Section 3133

SEC. 3133. IMPROVEMENT TO MEDICARE DISPROPORTIONATE SHARE HOSPITAL [DSH] PAYMENTS.

Section 1886 of the Social Security Act [42 U.S.C. 1395ww], as amended by sections 3001, 3008, and 3025, is amended--

[1] in subsection [d][5][F][i], by striking 'For' and inserting 'Subject to subsection [r], for'; and

[2] by adding at the end the following new subsection:

'[r] Adjustments to Medicare DSH Payments-

'[1] EMPIRICALLY JUSTIFIED DSH PAYMENTS- For fiscal year 2015 and each subsequent fiscal year, instead of the amount of disproportionate share hospital payment that would otherwise be made under subsection [d][5][F] to a subsection [d] hospital for the fiscal year, the Secretary shall pay to the subsection [d] hospital 25 percent of such amount [which represents the empirically justified amount for such payment, as determined by the Medicare Payment Advisory Commission in its March 2007 Report to the Congress].

'[2] ADDITIONAL PAYMENT- In addition to the payment made to a subsection [d] hospital under paragraph [1], for fiscal year 2015 and each subsequent fiscal year, the Secretary shall pay to such subsection [d] hospitals an additional amount equal to the product of the following factors:

'[A] FACTOR ONE- A factor equal to the difference between--

'[i] the aggregate amount of payments that would be made to subsection [d] hospitals under subsection [d][5][F] if this subsection did not apply for such fiscal year [as estimated by the Secretary]; and

'[ii] the aggregate amount of payments that are made to subsection [d] hospitals under paragraph [1] for such fiscal year [as so estimated].

'[B] FACTOR TWO-

'[i] FISCAL YEARS 2015, 2016, AND 2017- For each of fiscal years 2015, 2016, and 2017, a factor equal to 1 minus the percent change [divided by 100] in the percent of individuals under the age of 65 who are uninsured, as determined by comparing the percent of such individuals--

'[I] who are uninsured in 2012, the last year before coverage expansion under the Patient Protection and Affordable Care Act [as calculated by the Secretary based on the most recent estimates available from the Director of the Congressional Budget Office before a vote in either House on such Act that, if determined in the affirmative, would clear such Act for enrollment]; and

'[II] who are uninsured in the most recent period for which data is available [as so calculated].

'[ii] 2018 AND SUBSEQUENT YEARS- For fiscal year 2018 and each subsequent fiscal year, a factor equal to 1 minus the percent change [divided by 100] in the percent of individuals who are uninsured, as determined by comparing the percent of individuals--

'[I] who are uninsured in 2012 [as estimated by the Secretary, based on data from the Census Bureau or other sources the Secretary determines appropriate, and certified by the Chief Actuary of the Centers for Medicare & Medicaid Services]; and

'[II] who are uninsured in the most recent period for which data is available [as so estimated and certified].

'[C] FACTOR THREE- A factor equal to the percent, for each subsection [d] hospital, that represents the quotient of--

'[i] the amount of uncompensated care for such hospital for a period selected by the Secretary [as estimated by the Secretary, based on appropriate data [including, in the case where the Secretary determines that alternative data is available which is a better proxy for the costs of subsection [d] hospitals for treating the uninsured, the use of such alternative data]]; and

'[ii] the aggregate amount of uncompensated care for all subsection [d] hospitals that receive a payment under this subsection for such period [as so estimated, based on such data].

'[3] LIMITATIONS ON REVIEW- There shall be no administrative or judicial review under section 1869, section 1878, or otherwise of the following:

'[A] Any estimate of the Secretary for purposes of determining the factors described in paragraph [2].

'[B] Any period selected by the Secretary for such purposes.'.