article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Rural Health Care Protection Act of 1997''. SEC. 2. CLASSIFICATION AS RURAL REFERRAL CENTERS. (a) Prohibiting Denial of Request for Reclassification on Basis of Comparability of Wages.-- (1) In general.--Section 1886(d)(10)(D) of the Social Security Act (42 U.S.C. 1395ww(d)(10)(D)) is amended-- (A) by redesignating clause (iii) as clause (iv); and (B) by inserting after clause (ii) the following new clause: ``(iii) Under the guidelines published by the Secretary under clause (i), in the case of a hospital which has ever been classified by the Secretary as a rural referral center under paragraph (5)(C), the Board may not reject the application of the hospital under this paragraph on the basis of any comparison between the average hourly wage of the hospital and the average hourly wage of hospitals in the area in which it is located.''. (2) Effective date.--Notwithstanding section 1886(d)(10)(C)(ii) of the Social Security Act, a hospital may submit an application to the Medicare Geographic Classification Review Board during the 60-day period beginning on the date of the enactment of this Act requesting a change in its classification for purposes of determining the area wage index applicable to the hospital under section 1886(d)(3)(D) of such Act for fiscal year 1998 if the hospital would be eligible for such a change in its classification under the standards described in section 1886(d)(10)(D) (as amended by paragraph (1)) but for its failure to meet the deadline for applications under section 1886(d)(10)(C)(ii). (3) Reference to budget neutrality provision.--For a requirement that the Secretary of Health and Human Services make a proportional adjustment in the Medicare standardized payment amounts for inpatient hospital services to assure that geographic reclassifications of hospitals resulting from this subsection do not result in an increase in aggregate payments under section 1886 of the Social Security Act, see subsection (d)(8)(D) of such section. (b) Continuing Treatment of Previously Designated Centers.-- (1) In general.--Any hospital classified as a rural referral center by the Secretary of Health and Human Services under section 1886(d)(5)(C) of the Social Security Act for fiscal year 1991 shall be classified as such a rural referral center for fiscal year 1998 and each subsequent fiscal year. (2) Budget neutrality.--The provisions of section 1886(d)(8)(D) of the Social Security Act shall apply to reclassifications made pursuant to paragraph (1) in the same manner as such provisions apply to a reclassification under section 1886(d)(10) of such Act. SEC. 3. HOSPITAL GEOGRAPHIC RECLASSIFICATION PERMITTED FOR PURPOSES OF DISPROPORTIONATE SHARE PAYMENT ADJUSTMENTS. (a) In General.--Section 1886(d)(10)(C)(i) of the Social Security Act (42 U.S.C. 1395ww(d)(10)(C)(i)) is amended-- (1) by striking ``or'' at the end of subclause (I); (2) by striking the period at the end of subclause (II) and inserting ``, or''; (3) by inserting after subclause (II) the following: ``(III) eligibility for and amount of additional payment amounts under paragraph (5)(F).''; and (4) by adding at the end the following: ``Any application approved for purposes of subclause (I) for a fiscal year is deemed to be approved for purposes of subclause (III) for that fiscal year.''. (b) Effective Date.--Notwithstanding section 1886(d)(10)(C)(ii) of the Social Security Act, a hospital may submit an application to the Medicare Geographic Classification Review Board during the 60-day period beginning on the date of the enactment of this Act requesting a change in its classification for purposes of determining the disproportionate share hospital payment applicable to the hospital under section 1886(d)(5)(F) of such Act for fiscal year 1998 if the hospital would be eligible for such a change in its classification under the guidelines described in subsection (c) of this section but for its failure to meet the deadline for applications under section 1886(d)(10(C)(ii). (c) Applicable Guidelines.--Such Board shall apply the guidelines established for reclassification under subclause (I) of section 1886(d)(10)(C)(i) of such Act to reclassification under subclause (III) of such section until the Secretary of Health and Human Services promulgates separate guidelines for reclassification under such subclause (III). (d) Reference to Budget Neutrality Provision.--For a requirement that the Secretary of Health and Human Services make a proportional adjustment in the medicare standardized payment amounts for inpatient hospital services to assure that geographic reclassifications of hospitals resulting from this section do not result in an increase in aggregate payments under section 1886 of the Social Security Act, see subsection (d)(8)(D) of such section. SEC. 4. PERMITTING REBASING OF PAYMENT FOR SOLE COMMUNITY HOSPITALS USING FISCAL YEARS 1994 AND 1995 COSTS. Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)) is amended-- (1) in subparagraph (C), by inserting ``subject to subparagraph (F),'' after ``subsection (d)(5)(D)(iii)),''; and (2) by adding at the end the following new subparagraph: ``(F) In applying subparagraph (C) with respect to discharges occurring in fiscal year 1998 and each subsequent fiscal year, in no case shall the target amount for a hospital for fiscal year 1998 be less than the average of-- ``(i) the allowable operating costs of inpatient hospital services recognized under this title for the hospital's 12- month cost reporting period (if any) beginning during fiscal year 1994 increased (in a compounded manner) by the applicable percentage increase under subparagraph (B)(iv) for each of fiscal years 1995, 1996, 1997, and 1998, and ``(ii) the allowable operating costs of inpatient hospital services recognized under this title for the hospital's 12- month cost reporting period (if any) beginning during fiscal year 1995 increased (in a compounded manner) by the applicable percentage increase under subparagraph (B)(iv) for each of fiscal years 1996, 1997, and 1998.''.
summary: Rural Health Care Protection Act of 1997 - Amends title XVIII (Medicare) of the Social Security Act, with respect to a hospital which has ever been classified as a rural referral center, to prohibit denial of a request for its reclassification on the basis of any comparison between its average hourly wage and the average hourly wages of hospitals in the area in which it is located. Declares that any hospital classified as a rural referral center by the Secretary of Health and Human Services for FY 1991 shall be so classified for FY 1998 and each subsequent fiscal year. Permits hospital geographic reclassification for purposes of disproportionate share payment adjustments. Permits rebasing of Medicare payment for sole community hospitals using FY 1994 and 1995 costs.