Hospital Payment Improvement and Equity Act of 2006 - Directs the Secretary of Health and Human Services to establish a process under which a hospital may appeal its wage index classification under title XVIII (Medicare) of the Social Security Act and select another area within the state (or, at the Secretary's discretion, within a contiguous state) to which to be reclassified.
Prescribes special rules for: (1) a competitively disadvantaged hospital in a single-hospital Metropolitan Statistical Area (MSA) surrounded by rural counties; and (2) rehabilitation hospitals and rehabilitation units.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 4017 Introduced in Senate (IS)]
109th CONGRESS
2d Session
S. 4017
To provide for an appeals process for hospital wage index
classification under the Medicare program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 29, 2006
Mr. Specter (for himself and Mr. Santorum) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To provide for an appeals process for hospital wage index
classification under the Medicare program, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Hospital Payment Improvement and
Equity Act of 2006''.
SEC. 2. APPEALS PROCESS FOR HOSPITAL WAGE INDEX CLASSIFICATION.
(a) Establishment of Process.--
(1) In general.--The Secretary shall establish not later
than January 1, 2007, by instruction or otherwise, a process
under which a hospital may appeal the wage index classification
otherwise applicable to the hospital and select another area
within the State (or, at the discretion of the Secretary,
within a contiguous State) to which to be reclassified.
(2) Process requirements.--The process established under
paragraph (1) shall be consistent with the following:
(A) Such an appeal may be filed as soon as possible
after the date of the enactment of this Act but shall
be filed by not later than February 15, 2007.
(B) Such an appeal shall be heard by the Medicare
Geographic Reclassification Review Board.
(C) There shall be no further administrative or
judicial review of a decision of such Board.
(3) Reclassification upon successful appeal.--
(A) Reclassification.--If the Medicare Geographic
Reclassification Review Board determines that the
hospital is a qualifying hospital (as defined in
subsection (c)), the hospital shall be reclassified to
the area selected under paragraph (1).
(B) Applicability.--A reclassification under
subparagraph (A) shall apply with respect to discharges
occurring during the 3-year period beginning with April
1, 2007.
(4) Special rules.--
(A) In general.--Any qualifying hospital that is
within 3 miles driving distance, starting at the
hospital entrance and driving over improved roads, to
the nearest Metropolitan Statistical Area in which a
majority of the other qualifying hospitals located in
the same Metropolitan Statistical Area as the hospital
have been reclassified to (or if there is no majority,
the Metropolitan Statistical Area in which at least one
such other qualifying hospital has been reclassified to
(as determined appropriate by the Secretary of Health
and Human Services), the hospital shall be eligible to
select to be reclassified to such nearest Metropolitan
Statistical Area (or if no majority, to the area so
determined appropriate by the Secretary).
(B) Competitively disadvantaged hospital in a
single-hospital msa surrounded by rural counties.--
(i) In general.--If a hospital meets the
requirements described in clause (ii)--
(I) such hospital shall be deemed
to be a qualifying hospital; and
(II) such hospital shall be
reclassified to the closest urban area
which is part of a Combined Statistical
Area located in the same State as the
hospital.
(ii) Requirements.--The requirements
described in this clause are the following:
(I) The hospital is the only
hospital in its urban area.
(II) The hospital is in an urban
area that is not adjacent to any other
urban area.
(III) The hospital is seeking
reclassification to the closest urban
area which is part of a Combined
Statistical Area located in the same
state as the hospital.
(5) Inapplicability of certain provisions.--Except as the
Secretary may provide, the provisions of paragraphs (8) and
(10) of section 1886(d) of the Social Security Act (42 U.S.C.
1395ww(d)) shall not apply to an appeal under this section.
(b) Application of Reclassification.--In the case of an appeal
decided in favor of a qualifying hospital under subsection (a), the
wage index reclassification shall not affect the wage index computation
for any area or for any other hospital and shall not be effected in a
budget neutral manner. The provisions of this section shall not affect
payment for discharges occurring after the end of the 3-year-period
referred to in subsection (a)(3)(B).
(c) Qualifying Hospital Defined.--For purposes of this section, the
term ``qualifying hospital'' means a subsection (d) hospital (as
defined in section 1886(d)(1)(B) of the Social Security Act (42 U.S.C.
1395ww(d)(1)(B))) that--
(1) does not qualify for a change in wage index
classification under paragraph (8) or (10) of section 1886(d)
of such Act (42 U.S.C. 1395ww(d)) on the basis of requirements
relating to distance or commuting; and
(2) meets such other criteria, such as quality, as the
Secretary may specify by instruction or otherwise.
The Secretary may modify the wage comparison guidelines promulgated
under section 1886(d)(10)(D) of such Act (42 U.S.C. 1395ww(d)(10)(D))
in carrying out this section.
(d) Wage Index Classification.--For purposes of this section, the
term ``wage index classification'' means the geographic area in which
the hospital is classified for purposes of determining for a fiscal
year the factor used to adjust the DRG prospective payment rate under
section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) for
area differences in hospital wage levels that applies to such hospital
under paragraph (3)(E) of such section.
(e) Special Rule for Rehabilitation Hospitals and Rehabilitation
Units.--
(1) In general.--Effective for discharges occurring during
the 3-year period beginning with April 1, 2007, for purposes of
making payments under section 1886(j) of the Social Security
Act (42 U.S.C. 1395ww(j)) to a qualifying rehabilitation
facility, such facility shall be deemed to be located in the
area described in paragraph (3).
(2) Qualifying rehabilitation facility defined.--For
purposes of this subsection, the term ``qualifying
rehabilitation facility'' means a rehabilitation hospital or a
rehabilitation unit that is located in a Metropolitan
Statistical Area in which all subsection (d) hospitals (as
defined in subsection (d)(1)(B) of section 1886 of the Social
Security Act (42 U.S.C. 1395ww)) that are not sole community
hospitals (as defined in subsection (d)(5)(D)(iii) of such
section) located in the area have been reclassified to another
Metropolitan Statistical Area.
(3) Area described.--The area described in this paragraph
with respect to a qualifying rehabilitation facility is the
Metropolitan Statistical Area in which the majority of the
subsection (d) hospitals (as so defined) located in the same
Metropolitan Statistical Area as the qualifying rehabilitation
facility have been reclassified to (or if there is no majority,
the Metropolitan Statistical Area in which at least one such
subsection (d) hospital has been reclassified to (as determined
appropriate by the Secretary of Health and Human Services).
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S10693-10694)
Read twice and referred to the Committee on Finance.
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