,i #aacth ,,congress #ast ,session ,h4 ,r4 #bjbg ,,in ,,the ,,house ,,of ,,representatives ,may #af1 #bjac ,mr4 ,sam ,johnson of ,texas 7for himself1 ,mr4 ,hinojosa1 ,mr4 ,carson of ,indiana1 ,ms4 ,jackson ,lee1 ,ms4 ,jenkins1 ,mr4 ,marchant1 ,mr4 ,young of ,indiana1 ,mr4 ,burgess1 and ,mr4 ,yoder7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend section #ahgg 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 requirements1 hospital expansions1 and hospitals in financial distress1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,expanding ,patients' ,access to ,quality ,care ,act of #bjac4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,modification of ,stark requirements for certain hospitals that were under construction or development as of ,december #cj1 #bjaj4 ,sec4 #c4 ,modifying ,stark requirements for applicable hospitals to qualify for expansion of facility capacity4 ,sec4 #d4 ,additional exception for physician ownership and investment for hospitals in financial distress4 #b4 ,modification of ,stark requirements for certain hospitals that were under construction or development as of ,december #cj1 #bjaj ,section #ahgg7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acienn7i77 is amended-- 7#a7 in paragraph 7#a77;,a7-- 7,a7 in the matter preceding clause 7i71 by striking had2 7,b7 in clause 7i71 by striking 2 and and inserting the following3 1 and had a provider agreement under section #ahff in effect on such date or was under construction or was under development 7as defined in paragraph 7#g77;,a77 on such date2 or2 and 7,c7 by striking clause 7ii72 7#b7 in paragraph 7#a77;,b71 by inserting before the period at the end the following3 or if the hospital was under construction or under development on ,december #ca1 #bjaj1 no greater than the number of operating rooms1 procedure rooms1 and beds for which the hospital is licensed as of the date the hospital had a provider agreement in effect under section #ahff2 7#c7 in paragraph 7#a77;,d77i71 by inserting before the period at the end the following3 or if the hospital was under construction or under development on ,december #ca1 #bjaj1 as of the date the hospital had a provider agreement in effect under section #ahff2 7#d7 in paragraph 7#c77;,c77iii71 by inserting after ,december #ca1 #bjaj1 the following3 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 date12 and 7#e7 by adding at the end the following new paragraph3 7#g7 ,definitions ,for purposes of this subsection3 7,a7 ,under development ,a hospital shall be treated as being under development on ,december #ca1 #bjaj1 if on or before such date the hospital-- 7i7 submitted its enrollment application for a ,medicare provider agreement2 7ii7 had a binding written agreement with an outside1 unrelated party for the actual design1 construction1 renovation1 lease1 or demolition for a hospital1 and has expended at least #aj percent of the estimated cost of the project 7or1 if less1 #a1jjj1jjj72 or 7iii7 obtained a certificate of need in a ,state where one is required4 4 #c4 ,modifying ,stark requirements for applicable hospitals to qualify for expansion of facility capacity ,section #ahgg7;i77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acienn7i77#c77 is amended-- 7#a7 by striking subparagraphs 7,a71 7,e71 7,f71 7,h71 and 7,i72 7#b7 by amending subparagraph 7,b7 to read as follows3 7,b7 ,limitation on frequency of increases ,a hospital may not effect an increase described in subparagraph 7,c7 more often than once every #b years4 2 7#c7 in subparagraphs 7,c7 and 7,d71 by striking an applicable hospital and the applicable hospital and inserting a hospital and the hospital1 respectively1 each place it appears2 7#d7 in subparagraph 7,c77i7-- 7,a7 by striking granted an exception under the process described in subparagraph 7,a72 7,b7 by striking has been granted a previous exception under this paragraph and inserting has had a previous increase under this subsection2 and 7,c7 by striking such an exception and inserting this paragraph2 and 7#e7 in subparagraph 7,c77ii71 by striking ,the ,secretary shall not permit an increase in and inserting ,a hospital may not increase4 #d4 ,additional exception for physician ownership and investment for hospitals in financial distress ,section #ahgg7;i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acienn7i77 is amended-- 7#a7 in paragraph 7#a77;,a71 as amended by section #b7a71 by inserting after clause 7i7 the following new clause3 7ii7 had a provider agreement under section #ahff in effect ,december #ca1 #bjaj1 as of such date did not have physician ownership or investment1 but after such date is determined to be in financial distress 7as defined in paragraph 7#g77;,b774 2 7#b7 in paragraph 7#a77;,d77i71 by inserting before the period at the end the following3 1 except that such percentage limitation shall not apply to a hospital determined to be in financial distress 7as defined in paragraph 7#g77;,b772 and 7#c7 in paragraph 7#g71 as added by section #b7e71 by adding at the end the following new paragraph3 7,b7 ,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 #c consecutive cost reporting periods for which data are available4 ,once the ,secretary makes a determination that a hospital has such a negative operating margin for a cost reporting period1 the ,secretary may not reverse such determination for such period4 ,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 margin4 4