I 

114TH CONGRESS 

2D SESSION H. R. 4553 

To amend title XVIII of the Social Security Act to clarify reasonable costs 

for critical access hospital payments under the Medicare program, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 12, 2016 

Mr. HARPER (for himself, Mr. LOEBSACK, Mr. PETERSON, Mr. PALAZZO, Mr. 

KELLY of Mississippi, and Mr. THOMPSON of Mississippi) introduced the 

following bill; which was referred to the Committee on Ways and Means, 

and in addition to the Committee on Energy and Commerce, for a period 

to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee 

concerned 

A BILL 

To amend title XVIII of the Social Security Act to clarify 

reasonable costs for critical access hospital payments 

under the Medicare program, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Critical Access and 

5 Rural Equity Act of 2016’’ or the ‘‘CARE Act of 2016’’. 


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1 SEC. 2. CLARIFYING REASONABLE COSTS FOR CRITICAL 

2 ACCESS HOSPITAL MEDICARE PAYMENTS. 

3 (a) INCLUSION OF CERTAIN COSTS AS REASONABLE

4 COSTS.— 

5 (1) INPATIENT CRITICAL ACCESS HOSPITAL

6 SERVICES.—Section 1814(l) of the Social Security 

7 Act (42 U.S.C. 1395f(l)) is amended by adding at 

8 the end the following new paragraph: 

9 ‘‘(6) In determining payment and reasonable 

10 costs under paragraph (1) for inpatient critical ac11 cess services, the Secretary shall recognize as allow12 able costs of the critical access hospital at least the 

13 following: 

14 ‘‘(A) Costs of services that would be con15 sidered bona fide emergency services (as defined 

16 in section 1861(v)(1)(K)(ii)) if provided in a 

17 hospital emergency room, including professional 

18 services and any associated surgical on-call and 

19 standby costs. 

20 ‘‘(B) Costs of a test or procedure per21 formed at a critical access hospital or an entity 

22 owned by the critical access hospital, including 

23 a clinical diagnostic laboratory test, mammo24 gram (as defined in section 354(a)(5) of the 

25 Public Health Service Act), colonoscopy, cardiac 


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1 stress test, pulmonary function test, echocardio2 gram, and bone density study. 

3 ‘‘(C) Standby and on-call costs for certified 

4 registered nurse anesthetist services, regardless 

5 of the number of surgical procedures requiring 

6 anesthesia services and regardless of the num7 ber of full-time equivalent physicians. 

8 ‘‘(D) Costs of services provided by the crit9 ical access hospital or satellite facility of the 

10 critical access hospital that improve the total 

11 health of communities, including immunization 

12 programs, health clinics, and medical homes. 

13 ‘‘(E) Costs of services provided by an off14 campus provider-based clinic described in sec15 tion 1820(c)(2)(F) of the critical access hos16 pital, regardless of distance of such clinic from 

17 a hospital or another critical access hospital.’’. 

18 (2) OUTPATIENT CRITICAL ACCESS HOSPITAL

19 SERVICES.—Section 1834(g) of the Social Security 

20 Act (42 U.S.C. 1395m(g)) is amended by adding at 

21 the end the following new paragraph: 

22 ‘‘(6) COVERAGE OF CERTAIN ADDITIONAL

23 COSTS AS REASONABLE COSTS.—In determining the 

24 reasonable costs of outpatient critical access hospital 

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1 retary shall recognize as allowable the costs de2 scribed in paragraph (6) of section 1814(l).’’. 

3 (3) CONFORMING AMENDMENT.—Section 

4 1861(v)(7) of the Social Security Act (42 U.S.C. 

5 1395x(v)(7)) is amended by adding at the end the 

6 following new subparagraph: 

7 ‘‘(E) For provisions further describing costs 

8 recognized as reasonable costs for inpatient and out9 patient critical access hospital services, see sections 

10 1814(l)(6) and 1834(g)(6).’’. 

11 (b) TREATMENT OF PROVIDER-BASED CLINICS OF

12 CRITICAL ACCESS HOSPITALS.—Section 1820(c)(2) of the 

13 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is amend14 ed— 

15 (1) in subparagraph (B)(i)(I), by striking ‘‘is 

16 located’’ and inserting ‘‘subject to subparagraph 

17 (E), is located’’; and 

18 (2) by adding at the end the following new sub19 paragraph: 

20 ‘‘(F) TREATMENT OF OFF-CAMPUS

21 PROVIDER-BASED CLINICS.—Subparagraph 

22 (B)(i)(I) shall not apply to an off-campus 

23 provider-based clinic (as described in section 

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1 ulations) of a facility designated as a critical 

2 access hospital.’’. 

3 (c) ALLOWING COORDINATION FOR PROVISION OF

4 EMERGENCY SERVICES.—Section 1820(c)(2) of the Social 

5 Security Act (42 U.S.C. 1395i–4(c)(2)), as amended by 

6 subsection (b), is further amended— 

7 (1) in subparagraph (B)(ii), by striking 

8 ‘‘makes’’ and inserting ‘‘subject to subparagraph 

9 (G), makes’’; and 

10 (2) by adding at the end the following new sub11 paragraph: 

12 ‘‘(G) ALLOWING COORDINATION FOR PRO13 VISION OF EMERGENCY SERVICES.—The Sec14 retary may waive the requirements under sub15 paragraph (B)(ii), with respect to a facility, if 

16 such facility— 

17 ‘‘(i) is located not more than 15 miles 

18 of another facility or hospital that has an 

19 emergency department that satisfies the 

20 requirement of subparagraph (B)(ii); and 

21 ‘‘(ii) coordinates with such other facil22 ity or hospital with respect to furnishing 

23 24-hour emergency care services described 

24 in such subparagraph to the area served by 

25 such facility.’’. 


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1 (d) TREATMENT OF MEDICAID PROVIDER TAXES

2 FOR CRITICAL ACCESS HOSPITAL REASONABLE COSTS.— 

3 (1) INPATIENT CRITICAL ACCESS HOSPITAL

4 SERVICES.—Section 1814(l) of the Social Security 

5 Act (42 U.S.C. 1395f(l)), as amended by subsection 

6 (a)(1), is further amended by adding at the end the 

7 following new paragraph: 

8 ‘‘(7)(A) In determining payment and reasonable 

9 costs under paragraph (1) for inpatient critical ac10 cess services— 

11 ‘‘(i) with respect to a current permissible 

12 health care related tax imposed and paid by the 

13 critical access hospital for a cost reporting pe14 riod beginning before the date of enactment of 

15 this paragraph, the Secretary shall not, through 

16 recoupment or otherwise, disallow payment to 

17 the critical access hospital under this subsection 

18 on the basis that payments to the critical access 

19 hospital under this subsection offset some or all 

20 of the costs of such tax; and 

21 ‘‘(ii) with respect to a current permissible 

22 health care related tax imposed and paid by the 

23 critical access hospital for a cost reporting pe24 riod beginning on or after the date of enact25 ment of this paragraph, the Secretary shall— 


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1 ‘‘(I) assess the percentage of individ2 uals entitled to benefits under this part 

3 who are furnished inpatient critical access 

4 hospital services at such critical access 

5 hospital during such cost reporting period 

6 and who are also receiving medical assist7 ance under the Medicaid program under 

8 title XIX during such period; and 

9 ‘‘(II) adjust payments under this sub10 section with respect to such services fur11 nished during such period in a manner 

12 specified by the Secretary based on such 

13 percentage to take into account such tax. 

14 ‘‘(B) For purposes of this paragraph and sec15 tion 1834(g)(7), the term ‘current permissible health 

16 care related tax’ means a broad-based health care 

17 related tax (as defined in paragraph (3)(B) of such 

18 section) that is in effect prior to enactment of this 

19 paragraph and for which there is not in effect a hold 

20 harmless provision described in paragraph (4) of 

21 such section.’’. 

22 (2) OUTPATIENT CRITICAL ACCESS HOSPITAL

23 SERVICES.—Section 1834(g) of the Social Security 

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1 section (a)(2), is further amended by adding at the 

2 end the following new paragraph: 

3 ‘‘(7) TREATMENT OF MEDICAID PROVIDER

4 TAXES.—In determining payment for outpatient crit5 ical access hospital services under paragraphs (1) 

6 and (2), the provisions of paragraph (7) of section 

7 1814(l) shall apply to payment for such services 

8 under this subsection in the same manner as such 

9 provisions apply to payment for inpatient critical ac10 cess hospital services under section 1814(l), except 

11 that in applying subparagraph (B) of such para12 graph (7), the reference to ‘individuals entitled to 

13 benefits under this part’ shall be deemed a reference 

14 to ‘individuals enrolled under part B’.’’. 

Æ 


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