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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9128 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 9128
To amend title XVIII of the Social Security Act to establish a
designation for territorial safety net hospitals, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 24, 2024
Mr. Sablan (for himself and Mr. Moylan) introduced the following bill;
which was referred to the Committee on Energy and Commerce, and in
addition to the Committees on Ways and Means, and the Budget, 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 establish a
designation for territorial safety net hospitals, 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 ``Supporting Territorial Safety Net
Hospitals Act''.
SEC. 2. DESIGNATION FOR TERRITORIAL SAFETY NET HOSPITALS.
(a) Territorial Safety Net Hospital Defined.--Section 1861 of the
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end
the following new subsection:
``(nnn) Territorial Safety Net Hospital.--
``(1) The term `territorial safety net hospital' means a
hospital (as defined in subsection (e)) that is located in the
Northern Mariana Islands, American Samoa, Guam, or the Virgin
Islands.
``(2) The term `inpatient territorial safety net hospital
services' means items and services, furnished to an inpatient
of a territorial safety net hospital by such facility, that
would be inpatient hospital services if furnished to an
inpatient of a hospital by a hospital.
``(3) The term `outpatient territorial safety net hospital
services' means medical and other health services furnished by
a territorial safety net hospital on an outpatient basis.''.
(b) Payment for Inpatient Territorial Safety Net Hospital
Services.--
(1) In general.--Section 1814 of the Social Security Act
(42 U.S.C. 1395f) is amended--
(A) in subsection (b), by inserting ``other than a
territorial safety net hospital providing inpatient
territorial safety net hospital services,'' after
``critical access hospital providing inpatient critical
access hospital services,''; and
(B) by adding at the end the following new
subsection:
``(m) Payment for Inpatient Territorial Safety Net Hospital
Services.--The amount of payment under this part for inpatient
territorial safety net hospital services is equal to 101 percent of the
reasonable costs of the territorial safety net hospital in providing
such services.''.
(2) Scope of benefits.--Section 1812(a)(1) of the Social
Security Act (42 U.S.C. 1395d(a)(1)) is amended by striking
``or inpatient critical access hospital services'' and
inserting ``, inpatient critical access hospital services, or
inpatient territorial safety net hospital services''.
(3) Deductibles and coinsurance.--Section 1813 of the
Social Security Act (42 U.S.C. 1395e) is amended--
(A) in subsection (a)(1), by striking ``or
inpatient critical access hospital services'' each
place it appears and inserting ``, inpatient critical
access hospital services, or inpatient territorial
safety net hospital services''; and
(B) in subsection (b)(3)--
(i) in subparagraph (A), by striking ``or
inpatient critical access hospital services''
and inserting ``, inpatient critical access
hospital services, or inpatient territorial
safety net hospital services''; and
(ii) in subparagraph (B), by inserting ``,
inpatient territorial safety net hospital
services,'' after ``inpatient critical access
hospital services''.
(4) Payment to providers of services.--Section 1815(e)(2)
of the Social Security Act (42 U.S.C. 1395g(e)(2)) is amended--
(A) in subparagraph (D), by striking ``and'' at the
end;
(B) in subparagraph (E), by inserting ``and'' after
the semicolon at the end; and
(C) by adding at the end the following new
subparagraph:
``(F) inpatient territorial safety net hospital
services;''.
(5) Administration of part a.--Section 1816(c)(2)(C) of the
Social Security Act (42 U.S.C. 1395h(c)(2)(C)) is amended by
inserting ``territorial safety net hospital,'' after ``critical
access hospital,''.
(c) Payment for Outpatient Territorial Safety Net Hospital
Services.--
(1) In general.--Section 1834 of the Social Security Act
(42 U.S.C. 1395m) is amended by adding at the end the following
new subsection:
``(aa) Payment for Outpatient Territorial Safety Net Hospital
Services.--
``(1) In general.--The amount of payment for outpatient
territorial safety net hospital services of a territorial
safety net hospital is equal to 101 percent of the reasonable
costs of the hospital in providing such services, unless the
hospital makes the election under paragraph (2).
``(2) Election of cost-based hospital outpatient service
payment plus fee schedule for professional services.--A
territorial safety net hospital may elect to be paid for
outpatient territorial safety net hospital services amounts
equal to the sum of the following, less the amount that such
hospital may charge as described in section 1866(a)(2)(A):
``(A) Facility fee.--With respect to facility
services, not including any services for which payment
may be made under subparagraph (B), 101 percent of the
reasonable costs of the territorial safety net hospital
in providing such services.
``(B) Fee schedule for professional services.--With
respect to professional services otherwise included
within outpatient territorial safety net hospital
services, 115 percent of such amounts as would
otherwise be paid under this part if such services were
not included in outpatient territorial safety net
hospital services. Subsections (x) and (y) of section
1833 shall not be taken into account in determining the
amounts that would otherwise be paid pursuant to the
preceding sentence.
The Secretary may not require, as a condition for applying
subparagraph (B) with respect to a territorial safety net
hospital, that each physician or other practitioner providing
professional services in the hospital must assign billing
rights with respect to such services, except that such
subparagraph shall not apply to those physicians and
practitioners who have not assigned such billing rights.
``(3) Disregarding charges.--The payment amounts under this
subsection shall be determined without regard to the amount of
the customary or other charge.
``(4) Treatment of clinical diagnostic laboratory
services.--No coinsurance, deductible, copayment, or other
cost-sharing otherwise applicable under this part shall apply
with respect to clinical diagnostic laboratory services
furnished as an outpatient territorial safety net hospital
service. Nothing in this title shall be construed as providing
for payment for clinical diagnostic laboratory services
furnished as part of outpatient territorial safety net hospital
services, other than on the basis described in this subsection.
For purposes of the preceding sentence and section
1861(nnn)(3), clinical diagnostic laboratory services furnished
by a territorial safety net hospital shall be treated as being
furnished as part of outpatient critical access services
without regard to whether the individual with respect to whom
such services are furnished is physically present in the
territorial safety net hospital, or in a skilled nursing
facility or a clinic (including a rural health clinic) that is
operated by a territorial safety net hospital, at the time the
specimen is collected.
``(5) Coverage of costs for certain on-call emergency room
providers.--In determining the reasonable costs of outpatient
territorial safety net hospital services under paragraphs (1)
and (2)(A), the Secretary shall recognize as allowable costs,
amounts (as defined by the Secretary) for reasonable
compensation and related costs for physicians, physician
assistants, nurse practitioners, and clinical nurse specialists
who are on-call (as defined by the Secretary) to provide
emergency services but who are not present on the premises of
the territorial safety net hospital involved, and are not
otherwise furnishing services covered under this title and are
not on-call at any other provider or facility.''.
(2) Scope of benefits.--Section 1832(a)(2) of the Social
Security Act (42 U.S.C. 1395k(a)(2)) is amended--
(A) in subparagraph (I), by striking ``; and'' and
inserting a semicolon;
(B) in subparagraph (J), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
subparagraph:
``(K) outpatient territorial safety net hospital
services (as defined in section 1861(nnn)(3)).''.
(3) Payment of benefits.--Section 1833 of the Social
Security Act (42 U.S.C. 1395l) is amended--
(A) in subsection (a)--
(i) in paragraph (9), by striking ``; and''
and inserting a semicolon;
(ii) in paragraph (10), by striking the
period at the end and inserting ``; and''; and
(iii) by inserting after paragraph (10) the
following new paragraph:
``(11) in the case of outpatient territorial safety net
hospital services, the amounts described in section
1834(aa).'';
(B) in subsection (h)(5)(A)(iii), by inserting
``territorial safety net hospital,'' after ``critical
access hospital,'';
(C) in subsection (i)(1)(A), by inserting
``territorial safety net hospital,'' after ``critical
access hospital,'';
(D) in subsection (l)(5)--
(i) in subparagraph (A), by inserting
``territorial safety net hospital,'' after
``critical access hospital,'' in each place it
appears; and
(ii) in subparagraph (B), by striking ``or
critical access hospital'' in each place it
appears and inserting ``, critical access
hospital, or territorial safety net hospital''
in each such place;
(E) in subsection (r)--
(i) in paragraph (1), by inserting
``territorial safety net hospital,'' after
``critical access hospital''; and
(ii) in paragraph (2), by striking ``or
critical access hospital'' and inserting ``,
critical access hospital, or territorial safety
net hospital''; and
(F) in subsection (cc)(2), by adding at the end the
following new subparagraph:
``(F) Section 1834(aa), with respect to an
outpatient territorial safety net hospital service.''.
(4) Payment for ambulance services furnished by a
territorial safety net hospital.--Section 1834(l)(8) of the
Social Security Act (42 U.S.C. 1395m(l)(8)) is amended--
(A) in the heading, by inserting ``and territorial
safety net hospitals'' after ``critical access
hospitals'';
(B) in subparagraph (A), by inserting ``or a
territorial safety net hospital (as defined in section
1861(nnn))'' after ``(as defined in section
1861(mm)(1))'';
(C) in subparagraph (B), by inserting ``or a
territorial safety net hospital'' after ``critical
access hospital''; and
(D) by amending the flush left text following
subparagraph (B) to read as follows:
``but only if the critical access hospital, territorial safety
net hospital, or entity is the only provider or supplier of
ambulance services that is located within a 35-mile drive of
such critical access hospital or territorial safety net
hospital.''.
(d) Conforming Amendments.--
(1) Title xi.--
(A) Civil monetary penalties.--Section 1128A(b)(1)
of the Social Security Act (42 U.S.C. 1320a-7a(b)(1))
is amended by striking ``or a critical access
hospital'' in each place it appears and inserting ``,
critical access hospital, or territorial safety net
hospital'' in each such place.
(B) Criminal penalties for acts involving federal
health care programs.--Section 1128B(c) of the Social
Security Act (42 U.S.C. 1320a-7b(c)) is amended by
inserting ``territorial safety net hospital,'' after
``critical access hospital,''.
(C) Nonprofit hospital philanthropy.--Section 1134
of the Social Security Act (42 U.S.C. 1320b-4) is
amended in the matter preceding paragraph (1) by
striking ``or critical access hospitals'' in each place
it appears and inserting ``, critical access hospitals,
or territorial safety net hospitals'' in each such
place.
(D) Hospital protocols for organ procurement and
standards for organ procurement agencies.--Section 1138
of the Social Security Act (42 U.S.C. 1320b-8) is
amended by striking ``or critical access hospital'' in
each place it appears and inserting ``, critical access
hospital, or territorial safety net hospital'' in each
such place.
(2) Title xviii.--
(A) Definition of a hospital.--Section 1861(e) of
the Social Security Act (42 U.S.C. 1395x(e)) is amended
in the flush left matter at the end by striking ``or a
rural emergency hospital (as defined in subsection
(kkk)(2))'' and inserting ``, a rural emergency
hospital (as defined in subsection (kkk)(2)), or a
territorial safety net hospital (as defined in
subsection (nnn)(1))''.
(B) Definition of provider of services.--Section
1861(u) of the Social Security Act (42 U.S.C. 1395x(u))
is amended by inserting ``territorial safety net
hospital,'' after ``critical access hospital,''.
(C) Definition of reasonable costs.--Section
1861(v)(1)(S)(ii)(III) of the Social Security Act (42
U.S.C. 1395x(v)(1)(S)(ii)(III)) is amended by striking
``or a critical access hospital (as defined in section
1861(mm)(1))'' and inserting ``, a critical access
hospital (as defined in section 1861(mm)(1)), or a
territorial safety net hospital (as defined in
subsection (nnn) of such section)''.
(D) Definition of arrangements.--Section 1861(w) of
the Social Security Act (42 U.S.C. 1395x(w)) is
amended--
(i) in paragraph (1), by inserting
``territorial safety net hospital,'' after
``critical access hospital,''; and
(ii) in paragraph (2), by striking ``or
critical access hospital'' in each place it
appears and inserting ``, critical access
hospital, or territorial safety net hospital''
in each such place.
(E) Definition of post-institutional home health
services; home health spell of illness.--Section
1861(tt) of the Social Security Act (42 U.S.C.
1395x(tt)) is amended--
(i) in paragraph (1)(A), by striking ``or
critical access hospital'' and inserting ``,
critical access hospital, or territorial safety
net hospital''; and
(ii) in paragraph (2)(B), by striking ``or
critical access hospital'' and inserting ``,
critical access hospital, or territorial safety
net hospital''.
(F) Exclusion from coverage.--Section 1862(a)(14)
of the Social Security Act (42 U.S.C. 1395y(a)(14)) is
amended by striking ``or critical access hospital'' in
each place it appears and inserting ``, critical access
hospital, or territorial safety net hospital'' in each
such place.
(G) Use of state agencies to determine compliance
by providers of services with conditions of
participation.--Section 1864 of the Social Security Act
(42 U.S.C. 1395aa) is amended--
(i) in subsection (a), by inserting
``territorial safety net hospital, as defined
in section 1861(nnn)(1),'' after ``a critical
access hospital, as defined in section
1861(mm)(1),''; and
(ii) by adding at the end the following new
subparagraph:
``(f) For purposes of this section, the term `State' means the 50
States and includes the District of Columbia, Puerto Rico, the Virgin
Islands, Guam, American Samoa, and the Northern Mariana Islands.''.
(H) Agreements with providers of services.--Section
1866(a) of the Social Security Act (42 U.S.C.
1395cc(a)) is amended--
(i) in paragraph (1)--
(I) in subparagraph (F)(ii), by
inserting ``territorial safety net
hospitals,'' after ``critical access
hospitals,'';
(II) in subparagraph (H), by
striking ``and in the case of critical
access hospitals which provide critical
access hospital services'' and
inserting ``, in the case of critical
access hospitals which provide critical
access hospital services, and in the
case of territorial safety net
hospitals which provide territorial
safety net hospital services'';
(III) in subparagraph (I), by
inserting ``territorial safety net
hospital,'' after ``critical access
hospital,'' in each place it appears;
(IV) in subparagraph (N), by
inserting ``territorial safety net
hospital,'' after ``critical access
hospital,'' in each place it appears;
(V) in subparagraph (T), by
striking ``and critical access
hospitals'' and inserting ``, critical
access hospitals, and territorial
safety net hospitals''; and
(VI) in subparagraph (Y), by
striking ``or critical access
hospital'' each place it appears and
inserting ``, critical access hospital,
or territorial safety net hospital'' in
each such place; and
(ii) in paragraph (3)--
(I) in subparagraph (A), by
inserting ``territorial safety net
hospital,'' after ``critical access
hospital,'';
(II) in subparagraph (B), by
inserting ``territorial safety net
hospital,'' after ``critical access
hospital,'' in each place it appears;
and
(III) in subparagraph (C)(ii)(II),
by inserting ``territorial safety net
hospitals,'' after ``critical access
hospitals,'' in each place it appears.
(I) Examination and treatment for emergency medical
conditions and women in labor.--Section 1867(e)(5) of
the Social Security Act (42 U.S.C. 1395dd(e)(5)) is
amended by inserting ``, territorial safety net
hospital (as defined in section 1861(nnn)(1)),'' after
``(as defined in section 1861(mm)(1))''.
(J) Hospital providers of extended care services.--
Section 1883(a)(3) of the Social Security Act (42
U.S.C. 1395tt(a)(3)) is amended by inserting ``or a
territorial safety net hospital'' after ``critical
access hospital''.
(K) Payment to skilled nursing facilities for
routine care.--Section 1888(e)(6)(B) of the Social
Security Act (42 U.S.C. 1395yy(e)(6)(B)) is amended--
(i) in clause (i), by inserting ``or a
territorial safety net hospital'' after
``critical access hospital''; and
(ii) in clause (ii), by inserting ``or a
territorial safety net hospital'' after
``critical access hospital''.
(L) Standardized post-acute care (pac) assessment
data for quality, payment, and discharge planning.--
Section 1899B of the Social Security Act (42 U.S.C.
1395lll) is amended--
(i) in subsection (c)(1)(E)--
(I) in clause (i), by striking ``or
critical access hospital'' and
inserting ``, critical access hospital,
or territorial safety net hospital'';
and
(II) in clause (ii), by inserting
``territorial safety net hospital,''
after ``critical access hospital,'';
and
(ii) in subsection (i)(1)--
(I) in the first sentence, by
striking ``and critical access
hospitals'' and inserting ``, critical
access hospitals, and territorial
safety net hospitals''; and
(II) in the third sentence, by
inserting ``territorial safety net
hospitals,'' after ``critical access
hospitals,''.
SEC. 3. INCLUSION OF TERRITORIAL SAFETY NET HOSPITALS AS 340B COVERED
ENTITIES.
Section 340B(a)(4) of the Public Health Service Act (42 U.S.C.
256b(a)(4)) is amended by adding at the end the following new
subparagraph:
``(P) An entity that is a territorial safety net
hospital (as defined in section 1861(nnn) of the Social
Security Act), and that meets the requirements of
subparagraph (L)(i).''.
SEC. 4. ELIMINATING MEDICARE SEQUESTRATION FOR TERRITORIAL SAFETY NET
HOSPITALS.
(a) Eliminating Medicare Sequestration for Territorial Safety Net
Hospitals.--
(1) In general.--Section 256(d)(7) of the Balanced Budget
and Emergency Deficit Control Act of 1985 (2 U.S.C. 906(d)(7))
is amended by adding at the end the following:
``(D) Territorial safety net hospitals.--Payments
under part A or part B of title XVIII of the Social
Security Act with respect to items and services
furnished by a territorial safety net hospital (as
defined in section 1861(nnn)(1) of such Act).''.
(2) Applicability.--The amendment made by this section
applies with respect to orders of sequestration effective on or
after the date that is 60 days after the date of the enactment
of this Act.
(b) Reversing Cuts to Reimbursement of Bad Debt for Territorial
Safety Net Hospitals.--
(1) Territorial safety net hospitals.--Section
1861(v)(1)(W)(ii) of the Social Security Act (42 U.S.C.
1395x(v)(1)(W)(ii)) is amended by inserting after ``or (V)''
the following: ``, a territorial safety net hospital''.
(2) Applicability.--The amendments made by this section
apply with respect to cost reporting periods beginning more
than 60 days after the date of the enactment of this Act.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and the Budget, 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 Committees on Ways and Means, and the Budget, 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 Committees on Ways and Means, and the Budget, 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.
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