PACE Act of 2015

To amend title XVIII of the Social Security Act with respect to the treatment of hospitals under the Medicare program, and for other purposes. 1. Short title This Act may be cited as the Promoting Access, Competition, and Equity Act of 2015 PACE Act of 2015 2. Confirming methodology for hospital star rating system through Hospital Compare Section 1886(b)(3)(B)(viii) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3)(B)(viii) (XII) In order to ensure consistent longitudinal comparisons among calendar quarters that began before October 1, 2019, the Secretary shall use the same methodology as is in effect as of April 16, 2015, for computation of the star rating for hospitals posted on the Internet website maintained by the Secretary under subclause (VII) for such calendar quarters. The Secretary may promulgate a regulation to change such methodology used with respect to the computation of such star rating for hospitals for calendar quarters beginning on or after October 1, 2019. . 3. Revised criteria for application and exceptions to moratorium on expansion and construction of physician-owned hospitals (a) Temporary suspension of limitation on hospitals that can apply for facility expansions Section 1877(i)(3) of the Social Security Act ( 42 U.S.C. 1395nn(i)(3) (1) in subparagraph (E), by adding at the end, after clause (v), the following: With respect to applications filed under this paragraph during the period beginning on the date of the enactment of this sentence and ending on September 30, 2019, such term includes any hospital (other than a high Medicaid facility). ; and (2) in subparagraph (B), by inserting before the period at the end the following: , except that such limitation shall not apply with respect to applications filed before October 1, 2019 (b) Application of hospital expansion exception to hospitals with consistently high quality ratings Section 1877(i)(3) of the Social Security Act ( 42 U.S.C. 1395nn(i)(3) (1) in subparagraph (A)(i), by striking or is a high Medicaid facility described in subparagraph (F) , is a high Medicaid facility described in subparagraph (F), or is a hospital with a consistently high quality rating (as defined in subparagraph (H)) (2) in subparagraph (E), by adding at the end, after the matter added by subsection (a)(1), the following: Such term includes, with respect to subparagraphs (B) through (D), a hospital with a consistently high quality rating. ; and (3) by adding at the end, as amended by subsection (d), the following new subparagraph: (H) Hospital with a consistently high quality rating defined In this paragraph, the term hospital with a consistently high quality rating . (c) Exception and special rules for certain hospitals under development as of March 23, 2010 Section 1877 of the Social Security Act ( 42 U.S.C. 1395nn (1) in subsection (d)(3)(D), by inserting before the period at the end the following: or, in the case of a hospital under development as of March 23, 2010 (as defined in paragraph (7)(A)), meets such requirements as of the under development effective date (as defined in subsection (i)(7)(B)) (2) in subsection (i)— (A) in paragraph (1), by adding at the end the following new subparagraph: (G) Special timing rule for hospitals under development as of March 23, 2010 In applying this paragraph to a hospital under development as of March 23, 2010 (as defined in paragraph (7)(A)), any reference in this paragraph to the date of enactment of this subsection or to December 31, 2010, shall be deemed to be a reference to May 1, 2015. ; (B) in paragraph (3)(C)(iii), by striking provider agreement). provider agreement, or, in the case of a hospital under development as of March 23, 2010 (as defined in paragraph (7)(A)), May 1, 2015). (C) by adding at the end the following new paragraph: (7) Definitions relating to certain hospitals under development In this subsection: (A) Hospital under development as of March 23, 2010 The term hospital under development as of March 23, 2010 (i) has a binding written agreement with an outside, unrelated party for the actual construction, renovation, lease, or demolition for a hospital under section 1886(d), and has expended, before March 23, 2010, at least 10 percent of the estimated cost of the project (or, if less, $2,500,000); or (ii) has obtained an approved certificate of need in a State where one is required on or before March 23, 2010. Such term includes, with respect to such a hospital, any facility expansion of the hospital that is completed before the under development effective date. (B) Under development effective date The term under development effective date . (d) Change in processing of applications and elimination of appeals limitation Section 1877(i)(3) of the Social Security Act ( 42 U.S.C. 1305nn(i)(3) (1) in subparagraph (A), by striking clauses (ii) through (iv) and inserting the following: (ii) Deemed receipt of complete application and approval of application Unless the Secretary otherwise determines, an application submitted under this subparagraph shall be deemed complete as of the date that is 30 days after the date the Secretary receives the complete application. Not later than 60 days after the receipt of such a complete application, the Secretary shall publish a notice of the receipt of the application and a description of the expansion planned in the application. A complete application shall be deemed approved by the Secretary as of the end of the 60-day period beginning on the date of the Secretary’s receipt of the application unless the Secretary provides the applicant with a notice of disapproval of the application before the end of such period. ; and (2) by striking subparagraphs (H) and (I). (e) Effective date Except as otherwise provided, the amendments made by this section shall take effect on the date of the enactment of this Act and shall apply to applications made after the date of the enactment of this Act. 4. Savings from physician-owned hospitals (a) Documentation and coding adjustments not applicable Section 7(b)(1)(B)(iii) of the TMA, Abstinence Education, and QI Programs Extension Act of 2007 ( Public Law 110–90 Public Law 114–10 , except that this clause shall not apply in the case of a hospital that , except that this clause shall not apply in the case of a hospital in which physicians (or immediate family members of physicians) have a substantial ownership or investment interest in the hospital (as determined under rules established by the Secretary) (b) Extension of reductions in market basket increases Section 1886(b)(3)(B)(xii) of the Social Security Act ( 42 U.S.C. 1395ww(b)(3)(B)(xii) (1) by striking and (2) by striking the period at the end of subclause (V) and inserting ; and (3) by inserting after subclause (V) the following new subclause: (VI) for each of fiscal years 2020 through 2025, by 0.75 percentage point, but only with respect to a hospital and fiscal year for which the Secretary determines that physicians (or immediate family members of physicians) have a substantial ownership or investment interest in the hospital (as determined under rules established by the Secretary). .

Summary: Promoting Access, Competition, and Equity Act of 2015 or the PACE Act of 2015 This bill amends title XVIII (Medicare) of the Social Security Act to ease application criteria and procedures for physician-owned hospitals to expand their facilities. Under current law, expansion of physician-owned hospitals is subject to certain limitations, such as those regarding the extent and frequency of expansion and requiring community output. The bill suspends these limitations with respect to applications for expansion filed before October 1, 2019. Following the end of this suspension period, hospitals with consistently high quality ratings are included among those hospitals that may apply to expand their facilities. The Centers for Medicare & Medicaid Services may not alter the methodology for computing a hospital's quality rating before October 1, 2019. With respect to hospitals under development as of March 23, 2010, the bill extends to May 1, 2015, the date by which a hospital may qualify for an exception to the ownership or investment prohibition on physician self-referrals. The bill also: (1) exempts physician-owned hospitals from specified documentation and coding adjustments, and (2) extends reductions in certain inflationary increases associated with Medicare payments for inpatient hospital services.