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