124 STAT. 432 PUBLIC LAW 111–148—MAR. 23, 2010 (as defined in section 1886(b)(3)(B)(iii)) for the fiscal year.’’. (b) ADOPTION OF MEDPAC HOSPICE PROGRAM ELIGIBILITY RE- CERTIFICATION RECOMMENDATIONS.—Section 1814(a)(7) of the Social Security Act (42 U.S.C. 1395f(a)(7)) is amended— (1) in subparagraph (B), by striking ‘‘and’’ at the end; and (2) by adding at the end the following new subparagraph: ‘‘(D) on and after January 1, 2011— ‘‘(i) a hospice physician or nurse practitioner has a face-to-face encounter with the individual to deter- mine continued eligibility of the individual for hospice care prior to the 180th-day recertification and each subsequent recertification under subparagraph (A)(ii) and attests that such visit took place (in accordance with procedures established by the Secretary); and ‘‘(ii) in the case of hospice care provided an indi- vidual for more than 180 days by a hospice program for which the number of such cases for such program comprises more than a percent (specified by the Sec- retary) of the total number of such cases for all pro- grams under this title, the hospice care provided to such individual is medically reviewed (in accordance with procedures established by the Secretary); and’’. SEC. 3133. IMPROVEMENT TO MEDICARE DISPROPORTIONATE SHARE HOSPITAL (DSH) PAYMENTS. Section 1886 of the Social Security Act (42 U.S.C. 1395ww), as amended by sections 3001, 3008, and 3025, is amended— (1) in subsection (d)(5)(F)(i), by striking ‘‘For’’ and inserting ‘‘Subject to subsection (r), for’’; and (2) by adding at the end the following new subsection: ‘‘(r) ADJUSTMENTS TO MEDICARE DSH PAYMENTS.— ‘‘(1) EMPIRICALLY JUSTIFIED DSH PAYMENTS.—For fiscal year 2015 and each subsequent fiscal year, instead of the amount of disproportionate share hospital payment that would other- wise be made under subsection (d)(5)(F) to a subsection (d) hospital for the fiscal year, the Secretary shall pay to the subsection (d) hospital 25 percent of such amount (which rep- resents the empirically justified amount for such payment, as determined by the Medicare Payment Advisory Commission in its March 2007 Report to the Congress). ‘‘(2) ADDITIONAL PAYMENT.—In addition to the payment made to a subsection (d) hospital under paragraph (1), for fiscal year 2015 and each subsequent fiscal year, the Secretary shall pay to such subsection (d) hospitals an additional amount equal to the product of the following factors: ‘‘(A) FACTOR ONE.—A factor equal to the difference between— ‘‘(i) the aggregate amount of payments that would be made to subsection (d) hospitals under subsection (d)(5)(F) if this subsection did not apply for such fiscal year (as estimated by the Secretary); and ‘‘(ii) the aggregate amount of payments that are made to subsection (d) hospitals under paragraph (1) for such fiscal year (as so estimated). ‘‘(B) FACTOR TWO.—
