I 
116TH CONGRESS 
1ST SESSION H. R. 3416 
To provide for health equity and access for returning troops and 
servicemembers, to provide for ambulatory surgical payment transparency 
under the Medicare program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 21, 2019 
Ms. SEWELL of Alabama (for herself and Mr. SMITH of Nebraska) introduced 
the following bill; which was referred to the Committee on Energy and 
Commerce, and in addition to the Committees on Ways and Means, and 
Armed Services, for a period to be subsequently determined by the Speak-
er, in each case for consideration of such provisions as fall within the ju-
risdiction of the committee concerned 
A BILL 
To provide for health equity and access for returning troops 
and servicemembers, to provide for ambulatory surgical 
payment transparency under the Medicare program, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘HEARTS and Rural Relief Act’’. 
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(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Health Equity and Access for Returning Troops and Servicemembers 
and Rural Relief Act of 2019. 
Sec. 3. Ambulatory surgical center payment transparency. 
Sec. 4. Exclusion of complex rehabilitative manual wheelchairs from Medicare 
competitive acquisition program; non-application of Medicare 
fee schedule adjustments for certain wheelchair accessories and 
cushions. 
Sec. 5. Extension of enforcement instruction on supervision requirements for 
outpatient therapeutic services in critical access and small 
rural hospitals through 2021. 
SEC. 2. HEALTH EQUITY AND ACCESS FOR RETURNING 
TROOPS AND SERVICEMEMBERS AND RURAL 
RELIEF ACT OF 2019. 
(a) MODIFICATION OF REQUIREMENT FOR CERTAIN 
FORMER MEMBERS OF THE ARMED FORCES TO ENROLL 
IN MEDICARE PART B TO BE ELIGIBLE FOR TRICARE 
FOR LIFE.— 
(1) TRICARE ELIGIBILITY.— 
(A) IN GENERAL.—Subsection (d) of sec-
tion 1086 of title 10, United States Code, is 
amended by adding at the end the following 
new paragraph: 
‘‘(6)(A) The requirement in paragraph (2)(A) 
to enroll in the supplementary medical insurance 
program under part B of title XVIII of the Social 
Security Act (42 U.S.C. 1395j et seq.) shall not 
apply to a person described in subparagraph (B) 
during any month in which such person is not enti-
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tled to a benefit described in subparagraph (A) of 
section 226(b)(2) of the Social Security Act (42 
U.S.C. 426(b)(2)) if such person has received the 
counseling and information under subparagraph (C). 
‘‘(B) A person described in this subparagraph 
is a person— 
‘‘(i) who is under 65 years of age; 
‘‘(ii) who is entitled to hospital insurance 
benefits under part A of title XVIII of the So-
cial Security Act pursuant to subparagraph (A) 
or (C) of section 226(b)(2) of such Act (42 
U.S.C. 426(b)(2)); 
‘‘(iii) whose entitlement to a benefit de-
scribed in subparagraph (A) of such section has 
terminated due to performance of substantial 
gainful activity; and 
‘‘(iv) who is retired under chapter 61 of 
this title. 
‘‘(C) The Secretary of Defense shall coordinate 
with the Secretary of Health and Human Services 
and the Commissioner of Social Security to notify 
persons described in subparagraph (B) of, and pro-
vide information and counseling regarding, the ef-
fects of not enrolling in the supplementary medical 
insurance program under part B of title XVIII of 
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the Social Security Act (42 U.S.C. 1395j et seq.), as 
described in subparagraph (A).’’. 
(B) 
CONFORMING
AMENDMENT.—Para-
graph (2)(A) of such subsection is amended by 
striking ‘‘is enrolled’’ and inserting ‘‘except as 
provided by paragraph (6), is enrolled’’. 
(C) IDENTIFICATION
OF
PERSONS.—Sec-
tion 1110a of such title is amended by adding 
at the end the following new subsection: 
‘‘(c) CERTAIN INDIVIDUALS NOT REQUIRED TO EN-
ROLL IN MEDICARE PART B.—In carrying out subsection 
(a), the Secretary of Defense shall coordinate with the 
Secretary of Health and Human Services and the Commis-
sioner of Social Security to— 
‘‘(1) identify persons described in subparagraph 
(B) of section 1086(d)(6) of this title; and 
‘‘(2) provide information and counseling pursu-
ant to subparagraph (C) of such section.’’. 
(2) NON-APPLICATION OF MEDICARE PART B 
LATE ENROLLMENT PENALTY.—Section 1839(b) of 
the Social Security Act (42 U.S.C. 1395r(b)) is 
amended, in the second sentence, by inserting ‘‘or 
months for which the individual can demonstrate 
that the individual is an individual described in 
paragraph (6)(B) of section 1086(d) of title 10, 
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United States Code, who is enrolled in the 
TRICARE program pursuant to such section’’ after 
‘‘an individual described in section 1837(k)(3)’’. 
(3) REPORT.—Not later than October 1, 2024, 
the Secretary of Defense, the Secretary of Health 
and Human Services, and the Commissioner of So-
cial Security shall jointly submit to the Committees 
on Armed Services of the House of Representatives 
and the Senate, the Committee on Ways and Means 
and the Committee on Energy and Commerce of the 
House of Representatives, and the Committee on Fi-
nance of the Senate a report on the implementation 
of section 1086(d)(6) of title 10, United States 
Code, as added by paragraph (1). Such report shall 
include, with respect to the period covered by the re-
port— 
(A) the number of individuals enrolled in 
TRICARE for Life who are not enrolled in the 
supplementary 
medical 
insurance 
program 
under part B of title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395j et seq.) by reason of 
such section 1086(d)(6); and 
(B) the number of individuals who— 
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