I 113th CONGRESS 1st Session H. R. 2027 IN THE HOUSE OF REPRESENTATIVES May 16, 2013 Mr. Sam Johnson of Texas (for himself, Mr. Hinojosa , Mr. Carson of Indiana , 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 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 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.

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 expansion of facility capacity. Sec. 4. Additional exception for physician ownership and investment for hospitals in financial distress. 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 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 December 31, 2010, no greater than the number of operating 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 hospital 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: (7) Definitions For purposes of this subsection: (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 application for a Medicare provider agreement; (ii) had a binding written agreement with an outside, unrelated party for the actual design, construction, renovation, lease, or demolition for a hospital, and has expended 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. . 3. Modifying Stark requirements for applicable 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); (2) by amending subparagraph (B) to read as follows: (B) Limitation on frequency of increases A hospital may not effect an increase 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 hospital 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 previous exception under this paragraph and inserting 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 inserting A hospital may not increase . 4. Additional exception for physician ownership 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 distress (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 hospital determined to be in financial distress (as defined 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 determines that the hospital has had an overall negative combined Medicare inpatient prospective 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 determination 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 operating margin. .