I 
119TH CONGRESS 
1ST SESSION H. R. 3222 
To amend title XVIII of the Social Security Act to improve risk adjustment 
under Medicare Advantage, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 6, 2025 
Mrs. SPARTZ introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently 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 title XVIII of the Social Security Act to improve 
risk adjustment under Medicare Advantage, 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 ‘‘Stopping Medicare 
Abuses to Restore Trust in Health Care Act’’ or the 
‘‘SMART Health Care Act’’. 
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SEC. 2. IMPROVING RISK ADJUSTMENT UNDER MEDICARE 
ADVANTAGE. 
Section 1853(a)(3)(C)(iii) of the Social Security Act 
(42 U.S.C. 1395w–23(a)(3)(C)(iii)) is amended— 
(1) by striking ‘‘METHODOLOGY.—Such risk’’ 
and inserting ‘‘METHODOLOGY.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), such risk’’; and 
(2) by adding at the end the following new sub-
clauses: 
‘‘(II) USE
OF
HEALTH
STATUS 
DATA.—For 2026 and each subse-
quent year, the Secretary shall use 2 
years of diagnostic data (when avail-
able) under such risk adjustment 
methodology.’’. 
SEC. 3. PROMOTING MEDICARE SITE-NEUTRAL PAYMENTS. 
(a) IN GENERAL.—Section 1833(t)(21) of the Social 
Security Act (42 U.S.C. 1395l(t)(21)) is amended— 
(1) by redesignating subparagraph (E) as sub-
paragraph (F); and 
(2) by inserting after subparagraph (D) the fol-
lowing new subparagraphs: 
‘‘(E) SUNSET OF CERTAIN EXCEPTIONS.— 
The provisions of clauses (ii) and (iv) of sub-
paragraph (B) shall not apply with respect to 
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489.24(b) of title 42 of the Code of Federal 
Regulations). 
‘‘(B) ON-CAMPUS
OUTPATIENT
DEPART-
MENT OF A PROVIDER.— 
‘‘(i) IN
GENERAL.—On-campus out-
patient department of a provider— 
‘‘(I) on the campus (as defined in 
such section 413.65(a)(2) of title 42, 
Code of Federal Regulations) of such 
provider; or 
‘‘(II) within the distance (de-
scribed in such definition of campus) 
from a remote location of a hospital 
facility (as defined in such section 
413.65(a)(2) of title 42, Code of Fed-
eral Regulations). 
‘‘(ii) EXCEPTION FOR CERTAIN HOS-
PITALS LOCATED IN RURAL OR MEDICALLY 
UNDERSERVED
AREAS.—For purposes of 
paragraph (1)(B)(vi) and this paragraph 
with respect to applicable items and serv-
ices, the term ‘on-campus outpatient de-
partment of a provider’ shall not include a 
department of a provider (as so defined) if 
the provider is: 
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‘‘(I) A critical access hospital (as 
defined in section 1861(mm)(1)). 
‘‘(II) A sole community hospital 
(as 
defined 
in 
section 
1886(d)(5)(D)(iii)). 
‘‘(III) 
A 
Medicare-dependent, 
small rural hospital (as defined in sec-
tion 1886(d)(5)(G)(iv)). 
‘‘(IV) Any other hospital that is 
located in a rural area (as defined in 
section 1886(d)(2)(D)). 
‘‘(C) AVAILABILITY OF PAYMENT UNDER 
OTHER
PAYMENT
SYSTEMS.—With respect to 
items and services furnished in an on-campus 
provider-based department, payment under this 
section for such items and services shall be the 
amount determined under the fee schedule 
under section 1848 for such items and services 
furnished if furnished in a physician office set-
ting.’’. 
SEC. 4. INCREASING MEDICARE ACCESS FOR RURAL COM-
MUNITIES BY PHYSICIAN-OWNED HOSPITALS. 
Section 1877(d) of the Social Security Act (42 U.S.C. 
1395nn(d)) is amended by striking paragraph (2) and in-
serting the following: 
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‘‘(2) RURAL PROVIDERS.—In the case of des-
ignated health services furnished in a rural area (as 
defined in section 1886(d)(2)(D)) by an entity, if 
substantially all of the designated health services 
furnished by the entity are furnished to individuals 
residing in such a rural area.’’. 
SEC. 5. MAKING DRUGS MORE AFFORDABLE FOR MEDI-
CARE PATIENTS. 
Section 340B(a)(5) of the Public Health Service Act 
(42 U.S.C. 256b(a)(5)) is amended— 
(1) in subparagraph (C), by striking ‘‘subpara-
graphs (A) or (B)’’ and inserting ‘‘subparagraph 
(A), (B), or (E)’’; 
(2) in subparagraph (D), by striking ‘‘subpara-
graphs (A) or (B)’’ and inserting ‘‘subparagraph 
(A), (B), or (E)’’; and 
(3) by adding at the end the following: 
‘‘(E) REQUIREMENT
TO
PROVIDE
DRUG 
DISCOUNTS TO PATIENTS.— 
‘‘(i) IN GENERAL.—A covered entity 
shall ensure that each patient who receives 
a covered outpatient drug from such cov-
ered entity is provided such drug at a price 
that does not exceed the price at which the 
covered entity purchased the drug in ac-
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cordance with paragraph (1), less any ad-
ditional discounts or rebates received by 
the covered entity with respect to the drug. 
‘‘(ii) ESTABLISHMENT
OF
MECHA-
NISM.—The Secretary shall establish a 
mechanism— 
‘‘(I) ensure that covered entities 
comply with clause (i); 
‘‘(II) adjust reimbursement rates 
for covered entities for certain out-
patient prescription drugs provided by 
hospitals to Medicare patients under 
section 1395l(t)(14)(A)(iii); and 
‘‘(III) report the total amount 
paid and the total amount received for 
covered outpatient drugs under this 
subsection. 
‘‘(iii) PUBLIC REPORTING.—The Sec-
retary shall make the information reported 
under subclause (ii)(III) publicly avail-
able.’’. 
SEC. 6. IMPROVING QUALITY OF CARE AT THE SKILLED 
NURSING FACILITIES. 
Section 1888(e)(6) of the Social Security Act (42 
U.S.C. 1395yy(e)(6)) is amended by inserting ‘‘(or, with 
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respect to fiscal year 2025 or a subsequent fiscal year, 
by between 2 and 5 percentage points (as determined ap-
propriate by the Secretary))’’ after ‘‘2 percentage points’’. 
Æ 
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