Expanding Patients' Access to Quality Care Act of 2013

To amend section 1877 of the Social Security Act to modify the requirements for hospitals to qualify for the rural provider and hospital exception to physician ownership or investment prohibition in order to take into account hospitals that were under construction or development at the time of imposing such requirements, hospital expansions, and hospitals in financial distress, and for other purposes. 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. 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) (1) in paragraph (1)(A)— (A) in the matter preceding clause (i), by striking had (B) in clause (i), by striking ; and , 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 (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, 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, (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 (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. . 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) (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 the applicable hospital a hospital the hospital (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 has had a previous increase under this subsection (C) by striking such an exception this paragraph (5) in subparagraph (C)(ii), by striking The Secretary shall not permit an increase in A hospital may not increase 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) (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)) (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 .

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 "financial distress" 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.