Expanding Patients' Access to Quality Care Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act with respect to: (1) the limitation on certain physician referrals to hospitals in which the physician or an immediate family member has an ownership or investment interest exceeding a specified amount; and (2) the rural provider and hospital exception to the physician ownership or investment prohibition.
Extends the rural provider and hospital exception to hospitals that were under construction or development as of December 30, 2010, and hospitals in financial distress.
Defines "financial distress" for a cost reporting period as one in which a hospital has had an overall negative combined Medicare inpatient prospective payment system and outpatient prospective payment system operating margin for the most recent three consecutive cost reporting periods for which data are available.
Eliminates the process for applying for such an exception for expansions of hospital facility capacity. Limits increases in facility capacity to those hospitals that have had a previous increase.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2027 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 2027
To amend section 1877 of the Social Security Act to modify the
requirements for hospitals to qualify for the rural provider and
hospital exception to physician ownership or investment prohibition in
order to take into account hospitals that were under construction or
development at the time of imposing such requirements, hospital
expansions, and hospitals in financial distress, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 16, 2013
Mr. Sam Johnson of Texas (for himself, Mr. Hinojosa, Mr. Carson of
Indiana, Ms. Jackson Lee, Ms. Jenkins, Mr. Marchant, Mr. Young of
Indiana, Mr. Burgess, and Mr. Yoder) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committee on Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To amend section 1877 of the Social Security Act to modify the
requirements for hospitals to qualify for the rural provider and
hospital exception to physician ownership or investment prohibition in
order to take into account hospitals that were under construction or
development at the time of imposing such requirements, hospital
expansions, and hospitals in financial distress, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Expanding
Patients' Access to Quality Care Act of 2013''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Modification of Stark requirements for certain hospitals that
were under construction or development as
of December 30, 2010.
Sec. 3. Modifying Stark requirements for applicable hospitals to
qualify for expansion of facility capacity.
Sec. 4. Additional exception for physician ownership and investment for
hospitals in financial distress.
SEC. 2. MODIFICATION OF STARK REQUIREMENTS FOR CERTAIN HOSPITALS THAT
WERE UNDER CONSTRUCTION OR DEVELOPMENT AS OF DECEMBER 30,
2010.
Section 1877(i) of the Social Security Act (42 U.S.C. 1395nn(i)) is
amended--
(1) in paragraph (1)(A)--
(A) in the matter preceding clause (i), by striking
``had'';
(B) in clause (i), by striking ``; and'' and
inserting the following: ``, and had a provider
agreement under section 1866 in effect on such date or
was under construction or was under development (as
defined in paragraph (7)(A)) on such date; or''; and
(C) by striking clause (ii);
(2) in paragraph (1)(B), by inserting before the period at
the end the following: ``or if the hospital was under
construction or under development on December 31, 2010, no
greater than the number of operating rooms, procedure rooms,
and beds for which the hospital is licensed as of the date the
hospital had a provider agreement in effect under section
1866'';
(3) in paragraph (1)(D)(i), by inserting before the period
at the end the following: ``or if the hospital was under
construction or under development on December 31, 2010, as of
the date the hospital had a provider agreement in effect under
section 1866'';
(4) in paragraph (3)(C)(iii), by inserting after ``December
31, 2010,'' the following: ``or in the case of a hospital that
did not have a provider agreement in effect as of such date but
was under construction or under development on such date,'';
and
(5) by adding at the end the following new paragraph:
``(7) Definitions.--For purposes of this subsection:
``(A) Under development.--A hospital shall be
treated as being `under development' on December 31,
2010, if on or before such date the hospital--
``(i) submitted its enrollment application
for a Medicare provider agreement;
``(ii) had a binding written agreement with
an outside, unrelated party for the actual
design, construction, renovation, lease, or
demolition for a hospital, and has expended at
least 10 percent of the estimated cost of the
project (or, if less, $1,000,000); or
``(iii) obtained a certificate of need in a
State where one is required.''.
SEC. 3. MODIFYING STARK REQUIREMENTS FOR APPLICABLE HOSPITALS TO
QUALIFY FOR EXPANSION OF FACILITY CAPACITY.
Section 1877(i)(3) of the Social Security Act (42 U.S.C.
1395nn(i)(3)) is amended--
(1) by striking subparagraphs (A), (E), (F), (H), and (I);
(2) by amending subparagraph (B) to read as follows:
``(B) Limitation on frequency of increases.--A
hospital may not effect an increase described in
subparagraph (C) more often than once every 2 years.'';
(3) in subparagraphs (C) and (D), by striking ``an
applicable hospital'' and ``the applicable hospital'' and
inserting ``a hospital'' and ``the hospital'', respectively,
each place it appears;
(4) in subparagraph (C)(i)--
(A) by striking ``granted an exception under the
process described in subparagraph (A)'';
(B) by striking ``has been granted a previous
exception under this paragraph'' and inserting ``has
had a previous increase under this subsection''; and
(C) by striking ``such an exception'' and inserting
``this paragraph''; and
(5) in subparagraph (C)(ii), by striking ``The Secretary
shall not permit an increase in'' and inserting ``A hospital
may not increase''.
SEC. 4. ADDITIONAL EXCEPTION FOR PHYSICIAN OWNERSHIP AND INVESTMENT FOR
HOSPITALS IN FINANCIAL DISTRESS.
Section 1877(i) of the Social Security Act (42 U.S.C. 1395nn(i)) is
amended--
(1) in paragraph (1)(A), as amended by section 2(1), by
inserting after clause (i) the following new clause:
``(ii) had a provider agreement under
section 1866 in effect December 31, 2010, as of
such date did not have physician ownership or
investment, but after such date is determined
to be in financial distress (as defined in
paragraph (7)(B)).'';
(2) in paragraph (1)(D)(i), by inserting before the period
at the end the following: ``, except that such percentage
limitation shall not apply to a hospital determined to be in
financial distress (as defined in paragraph (7)(B))''; and
(3) in paragraph (7), as added by section 2(5), by adding
at the end the following new paragraph:
``(B) Financial distress.--A hospital shall be
treated as being `in financial distress' for a cost
reporting period if the Secretary determines that the
hospital has had an overall negative combined Medicare
inpatient prospective payment system and outpatient
prospective payment system operating margin for the
most recent 3 consecutive cost reporting periods for
which data are available. Once the Secretary makes a
determination that a hospital has such a negative
operating margin for a cost reporting period, the
Secretary may not reverse such determination for such
period. A hospital that is treated as being in
financial distress under this subparagraph for a cost
reporting period shall continue to be so treated for
all subsequent cost reporting periods as being in
financial distress without regard to changes in the
hospital's operating margin.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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