,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #gade  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,janu>y #af1          
#bjbf,mrs4 ,trahan 7= h]self1 ,mr4      
,valadao1 ,mr4 ,ciscomani1 ,mr4 ,c>t] ( 
,l\isiana1 ,mr4 ,veasey1 & ,mr4 ,soto7  
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce  ,a  
,,bill  ,to am5d title ,,xix ( ! ,social
 ,security ,act to e/abli% a def9ition (
 ess5tial heal? sy/em 9 /atute & = o!r  
relat$ purposes4  #a4 ,e/abli%+ a       
def9ition ( ess5tial heal? sy/em 9      
/atute  7a7 7#a7 ,9 g5]al ,section #aije
 ( ! ,social ,security ,act 7#db        
,u4,s4,c4 #acif;d7 is am5d$ by add+ at !
 end ! foll[+ new subsection3  7ll7     
,ess5tial heal? sy/em ,! t]m ess5tial   
heal? sy/em means a hospital-- 7#a7 7,a7
 t is a subsection 7d7 hospital 7z def9$
 9 section #ahhf7;d77#a77;,b772  7,b7 t 
is a non-,f$]al gov]nm5tal or private   
nonpr(it hospital2 &  7,c7 t met "o ( ! 
foll[+ ?ree crit]ia 9 at lea/ two ( !   
?ree mo/ rec5t fiscal ye>s1 demon/rat+ !

 hospital provides a high-volume ( c>e  
to ,m$icaid & o!r l[-income pati5ts3 7i7
 ,m$icaid & l[-income m$ic>e crit]ia    
7,i7 ,! hospital _h a ,m$ic>e           
disproportionate pati5t p]c5tage ( at   
lea/ #ce p]c5t 7z def9$ 9 section       
#ahhf7;d77#e77;,f77vi774  7ii7          
,uncomp5sat$ c>e crit]ia  7,i7 ,!       
hospital _h a ,m$ic>e disproportionate  
%>e hospital uncomp5sat$ c>e paym5t     
factor ( #j4jjje or m 7z def9$ 9 section
 #ahhf7r77#b77;,c774  7iii7 ,/ate-adju/$
 l[-income c>e crit]ia  7,i7 ,! hospital
 _h a value = ! crit]ia describ$ 9      
clause 7i7 or clause 7ii7 t is 9 ! top  
#af? p]c5tile = subsection 7d7 hospitals
 7z def9$ 9 section #ahhf7;d77#a77;,b77 
9 ! /ate 9 :i* x is locat$4  ,9 det]m9+ 
:e!r a hospital meets at lea/ "o ( !    
crit]ia specifi$ 9 subp>agraph 7,c71 !  
,secret>y %all utilize data publi%$ ) ! 
f9al rules revis+ ! ,m$ic>e inpati5t    
prospective paym5t sy/ems = ! ?ree mo/  
rec5t fiscal ye>s4  7#b7 ,p]iod (       
designation ,! designation ( an ess5tial

 heal? sy/em "u p>agraph 7#a7 %all be   
effective = a p]iod ( #e ye>s1 provid$ !
 hospital cont9ues to meet ! crit]ia 9  
subp>agraphs 7,a7 & 7,b7 9 ea* ye>1 &   
%all be subject to r$esignation !reaft] 
"u p>agraph 7#a7 = five ye> p]iods      
!reaft]4  4  7b7 ,ess5tial heal? sy/em  
designation & index ,section #aijj7;b7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acif7;b77 is am5d$-- 7#a7 by          
r$esignat+ p>agraphs 7#g7 ?r\gh 7#ad7 z 
p>agraphs 7#h7 ?r\gh 7#ae7 respectively2
 &  7#b7 by ins]t+ aft] p>agraph 7#f7 ! 
foll[+3  7#g7 ,ess5tial heal? sy/em     
index  7,a7 ,n lat] ?an six mon?s aft] !
 date ( enactm5t & by ,augu/ #a/ 9 ea*  
ye> !reaft]1 ,,macpac %all-- 7i7 ,prep>e
 & submit to ,congress a li/ ( ess5tial 
heal? sy/ems t meet ! crit]ia specifi$ 9
 section#aije7ll71 includ+ hospitals    
newly meet+ ! crit]ia & ^? t 7 s        
designat$ 9 "o ( ! previ\s f\r fiscal   
ye>s2 &  7ii7 ,e/abli% & publi% ess5tial
 heal? sy/em index values = ea* hospital
 t is a subsection 7d7 hospital 7z def9$

 9 section #ahhf7;d77#a77;,b77 9        
accordance ) subp>agraph 7,b74  7,b7 ,9 
?is subp>agraph1 ! t]m ess5tial heal?   
sy/em index value is a computation ( ea*
 hospital's p]c5tile rank+ = ! mo/ rec5t
 fiscal ye> = :i* data is available on !
 measures describ$ 9                    
section#aije7ll77#a77;,c77i7 & 7ii7     
comp>$ to o!r subsection 7d7 hospitals 9
 !3 7i7 same core-bas$ /ati/ical area   
7if applicable71  7ii7 same /ate1 &     
7iii7 nationally4  7,c7 ,,macpac %all   
report ^! values individually & %all    
also report a composite index value     
calculat$ z ! av]age ( ! individual     
index values specifi$ 9 subp>agraph     
7,b74  4  7c7 ,,macpac ag5da ,section   
#aijj7;b77#b77;,a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acif7;b77#b77;,a77
 is am5d$--  7#a7 9 clause 7ii71 by     
/rik+ & at ! end2  7#b7 9 clause 7iii71 
by /rik+ ! p]iod at ! end & ins]t+ 2 &  
at ! end2 &  7#c7 by add+ at ! end !    
foll[+ new clause3  7iv7 paym5t policies
 t use ! crit]ia describ$ 9 subp>agraph 

7b77#g7 to provide t>get$ support =     
ess5tial heal? sy/ems & ensure access to
 ! ess5tial community s]vices t !y      
provide4  4