text: 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.''.
target: 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.
feat_title: Rural Health Care Protection Act of 1997