Bill summaries are authored by CRS.

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Conference report filed in House (11/27/1991)

Medicaid Voluntary Contribution and Provider-Specific Tax Amendments of 1991 - Amends title XIX (Medicaid) of the Social Security Act to reduce the Federal share of Medicaid funding for medical assistance provided under State plans by the sum of any revenues received during the fiscal year by the State or a local government from: (1) provider-related donations (donations or other voluntary payments made to a State or local government by a health care provider, related entity, or administrative contractor), except bona fide provider-related donations (provider-related donations that have no relationship to payments made under Medicaid to providers or related entities) and donations in the form of funds expended by a hospital or similar entity for the direct cost of Medicaid eligibility personnel, received on or after January 1, 1992; (2) health care related taxes (those taxes that are related to the provision of health care items or services provided at least 85 percent of the tax burden falls on health care providers or those taxes not equally imposed on non-health care items or services) that are not broad-based; (3) health care related taxes that are broad-based (generally, those taxes uniformly imposed at least with respect to all items or services in the class furnished by all non-Federal, nonpublic providers in the State or locality or uniformly imposed with respect to such providers in the class) and with respect to which there is in effect a hold harmless provision (one that provides for a non-Medicaid payment to the taxpayer that is correlated to the tax or to the difference between the tax and Medicaid payment, Medicaid payment that varies on the basis of taxes paid, or a State or local guarantee to hold taxpayers harmless for any portion of the costs of tax); or (4) broad-based health care related taxes to the extent the amount of such taxes collected exceeds 25 percent (or, if greater, the State base percentage) of the State's share of Medicaid in all or part of any State fiscal year beginning on or after January 1, 1992, and before October 1, 1995.

Provides that starting in FY 1993 the Federal share of Medicaid funding for administrative expenditures under State plans shall be reduced by the sum of any revenues received by the State or a local government in all quarters in the Federal fiscal year from donations in the form described above, to the extent the amount of such donations exceeds ten percent of State plan administrative costs.

Permits Federal financial participation for certain otherwise prohibited revenues received before: (1) October 1, 1992, for States with a fiscal year beginning on or before July 1; (2) January 1, 1993, for States with fiscal years beginning after July 1; or (3) July 1, 1993, for a State that has enacted a provider-specific tax on November 4, 1991, or whose legislature is not scheduled to meet in 1992 or 1993. Prohibits the Secretary of Health and Human Services from disallowing or withholding Federal financial participation, before the applicable date above, for expenditures for medical assistance which are based on such revenues. Permits Federal financial participation for donations received before the applicable date above, provided that they are received under a program in effect or reported to the Secretary by September 30, 1991. Provides that in the case of such donations received in State fiscal year 1993, the maximum amount of such donations may not exceed those received in State fiscal year 1992. Provides that the sum of allowed donations and taxes for the part of a State's fiscal year 1992 occurring in calendar year 1992, or for all of State fiscal year 1993, may not exceed 25 percent, or, if greater, the State base percentage, of the State's share of Medicaid minus the total amount of broad-based health care related taxes received. Permits Federal financial participation for non-broad-based health care related taxes or broad-based health care related taxes with respect to which a hold harmless provision is applicable, if such taxes are received before the applicable date above, only if the taxes were in effect, or the legislation or regulations imposing such taxes were enacted or adopted, as of November 22, 1991.

Prohibits the Secretary from restricting States' use of funds derived from State or local taxes (or funds appropriated to State university teaching hospitals) transferred from or certified by local government units (including units that are providers) unless the transfers exceed the 40 percent limit on local government sharing under Medicaid or stem from otherwise prohibited donations or taxes.

Nullifies the Secretary's October 31, 1991, interim final rule relating to the State share of financial participation under Medicaid.

Repeals the prohibition with respect to limiting State payment adjustments to hospitals which serve a disproportionate number of low-income patients with special needs.

Establishes, effective January 1, 1992, a national limit on disproportionate share hospital payment adjustments during each fiscal year equal to 12 percent of total Medicaid spending for that year.

Limits a State's disproportionate share adjustments in that part of FY 1992 beginning on or after January 1, 1992, to those made under: (1) the State plan in effect or as submitted to the Secretary by September 30, 1991; (2) a payment methodology established and in effect by that date; (3) legislation or regulations enacted or adopted by that date; or (4) a State plan in effect or as submitted to the Secretary by November 26, 1991, which designates only disproportionate share hospitals with a Medicaid or low-income utilization percentage at or above the Statewide arithmetic mean. Permits higher payment adjustments if necessary in order to meet the minimum adjustments prescribed under Medicaid.

Limits a State's disproportionate share adjustments for FY 1993 and subsequent fiscal years to the amount of the State's disproportionate share hospital allotment for the year.

Provides that starting in 1996 a State, at its option, will not be subject to the limitations above if it defines as disproportionate share hospitals only facilities: (1) whose low-income or utilization rate is at or above the State mena; (2) that account for at least one percent of all Medicaid days in the State; or (3) that meet such alternative requirements as the Secretary may establish, taking into account the special circumstances of children's hospitals, hospitals located in rural areas, and sole community hospitals. Provides that such option shall apply only after the enactment of legislation establishing a limit on payment adjustments to disproproationate share hospitals for application in the case of a State exercising such option.

Requires the Secretary to estimate and publish State allotments and national limits for each fiscal year, beginning in FY 1993, before the beginning of the year.

Sets forth provisions providing for the determination of State disproportionate share hospital allotments and State supplemental amounts for each State that is not a high disproportionate share hospital State.

Prohibits the Secretary from restricting a State's authority to designate hospitals as disproportionate share hospitals.

Directs the Prospective Payment Assessment Commission to conduct a study and report to specified congressional committees on maximum and minimum payment adjustments to be established for disproportionate share hospitals and criteria appropriate for the designation of disproportionate share hospitals.

Cancels the Secretary's proposed October 31, 1991, rule relating to the standards for defining disproportionate share hospitals.

Requires States to report annually on donations received and health care related taxes collected by the State or local governments during each fiscal year and on the total amount of payment adjustments made to disproportionate share providers during the year, beginning with fiscal years ending after the enactment of this Act.

Prohibits the Secretary from issuing any interim final regulation that changes the treatment of public funds as a source of State share of financial participation under Medicaid, except as may be necessary to permit the Secretary to deny Federal financial participation for public funds described under this Act that are derived from donations or taxes that would not otherwise be recognized as the non-Federal share under this Act.