PROTECTIONS FOR FRONTIER STATES.

SEC. 10324. PROTECTIONS FOR FRONTIER STATES. (a) Floor on Area Wage Index for Hospitals in Frontier States.— (1) In general.—Section 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)) is amended— (A) in clause (i), by striking “clause (ii)” and inserting “clause (ii) or (iii)”; and (B) by adding at the end the following new clause: “(iii) Floor on area wage index for hospitals in frontier States.— “(I) In general.—Subject to subclause (IV), for discharges occurring on or after October 1, 2010, the area wage index applicable under this subparagraph to any hospital which is located in a frontier State (as defined in subclause (II)) may not be less than 1.00. “(II) Frontier State defined.—In this clause, the term ‘frontier State’ means a State in which at least 50 percent of the counties in the State are frontier counties. “(III) Frontier county defined.—In this clause, the term ‘frontier county’ means a county in which the population per square mile is less than 6. “(IV) Limitation.—This clause shall not apply to any hospital located in a State that receives a non-labor related share adjustment under paragraph (5)(H).” . (2) Waiving budget neutrality.—Section 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 1395ww(d)(3)(E)), as amended by subsection (a), is amended in the third sentence by inserting “and the amendments made by section 10324(a)(1) of the Patient Protection and Affordable Care Act” after “2003”. (b) Floor on Area Wage Adjustment Factor for Hospital Outpatient Department Services in Frontier States.—Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)), as amended by section 3138, is amended— (1) in paragraph (2)(D), by striking “the Secretary” and inserting “subject to paragraph (19), the Secretary”; and (2) by adding at the end the following new paragraph: “(19) Floor on area wage adjustment factor for hospital outpatient department services in frontier States.— “(A) In general.—Subject to subparagraph (B), with respect to covered OPD services furnished on or after January 1, 2011, the area wage adjustment factor applicable under the payment system established under this subsection to any hospital outpatient department which is located in a frontier State (as defined in section 1886(d)(3)(E)(iii)(II)) may not be less than 1.00. The preceding sentence shall not be applied in a budget neutral manner. “(B) Limitation.—This paragraph shall not apply to any hospital outpatient department located in a State that receives a non-labor related share adjustment under section 1886(d)(5)(H).” . (c) Floor for Practice Expense Index for Physicians' Services Furnished in Frontier States.—Section 1848(e)(1) of the Social Security Act (42 U.S.C. 1395w–4(e)(1)), as amended by section 3102, is amended— (1) in subparagraph (A), by striking “and (H)” and inserting “(H), and (I)”; and (2) by adding at the end the following new subparagraph: “(I) Floor for practice expense index for services furnished in frontier States.— “(i) In general.—Subject to clause (ii), for purposes of payment for services furnished in a frontier State (as defined in section 1886(d)(3)(E)(iii)(II)) on or after January 1, 2011, after calculating the practice expense index in subparagraph (A)(i), the Secretary shall increase any such index to 1.00 if such index would otherwise be less that 1.00. The preceding sentence shall not be applied in a budget neutral manner. “(ii) Limitation.—This subparagraph shall not apply to services furnished in a State that receives a non-labor related share adjustment under section 1886(d)(5)(H).” [Section 10325 repealed by section 202 of Public Law 111-309 (no conforming amendment was included for the item relating to such section in the table of contents).]