Critical Access and Rural Equity Act of 2017 or the CARE Act of 2017
This bill amends title XVIII (Medicare) of the Social Security Act to specify that, for purposes of determining Medicare payment and reasonable costs for both inpatient and outpatient critical access hospital (CAH) services, the Centers for Medicare & Medicaid Services (CMS) shall recognize as allowable costs those related to specified emergency, diagnostic, anesthetist, community health, and off-campus clinical services.
Furthermore, in determining payment and reasonable costs for both inpatient and outpatient CAH services, CMS shall not disallow payment to a CAH on the basis that such payment offsets the cost of a current permissible health care-related tax imposed on and paid by the CAH. CMS must make specified payment adjustments to account for such a tax.
Generally, under current law, a facility must be located beyond a specified driving distance from another hospital or facility in order to be designated as a CAH. The bill specifies that this requirement does not apply with respect to a CAH's off-campus provider-based clinic.
Current law further requires a facility to provide certain 24-hour emergency care services as a condition of designation as a CAH. The bill allows CMS to waive this requirement with respect to a facility that coordinates with a nearby facility or hospital that provides such services.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3224 Introduced in House (IH)]
<DOC>
115th CONGRESS
1st Session
H. R. 3224
To amend title XVIII of the Social Security Act to clarify reasonable
costs for critical access hospital payments under the Medicare program,
and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 13, 2017
Mr. Harper (for himself, Mr. Loebsack, Mr. Kind, Mr. Kelly of
Mississippi, Mr. Thompson of Mississippi, Mr. Palazzo, and Mr.
Peterson) introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, 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 title XVIII of the Social Security Act to clarify reasonable
costs for critical access hospital payments under the Medicare program,
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.
This Act may be cited as the ``Critical Access and Rural Equity Act
of 2017'' or the ``CARE Act of 2017''.
SEC. 2. CLARIFYING REASONABLE COSTS FOR CRITICAL ACCESS HOSPITAL
MEDICARE PAYMENTS.
(a) Inclusion of Certain Costs as Reasonable Costs.--
(1) Inpatient critical access hospital services.--Section
1814(l) of the Social Security Act (42 U.S.C. 1395f(l)) is
amended by adding at the end the following new paragraph:
``(6) In determining payment and reasonable costs under
paragraph (1) for inpatient critical access services, the
Secretary shall recognize as allowable costs of the critical
access hospital at least the following:
``(A) Costs of services that would be considered
bona fide emergency services (as defined in section
1861(v)(1)(K)(ii)) if provided in a hospital emergency
room, including professional services and any
associated surgical on-call and standby costs.
``(B) Costs of a test or procedure performed at a
critical access hospital or an entity owned by the
critical access hospital, including a clinical
diagnostic laboratory test, mammogram (as defined in
section 354(a)(5) of the Public Health Service Act),
colonoscopy, cardiac stress test, pulmonary function
test, echocardiogram, and bone density study.
``(C) Standby and on-call costs for certified
registered nurse anesthetist services, regardless of
the number of surgical procedures requiring anesthesia
services and regardless of the number of full-time
equivalent physicians.
``(D) Costs of services provided by the critical
access hospital or satellite facility of the critical
access hospital that improve the total health of
communities, including immunization programs, health
clinics, and medical homes.
``(E) Costs of services provided by an off-campus
provider-based clinic described in section
1820(c)(2)(F) of the critical access hospital,
regardless of distance of such clinic from a hospital
or another critical access hospital.''.
(2) Outpatient critical access hospital services.--Section
1834(g) of the Social Security Act (42 U.S.C. 1395m(g)) is
amended by adding at the end the following new paragraph:
``(6) Coverage of certain additional costs as reasonable
costs.--In determining the reasonable costs of outpatient
critical access hospital services under paragraphs (1) and
(2)(A), the Secretary shall recognize as allowable the costs
described in paragraph (6) of section 1814(l).''.
(3) Conforming amendment.--Section 1861(v)(7) of the Social
Security Act (42 U.S.C. 1395x(v)(7)) is amended by adding at
the end the following new subparagraph:
``(E) For provisions further describing costs recognized as
reasonable costs for inpatient and outpatient critical access
hospital services, see sections 1814(l)(6) and 1834(g)(6).''.
(b) Treatment of Provider-Based Clinics of Critical Access
Hospitals.--Section 1820(c)(2) of the Social Security Act (42 U.S.C.
1395i-4(c)(2)) is amended--
(1) in subparagraph (B)(i)(I), by striking ``is located''
and inserting ``subject to subparagraph (E), is located''; and
(2) by adding at the end the following new subparagraph:
``(F) Treatment of off-campus provider-based
clinics.--Subparagraph (B)(i)(I) shall not apply to an
off-campus provider-based clinic (as described in
section 485.610 of title 45 of the Code of Federal
Regulations) of a facility designated as a critical
access hospital.''.
(c) Allowing Coordination for Provision of Emergency Services.--
Section 1820(c)(2) of the Social Security Act (42 U.S.C. 1395i-
4(c)(2)), as amended by subsection (b), is further amended--
(1) in subparagraph (B)(ii), by striking ``makes'' and
inserting ``subject to subparagraph (G), makes''; and
(2) by adding at the end the following new subparagraph:
``(G) Allowing coordination for provision of
emergency services.--The Secretary may waive the
requirements under subparagraph (B)(ii), with respect
to a facility, if such facility--
``(i) is located not more than 15 miles of
another facility or hospital that has an
emergency department that satisfies the
requirement of subparagraph (B)(ii); and
``(ii) coordinates with such other facility
or hospital with respect to furnishing 24-hour
emergency care services described in such
subparagraph to the area served by such
facility.''.
(d) Treatment of Medicaid Provider Taxes for Critical Access
Hospital Reasonable Costs.--
(1) Inpatient critical access hospital services.--Section
1814(l) of the Social Security Act (42 U.S.C. 1395f(l)), as
amended by subsection (a)(1), is further amended by adding at
the end the following new paragraph:
``(7)(A) In determining payment and reasonable costs under
paragraph (1) for inpatient critical access services--
``(i) with respect to a current permissible health
care related tax imposed and paid by the critical
access hospital for a cost reporting period beginning
before the date of enactment of this paragraph, the
Secretary shall not, through recoupment or otherwise,
disallow payment to the critical access hospital under
this subsection on the basis that payments to the
critical access hospital under this subsection offset
some or all of the costs of such tax; and
``(ii) with respect to a current permissible health
care related tax imposed and paid by the critical
access hospital for a cost reporting period beginning
on or after the date of enactment of this paragraph,
the Secretary shall--
``(I) assess the percentage of individuals
entitled to benefits under this part who are
furnished inpatient critical access hospital
services at such critical access hospital
during such cost reporting period and who are
also receiving medical assistance under the
Medicaid program under title XIX during such
period; and
``(II) adjust payments under this
subsection with respect to such services
furnished during such period in a manner
specified by the Secretary based on such
percentage to take into account such tax.
``(B) For purposes of this paragraph and section
1834(g)(7), the term `current permissible health care related
tax' means a broad-based health care related tax (as defined in
paragraph (3)(B) of such section) that is in effect prior to
enactment of this paragraph and for which there is not in
effect a hold harmless provision described in paragraph (4) of
such section.''.
(2) Outpatient critical access hospital services.--Section
1834(g) of the Social Security Act (42 U.S.C. 1395m(g)), as
amended by subsection (a)(2), is further amended by adding at
the end the following new paragraph:
``(7) Treatment of medicaid provider taxes.--In determining
payment for outpatient critical access hospital services under
paragraphs (1) and (2), the provisions of paragraph (7) of
section 1814(l) shall apply to payment for such services under
this subsection in the same manner as such provisions apply to
payment for inpatient critical access hospital services under
section 1814(l), except that in applying subparagraph (B) of
such paragraph (7), the reference to `individuals entitled to
benefits under this part' shall be deemed a reference to
`individuals enrolled under part B'.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 Ways and Means, and in addition to the Committee on Energy and Commerce, 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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