I 

113TH CONGRESS 

2D SESSION H. R. 5098 

To amend the Internal Revenue Code of 1986 to temporarily exempt from 

the employer health insurance mandate certain Medicare and Medicaid 

providers. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 14, 2014 

Mr. DAINES introduced the following bill; which was referred to the 

Committee on Ways and Means 

A BILL 

To amend the Internal Revenue Code of 1986 to temporarily 

exempt from the employer health insurance mandate certain Medicare and Medicaid providers. 

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 ‘‘Ensuring Medicaid and 

5 Medicare Access to Providers Act’’. 


smartinez on DSK4TPTVN1PROD with BILLS
2 

•HR 5098 IH

1 SEC. 2. CERTAIN MEDICARE AND MEDICAID PROVIDERS 

2 TEMPORARILY EXEMPT FROM EMPLOYER 

3 HEALTH INSURANCE MANDATE. 

4 (a) IN GENERAL.—Section 4980H(c)(2) of the Inter5 nal Revenue Code of 1986 is amended by adding at the 

6 end the following new subparagraph: 

7 ‘‘(F) EXCEPTION FOR CERTAIN MEDICARE

8 AND MEDICAID PROVIDERS.— 

9 ‘‘(i) IN GENERAL.—In the case of any 

10 month beginning in 2014 or 2015, the 

11 term ‘applicable large employer’ shall not 

12 include any employer who is a specified 

13 Medicare and Medicaid provider with re14 spect to the calendar year in which such 

15 month begins. 

16 ‘‘(ii) SPECIFIED MEDICARE AND MED17 ICAID PROVIDER.—The term ‘specified 

18 Medicare and Medicaid provider’ means, 

19 with respect to any calendar year, any em20 ployer if the total specified Medicare and 

21 Medicaid payments received by such em22 ployer during the applicable period equals 

23 or exceeds 60 percent of the total gross re24 ceipts of such employer for such period. 


smartinez on DSK4TPTVN1PROD with BILLS
3 

•HR 5098 IH

1 ‘‘(iii) SPECIFIED MEDICARE AND MED2 ICAID PAYMENTS.—The term ‘specified 

3 Medicare and Medicaid payments’ means— 

4 ‘‘(I) any payment made to the 

5 employer under title XIX of the Social 

6 Security Act for the furnishing of 

7 items and services included as medical 

8 assistance (as defined in section 

9 1905(a) of the Social Security Act (42 

10 U.S.C. 1396d(a))) under such title, 

11 and 

12 ‘‘(II) any payment made to the 

13 employer under title XVIII of such 

14 Act for the furnishing of items and 

15 services to individuals entitled to ben16 efits under part A of such title or en17 rolled under part B of such title, in18 cluding dual eligible individuals (as 

19 defined in section 1915(h)(2)(B) of 

20 such Act (42 U.S.C. 

21 1396n(h)(2)(B))). 

22 ‘‘(iv) TREATMENT OF PAYMENT FOR

23 ITEMS AND SERVICES FURNISHED

24 THROUGH A HEALTH PLAN.—In applying 

25 clause (iii) with respect to the payment for 


smartinez on DSK4TPTVN1PROD with BILLS
4 

•HR 5098 IH

1 items and services furnished to individuals 

2 enrolled in a health plan under a contract 

3 under title XVIII or XIX of the Social Se4 curity Act, payment for such items and 

5 services under such plan shall be treated 

6 as payment under such respective title. 

7 ‘‘(v) APPLICABLE PERIOD.— 

8 ‘‘(I) IN GENERAL.—For purposes 

9 of this subparagraph, the term ‘appli10 cable period’ means, with respect to 

11 any calendar year, the 3 taxable years 

12 ending before the beginning of such 

13 calendar year. 

14 ‘‘(II) APPLICATION OF CERTAIN

15 RULES.—Rules similar to the rules of 

16 subparagraphs (A), (C), and (D) of 

17 section 448(c)(3) shall apply for pur18 poses of this clause. 

19 ‘‘(III) SPECIAL RULE FOR FIRST

20 TAXABLE YEAR OF EXISTENCE.—In 

21 the case of an employer no taxable 

22 year of which ends before the begin23 ning of the calendar year, the applica24 ble period for such calendar year shall 

25 be the period beginning on the date 


smartinez on DSK4TPTVN1PROD with BILLS
5 

•HR 5098 IH

1 that such employer came into exist2 ence and ending with the close of such 

3 calendar year.’’. 

4 (b) EFFECTIVE DATE.—The amendment made by 

5 this section shall apply to months beginning after Decem6 ber 31, 2013. 

Æ 


smartinez on DSK4TPTVN1PROD with BILLS