Expanding Patients’ Access to Quality Care Act of 2013
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.
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—
in paragraph (1)(A)—
in the matter preceding clause (i), by striking “had”;
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
by striking clause (ii);
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”;
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”;
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
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—
by striking subparagraphs (A), (E), (F), (H), and (I);
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.”
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;
in subparagraph (C)(i)—
by striking “granted an exception under the process described in subparagraph (A)”;
by striking “has been granted a previous exception under this paragraph” and inserting “has had a previous increase under this subsection”; and
by striking “such an exception” and inserting “this paragraph”; and
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—
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)).”
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
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.”