CARE Act of 2016

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. Short title This Act may be cited as the Critical Access and Rural Equity Act of 2016 CARE Act of 2016 2. Clarifying reasonable costs for critical access hospital Medicare payments (a) Inclusion of certain costs as reasonable costs (1) Inpatient critical access hospital services Section 1814(l) of the Social Security Act ( 42 U.S.C. 1395f(l) (6) In determining payment and reasonable costs under paragraph (1) for inpatient critical access services, the Secretary shall recognize as allowable costs of the critical access hospital at least the following: (A) Costs of services that would be considered bona fide emergency services (as defined in section 1861(v)(1)(K)(ii)) if provided in a hospital emergency room, including professional services and any associated surgical on-call and standby costs. (B) Costs of a test or procedure performed at a critical access hospital or an entity owned by the critical access hospital, including a clinical diagnostic laboratory test, mammogram (as defined in section 354(a)(5) of the Public Health Service Act), colonoscopy, cardiac stress test, pulmonary function test, echocardiogram, and bone density study. (C) Standby and on-call costs for certified registered nurse anesthetist services, regardless of the number of surgical procedures requiring anesthesia services and regardless of the number of full-time equivalent physicians. (D) Costs of services provided by the critical access hospital or satellite facility of the critical access hospital that improve the total health of communities, including immunization programs, health clinics, and medical homes. (E) Costs of services provided by an off-campus provider-based clinic described in section 1820(c)(2)(F) of the critical access hospital, regardless of distance of such clinic from a hospital or another critical access hospital. . (2) Outpatient critical access hospital services Section 1834(g) of the Social Security Act ( 42 U.S.C. 1395m(g) (6) Coverage of certain additional costs as reasonable costs In determining the reasonable costs of outpatient critical access hospital services under paragraphs (1) and (2)(A), the Secretary shall recognize as allowable the costs described in paragraph (6) of section 1814(l). . (3) Conforming amendment Section 1861(v)(7) of the Social Security Act ( 42 U.S.C. 1395x(v)(7) (E) For provisions further describing costs recognized as reasonable costs for inpatient and outpatient critical access hospital services, see sections 1814(l)(6) and 1834(g)(6). . (b) Treatment of provider-Based clinics of critical access hospitals Section 1820(c)(2) of the Social Security Act ( 42 U.S.C. 1395i–4(c)(2) (1) in subparagraph (B)(i)(I), by striking is located subject to subparagraph (E), is located (2) by adding at the end the following new subparagraph: (F) Treatment of off-campus pro­vider-based clinics Subparagraph (B)(i)(I) shall not apply to an off-campus provider-based clinic (as described in section 485.610 of title 45 of the Code of Federal Regulations) of a facility designated as a critical access hospital. . (c) Allowing coordination for provision of emergency services Section 1820(c)(2) of the Social Security Act ( 42 U.S.C. 1395i–4(c)(2) (1) in subparagraph (B)(ii), by striking makes subject to subparagraph (G), makes (2) by adding at the end the following new subparagraph: (G) Allowing coordination for provision of emergency services The Secretary may waive the requirements under subparagraph (B)(ii), with respect to a facility, if such facility— (i) is located not more than 15 miles of another facility or hospital that has an emergency department that satisfies the requirement of subparagraph (B)(ii); and (ii) coordinates with such other facility or hospital with respect to furnishing 24-hour emergency care services described in such subparagraph to the area served by such facility. . (d) Treatment of Medicaid provider taxes for critical access hospital reasonable costs (1) Inpatient critical access hospital services Section 1814(l) of the Social Security Act ( 42 U.S.C. 1395f(l) (7) (A) In determining payment and reasonable costs under paragraph (1) for inpatient critical access services— (i) with respect to a current permissible health care related tax imposed and paid by the critical access hospital for a cost reporting period beginning before the date of enactment of this paragraph, the Secretary shall not, through recoupment or otherwise, disallow payment to the critical access hospital under this subsection on the basis that payments to the critical access hospital under this subsection offset some or all of the costs of such tax; and (ii) with respect to a current permissible health care related tax imposed and paid by the critical access hospital for a cost reporting period beginning on or after the date of enactment of this paragraph, the Secretary shall— (I) assess the percentage of individuals entitled to benefits under this part who are furnished inpatient critical access hospital services at such critical access hospital during such cost reporting period and who are also receiving medical assistance under the Medicaid program under title XIX during such period; and (II) adjust payments under this subsection with respect to such services furnished during such period in a manner specified by the Secretary based on such percentage to take into account such tax. (B) For purposes of this paragraph and section 1834(g)(7), the term current permissible health care related tax . (2) Outpatient critical access hospital services Section 1834(g) of the Social Security Act ( 42 U.S.C. 1395m(g) (7) Treatment of Medicaid provider taxes In determining payment for outpatient critical access hospital services under paragraphs (1) and (2), the provisions of paragraph (7) of section 1814(l) shall apply to payment for such services under this subsection in the same manner as such provisions apply to payment for inpatient critical access hospital services under section 1814(l), except that in applying subparagraph (B) of such paragraph (7), the reference to individuals entitled to benefits under this part individuals enrolled under part B .

Summary: Critical Access and Rural Equity Act of 2016 or the CARE Act of 2016 This bill amends title XVIII (Medicare) of the Social Security Act to specify that, for purposes of determining Medicare payment and reasonable costs for both inpatient and outpatient critical access hospital (CAH) services, the Centers for Medicare & Medicaid Services (CMS) shall recognize as allowable costs those related to specified emergency, diagnostic, anesthetist, community health, and off-campus clinical services. Furthermore, in determining payment and reasonable costs for both inpatient and outpatient CAH services, CMS shall not disallow payment to a CAH on the basis that such payment offsets the cost of a current permissible health care-related tax imposed on and paid by the CAH. CMS must make specified payment adjustments to account for such a tax.  Generally, under current law, a facility must be located beyond a specified driving distance from another hospital or facility in order to be designated as a CAH. The bill specifies that this requirement does not apply with respect to a CAH's off-campus provider-based clinic. Current law further requires a facility to provide certain 24-hour emergency care services as a condition of designation as a CAH. The bill allows CMS to waive this requirement with respect to a facility that coordinates with a nearby facility or hospital that provides such services.