,i #aac? ,,congress #a/ ,session ,h4 ,r4 #bjbg ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #af1 #bjac ,mr4 ,sam ,johnson ( ,texas 7= himself1 ,mr4 ,h9ojosa1 ,mr4 ,c>son ( ,indiana1 ,ms4 ,jackson ,lee1 ,ms4 ,j5k9s1 ,mr4 ,m>*ant1 ,mr4 ,"y ( ,indiana1 ,mr4 ,burgess1 & ,mr4 ,yod]7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d section #ahgg ( ! ,social ,security ,act to modify ! requirem5ts = hospitals to qualify = ! rural provid] & hospital exception to physician own]%ip or inve/m5t prohibition 9 ord] to take into acc\nt hospitals t 7 "u con/ruction or developm5t at ! "t ( impos+ su* requirem5ts1 hospital expansions1 & hospitals 9 f9ancial di/ress1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,exp&+ ,pati5ts' ,access to ,quality ,c>e ,act ( #bjac4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,modification ( ,/>k requirem5ts = c]ta9 hospitals t 7 "u con/ruction or developm5t z ( ,decemb] #cj1 #bjaj4 ,sec4 #c4 ,modify+ ,/>k requirem5ts = applicable hospitals to qualify = expansion ( facility capacity4 ,sec4 #d4 ,additional exception = physician own]%ip & inve/m5t = hospitals 9 f9ancial di/ress4 #b4 ,modification ( ,/>k requirem5ts = c]ta9 hospitals t 7 "u con/ruction or developm5t z ( ,decemb] #cj1 #bjaj ,section #ahgg7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acienn7i77 is am5d$-- 7#a7 9 p>agraph 7#a77;,a7-- 7,a7 9 ! matt] prec$+ clause 7i71 by /rik+ _h2 7,b7 9 clause 7i71 by /rik+ 2 & & ins]t+ ! foll[+3 1 & _h a provid] agreem5t "u section #ahff 9 effect on su* date or 0 "u con/ruction or 0 "u developm5t 7z def9$ 9 p>agraph 7#g77;,a77 on su* date2 or2 & 7,c7 by /rik+ clause 7ii72 7#b7 9 p>agraph 7#a77;,b71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 or if ! hospital 0 "u con/ruction or "u developm5t on ,decemb] #ca1 #bjaj1 no great] ?an ! numb] ( op]at+ rooms1 proc$ure rooms1 & b$s = :i* ! hospital is lic5s$ z ( ! date ! hospital _h a provid] agreem5t 9 effect "u section #ahff2 7#c7 9 p>agraph 7#a77;,d77i71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 or if ! hospital 0 "u con/ruction or "u developm5t on ,decemb] #ca1 #bjaj1 z ( ! date ! hospital _h a provid] agreem5t 9 effect "u section #ahff2 7#d7 9 p>agraph 7#c77;,c77iii71 by ins]t+ aft] ,decemb] #ca1 #bjaj1 ! foll[+3 or 9 ! case ( a hospital t did n h a provid] agreem5t 9 effect z ( su* date b 0 "u con/ruction or "u developm5t on su* date12 & 7#e7 by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,def9itions ,= purposes ( ?is subsection3 7,a7 ,"u developm5t ,a hospital %all be treat$ z be+ "u developm5t on ,decemb] #ca1 #bjaj1 if on or be=e su* date ! hospital-- 7i7 submitt$ its enrollm5t application = a ,m$ic>e provid] agreem5t2 7ii7 _h a b9d+ writt5 agreem5t ) an outside1 unrelat$ p>ty = ! actual design1 con/ruction1 r5ovation1 lease1 or demolition = a hospital1 & has exp5d$ at lea/ #aj p]c5t ( ! e/imat$ co/ ( ! project 7or1 if less1 #a1jjj1jjj72 or 7iii7 obta9$ a c]tificate ( ne$ 9 a ,/ate :]e "o is requir$4 4 #c4 ,modify+ ,/>k requirem5ts = applicable hospitals to qualify = expansion ( facility capacity ,section #ahgg7;i77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acienn7i77#c77 is am5d$-- 7#a7 by /rik+ subp>agraphs 7,a71 7,e71 7,f71 7,h71 & 7,i72 7#b7 by am5d+ subp>agraph 7,b7 to read z foll[s3 7,b7 ,limitation on frequ5cy ( increases ,a hospital may n effect an increase describ$ 9 subp>agraph 7,c7 m (t5 ?an once e #b ye>s4 2 7#c7 9 subp>agraphs 7,c7 & 7,d71 by /rik+ an applicable hospital & ! applicable hospital & ins]t+ a hospital & ! hospital1 respectively1 ea* place x appe>s2 7#d7 9 subp>agraph 7,c77i7-- 7,a7 by /rik+ grant$ an exception "u ! process describ$ 9 subp>agraph 7,a72 7,b7 by /rik+ has be5 grant$ a previ\s exception "u ?is p>agraph & ins]t+ has _h a previ\s increase "u ?is subsection2 & 7,c7 by /rik+ su* an exception & ins]t+ ?is p>agraph2 & 7#e7 9 subp>agraph 7,c77ii71 by /rik+ ,! ,secret>y %all n p]mit an increase 9 & ins]t+ ,a hospital may n increase4 #d4 ,additional exception = physician own]%ip & inve/m5t = hospitals 9 f9ancial di/ress ,section #ahgg7;i7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acienn7i77 is am5d$-- 7#a7 9 p>agraph 7#a77;,a71 z am5d$ by section #b7a71 by ins]t+ aft] clause 7i7 ! foll[+ new clause3 7ii7 _h a provid] agreem5t "u section #ahff 9 effect ,decemb] #ca1 #bjaj1 z ( su* date did n h physician own]%ip or inve/m5t1 b aft] su* date is det]m9$ to be 9 f9ancial di/ress 7z def9$ 9 p>agraph 7#g77;,b774 2 7#b7 9 p>agraph 7#a77;,d77i71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 except t su* p]c5tage limitation %all n apply to a hospital det]m9$ to be 9 f9ancial di/ress 7z def9$ 9 p>agraph 7#g77;,b772 & 7#c7 9 p>agraph 7#g71 z add$ by section #b7e71 by add+ at ! end ! foll[+ new p>agraph3 7,b7 ,f9ancial di/ress ,a hospital %all be treat$ z be+ 9 f9ancial di/ress = a co/ report+ p]iod if ! ,secret>y det]m9es t ! hospital has _h an ov]all negative comb9$ ,m$ic>e inpati5t prospective paym5t sy/em & outpati5t prospective paym5t sy/em op]at+ m>g9 = ! mo/ rec5t #c consecutive co/ report+ p]iods = :i* data are available4 ,once ! ,secret>y makes a det]m9ation t a hospital has su* a negative op]at+ m>g9 = a co/ report+ p]iod1 ! ,secret>y may n rev]se su* det]m9ation = su* p]iod4 ,a hospital t is treat$ z be+ 9 f9ancial di/ress "u ?is subp>agraph = a co/ report+ p]iod %all cont9ue to be s treat$ = all subsequ5t co/ report+ p]iods z be+ 9 f9ancial di/ress )\t reg>d to *anges 9 ! hospital's op]at+ m>g94 4