SMART Health Care Act

[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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