HR3222-119

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.

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— by striking methodology.—Such risk and inserting methodology.— Subject to subclause (II), such risk by adding at the end the following new subclauses: For 2026 and each subsequent year, the Secretary shall use 2 years of diagnostic data (when available) under such risk adjustment methodology. methodology.— (I)In generalSubject to subclause (II), such risk; and (II)Use of health status dataFor 2026 and each subsequent year, the Secretary shall use 2 years of diagnostic data (when available) under such risk adjustment methodology..

3. Promoting Medicare site-neutral payments Section 1833(t)(21) of the Social Security Act (42 U.S.C. 1395l(t)(21)) is amended— by redesignating subparagraph (E) as subparagraph (F); and by inserting after subparagraph (D) the following new subparagraphs: 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. Section 1833(t) of the Social Security Act is amended— in paragraph (1)(B)— in cause (iv), by striking and at the end; in cause (v), by striking the period at the end and inserting ; and; and by inserting at the end the following new clause: does not include applicable items and services (as defined in subparagraph (A) of paragraph (23)); and by adding at the end the following new paragraph: 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). On-campus outpatient department of a provider— on the campus (as defined in such section 413.65(a)(2) of title 42, Code of Federal Regulations) of such provider; or 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). 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: A critical access hospital (as defined in section 1861(mm)(1)). A sole community hospital (as defined in section 1886(d)(5)(D)(iii)). A Medicare-dependent, small rural hospital (as defined in section 1886(d)(5)(G)(iv)). Any other hospital that is located in a rural area (as defined in section 1886(d)(2)(D)). 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. (E)Sunset of certain exceptionsThe 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.. (vi) does not include applicable items and services (as defined in subparagraph (A) of paragraph (23)); and ; and (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. .

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: 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. (2)Rural providersIn 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..

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— in subparagraph (C), by striking subparagraphs (A) or (B) and inserting subparagraph (A), (B), or (E); in subparagraph (D), by striking subparagraphs (A) or (B) and inserting subparagraph (A), (B), or (E); and by adding at the end the following: 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. The Secretary shall establish a mechanism— ensure that covered entities comply with clause (i); 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 report the total amount paid and the total amount received for covered outpatient drugs under this subsection. The Secretary shall make the information reported under subclause (ii)(III) publicly available. (E)Requirement to provide drug discounts to patients (i)In generalA 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 mechanismThe 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 reportingThe Secretary shall make the information reported under subclause (ii)(III) publicly available..

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.