,i  #aaeth ,,congress  #b;d ,session    
,h4 ,r4 #eeih  ,,in ,,the ,,house ,,of  
,,representatives  ,april #bd1 #bjah    
,mr4 ,carter of ,georgia 7for himself   
and ,mr4 ,collins of ,new ,york7        
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce  ,a ,,bill  ,to amend the 
,public ,health ,service ,act to require
 certain disproportionate share hospital
 covered entities under the #cdj;,b drug
 discount program to submit to the      
,secretary of ,health and ,human        
,services reports on low-income         
utilization rates of outpatient hospital
 services furnished by such entities4   
#a4 ,short title ,this ,act may be cited
 as the #cdj;,b ,optimization ,act4  #b4
 ,requiring #cdj;,b drug discount       
program reports by ,,dsh hospital       
covered entities on low-income          
utilization rate of outpatient hospital 
services  7a7 ,in general ,section      
#cdj;,b7d77#b7 of the ,public ,health   
,service ,act 7#db ,u4,s4,c4            

#bef;b7d77#b77 is amended--  7#a7 in    
subparagraph 7,b77i71 by inserting      
before the period at the end the        
following3 1 including1 with respect to 
such updates made on or after ,january  
#a1 #bjbj1 by requiring covered entities
 described in subsection 7a77#d77,l7 to 
submit 7and to so regularly update7     
information described in subparagraph   
7,c72 and  7#b7 by adding at the end the
 following new subparagraph3  7,c7      
,information on low-income utilization  
rate of outpatient hospital services    
7i7 ,in general ,for purposes of        
subparagraph 7,b77i71 the information   
described in this subparagraph1 with    
respect to a covered entity described in
 subsection 7a77#d77,l7 and an update   
under such subparagraph 7,b77i71 is--   
7,i7 the low-income outpatient          
utilization rate of such covered entity 
for the most recent fiscal year2 and    
7,,ii7 the low-income outpatient        
utilization rate of off-site outpatient 
facilities1 clinics1 eligible off-site  

locations1 and associated sites of such 
entity identified as child sites of such
 entity pursuant to the identification  
system under subparagraph 7,b77iv7 for  
the most recent fiscal year4  7ii7      
,low-income outpatient utilization rate 
defined ,in this subparagraph1 the term 
low-income outpatient utilization rate  
has the meaning given the term          
low-income utilization rate under       
paragraph 7#c7 of section #aibc7;b7 of  
the ,social ,security ,act1 except      
that--  7,i7 clauses 7i7 and 7ii7 of    
subparagraph 7,a7 of such paragraph     
shall be applied as if-- 7aa7 each      
reference to patient services were a    
reference to patient services furnished 
on an outpatient basis2 and  7bb7 for   
purposes of clause 7i77,,ii7 of this    
subparagraph1 each reference to hospital
 were a reference to off-site outpatient
 facilities1 clinics1 eligible off-site 
locations1 and associated sites of the  
hospital that are identified as child   
sites of the hospital pursuant to the   

identification system under section     
#cdj;,b7d77#b77;,b77iv7 of the ,public  
,health ,service ,act2 and  7,,ii7      
clauses 7i7 and 7ii7 of subparagraph    
7,b7 of such paragraph shall be applied 
as if--  7aa7 each reference to         
inpatient hospital services were a      
reference to outpatient hospital        
services2 and  7bb7 for purposes of     
clause 7i77,,ii7 each reference to      
hospital's charges were a reference to  
charges of the off-site outpatient      
facilities1 clinics1 eligible off-site  
locations1 and associated sites of the  
hospital that are identified as child   
sites of the hospital pursuant to the   
identification system under section     
#cdj;,b7d77#b77;,b77iv7 of the ,public  
,health ,service ,act4  4  7b7 ,annual  
reports ,not later than ,january #a1    
#bjba1 and annually thereafter1 the     
,administrator of the ,health ,resources
 and ,services ,administration shall    
submit to ,congress a report on         
information submitted by covered        

entities for the previous year pursuant 
to the amendments made by subsection    
7a74