,i #aai? ,,congress #a/ ,session ,h4 ,r4 #cbbb ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #f1 #bjbe,mrs4 ,sp>tz 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 title ,,xviii ( ! ,social ,security ,act to improve risk adju/m5t "u ,m$ic>e ,advantage1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,/opp+ ,m$ic>e ,abuses to ,re/ore ,tru/ 9 ,heal? ,c>e ,act or ! ,,sm>t ,heal? ,c>e ,act4 #b4 ,improv+ risk adju/m5t "u ,m$ic>e ,advantage ,section #ahec7;a77#c77;,c77iii7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bc7;a77#c77;,c77iii77 is am5d$-- 7#a7 by /rik+ me?odology4--,su* risk & ins]t+ me?odology4-- 7,i7 ,9 g5]al ,subject to subclause 7,,ii71 su* risk 2 & 7#b7 by add+ at ! end ! foll[+ new subclauses3 7,,ii7 ,use ( heal? /atus data ,= #bjbf & ea* subsequ5t ye>1 ! ,secret>y %all use #b ye>s ( diagno/ic data 7:5 available7 "u su* risk adju/m5t me?odology4 4 #c4 ,promot+ ,m$ic>e site-neutral paym5ts 7a7 ,9 g5]al ,section #ahcc7t77#ba7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7t77#ba77 is am5d$-- 7#a7 by r$esignat+ subp>agraph 7,e7 z subp>agraph 7,f72 & 7#b7 by ins]t+ aft] subp>agraph 7,d7 ! foll[+ new subp>agraphs3 7,e7 ,sunset ( c]ta9 exceptions ,! provisions ( clauses 7ii7 & 7iv7 ( subp>agraph 7,b7 %all n apply ) respect to applicable items & s]vices furni%$ on or aft] ,janu>y #a1 #bjbf4 4 7b7 ,on-,campus outpati5t dep>tm5ts ,section #ahcc7t7 ( ! ,social ,security ,act is am5d$-- 7#a7 9 p>agraph 7#a77;,b7-- 7,a7 9 cause 7iv71 by /rik+ & at ! end2 7,b7 9 cause 7v71 by /rik+ ! p]iod at ! end & ins]t+ 2 &2 & 7,c7 by ins]t+ at ! end ! foll[+ new clause3 7vi7 does n include applicable items & s]vices 7z def9$ 9 subp>agraph 7,a7 ( p>agraph 7#bc772 & 2 & 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#bc7 ,s]vices furni%$ by an on-campus outpati5t dep>tm5t ( a provid] 7,a7 ,applicable items & s]vices ,= purposes ( p>agraph 7#a77;,b77v7 & ?is p>agraph1 ! t]m applicable items & s]vices means items & s]vices o!r ?an items & s]vices furni%$ by a d$icat$ em]g5cy dep>tm5t 7z def9$ 9 section #dhi4bd7;b7 ( title #db ( ! ,code ( ,f$]al ,regulations74 7,b7 ,on-campus outpati5t dep>tm5t ( a provid] 7i7 ,9 g5]al ,on-campus outpati5t dep>tm5t ( a provid]-- 7,i7 on ! campus 7z def9$ 9 su* section #dac4fe7;a77#b7 ( title #db1 ,code ( ,f$]al ,regulations7 ( su* provid]2 or 7,,ii7 )9 ! di/ance 7describ$ 9 su* def9ition ( campus7 f a remote location ( a hospital facility 7z def9$ 9 su* section #dac4fe7;a77#b7 ( title #db1 ,code ( ,f$]al ,regulations74 7ii7 ,exception = c]ta9 hospitals locat$ 9 rural or m$ically und]s]v$ areas ,= purposes ( p>agraph 7#a77;,b77vi7 & ?is p>agraph ) respect to applicable items & s]vices1 ! t]m on-campus outpati5t dep>tm5t ( a provid] %all n include a dep>tm5t ( a provid] 7z s def9$7 if ! provid] is3 7,i7 ,a critical access hospital 7z def9$ 9 section #ahfa7mm77#a774 7,,ii7 ,a sole community hospital 7z def9$ 9 section #ahhf7;d77#e77;,d77iii774 7,,iii7 ,a ,m$ic>e-dep5d5t1 small rural hospital 7z def9$ 9 section #ahhf7;d77#e77;,g77iv774 7,,iv7 ,any o!r hospital t is locat$ 9 a rural area 7z def9$ 9 section #ahhf7;d77#b77;,d774 7,c7 ,availability ( paym5t "u o!r paym5t sy/ems ,) respect to items & s]vices furni%$ 9 an on-campus provid]-bas$ dep>tm5t1 paym5t "u ?is section = su* items & s]vices %all be ! am\nt det]m9$ "u ! fee s*$ule "u section #ahdh = su* items & s]vices furni%$ if furni%$ 9 a physician (fice sett+4 4 #d4 ,increas+ ,m$ic>e access = rural communities by physician-own$ hospitals ,section #ahgg7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acienn7d77 is am5d$ by /rik+ p>agraph 7#b7 & ins]t+ ! foll[+3 7#b7 ,rural provid]s ,9 ! case ( designat$ heal? s]vices furni%$ 9 a rural area 7z def9$ 9 section #ahhf7;d77#b77;,d77 by an entity1 if sub/antially all ( ! designat$ heal? s]vices furni%$ by ! entity are furni%$ to individuals resid+ 9 su* a rural area4 4 #e4 ,mak+ drugs m af=dable = m$ic>e pati5ts ,section #cdj;,b7a77#e7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bef;b7a77#e77 is am5d$-- 7#a7 9 subp>agraph 7,c71 by /rik+ subp>agraphs 7,a7 or 7,b7 & ins]t+ subp>agraph 7,a71 7,b71 or 7,e72 7#b7 9 subp>agraph 7,d71 by /rik+ subp>agraphs 7,a7 or 7,b7 & ins]t+ subp>agraph 7,a71 7,b71 or 7,e72 & 7#c7 by add+ at ! end ! foll[+3 7,e7 ,requirem5t to provide drug disc\nts to pati5ts 7i7 ,9 g5]al ,a cov]$ entity %all ensure t ea* pati5t :o receives a cov]$ outpati5t drug f su* cov]$ entity is provid$ su* drug at a price t does n exce$ ! price at :i* ! cov]$ entity pur*as$ ! drug 9 accordance ) p>agraph 7#a71 less any additional disc\nts or rebates receiv$ by ! cov]$ entity ) respect to ! drug4 7ii7 ,e/abli%m5t ( me*anism ,! ,secret>y %all e/abli% a me*anism-- 7,i7 ensure t cov]$ entities comply ) clause 7i72 7,,ii7 adju/ reimbursem5t rates = cov]$ entities = c]ta9 outpati5t prescription drugs provid$ by hospitals to ,m$ic>e pati5ts "u section #aciel7t77#ad77;,a77iii72 & 7,,iii7 report ! total am\nt paid & ! total am\nt receiv$ = cov]$ outpati5t drugs "u ?is subsection4 7iii7 ,public report+ ,! ,secret>y %all make ! in=mation report$ "u subclause 7ii77,,iii7 publicly available4 4 #f4 ,improv+ quality ( c>e at ! skill$ nurs+ facilities ,section #ahhh7;e77#f7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieyy7e77#f77 is am5d$ by ins]t+ 7or1 ) respect to fiscal ye> #bjbe or a subsequ5t fiscal ye>1 by betwe5 #b & #e p]c5tage po9ts 7z det]m9$ appropriate by ! ,secret>y77 aft] #b p]c5tage po9ts4