I 
114TH CONGRESS 
1ST SESSION H. R. 2513 
To amend title XVIII of the Social Security Act with respect to the treatment 
of hospitals under the Medicare program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 21, 2015 
Mr. SAM JOHNSON of Texas (for himself and Mr. HINOJOSA) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend title XVIII of the Social Security Act with respect 
to the treatment of hospitals under the Medicare pro-
gram, 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. 
This Act may be cited as the ‘‘Promoting Access, 
Competition, and Equity Act of 2015’’ or as the ‘‘PACE 
Act of 2015’’. 
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SEC. 2. CONFIRMING METHODOLOGY FOR HOSPITAL STAR 
RATING SYSTEM THROUGH HOSPITAL COM-
PARE. 
Section 1886(b)(3)(B)(viii) of the Social Security Act 
(42 U.S.C. 1395ww(b)(3)(B)(viii)) is amended by adding 
at the end the following new subclause: 
‘‘(XII) In order to ensure consistent longitudinal 
comparisons among calendar quarters that began before 
October 1, 2019, the Secretary shall use the same method-
ology 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.’’. 
SEC. 3. REVISED CRITERIA FOR APPLICATION AND EXCEP-
TIONS TO MORATORIUM ON EXPANSION AND 
CONSTRUCTION OF PHYSICIAN-OWNED HOS-
PITALS. 
(a) TEMPORARY SUSPENSION
OF LIMITATION
ON 
HOSPITALS THAT CAN APPLY FOR FACILITY EXPAN-
SIONS.—Section 1877(i)(3) of the Social Security Act (42 
U.S.C. 1395nn(i)(3)) is amended— 
(1) in subparagraph (E), by adding at the end, 
after clause (v), the following: 
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‘‘With respect to applications filed under this 
paragraph during the period beginning on the 
date of the enactment of this sentence and end-
ing on September 30, 2019, such term includes 
any hospital (other than a high Medicaid facil-
ity).’’; 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 appli-
cations filed before October 1, 2019’’. 
(b) APPLICATION OF HOSPITAL EXPANSION EXCEP-
TION TO HOSPITALS WITH CONSISTENTLY HIGH QUAL-
ITY RATINGS.—Section 1877(i)(3) of the Social Security 
Act (42 U.S.C. 1395nn(i)(3)) is amended— 
(1) in subparagraph (A)(i), by striking ‘‘or is a 
high Medicaid facility described in subparagraph 
(F)’’ and inserting ‘‘, is a high Medicaid facility de-
scribed in subparagraph (F), or is a hospital with a 
consistently high quality rating (as defined in sub-
paragraph (H))’’; 
(2) in subparagraph (E), by adding at the end, 
after the matter added by subsection (a)(1), the fol-
lowing: 
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‘‘Such term includes, with respect to subpara-
graphs (B) through (D), a hospital with a con-
sistently high quality rating.’’; and 
(3) by adding at the end, as amended by sub-
section (d), the following new subparagraph: 
‘‘(H) HOSPITAL
WITH
A
CONSISTENTLY 
HIGH
QUALITY
RATING
DEFINED.—In this 
paragraph, the term ‘hospital with a consist-
ently high quality rating’, with respect to a cal-
endar quarter (beginning on or after October 1, 
2019), means a hospital that has had a rating 
of 3 stars or higher under the hospital star rat-
ing system posted on the Internet website main-
tained 
by 
the 
Secretary 
under 
section 
1886(b)(3)(B)(viii)(VII) for each of the 12 cal-
endar quarters before the calendar quarter in-
volved.’’. 
(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) is amended— 
(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 
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development as of March 23, 2010’ means a 
hospital that— 
‘‘(i) has a binding written agreement 
with an outside, unrelated party for the ac-
tual 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 esti-
mated cost of the project (or, if less, 
$2,500,000); or 
‘‘(ii) has obtained an approved certifi-
cate of need in a State where one is re-
quired on or before March 23, 2010. 
Such term includes, with respect to such a hos-
pital, any facility expansion of the hospital that 
is completed before the under development ef-
fective date. 
‘‘(B) UNDER
DEVELOPMENT
EFFECTIVE 
DATE.—The term ‘under development effective 
date’ means the date that is 6 months after the 
date of the enactment of this paragraph.’’. 
(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)) is amended— 
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(1) in subparagraph (A), by striking clauses (ii) 
through (iv) and inserting the following: 
‘‘(ii) DEEMED RECEIPT OF COMPLETE 
APPLICATION AND APPROVAL OF APPLICA-
TION.—Unless the Secretary otherwise de-
termines, an application submitted under 
this subparagraph shall be deemed com-
plete as of the date that is 30 days after 
the date the Secretary receives the com-
plete application. Not later than 60 days 
after the receipt of such a complete appli-
cation, the Secretary shall publish a notice 
of the receipt of the application and a de-
scription 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 pro-
vided, the amendments made by this section shall take ef-
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fect on the date of the enactment of this Act and shall 
apply to applications made after the date of the enactment 
of this Act. 
SEC. 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), as added amended by section 
414(1)(B)(iii) of the Medicare Access and CHIP Reau-
thorization Act of 2015 (Public Law 114–10), is amended 
by inserting before the period at the end the following: 
‘‘, 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 owner-
ship or investment interest in the hospital (as determined 
under rules established by the Secretary)’’. 
(b) EXTENSION OF REDUCTIONS IN MARKET BAS-
KET INCREASES.—Section 1886(b)(3)(B)(xii) of the So-
cial Security Act (42 U.S.C. 1395ww(b)(3)(B)(xii)) is 
amended— 
(1) by striking ‘‘and’’ at the end of subclause 
(IV); 
(2) by striking the period at the end of sub-
clause (V) and inserting ‘‘; and’’; and 
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(3) by inserting after subclause (V) the fol-
lowing new subclause: 
‘‘(VI) for each of fiscal years 2020 through 
2025, by 0.75 percentage point, but only with re-
spect to a hospital and fiscal year for which the Sec-
retary 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 Sec-
retary).’’. 
Æ 
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