I 
113TH CONGRESS 
1ST SESSION H. R. 2027 
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. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 16, 2013 
Mr. SAM JOHNSON of Texas (for himself, Mr. HINOJOSA, Mr. CARSON of Indi-
ana, Ms. JACKSON LEE, Ms. JENKINS, Mr. MARCHANT, Mr. YOUNG of 
Indiana, Mr. BURGESS, and Mr. YODER) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
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 ex-
pansions, and hospitals in financial distress, and for 
other purposes. 
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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 
‘‘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 ex-
pansion of facility capacity. 
Sec. 4. Additional exception for physician ownership and investment for hos-
pitals in financial distress. 
SEC. 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)) is amended— 
(1) in paragraph (1)(A)— 
(A) in the matter preceding clause (i), by 
striking ‘‘had’’; 
(B) in clause (i), by striking ‘‘; and’’ and 
inserting the following: ‘‘, and had a provider 
agreement under section 1866 in effect on such 
date or was under construction or was under 
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development (as defined in paragraph (7)(A)) 
on such date; or’’; and 
(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 De-
cember 31, 2010, no greater than the number of op-
erating 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 hos-
pital 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,’’ the following: ‘‘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,’’; and 
(5) by adding at the end the following new 
paragraph: 
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‘‘(7) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) UNDER DEVELOPMENT.—A hospital 
shall be treated as being ‘under development’ 
on December 31, 2010, if on or before such 
date the hospital— 
‘‘(i) submitted its enrollment applica-
tion for a Medicare provider agreement; 
‘‘(ii) had a binding written agreement 
with an outside, unrelated party for the ac-
tual design, construction, renovation, lease, 
or demolition for a hospital, and has ex-
pended 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.’’. 
SEC. 3. MODIFYING STARK REQUIREMENTS FOR APPLICA-
BLE HOSPITALS TO QUALIFY FOR EXPANSION 
OF FACILITY CAPACITY. 
Section 1877(i)(3) of the Social Security Act (42 
U.S.C. 1395nn(i)(3)) is amended— 
(1) by striking subparagraphs (A), (E), (F), 
(H), and (I); 
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(2) by amending subparagraph (B) to read as 
follows: 
‘‘(B) LIMITATION ON FREQUENCY OF IN-
CREASES.—A hospital may not effect an in-
crease described in subparagraph (C) more 
often than once every 2 years.’’; 
(3) in subparagraphs (C) and (D), by striking 
‘‘an applicable hospital’’ and ‘‘the applicable hos-
pital’’ and inserting ‘‘a hospital’’ and ‘‘the hospital’’, 
respectively, each place it appears; 
(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 pre-
vious exception under this paragraph’’ and in-
serting ‘‘has had a previous increase under this 
subsection’’; and 
(C) by striking ‘‘such an exception’’ and 
inserting ‘‘this paragraph’’; and 
(5) in subparagraph (C)(ii), by striking ‘‘The 
Secretary shall not permit an increase in’’ and in-
serting ‘‘A hospital may not increase’’. 
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SEC. 4. ADDITIONAL EXCEPTION FOR PHYSICIAN OWNER-
SHIP AND INVESTMENT FOR HOSPITALS IN 
FINANCIAL DISTRESS. 
Section 1877(i) of the Social Security Act (42 U.S.C. 
1395nn(i)) is amended— 
(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 dis-
tress (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 hos-
pital determined to be in financial distress (as de-
fined in paragraph (7)(B))’’; and 
(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’ 
for a cost reporting period if the Secretary de-
termines that the hospital has had an overall 
negative combined Medicare inpatient prospec-
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tive payment system and outpatient prospective 
payment system operating margin for the most 
recent 3 consecutive cost reporting periods for 
which data are available. Once the Secretary 
makes a determination that a hospital has such 
a negative operating margin for a cost reporting 
period, the Secretary may not reverse such de-
termination for such period. A hospital that is 
treated as being in financial distress under this 
subparagraph for a cost reporting period shall 
continue to be so treated for all subsequent cost 
reporting periods as being in financial distress 
without regard to changes in the hospital’s op-
erating margin.’’. 
Æ 
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