Sole Community Hospital Preservation Act of 2009

Sole Community Hospital Preservation Act of 2009 - Amends title XVIII (Medicare) of the Social Security Act with respect to the prospective payment system (PPS) for hospital outpatient department (OPD) services, particularly the transitional adjustment for sole community hospitals to limit any decline in payment. Continues to hold sole community hospitals harmless from any decline in payment. Increases the payment for covered OPD services furnished on or after January 1, 2010, in a sole community hospital by the amount of any difference between the pre-Balanced Budget Act of 1997 (pre-BBA) amount and a lesser PPS amount.

Prescribes an increase of 7.1% in payment for such services (before the application of outliers and coinsurance). Permits the Secretary of Health and Human Services to revise such percentage based on a study comparing costs incurred by sole community hospitals located in rural areas by ambulatory payment classification groups (APCs) to costs incurred by hospitals located in urban areas. Bars any such increase in payment for devices, drugs, or biologicals.

[Congressional Bills 111th Congress]
[From the U.S. Government Printing Office]
[H.R. 1051 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 1051

 To amend title XVIII of the Social Security Act to extend and improve 
  protections for sole community hospitals under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 12, 2009

  Mr. Tanner introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend title XVIII of the Social Security Act to extend and improve 
  protections for sole community hospitals under the Medicare Program.

    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 ``Sole Community Hospital Preservation 
Act of 2009''.

SEC. 2. EXTENSION OF THE MEDICARE HOLD HARMLESS PROVISION UNDER THE 
              PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT 
              DEPARTMENT SERVICES FOR SOLE COMMUNITY HOSPITALS.

    Section 1833(t)(7)(D)(i) of the Social Security Act (42 U.S.C. 
1395l(t)(7)(D)(i)) is amended by adding at the end the following new 
subclause:
                            ``(IV) In the case of a sole community 
                        hospital (as defined in section 
                        1886(d)(5)(D)(iii)), for covered OPD services 
                        furnished on or after January 1, 2010, for 
                        which the PPS amount is less than the pre-BBA 
                        amount, the amount of payment under this 
                        subsection shall be increased by the amount of 
                        such difference.''.

SEC. 3. ADJUSTMENT UNDER THE PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL 
              OUTPATIENT DEPARTMENT SERVICES FOR SOLE COMMUNITY 
              HOSPITALS.

    Section 1833(t)(13) of the Social Security Act (42 U.S.C. 
1395l(t)(13)) is amended--
            (1) in the heading, by striking ``Authorization of 
        adjustment'' and inserting ``Adjustment''; and
            (2) by adding at the end the following new subparagraph:
                    ``(C) Adjustment for sole community hospitals.--
                            ``(i) Adjustment.--
                                    ``(I) In general.--Subject to 
                                clause (ii), in the case of covered OPD 
                                services furnished on or after January 
                                1, 2010, by a sole community hospital 
                                (as defined in section 
                                1886(d)(5)(D)(iii)), the amount of 
                                payment that would otherwise be made 
                                for such services under this subsection 
                                (before the application of outliers and 
                                coinsurance) shall be increased by an 
                                amount equal to 7.1 percent of such 
                                amount.
                                    ``(II) Revision with notice and 
                                comment.--In the case of covered OPD 
                                services furnished on or after January 
                                1, 2012, the Secretary may revise the 
                                percent described in subclause (I) 
                                based on a study described in 
                                subparagraph (A) comparing the costs 
                                incurred by sole community hospitals to 
                                costs incurred by hospitals located in 
                                urban areas. Such a revised adjustment 
                                shall not be effective earlier than 1 
                                year after the date of promulgation of 
                                a regulation providing for such revised 
                                adjustment.
                            ``(ii) Not applicable to pass-through 
                        devices, drugs, and biologicals.--The increase 
                        under clause (i) shall not apply to the payment 
                        for a device, drug, or biological described in 
                        clause (i), (ii), (iii), or (iv) of paragraph 
                        (6)(A).
                            ``(iii) Exemption from budget neutrality.--
                        The provisions of this subparagraph shall not 
                        be effected in a manner that results in or 
                        requires a reduction or other adjustment in 
                        other payment amounts under this subsection.''.
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