,i #aad? ,,congress #a/ ,session ,h4 ,r4 #beac ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #ba1 #bjae ,mr4 ,sam ,johnson ( ,texas 7= himself & ,mr4 ,h9ojosa7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means1 & 9 addition to ! ,committee on ,en]gy & ,comm]ce1 = 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 title ,,xviii ( ! ,social ,security ,act ) respect to ! treatm5t ( hospitals "u ! ,m$ic>e program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,promot+ ,access1 ,competition1 & ,equity ,act ( #bjae or z ! ,,pace ,act ( #bjae4 #b4 ,confirm+ me?odology = hospital /> rat+ sy/em ?r\gh ,hospital ,comp>e ,section #ahhf7;b77#c77;,b77viii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77viii77 is am5d$ by add+ at ! end ! foll[+ new subclause3 7,,xii7 ,9 ord] to ensure consi/5t longitud9al comp>isons among cal5d> qu>t]s t began be=e ,octob] #a1 #bjai1 ! ,secret>y %all use ! same me?odology z is 9 effect z ( ,april #af1 #bjae1 = computation ( ! /> rat+ = hospitals po/$ on ! ,int]net website ma9ta9$ by ! ,secret>y "u subclause 7,,vii7 = su* cal5d> qu>t]s4 ,! ,secret>y may promulgate a regulation to *ange su* me?odology us$ ) respect to ! computation ( su* /> rat+ = hospitals = cal5d> qu>t]s beg9n+ on or aft] ,octob] #a1 #bjai4 4 #c4 ,revis$ crit]ia = application & exceptions to moratorium on expansion & con/ruction ( physician-own$ hospitals 7a7 ,tempor>y susp5sion ( limitation on hospitals t c apply = facility expansions ,section #ahgg7;i77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acienn7i77#c77 is am5d$-- 7#a7 9 subp>agraph 7,e71 by add+ at ! end1 aft] clause 7v71 ! foll[+3 ,) respect to applications fil$ "u ?is p>agraph dur+ ! p]iod beg9n+ on ! date ( ! enactm5t ( ?is s5t5ce & end+ on ,septemb] #cj1 #bjai1 su* t]m includes any hospital 7o!r ?an a high ,m$icaid facility74 2 & 7#b7 9 subp>agraph 7,b71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 except t su* limitation %all n apply ) respect to applications fil$ be=e ,octob] #a1 #bjai4 7b7 ,application ( hospital expansion exception to hospitals ) consi/5tly high quality rat+s ,section #ahgg7;i77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acienn7i77#c77 is am5d$-- 7#a7 9 subp>agraph 7,a77i71 by /rik+ or is a high ,m$icaid facility describ$ 9 subp>agraph 7,f7 & ins]t+ 1 is a high ,m$icaid facility describ$ 9 subp>agraph 7,f71 or is a hospital ) a consi/5tly high quality rat+ 7z def9$ 9 subp>agraph 7,h772 7#b7 9 subp>agraph 7,e71 by add+ at ! end1 aft] ! matt] add$ by subsection 7a77#a71 ! foll[+3 ,su* t]m includes1 ) respect to subp>agraphs 7,b7 ?r\gh 7,d71 a hospital ) a consi/5tly high quality rat+4 2 & 7#c7 by add+ at ! end1 z am5d$ by subsection 7d71 ! foll[+ new subp>agraph3 7,h7 ,hospital ) a consi/5tly high quality rat+ def9$ ,9 ?is p>agraph1 ! t]m hospital ) a consi/5tly high quality rat+1 ) respect to a cal5d> qu>t] 7beg9n+ on or aft] ,octob] #a1 #bjai71 means a hospital t has _h a rat+ ( #c />s or high] "u ! hospital /> rat+ sy/em po/$ on ! ,int]net website ma9ta9$ by ! ,secret>y "u section #ahhf7;b77#c77;,b77viii77,,vii7 = ea* ( ! #ab cal5d> qu>t]s be=e ! cal5d> qu>t] involv$4 4 7c7 ,exception & special rules = c]ta9 hospitals "u developm5t z ( ,m>* #bc1 #bjaj ,section #ahgg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acienn7 is am5d$-- 7#a7 9 subsection 7d77#c77;,d71 by ins]t+ be=e ! p]iod at ! end ! foll[+3 or1 9 ! case ( a hospital "u developm5t z ( ,m>* #bc1 #bjaj 7z def9$ 9 p>agraph 7#g77;,a771 meets su* requirem5ts z ( ! "u developm5t effective date 7z def9$ 9 subsection 7i77#g77;,b772 & 7#b7 9 subsection 7i7-- 7,a7 9 p>agraph 7#a71 by add+ at ! end ! foll[+ new subp>agraph3 7,g7 ,special tim+ rule = hospitals "u developm5t z ( ,m>* #bc1 #bjaj ,9 apply+ ?is p>agraph to a hospital "u developm5t z ( ,m>* #bc1 #bjaj 7z def9$ 9 p>agraph 7#g77;,a771 any ref]5ce 9 ?is p>agraph to ! date ( enactm5t ( ?is subsection or to ,decemb] #ca1 #bjaj1 %all be deem$ to be a ref]5ce to ,may #a1 #bjae4 2 7,b7 9 p>agraph 7#c77;,c77iii71 by /rik+ provid] agreem5t74 & ins]t+ provid] agreem5t1 or1 9 ! case ( a hospital "u developm5t z ( ,m>* #bc1 #bjaj 7z def9$ 9 p>agraph 7#g77;,a771 ,may #a1 #bjae742 & 7,c7 by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,def9itions relat+ to c]ta9 hospitals "u developm5t ,9 ?is subsection3 7,a7 ,hospital "u developm5t z ( ,m>* #bc1 #bjaj ,! t]m hospital "u developm5t z ( ,m>* #bc1 #bjaj means a hospital t-- 7i7 has a b9d+ writt5 agreem5t ) an outside1 unrelat$ p>ty = ! actual con/ruction1 r5ovation1 lease1 or demolition = a hospital "u section #ahhf7;d71 & has exp5d$1 be=e ,m>* #bc1 #bjaj1 at lea/ #aj p]c5t ( ! e/imat$ co/ ( ! project 7or1 if less1 #b1ejj1jjj72 or 7ii7 has obta9$ an approv$ c]tificate ( ne$ 9 a ,/ate :]e "o is requir$ on or be=e ,m>* #bc1 #bjaj4 ,su* t]m includes1 ) respect to su* a hospital1 any facility expansion ( ! hospital t is complet$ be=e ! "u developm5t effective date4 7,b7 ,"u developm5t effective date ,! t]m "u developm5t effective date means ! date t is #f mon?s aft] ! date ( ! enactm5t ( ?is p>agraph4 4 7d7 ,*ange 9 process+ ( applications & elim9ation ( appeals limitation ,section #ahgg7;i77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acjenn7i77#c77 is am5d$-- 7#a7 9 subp>agraph 7,a71 by /rik+ clauses 7ii7 ?r\gh 7iv7 & ins]t+ ! foll[+3 7ii7 ,deem$ receipt ( complete application & approval ( application ,unless ! ,secret>y o!rwise det]m9es1 an application submitt$ "u ?is subp>agraph %all be deem$ complete z ( ! date t is #cj days aft] ! date ! ,secret>y receives ! complete application4 ,n lat] ?an #fj days aft] ! receipt ( su* a complete application1 ! ,secret>y %all publi% a notice ( ! receipt ( ! application & a description ( ! expansion plann$ 9 ! application4 ,a complete application %all be deem$ approv$ by ! ,secret>y z ( ! end ( ! #fj-;day p]iod beg9n+ on ! date ( ! ,secret>y's receipt ( ! application unless ! ,secret>y provides ! applicant ) a notice ( disapproval ( ! application be=e ! end ( su* p]iod4 2 & 7#b7 by /rik+ subp>agraphs 7,h7 & 7,i74 7e7 ,effective date ,except z o!rwise provid$1 ! am5dm5ts made by ?is section %all take effect on ! date ( ! enactm5t ( ?is ,act & %all apply to applications made aft] ! date ( ! enactm5t ( ?is ,act4 #d4 ,sav+s f physician-own$ hospitals 7a7 ,docum5tation & cod+ adju/m5ts n applicable ,section #g7;b77#a77;,b77iii7 ( ! ,,tma1 ,ab/95ce ,education1 & ,,qi ,programs ,ext5sion ,act ( #bjjg 7,public ,law #aaj-ij71 z add$ am5d$ by section #dad7a77;,b77iii7 ( ! ,m$ic>e ,access & ,,*ip ,reau?orization ,act ( #bjae 7,public ,law #aad-aj71 is am5d$ by ins]t+ be=e ! p]iod at ! end ! foll[+3 1 except t ?is clause %all n apply 9 ! case ( a hospital t 1 except t ?is clause %all n apply 9 ! case ( a hospital 9 :i* physicians 7or imm$iate family memb]s ( physicians7 h a sub/antial own]%ip or inve/m5t int]e/ 9 ! hospital 7z det]m9$ "u rules e/abli%$ by ! ,secret>y74 7b7 ,ext5sion ( r$uctions 9 m>ket basket increases ,section #ahhf7;b77#c77;,b77xii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieww7b77#c77;,b77xii77 is am5d$-- 7#a7 by /rik+ & at ! end ( subclause 7,,iv72 7#b7 by /rik+ ! p]iod at ! end ( subclause 7,v7 & ins]t+ 2 &2 & 7#c7 by ins]t+ aft] subclause 7,v7 ! foll[+ new subclause3 7,,vi7 = ea* ( fiscal ye>s #bjbj ?r\gh #bjbe1 by #j4ge p]c5tage po9t1 b only ) respect to a hospital & fiscal ye> = :i* ! ,secret>y det]m9es t physicians 7or imm$iate family memb]s ( physicians7 h a sub/antial own]%ip or inve/m5t int]e/ 9 ! hospital 7z det]m9$ "u rules e/abli%$ by ! ,secret>y74 4