Page:United States Statutes at Large Volume 124.djvu/467

 124 STAT. 441 PUBLIC LAW 111–148—MAR. 23, 2010 has improved patient care, quality of life, and cost-effectiveness for Medicare beneficiaries participating in the demonstration program. (2) REPORTS.—The Secretary shall submit to Congress a report containing the results of the evaluation conducted under paragraph (1), together with such recommendations as the Sec- retary determines appropriate. (c) BUDGET NEUTRALITY.—With respect to the 3-year period of the demonstration program under this section, the Secretary shall ensure that the aggregate expenditures under title XVIII for such period shall not exceed the aggregate expenditures that would have been expended under such title if the demonstration program under this section had not been implemented. SEC. 3141. APPLICATION OF BUDGET NEUTRALITY ON A NATIONAL BASIS IN THE CALCULATION OF THE MEDICARE HOS- PITAL WAGE INDEX FLOOR. In the case of discharges occurring on or after October 1, 2010, for purposes of applying section 4410 of the Balanced Budget Act of 1997 (42 U.S.C. 1395ww note) and paragraph (h)(4) of section 412.64 of title 42, Code of Federal Regulations, the Secretary of Health and Human Services shall administer subsection (b) of such section 4410 and paragraph (e) of such section 412.64 in the same manner as the Secretary administered such subsection (b) and paragraph (e) for discharges occurring during fiscal year 2008 (through a uniform, national adjustment to the area wage index). SEC. 3142. HHS STUDY ON URBAN MEDICARE-DEPENDENT HOSPITALS. (a) STUDY.— (1) IN GENERAL.—The Secretary of Health and Human Services (in this section referred to as the ‘‘Secretary’’) shall conduct a study on the need for an additional payment for urban Medicare-dependent hospitals for inpatient hospital serv- ices under section 1886 of the Social Security Act (42 U.S.C. 1395ww). Such study shall include an analysis of— (A) the Medicare inpatient margins of urban Medicare- dependent hospitals, as compared to other hospitals which receive 1 or more additional payments or adjustments under such section (including those payments or adjust- ments described in paragraph (2)(A)); and (B) whether payments to medicare-dependent, small rural hospitals under subsection (d)(5)(G) of such section should be applied to urban Medicare-dependent hospitals. (2) URBAN MEDICARE-DEPENDENT HOSPITAL DEFINED.—For purposes of this section, the term ‘‘urban Medicare-dependent hospital’’ means a subsection (d) hospital (as defined in sub- section (d)(1)(B) of such section) that— (A) does not receive any additional payment or adjust- ment under such section, such as payments for indirect medical education costs under subsection (d)(5)(B) of such section, disproportionate share payments under subsection (d)(5)(A) of such section, payments to a rural referral center under subsection (d)(5)(C) of such section, payments to a critical access hospital under section 1814(l) of such Act (42 U.S.C. 1395f(l)), payments to a sole community hospital under subsection (d)(5)(D) of such section 1886, or pay- ments to a medicare-dependent, small rural hospital under subsection (d)(5)(G) of such section 1886; and 42 USC 1395ww note.