,i  #aadth ,,congress  #ast ,session    
,h4 ,r4 #beac  ,,in ,,the ,,house ,,of  
,,representatives  ,may #ba1 #bjae ,mr4 
,sam ,johnson of ,texas 7for himself and
 ,mr4 ,hinojosa7 introduced the         
following bill2 which was referred to   
the ,committee on ,ways and ,means1 and 
in addition to the ,committee on ,energy
 and ,commerce1 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 title ,,xviii of   
the ,social ,security ,act with respect 
to the treatment of hospitals under the 
,medicare program1 and for other        
purposes4  #a4 ,short title ,this ,act  
may be cited as the ,promoting ,access1 
,competition1 and ,equity ,act of #bjae 
or as the ,,pace ,act of #bjae4  #b4    
,confirming methodology for hospital    
star rating system through ,hospital    
,compare ,section                       
#ahhf7;b77#c77;,b77viii7 of the ,social 

,security ,act 7#db ,u4,s4,c4           
#acieww7b77#c77;,b77viii77 is amended by
 adding at the end the following new    
subclause3  7,,xii7 ,in order to ensure 
consistent longitudinal comparisons     
among calendar quarters that began      
before ,october #a1 #bjai1 the          
,secretary shall use the same           
methodology as is in effect as of ,april
 #af1 #bjae1 for computation of the star
 rating for hospitals posted on the     
,internet website maintained by the     
,secretary under subclause 7,,vii7 for  
such calendar quarters4 ,the ,secretary 
may promulgate a regulation to change   
such methodology used with respect to   
the computation of such star rating for 
hospitals for calendar quarters         
beginning on or after ,october #a1      
#bjai4  4  #c4 ,revised criteria for    
application and exceptions to moratorium
 on expansion and construction of       
physician-owned hospitals  7a7          
,temporary suspension of limitation on  
hospitals that can apply for facility   

expansions ,section #ahgg7;i77#c7 of the
 ,social ,security ,act 7#db ,u4,s4,c4  
#acienn7i77#c77 is amended--  7#a7 in   
subparagraph 7,e71 by adding at the end1
 after clause 7v71 the following3 ,with 
respect to applications filed under this
 paragraph during the period beginning  
on the date of the enactment of this    
sentence and ending on ,september #cj1  
#bjai1 such term includes any hospital  
7other than a high ,medicaid facility74 
2 and  7#b7 in subparagraph 7,b71 by    
inserting before the period at the end  
the following3 1 except that such       
limitation shall not apply with respect 
to applications filed before ,october   
#a1 #bjai4  7b7 ,application of hospital
 expansion exception to hospitals with  
consistently high quality ratings       
,section #ahgg7;i77#c7 of the ,social   
,security ,act 7#db ,u4,s4,c4           
#acienn7i77#c77 is amended-- 7#a7 in    
subparagraph 7,a77i71 by striking or is 
a high ,medicaid facility described in  
subparagraph 7,f7 and inserting 1 is a  

high ,medicaid facility described in    
subparagraph 7,f71 or is a hospital with
 a consistently high quality rating 7as 
defined in subparagraph 7,h772  7#b7 in 
subparagraph 7,e71 by adding at the end1
 after the matter added by subsection   
7a77#a71 the following3 ,such term      
includes1 with respect to subparagraphs 
7,b7 through 7,d71 a hospital with a    
consistently high quality rating4 2 and 
7#c7 by adding at the end1 as amended by
 subsection 7d71 the following new      
subparagraph3  7,h7 ,hospital with a    
consistently high quality rating defined
 ,in this paragraph1 the term hospital  
with a consistently high quality rating1
 with respect to a calendar quarter     
7beginning on or after ,october #a1     
#bjai71 means a hospital that has had a 
rating of #c stars or higher under the  
hospital star rating system posted on   
the ,internet website maintained by the 
,secretary under section                
#ahhf7;b77#c77;,b77viii77,,vii7 for each
 of the #ab calendar quarters before the

 calendar quarter involved4  4  7c7     
,exception and special rules for certain
 hospitals under development as of      
,march #bc1 #bjaj ,section #ahgg of the 
,social ,security ,act 7#db ,u4,s4,c4   
#acienn7 is amended--  7#a7 in          
subsection 7d77#c77;,d71 by inserting   
before the period at the end the        
following3 or1 in the case of a hospital
 under development as of ,march #bc1    
#bjaj 7as defined in paragraph          
7#g77;,a771 meets such requirements as  
of the under development effective date 
7as defined in subsection 7i77#g77;,b772
 and  7#b7 in subsection 7i7--  7,a7 in 
paragraph 7#a71 by adding at the end the
 following new subparagraph3  7,g7      
,special timing rule for hospitals under
 development as of ,march #bc1 #bjaj ,in
 applying this paragraph to a hospital  
under development as of ,march #bc1     
#bjaj 7as defined in paragraph          
7#g77;,a771 any reference in this       
paragraph to the date of enactment of   
this subsection or to ,december #ca1    

#bjaj1 shall be deemed to be a reference
 to ,may #a1 #bjae4  2  7,b7 in         
paragraph 7#c77;,c77iii71 by striking   
provider agreement74 and inserting      
provider agreement1 or1 in the case of a
 hospital under development as of ,march
 #bc1 #bjaj 7as defined in paragraph    
7#g77;,a771 ,may #a1 #bjae742 and  7,c7 
by adding at the end the following new  
paragraph3  7#g7 ,definitions relating  
to certain hospitals under development  
,in this subsection3 7,a7 ,hospital     
under development as of ,march #bc1     
#bjaj ,the term hospital under          
development as of ,march #bc1 #bjaj     
means a hospital that--  7i7 has a      
binding written agreement with an       
outside1 unrelated party for the actual 
construction1 renovation1 lease1 or     
demolition for a hospital under section 
#ahhf7;d71 and has expended1 before     
,march #bc1 #bjaj1 at least #aj percent 
of the estimated cost of the project    
7or1 if less1 #b1ejj1jjj72 or  7ii7 has 
obtained an approved certificate of need

 in a ,state where one is required on or
 before ,march #bc1 #bjaj4  ,such term  
includes1 with respect to such a        
hospital1 any facility expansion of the 
hospital that is completed before the   
under development effective date4  7,b7 
,under development effective date ,the  
term under development effective date   
means the date that is #f months after  
the date of the enactment of this       
paragraph4  4  7d7 ,change in processing
 of applications and elimination of     
appeals limitation ,section             
#ahgg7;i77#c7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acjenn7i77#c77 is  
amended--  7#a7 in subparagraph 7,a71 by
 striking clauses 7ii7 through 7iv7 and 
inserting the following3  7ii7 ,deemed  
receipt of complete application and     
approval of application ,unless the     
,secretary otherwise determines1 an     
application submitted under this        
subparagraph shall be deemed complete as
 of the date that is #cj days after the 
date the ,secretary receives the        

complete application4 ,not later than   
#fj days after the receipt of such a    
complete application1 the ,secretary    
shall publish a notice of the receipt of
 the application and a description of   
the expansion planned in the            
application4 ,a complete application    
shall be deemed approved by the         
,secretary as of the end of the #fj-;day
 period beginning on the date of the    
,secretary's receipt of the application 
unless the ,secretary provides the      
applicant with a notice of disapproval  
of the application before the end of    
such period4  2 and  7#b7 by striking   
subparagraphs 7,h7 and 7,i74  7e7       
,effective date ,except as otherwise    
provided1 the amendments made by this   
section shall take effect on the date of
 the enactment of this ,act and shall   
apply to applications made after the    
date of the enactment of this ,act4  #d4
 ,savings from physician-owned hospitals
  7a7 ,documentation and coding         
adjustments not applicable ,section     

#g7;b77#a77;,b77iii7 of the ,,tma1      
,abstinence ,education1 and ,,qi        
,programs ,extension ,act of #bjjg      
7,public ,law #aaj-ij71 as added amended
 by section #dad7a77;,b77iii7 of the    
,medicare ,access and ,,chip            
,reauthorization ,act of #bjae 7,public 
,law #aad-aj71 is amended by inserting  
before the period at the end the        
following3 1 except that this clause    
shall not apply in the case of a        
hospital that 1 except that this clause 
shall not apply in the case of a        
hospital in which physicians 7or        
immediate family members of physicians7 
have a substantial ownership or         
investment interest in the hospital 7as 
determined under rules established by   
the ,secretary74  7b7 ,extension of     
reductions in market basket increases   
,section #ahhf7;b77#c77;,b77xii7 of the 
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7b77#c77;,b77xii77 is amended--  
7#a7 by striking and at the end of      
subclause 7,,iv72  7#b7 by striking the 

period at the end of subclause 7,v7 and 
inserting 2 and2 and  7#c7 by inserting 
after subclause 7,v7 the following new  
subclause3  7,,vi7 for each of fiscal   
years #bjbj through #bjbe1 by #j4ge     
percentage point1 but only with respect 
to a hospital and fiscal year for which 
the ,secretary determines that          
physicians 7or immediate family members 
of physicians7 have a substantial       
ownership or investment interest in the 
hospital 7as determined under rules     
established by the ,secretary74  4