Children's Hospital Protection Act

II 116TH CONGRESS 2D SESSION S. 5077 To amend title XIX of the Social Security Act to adjust the limitations on Medicaid disproportionate share hospital payments. IN THE SENATE OF THE UNITED STATES DECEMBER 20, 2020 Mr. CORNYN 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 adjust the limitations on Medicaid disproportionate share hos- pital payments. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Children’s Hospital 4 Protection Act’’. 5 SEC. 2. MEDICAID SHORTFALL AND THIRD-PARTY PAY- 6 MENTS. 7 (a) IN GENERAL.—Subsection (g) of section 1923 of 8 the Social Security Act (42 U.S.C. 1396r–4) is amended 9 to read as follows: 10 VerDate Sep 11 2014 00:07 Jan 11, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S5077.IS S5077 kjohnson on DSK79L0C42PROD with BILLS 2 •S 5077 IS ‘‘(g) LIMIT ON AMOUNT OF PAYMENT TO HOS- 1 PITAL.— 2 ‘‘(1) IN GENERAL.— 3 ‘‘(A) AMOUNT OF ADJUSTMENT SUBJECT 4 TO UNCOMPENSATED COSTS.—A payment ad- 5 justment during a fiscal year shall not be con- 6 sidered to be consistent with subsection (c) with 7 respect to a hospital (other than a hospital de- 8 scribed in paragraph (2)(B)) if the payment ad- 9 justment exceeds an amount equal to— 10 ‘‘(i) the costs incurred during the year 11 of furnishing hospital services by the hos- 12 pital to individuals described in subpara- 13 graph (B) minus— 14 ‘‘(ii) the sum of— 15 ‘‘(I) payments under this title 16 (other than under this section) for 17 such services; and 18 ‘‘(II) payments by uninsured pa- 19 tients for such services. 20 ‘‘(B) INDIVIDUALS DESCRIBED.—For pur- 21 poses of subparagraph (A), the individuals de- 22 scribed in this clause are the following: 23 ‘‘(i) Individuals who are eligible for 24 medical assistance under the State plan or 25 VerDate Sep 11 2014 00:07 Jan 11, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S5077.IS S5077 kjohnson on DSK79L0C42PROD with BILLS 3 •S 5077 IS under a waiver of such plan and for whom 1 the State plan or waiver is the primary 2 payor for such services. 3 ‘‘(ii) Subject to subparagraph (C), in- 4 dividuals who have no health insurance (or 5 other source of third party coverage) for 6 services provided during the year, as deter- 7 mined by the Secretary. 8 ‘‘(C) EXCLUSION OF CERTAIN PAY- 9 MENTS.—For purposes of subparagraph (B)(ii), 10 payments made to a hospital for services pro- 11 vided to indigent patients made by a State or 12 a unit of local government within a State shall 13 not be considered to be a source of third party 14 coverage. 15 ‘‘(2) APPLICATION OF LIMITS FOR CERTAIN 16 HOSPITALS.— 17 ‘‘(A) IN GENERAL.—A payment adjust- 18 ment during a fiscal year shall not be consid- 19 ered to be consistent with subsection (c) with 20 respect to a hospital described in subparagraph 21 (B) if the payment adjustment exceeds the 22 higher of— 23 VerDate Sep 11 2014 00:07 Jan 11, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S5077.IS S5077 kjohnson on DSK79L0C42PROD with BILLS 4 •S 5077 IS ‘‘(i) the amount determined for the 1 hospital and fiscal year under paragraph 2 (1)(A); and 3 ‘‘(ii) the amount determined for the 4 hospital under paragraph (1)(A) as in ef- 5 fect on January 1, 2020. 6 ‘‘(B) HOSPITALS DESCRIBED.—A hospital 7 is described in this subparagraph for a fiscal 8 year if, for the most recent cost reporting pe- 9 riod ending before such fiscal year, the hospital 10 is in at least the 98th percentile of all hospitals 11 with respect to the number of hospital days for 12 such period that were made up of patients who 13 (for such days) were entitled to benefits under 14 part A of title XVIII and were entitled to sup- 15 plemental security income benefits under title 16 XVI (excluding any State supplementary bene- 17 fits paid with respect to such patients).’’. 18 (b) EFFECTIVE DATE.—The amendment made by 19 this section shall take effect on October 1, 2021, and shall 20 apply to payment adjustments made under section 1923 21 of the Social Security Act (42 U.S.C. 1396r–4) during fis- 22 cal years beginning on or after such date. 23 Æ VerDate Sep 11 2014 00:07 Jan 11, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\S5077.IS S5077 kjohnson on DSK79L0C42PROD with BILLS