,i #aaeth ,,congress #ast ,session ,h4 ,r4 #cbbd ,,in ,,the ,,house ,,of ,,representatives ,july #ac1 #bjag,mr4 ,harper 7for himself1 ,mr4 ,loebsack1 ,mr4 ,kind1 ,mr4 ,kelly of ,mississippi1 ,mr4 ,thompson of ,mississippi1 ,mr4 ,palazzo1 and ,mr4 ,peterson7 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 to clarify reasonable costs for critical access hospital payments under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,critical ,access and ,rural ,equity ,act of #bjag or the ,,care ,act of #bjag4 #b4 ,clarifying reasonable costs for critical access hospital ,medicare payments 7a7 ,inclusion of certain costs as reasonable costs 7#a7 ,inpatient critical access hospital services ,section #ahad7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l77 is amended by adding at the end the following new paragraph3 7#f7 ,in determining payment and reasonable costs under paragraph 7#a7 for inpatient critical access services1 the ,secretary shall recognize as allowable costs of the critical access hospital at least the following3 7,a7 ,costs of services that would be considered bona fide emergency services 7as defined in section #ahfa7v77#a77,k77ii77 if provided in a hospital emergency room1 including professional services and any associated surgical on-call and standby costs4 7,b7 ,costs of a test or procedure performed at a critical access hospital or an entity owned by the critical access hospital1 including a clinical diagnostic laboratory test1 mammogram 7as defined in section #ced7;a77#e7 of the ,public ,health ,service ,act71 colonoscopy1 cardiac stress test1 pulmonary function test1 echocardiogram1 and bone density study4 7,c7 ,standby and on-call costs for certified registered nurse anesthetist services1 regardless of the number of surgical procedures requiring anesthesia services and regardless of the number of full-time equivalent physicians4 7,d7 ,costs of services provided by the critical access hospital or satellite facility of the critical access hospital that improve the total health of communities1 including immunization programs1 health clinics1 and medical homes4 7,e7 ,costs of services provided by an off-campus provider-based clinic described in section #ahbj7;c77#b77;,f7 of the critical access hospital1 regardless of distance of such clinic from a hospital or another critical access hospital4 4 7#b7 ,outpatient critical access hospital services ,section #ahcd7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7g77 is amended by adding at the end the following new paragraph3 7#f7 ,coverage of certain additional costs as reasonable costs ,in determining the reasonable costs of outpatient critical access hospital services under paragraphs 7#a7 and 7#b77;,a71 the ,secretary shall recognize as allowable the costs described in paragraph 7#f7 of section #ahad7l74 4 7#c7 ,conforming amendment ,section #ahfa7v77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7v77#g77 is amended by adding at the end the following new subparagraph3 7,e7 ,for provisions further describing costs recognized as reasonable costs for inpatient and outpatient critical access hospital services1 see sections #ahad7l77#f7 and #ahcd7;g77#f74 4 7b7 ,treatment of provider-,based clinics of critical access hospitals ,section #ahbj7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;c77#b77 is amended-- 7#a7 in subparagraph 7,b77i77,i71 by striking is located and inserting subject to subparagraph 7,e71 is located2 and 7#b7 by adding at the end the following new subparagraph3 7,f7 ,treatment of off-campus provider-based clinics ,subparagraph 7,b77i77,i7 shall not apply to an off-campus provider-based clinic 7as described in section #dhe4faj of title #de of the ,code of ,federal ,regulations7 of a facility designated as a critical access hospital4 4 7c7 ,allowing coordination for provision of emergency services ,section #ahbj7;c77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#d7;c77#b771 as amended by subsection 7b71 is further amended-- 7#a7 in subparagraph 7,b77ii71 by striking makes and inserting subject to subparagraph 7,g71 makes2 and 7#b7 by adding at the end the following new subparagraph3 7,g7 ,allowing coordination for provision of emergency services ,the ,secretary may waive the requirements under subparagraph 7,b77ii71 with respect to a facility1 if such facility-- 7i7 is located not more than #ae miles of another facility or hospital that has an emergency department that satisfies the requirement of subparagraph 7,b77ii72 and 7ii7 coordinates with such other facility or hospital with respect to furnishing #bd-;hour emergency care services described in such subparagraph to the area served by such facility4 4 7d7 ,treatment of ,medicaid provider taxes for critical access hospital reasonable costs 7#a7 ,inpatient critical access hospital services ,section #ahad7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7l771 as amended by subsection 7a77#a71 is further amended by adding at the end the following new paragraph3 7#g7 7,a7 ,in determining payment and reasonable costs under paragraph 7#a7 for inpatient critical access services-- 7i7 with respect to a current permissible health care related tax imposed and paid by the critical access hospital for a cost reporting period beginning before the date of enactment of this paragraph1 the ,secretary shall not1 through recoupment or otherwise1 disallow payment to the critical access hospital under this subsection on the basis that payments to the critical access hospital under this subsection offset some or all of the costs of such tax2 and 7ii7 with respect to a current permissible health care related tax imposed and paid by the critical access hospital for a cost reporting period beginning on or after the date of enactment of this paragraph1 the ,secretary shall-- 7,i7 assess the percentage of individuals entitled to benefits under this part who are furnished inpatient critical access hospital services at such critical access hospital during such cost reporting period and who are also receiving medical assistance under the ,medicaid program under title ,,xix during such period2 and 7,,ii7 adjust payments under this subsection with respect to such services furnished during such period in a manner specified by the ,secretary based on such percentage to take into account such tax4 7,b7 ,for purposes of this paragraph and section #ahcd7;g77#g71 the term current permissible health care related tax means a broad-based health care related tax 7as defined in paragraph 7#c77;,b7 of such section7 that is in effect prior to enactment of this paragraph and for which there is not in effect a hold harmless provision described in paragraph 7#d7 of such section4 4 7#b7 ,outpatient critical access hospital services ,section #ahcd7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciem7g771 as amended by subsection 7a77#b71 is further amended by adding at the end the following new paragraph3 7#g7 ,treatment of ,medicaid provider taxes ,in determining payment for outpatient critical access hospital services under paragraphs 7#a7 and 7#b71 the provisions of paragraph 7#g7 of section #ahad7l7 shall apply to payment for such services under this subsection in the same manner as such provisions apply to payment for inpatient critical access hospital services under section #ahad7l71 except that in applying subparagraph 7,b7 of such paragraph 7#g71 the reference to individuals entitled to benefits under this part shall be deemed a reference to individuals enrolled under part ,b4 4