Protecting Front Line Multimission Hospitals Act of 2024
This bill allows for increased payment adjustments under Medicaid for certain hospitals that provide multiple types of services for Medicaid-eligible or uninsured individuals (i.e., multimission hospitals).
Specifically, the bill allows hospitals to receive higher disproportionate share hospital payments under Medicaid for costs associated with physician services, emergency medical services, or services provided at federally qualified health centers or other clinical outpatient settings, if such services are provided to maintain a certain level of care under Medicaid. The hospital's patient population must meet certain higher indexes with respect to the number of Medicaid-eligible and uninsured individuals served.
Additionally, state Medicaid programs must ensure that relevant payment plans for these hospitals support the financial viability of the hospitals and their ability to provide the requisite level of care under Medicaid.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7327 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 7327
To amend title XIX of the Social Security Act to ensure adequate
consideration of payment rates for multimission hospitals under the
Medicaid program, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 13, 2024
Ms. DeGette introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to ensure adequate
consideration of payment rates for multimission hospitals under the
Medicaid 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 ``Protecting Front Line Multimission
Hospitals Act of 2024''.
SEC. 2. ENSURING APPROPRIATE PAYMENT RATES FOR MULTIMISSION HOSPITALS
UNDER THE MEDICAID PROGRAM.
Section 1902(a)(13)(A) of the Social Security Act (42 U.S.C.
1396a(a)(13)(A)) is amended--
(1) in clause (iii), by striking ``and'' at the end;
(2) in clause (iv), by striking the semicolon and inserting
``; and''; and
(3) by adding at the end the following new clause:
``(v) in the case of multimission hospitals
(as defined in section 1923(k)) located within
the State (or located within 100 miles of the
State, in the case of a hospital that provides
tertiary services under the State plan), such
rates--
``(I) take into account the short-
and long-term financial viability of
such hospitals;
``(II) provide stable, predictable,
and sufficient reimbursement to improve
or maintain the financial viability of
such hospitals; and
``(III) ensure that items and
services are available to be furnished
at such hospitals under the State plan
(or waiver of such plan) to the same
extent that such items and services are
available to be furnished at such
hospitals to the general population in
a geographic region;''.
SEC. 3. ALLOWING FOR INCREASED DISPROPORTIONATE SHARE HOSPITAL
ADJUSTMENTS FOR CERTAIN HOSPITALS UNDER THE MEDICAID
PROGRAM.
(a) In General.--Section 1923 of the Social Security Act (42 U.S.C.
1396r-4) is amended by adding at the end the following new subsection:
``(k) Allowable Increase in Adjustments for Certain Hospitals.--
``(1) In general.--A payment adjustment under this section
during a fiscal year with respect to a hospital that is a
multimission hospital for such fiscal year that exceeds the
amount determined under subsection (g) with respect to such
hospital and fiscal year shall be deemed to be consistent with
subsection (c) to the extent that such payment adjustment is
less than or equal to the amount that would have been
determined under subsection (g) with respect to such hospital
and fiscal year had the costs incurred during such fiscal year
by such hospital (as described in paragraph (1)(A) of such
subsection (or, in the case of a specified hospital (as defined
in paragraph (5)), as described in paragraph (1)(A) of such
subsection as in effect on January 1, 2020)) to individuals
described in paragraph (1)(B) of such subsection (or, in the
case of a specified hospital, individuals described in
paragraph (1)(A) of such subsection as in effect on January 1,
2020) included costs incurred by such hospital during such
fiscal year that are described in paragraph (2) with respect to
individuals described in paragraph (3) and that are so incurred
for the purpose (as determined by the State) described in
paragraph (4).
``(2) Costs described.--For purposes of paragraph (1), the
costs described in this paragraph are costs for furnishing or
supporting the furnishing of physicians' services (as defined
in section 1848), services provided at Federally qualified
health center or any other clinical outpatient setting, and
emergency medical services (as defined in section 303(j)(13) of
the Controlled Substances Act).
``(3) Individuals described.--For purposes of paragraph
(1), the individuals described in this paragraph are, with
respect to costs incurred by a hospital for a fiscal year--
``(A) except as provided in subparagraph (B),
individuals described in paragraph (1)(B) of subsection
(g); and
``(B) in the case the amount determined under such
subsection for such hospital and such year is so
determined under paragraph (2)(A)(ii) of such
subsection, individuals described in paragraph (1)(A)
of such subsection as in effect on January 1, 2020.
``(4) Purpose described.--For purposes of paragraph (1),
the purpose described in this paragraph is to ensure that care
and services are available under the State plan (or waiver of
such plan) in a geographic area at least to the extent that
such care and services are available to the general population
in such area.
``(5) Definitions.--In this subsection:
``(A) Disproportionate patient bed count.--The term
`disproportionate patient bed count' means, with
respect to a hospital and a fiscal year, the product
of--
``(i) such hospital's disproportionate
patient percentage for such fiscal year; and
``(ii) such hospital's number of beds for
such fiscal year.
``(B) Multimission hospital.--The term
`multimission hospital' means, with respect to a fiscal
year--
``(i) a public hospital with 100 or more
beds that has--
``(I) an average Medicare case mix
index of at least 1.3;
``(II) an intern and resident to
bed ratio of at least 0.17 (or at least
125 residents and fellows); and
``(III) an average disproportionate
patient percentage over the 3-year
period ending on the last day of such
fiscal year of at least 40 percent (or
a disproportionate patient percentage
for such fiscal year of at least 40
percent);
``(ii) a nonprofit hospital with more than
199 but fewer than 1,000 beds that has an
average disproportionate patient percentage
over the 3-year period ending on the last day
of such fiscal year of at least 40 percent (or
a disproportionate patient percentage for such
fiscal year of at least 40 percent) and has--
``(I) in the case of such a
hospital with an average
disproportionate patient percentage
over such period of at least 45
percent--
``(aa) an average Medicare
case mix index of at least 1.5;
and
``(bb) an intern and
resident to bed ratio of at
least 0.19 (or at least 150
residents and fellows); or
``(II) in the case of such a
hospital not described in subclause
(I)--
``(aa) a disproportionate
patient bed count of at least
250;
``(bb) an average Medicare
case mix index of at least 2.0;
and
``(cc) an intern and
resident to bed ratio of at
least 0.2 (or at least 175
residents and fellows); and
``(iii) a nonprofit hospital with 1,000 or
more beds that has an average disproportionate
patient percentage over the 3-year period
ending on the last day of such fiscal year of
at least 55 percent (or a disproportionate
patient percentage for such fiscal year of at
least 55 percent).
``(C) Specified hospital.--The term `specified
hospital' means, with respect to a fiscal year, a
hospital with an amount determined under subsection (g)
for such year that is so determined under paragraph
(2)(A)(ii) of such subsection.''.
(b) Conforming Amendment.--Section 1923(g)(1) of the Social
Security Act (42 U.S.C. 1396r-4(g)(1)) is amended by striking ``A
payment adjustment'' and inserting ``Subject to subsection (k), a
payment adjustment''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to fiscal year 2024 and each subsequent fiscal year.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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