Expanding Patients' Access to Quality Care Act of 2013

Summary: Expanding Patients' Access to Quality Care Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act with respect to: (1) the limitation on certain physician referrals to hospitals in which the physician or an immediate family member has an ownership or investment interest exceeding a specified amount; and (2) the rural provider and hospital exception to the physician ownership or investment prohibition. Extends the rural provider and hospital exception to hospitals that were under construction or development as of December 30, 2010, and hospitals in financial distress. Defines &quot;financial distress&quot; for a cost reporting period as one in which a hospital has had an overall negative combined Medicare inpatient prospective payment system and outpatient prospective payment system operating margin for the most recent three consecutive cost reporting periods for which data are available. Eliminates the process for applying for such an exception for expansions of hospital facility capacity. Limits increases in facility capacity to those hospitals that have had a previous increase.

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Expanding 
Patients' Access to Quality Care Act of 2013''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Modification of Stark requirements for certain hospitals that 
                            were under construction or development as 
                            of December 30, 2010.
Sec. 3. Modifying Stark requirements for applicable hospitals to 
                            qualify for expansion of facility capacity.
Sec. 4. Additional exception for physician ownership and investment for 
                            hospitals in financial distress.

SEC. 2. MODIFICATION OF STARK REQUIREMENTS FOR CERTAIN HOSPITALS THAT 
              WERE UNDER CONSTRUCTION OR DEVELOPMENT AS OF DECEMBER 30, 
              2010.

    Section 1877(i) of the Social Security Act (42 U.S.C. 1395nn(i)) is 
amended--
            (1) in paragraph (1)(A)--
                    (A) in the matter preceding clause (i), by striking 
                ``had'';
                    (B) in clause (i), by striking ``; and'' and 
                inserting the following: ``, and had a provider 
                agreement under section 1866 in effect on such date or 
                was under construction or was under development (as 
                defined in paragraph (7)(A)) on such date; or''; and
                    (C) by striking clause (ii);
            (2) in paragraph (1)(B), by inserting before the period at 
        the end the following: ``or if the hospital was under 
        construction or under development on December 31, 2010, no 
        greater than the number of operating rooms, procedure rooms, 
        and beds for which the hospital is licensed as of the date the 
        hospital had a provider agreement in effect under section 
        1866'';
            (3) in paragraph (1)(D)(i), by inserting before the period 
        at the end the following: ``or if the hospital was under 
        construction or under development on December 31, 2010, as of 
        the date the hospital had a provider agreement in effect under 
        section 1866'';
            (4) in paragraph (3)(C)(iii), by inserting after ``December 
        31, 2010,'' the following: ``or in the case of a hospital that 
        did not have a provider agreement in effect as of such date but 
        was under construction or under development on such date,''; 
        and
            (5) by adding at the end the following new paragraph:
            ``(7) Definitions.--For purposes of this subsection:
                    ``(A) Under development.--A hospital shall be 
                treated as being `under development' on December 31, 
                2010, if on or before such date the hospital--
                            ``(i) submitted its enrollment application 
                        for a Medicare provider agreement;
                            ``(ii) had a binding written agreement with 
                        an outside, unrelated party for the actual 
                        design, construction, renovation, lease, or 
                        demolition for a hospital, and has expended at 
                        least 10 percent of the estimated cost of the 
                        project (or, if less, $1,000,000); or
                            ``(iii) obtained a certificate of need in a 
                        State where one is required.''.

SEC. 3. MODIFYING STARK REQUIREMENTS FOR APPLICABLE HOSPITALS TO 
              QUALIFY FOR EXPANSION OF FACILITY CAPACITY.

    Section 1877(i)(3) of the Social Security Act (42 U.S.C. 
1395nn(i)(3)) is amended--
            (1) by striking subparagraphs (A), (E), (F), (H), and (I);
            (2) by amending subparagraph (B) to read as follows:
                    ``(B) Limitation on frequency of increases.--A 
                hospital may not effect an increase described in 
                subparagraph (C) more often than once every 2 years.'';
            (3) in subparagraphs (C) and (D), by striking ``an 
        applicable hospital'' and ``the applicable hospital'' and 
        inserting ``a hospital'' and ``the hospital'', respectively, 
        each place it appears;
            (4) in subparagraph (C)(i)--
                    (A) by striking ``granted an exception under the 
                process described in subparagraph (A)'';
                    (B) by striking ``has been granted a previous 
                exception under this paragraph'' and inserting ``has 
                had a previous increase under this subsection''; and
                    (C) by striking ``such an exception'' and inserting 
                ``this paragraph''; and
            (5) in subparagraph (C)(ii), by striking ``The Secretary 
        shall not permit an increase in'' and inserting ``A hospital 
        may not increase''.

SEC. 4. ADDITIONAL EXCEPTION FOR PHYSICIAN OWNERSHIP AND INVESTMENT FOR 
              HOSPITALS IN FINANCIAL DISTRESS.

    Section 1877(i) of the Social Security Act (42 U.S.C. 1395nn(i)) is 
amended--
            (1) in paragraph (1)(A), as amended by section 2(1), by 
        inserting after clause (i) the following new clause:
                            ``(ii) had a provider agreement under 
                        section 1866 in effect December 31, 2010, as of 
                        such date did not have physician ownership or 
                        investment, but after such date is determined 
                        to be in financial distress (as defined in 
                        paragraph (7)(B)).'';
            (2) in paragraph (1)(D)(i), by inserting before the period 
        at the end the following: ``, except that such percentage 
        limitation shall not apply to a hospital determined to be in 
        financial distress (as defined in paragraph (7)(B))''; and
            (3) in paragraph (7), as added by section 2(5), by adding 
        at the end the following new paragraph:
                    ``(B) Financial distress.--A hospital shall be 
                treated as being `in financial distress' for a cost 
                reporting period if the Secretary determines that the 
                hospital has had an overall negative combined Medicare 
                inpatient prospective payment system and outpatient 
                prospective payment system operating margin for the 
                most recent 3 consecutive cost reporting periods for 
                which data are available. Once the Secretary makes a 
                determination that a hospital has such a negative 
                operating margin for a cost reporting period, the 
                Secretary may not reverse such determination for such 
                period. A hospital that is treated as being in 
                financial distress under this subparagraph for a cost 
                reporting period shall continue to be so treated for 
                all subsequent cost reporting periods as being in 
                financial distress without regard to changes in the 
                hospital's operating margin.''.