119-hr3222

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3222 Introduced in House

    (IH) ]

<DOC>

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 
 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 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 Representatives 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''.

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 subclauses:
 ``
            (II) Use of health status data.--
 For 2026 and each subsequent year, the 
 Secretary shall use 2 years of 
 diagnostic data (when available) 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 subparagraph
        (F) ; 
 and

    (2) by inserting after subparagraph
            (D) the following new 
 subparagraphs:
 ``
        (E) Sunset of certain exceptions.--The provisions 
 of clauses
            (ii) and
            (iv) of subparagraph
        (B) shall not 
 apply with respect to applicable items and services 
 furnished on or after January 1, 2026.''.

    (b) On-Campus Outpatient Departments.--

Section 1833

    (t) of the 
Social Security Act is amended--

    (1) in paragraph

    (1)
        (B) --
        (A) in cause
            (iv) , by striking ``and'' at the end;
        (B) in cause
            (v) , by striking the period at the end 
 and inserting ``; and''; and
            (C) by inserting at the end the following new 
 clause:
 ``
            (vi) does not include applicable items 
 and services (as defined in subparagraph
        (A) of 
 paragraph

    (23) ); and''; and

    (2) by adding at the end the following new paragraph:
 ``

    (23) Services furnished by an on-campus outpatient 
 department of a provider.--
 ``
        (A) Applicable items and services.--For purposes 
 of paragraph

    (1)
        (B)
            (v) and this paragraph, the term 
 `applicable items and services' means items and 
 services other than items and services furnished by a 
 dedicated emergency department (as defined in 

section 489.24

    (b) of title 42 of the Code of Federal 
 Regulations).
 ``
        (B) On-campus outpatient department of a 
 provider.--
 ``
            (i) In general.--On-campus outpatient 
 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 
 (described 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 Federal Regulations).
 ``
            (ii) Exception for certain hospitals 
 located in rural or medically underserved 
 areas.--For purposes of paragraph

    (1)
        (B)
            (vi) and this paragraph with respect to applicable 
 items and services, the term `on-campus 
 outpatient department of a provider' shall not 
 include a department of a provider (as so 
 defined) if the provider is:
 ``
            (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 

section 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 setting.''.

SEC. 4. INCREASING MEDICARE ACCESS FOR RURAL COMMUNITIES 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 inserting the following:
 ``

    (2) Rural providers.--In the case of designated 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 MEDICARE 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 ``subparagraphs
        (A) or
        (B) '' and inserting ``subparagraph
        (A) ,
        (B) , or
        (E) '';

    (2) in subparagraph
            (D) , by striking ``subparagraphs
        (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 covered entity is 
 provided such drug at a price that does not 
 exceed the price at which the covered entity 
 purchased the drug in accordance with paragraph

    (1) , less any additional discounts or rebates 
 received by the covered entity with respect to 
 the drug.
 ``
            (ii) Establishment of mechanism.--The 
 Secretary shall establish a mechanism--
 ``
            (I) ensure that covered entities 
 comply with clause
            (i) ;
 ``
            (II) adjust reimbursement rates 
 for covered entities for certain 
 outpatient 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 Secretary 
 shall make the information reported under 
 subclause
            (ii) 
            (III) publicly available.''.

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 respect to fiscal 
year 2025 or a subsequent fiscal year, by between 2 and 5 percentage 
points (as determined appropriate by the Secretary))'' after ``2 
percentage points''.
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