,i  #aaith ,,congress  #b;d ,session    
,h4 ,r4 #gade  ,,in ,,the ,,house ,,of  
,,representatives  ,january #af1        
#bjbf,mrs4 ,trahan 7for herself1 ,mr4   
,valadao1 ,mr4 ,ciscomani1 ,mr4 ,carter 
of ,louisiana1 ,mr4 ,veasey1 and ,mr4   
,soto7 introduced the following bill2   
which was referred to the ,committee on 
,energy and ,commerce  ,a ,,bill  ,to   
amend title ,,xix of the ,social        
,security ,act to establish a definition
 of essential health system in statute  
and for other related purposes4  #a4    
,establishing a definition of essential 
health system in statute  7a7 7#a7 ,in  
general ,section #aije of the ,social   
,security ,act 7#db ,u4,s4,c4 #acif;d7  
is amended by adding at the end the     
following new subsection3  7ll7         
,essential health system ,the term      
essential health system means a         
hospital-- 7#a7 7,a7 that is a          
subsection 7d7 hospital 7as defined in  
section #ahhf7;d77#a77;,b772  7,b7 that 
is a non-,federal governmental or       

private nonprofit hospital2 and  7,c7   
that met one of the following three     
criteria in at least two of the three   
most recent fiscal years1 demonstrating 
the hospital provides a high-volume of  
care to ,medicaid and other low-income  
patients3 7i7 ,medicaid and low-income  
medicare criteria  7,i7 ,the hospital   
had a ,medicare disproportionate patient
 percentage of at least #ce percent 7as 
defined in section                      
#ahhf7;d77#e77;,f77vi774  7ii7          
,uncompensated care criteria  7,i7 ,the 
hospital had a ,medicare                
disproportionate share hospital         
uncompensated care payment factor of    
#j4jjje or more 7as defined in section  
#ahhf7r77#b77;,c774  7iii7              
,state-adjusted low-income care criteria
  7,i7 ,the hospital had a value for the
 criteria described in clause 7i7 or    
clause 7ii7 that is in the top #afth    
percentile for subsection 7d7 hospitals 
7as defined in section                  
#ahhf7;d77#a77;,b77 in the state in     

which it is located4  ,in determining   
whether a hospital meets at least one of
 the criteria specified in subparagraph 
7,c71 the ,secretary shall utilize data 
published with the final rules revising 
the ,medicare inpatient prospective     
payment systems for the three most      
recent fiscal years4  7#b7 ,period of   
designation ,the designation of an      
essential health system under paragraph 
7#a7 shall be effective for a period of 
#e years1 provided the hospital         
continues to meet the criteria in       
subparagraphs 7,a7 and 7,b7 in each     
year1 and shall be subject to           
redesignation thereafter under paragraph
 7#a7 for five year periods thereafter4 
4  7b7 ,essential health system         
designation and index ,section #aijj7;b7
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #acif7;b77 is amended-- 7#a7  
by redesignating paragraphs 7#g7 through
 7#ad7 as paragraphs 7#h7 through 7#ae7 
respectively2 and  7#b7 by inserting    
after paragraph 7#f7 the following3     

7#g7 ,essential health system index     
7,a7 ,not later than six months after   
the date of enactment and by ,august    
#ast in each year thereafter1 ,,macpac  
shall-- 7i7 ,prepare and submit to      
,congress a list of essential health    
systems that meet the criteria specified
 in section#aije7ll71 including         
hospitals newly meeting the criteria and
 those that were so designated in one of
 the previous four fiscal years2 and    
7ii7 ,establish and publish essential   
health system index values for each     
hospital that is a subsection 7d7       
hospital 7as defined in section         
#ahhf7;d77#a77;,b77 in accordance with  
subparagraph 7,b74  7,b7 ,in this       
subparagraph1 the term essential health 
system index value is a computation of  
each hospital's percentile ranking for  
the most recent fiscal year for which   
data is available on the measures       
described in                            
section#aije7ll77#a77;,c77i7 and 7ii7   
compared to other subsection 7d7        

hospitals in the3 7i7 same core-based   
statistical area 7if applicable71  7ii7 
same state1 and  7iii7 nationally4  7,c7
 ,,macpac shall report these values     
individually and shall also report a    
composite index value calculated as the 
average of the individual index values  
specified in subparagraph 7,b74  4  7c7 
,,macpac agenda ,section                
#aijj7;b77#b77;,a7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acif7;b77#b77;,a77 is amended--  7#a7  
in clause 7ii71 by striking and at the  
end2  7#b7 in clause 7iii71 by striking 
the period at the end and inserting 2   
and at the end2 and  7#c7 by adding at  
the end the following new clause3  7iv7 
payment policies that use the criteria  
described in subparagraph 7b77#g7 to    
provide targeted support for essential  
health systems and ensure access to the 
essential community services that they  
provide4  4