TITLE V--PROVISIONS RELATING TO PART A
Subtitle A--Inpatient Hospital Services
SEC. 508. ONE-TIME APPEALS PROCESS FOR HOSPITAL WAGE INDEX
CLASSIFICATION.
(a) ESTABLISHMENT OF PROCESS-
(1) IN GENERAL- The Secretary shall
establish not later than January 1, 2004, 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, 2004.
(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- 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).
Such reclassification shall apply with respect to discharges occurring during
the 3-year period beginning with April 1, 2004.
(4) 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).
(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
the Social Security 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 it 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) LIMITATION ON EXPENDITURES- The aggregate
amount of additional expenditures resulting from the application of this section
shall not exceed $900,000,000.
(f) TRANSITIONAL EXTENSION- Any reclassification
of a county or other area made by Act of Congress for purposes of making payments
under section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) that
expired on September 30, 2003, shall be deemed to be in effect during the period
beginning on January 1, 2004, and ending on September 30, 2004.
