portions of such periods described in clause (i) shall not exceed the amounts appropriated under this section for fiscal years 2007 and 2008.

(B)

Fiscal years 2009 and 2010

(i)

In general

For cost reporting periods or portions of such periods occurring during fiscal year 2009 or 2010, hospitals shall receive supplemental Federal payments reflecting measures of quality and performance and a pay-for-performance methodology developed by the Secretary in consultation with the entities described in subsection (b). Such methodology shall recognize clinical measures, patient satisfaction and adoption of information technology.

(ii)

Limitation

The total amount of all Federal supplemental payments made for cost reporting periods or portions of such periods described in clause (i) shall not exceed the amounts appropriated under this section for fiscal years 2009 and 2010.

(2)

State maintenance of effort

With respect to the periods for payment of the Federal supplemental payments established under paragraph (1), in no case shall a State—

(A)

pay a participating hospital less for services for children eligible for medical assistance under the medicaid program than the hospital was paid with respect to the most recent cost reporting period ending before the date of enactment of this Act; or

(B)

not provide an eligible children’s hospital participating in the program established under this section (determined on a facility-specific basis) with the same increase in payment that the State may provide to any other hospital participating in the State medicaid program, including any State-owned or operated hospital or any hospital operated by a State university system.

(f)

Appropriations

(1)

In general

Out of funds in the Treasury not otherwise appropriated, there are appropriated for making payments under this section—

(A)

for fiscal year 2007, $80,000,000;

(B)

for fiscal year 2008, $100,000,000; and

(C)

for each of fiscal years 2009 and 2010, $120,000,000.

(2)

Carryover

Any amount appropriated under paragraph (1) with respect to a fiscal year that remains unobligated as of the end of that fiscal year, shall remain available for obligation during the succeeding fiscal year, in addition to the amount appropriated under that paragraph for such succeeding fiscal year.

(g)

Evaluation and report

Not later than September 1, 2010, the Secretary shall report to Congress on the program established under this section. In providing such a report, the Secretary shall—

(1)

conduct an independent evaluation;

(2)

consult with States, eligible children's hospitals participating in the program, the National Association of Children’s Hospitals and Related Institutions, and other national pediatric organizations and individuals with expertise in pediatric measures of quality and performance;

(3)

include a detailed description of the measures and payment enhancements used in determining and rewarding performance under the program;

(4)

assess the impact of rewarding performance through the Federal supplemental payments provided under the program, including with respect to any improvements and innovations in the delivery of children's hospital care and children's access to appropriate care;

(5)

assess how State hospital payment methodologies under the medicaid program, including hospital and physician payments and coverage, affect the capacity of the medicaid program to reward performance; and

(6)

include recommendations to the Committee on Finance of the Senate and the Committee on Energy and Commerce of the House of Representatives regarding the implementation and design of the performance-based payments made under the program, whether to continue such program, and potential alternative approaches to making performance-based payments to such hospitals.

302.

Inclusion of children's hospitals as covered entities for purposes of limitation of purchased drug price

(a)

In general

Section 340B(a)(4) of the Public Health Services Act (42 U.S.C. 256b(a)(4)) is amended by adding at the end the following new subparagraph:

(M)

A children's hospital described in section 1886(d)(1)(B)(iii) of the Social Security Act which meets the requirements of clauses (i) and (iii) of subparagraph (L) and which would meet the requirements of clause (ii) of such subparagraph if that clause were applied by taking into account the percentage of care provided by the hospital to patients eligible for medical assistance under the medicaid program.

.

(b)

Effective Date

The amendment made by subsection (a) shall apply to drugs purchased on or after the date of enactment of this Act.