[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9128 Introduced in House (IH)]

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118th CONGRESS
  2d Session
                                H. R. 9128

    To amend title XVIII of the Social Security Act to establish a 
    designation for territorial safety net hospitals, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 24, 2024

Mr. Sablan (for himself and Mr. Moylan) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
  addition to the Committees on Ways and Means, and the Budget, 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 establish a 
    designation for territorial safety net hospitals, 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 ``Supporting Territorial Safety Net 
Hospitals Act''.

SEC. 2. DESIGNATION FOR TERRITORIAL SAFETY NET HOSPITALS.

    (a) Territorial Safety Net Hospital Defined.--Section 1861 of the 
Social Security Act (42 U.S.C. 1395x) is amended by adding at the end 
the following new subsection:
    ``(nnn) Territorial Safety Net Hospital.--
            ``(1) The term `territorial safety net hospital' means a 
        hospital (as defined in subsection (e)) that is located in the 
        Northern Mariana Islands, American Samoa, Guam, or the Virgin 
        Islands.
            ``(2) The term `inpatient territorial safety net hospital 
        services' means items and services, furnished to an inpatient 
        of a territorial safety net hospital by such facility, that 
        would be inpatient hospital services if furnished to an 
        inpatient of a hospital by a hospital.
            ``(3) The term `outpatient territorial safety net hospital 
        services' means medical and other health services furnished by 
        a territorial safety net hospital on an outpatient basis.''.
    (b) Payment for Inpatient Territorial Safety Net Hospital 
Services.--
            (1) In general.--Section 1814 of the Social Security Act 
        (42 U.S.C. 1395f) is amended--
                    (A) in subsection (b), by inserting ``other than a 
                territorial safety net hospital providing inpatient 
                territorial safety net hospital services,'' after 
                ``critical access hospital providing inpatient critical 
                access hospital services,''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(m) Payment for Inpatient Territorial Safety Net Hospital 
Services.--The amount of payment under this part for inpatient 
territorial safety net hospital services is equal to 101 percent of the 
reasonable costs of the territorial safety net hospital in providing 
such services.''.
            (2) Scope of benefits.--Section 1812(a)(1) of the Social 
        Security Act (42 U.S.C. 1395d(a)(1)) is amended by striking 
        ``or inpatient critical access hospital services'' and 
        inserting ``, inpatient critical access hospital services, or 
        inpatient territorial safety net hospital services''.
            (3) Deductibles and coinsurance.--Section 1813 of the 
        Social Security Act (42 U.S.C. 1395e) is amended--
                    (A) in subsection (a)(1), by striking ``or 
                inpatient critical access hospital services'' each 
                place it appears and inserting ``, inpatient critical 
                access hospital services, or inpatient territorial 
                safety net hospital services''; and
                    (B) in subsection (b)(3)--
                            (i) in subparagraph (A), by striking ``or 
                        inpatient critical access hospital services'' 
                        and inserting ``, inpatient critical access 
                        hospital services, or inpatient territorial 
                        safety net hospital services''; and
                            (ii) in subparagraph (B), by inserting ``, 
                        inpatient territorial safety net hospital 
                        services,'' after ``inpatient critical access 
                        hospital services''.
            (4) Payment to providers of services.--Section 1815(e)(2) 
        of the Social Security Act (42 U.S.C. 1395g(e)(2)) is amended--
                    (A) in subparagraph (D), by striking ``and'' at the 
                end;
                    (B) in subparagraph (E), by inserting ``and'' after 
                the semicolon at the end; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(F) inpatient territorial safety net hospital 
                services;''.
            (5) Administration of part a.--Section 1816(c)(2)(C) of the 
        Social Security Act (42 U.S.C. 1395h(c)(2)(C)) is amended by 
        inserting ``territorial safety net hospital,'' after ``critical 
        access hospital,''.
    (c) Payment for Outpatient Territorial Safety Net Hospital 
Services.--
            (1) In general.--Section 1834 of the Social Security Act 
        (42 U.S.C. 1395m) is amended by adding at the end the following 
        new subsection:
    ``(aa) Payment for Outpatient Territorial Safety Net Hospital 
Services.--
            ``(1) In general.--The amount of payment for outpatient 
        territorial safety net hospital services of a territorial 
        safety net hospital is equal to 101 percent of the reasonable 
        costs of the hospital in providing such services, unless the 
        hospital makes the election under paragraph (2).
            ``(2) Election of cost-based hospital outpatient service 
        payment plus fee schedule for professional services.--A 
        territorial safety net hospital may elect to be paid for 
        outpatient territorial safety net hospital services amounts 
        equal to the sum of the following, less the amount that such 
        hospital may charge as described in section 1866(a)(2)(A):
                    ``(A) Facility fee.--With respect to facility 
                services, not including any services for which payment 
                may be made under subparagraph (B), 101 percent of the 
                reasonable costs of the territorial safety net hospital 
                in providing such services.
                    ``(B) Fee schedule for professional services.--With 
                respect to professional services otherwise included 
                within outpatient territorial safety net hospital 
                services, 115 percent of such amounts as would 
                otherwise be paid under this part if such services were 
                not included in outpatient territorial safety net 
                hospital services. Subsections (x) and (y) of section 
                1833 shall not be taken into account in determining the 
                amounts that would otherwise be paid pursuant to the 
                preceding sentence.
        The Secretary may not require, as a condition for applying 
        subparagraph (B) with respect to a territorial safety net 
        hospital, that each physician or other practitioner providing 
        professional services in the hospital must assign billing 
        rights with respect to such services, except that such 
        subparagraph shall not apply to those physicians and 
        practitioners who have not assigned such billing rights.
            ``(3) Disregarding charges.--The payment amounts under this 
        subsection shall be determined without regard to the amount of 
        the customary or other charge.
            ``(4) Treatment of clinical diagnostic laboratory 
        services.--No coinsurance, deductible, copayment, or other 
        cost-sharing otherwise applicable under this part shall apply 
        with respect to clinical diagnostic laboratory services 
        furnished as an outpatient territorial safety net hospital 
        service. Nothing in this title shall be construed as providing 
        for payment for clinical diagnostic laboratory services 
        furnished as part of outpatient territorial safety net hospital 
        services, other than on the basis described in this subsection. 
        For purposes of the preceding sentence and section 
        1861(nnn)(3), clinical diagnostic laboratory services furnished 
        by a territorial safety net hospital shall be treated as being 
        furnished as part of outpatient critical access services 
        without regard to whether the individual with respect to whom 
        such services are furnished is physically present in the 
        territorial safety net hospital, or in a skilled nursing 
        facility or a clinic (including a rural health clinic) that is 
        operated by a territorial safety net hospital, at the time the 
        specimen is collected.
            ``(5) Coverage of costs for certain on-call emergency room 
        providers.--In determining the reasonable costs of outpatient 
        territorial safety net hospital services under paragraphs (1) 
        and (2)(A), the Secretary shall recognize as allowable costs, 
        amounts (as defined by the Secretary) for reasonable 
        compensation and related costs for physicians, physician 
        assistants, nurse practitioners, and clinical nurse specialists 
        who are on-call (as defined by the Secretary) to provide 
        emergency services but who are not present on the premises of 
        the territorial safety net hospital involved, and are not 
        otherwise furnishing services covered under this title and are 
        not on-call at any other provider or facility.''.
            (2) Scope of benefits.--Section 1832(a)(2) of the Social 
        Security Act (42 U.S.C. 1395k(a)(2)) is amended--
                    (A) in subparagraph (I), by striking ``; and'' and 
                inserting a semicolon;
                    (B) in subparagraph (J), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(K) outpatient territorial safety net hospital 
                services (as defined in section 1861(nnn)(3)).''.
            (3) Payment of benefits.--Section 1833 of the Social 
        Security Act (42 U.S.C. 1395l) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (9), by striking ``; and'' 
                        and inserting a semicolon;
                            (ii) in paragraph (10), by striking the 
                        period at the end and inserting ``; and''; and
                            (iii) by inserting after paragraph (10) the 
                        following new paragraph:
            ``(11) in the case of outpatient territorial safety net 
        hospital services, the amounts described in section 
        1834(aa).'';
                    (B) in subsection (h)(5)(A)(iii), by inserting 
                ``territorial safety net hospital,'' after ``critical 
                access hospital,'';
                    (C) in subsection (i)(1)(A), by inserting 
                ``territorial safety net hospital,'' after ``critical 
                access hospital,'';
                    (D) in subsection (l)(5)--
                            (i) in subparagraph (A), by inserting 
                        ``territorial safety net hospital,'' after 
                        ``critical access hospital,'' in each place it 
                        appears; and
                            (ii) in subparagraph (B), by striking ``or 
                        critical access hospital'' in each place it 
                        appears and inserting ``, critical access 
                        hospital, or territorial safety net hospital'' 
                        in each such place;
                    (E) in subsection (r)--
                            (i) in paragraph (1), by inserting 
                        ``territorial safety net hospital,'' after 
                        ``critical access hospital''; and
                            (ii) in paragraph (2), by striking ``or 
                        critical access hospital'' and inserting ``, 
                        critical access hospital, or territorial safety 
                        net hospital''; and
                    (F) in subsection (cc)(2), by adding at the end the 
                following new subparagraph:
                    ``(F) Section 1834(aa), with respect to an 
                outpatient territorial safety net hospital service.''.
            (4) Payment for ambulance services furnished by a 
        territorial safety net hospital.--Section 1834(l)(8) of the 
        Social Security Act (42 U.S.C. 1395m(l)(8)) is amended--
                    (A) in the heading, by inserting ``and territorial 
                safety net hospitals'' after ``critical access 
                hospitals'';
                    (B) in subparagraph (A), by inserting ``or a 
                territorial safety net hospital (as defined in section 
                1861(nnn))'' after ``(as defined in section 
                1861(mm)(1))'';
                    (C) in subparagraph (B), by inserting ``or a 
                territorial safety net hospital'' after ``critical 
                access hospital''; and
                    (D) by amending the flush left text following 
                subparagraph (B) to read as follows:
        ``but only if the critical access hospital, territorial safety 
        net hospital, or entity is the only provider or supplier of 
        ambulance services that is located within a 35-mile drive of 
        such critical access hospital or territorial safety net 
        hospital.''.
    (d) Conforming Amendments.--
            (1) Title xi.--
                    (A) Civil monetary penalties.--Section 1128A(b)(1) 
                of the Social Security Act (42 U.S.C. 1320a-7a(b)(1)) 
                is amended by striking ``or a critical access 
                hospital'' in each place it appears and inserting ``, 
                critical access hospital, or territorial safety net 
                hospital'' in each such place.
                    (B) Criminal penalties for acts involving federal 
                health care programs.--Section 1128B(c) of the Social 
                Security Act (42 U.S.C. 1320a-7b(c)) is amended by 
                inserting ``territorial safety net hospital,'' after 
                ``critical access hospital,''.
                    (C) Nonprofit hospital philanthropy.--Section 1134 
                of the Social Security Act (42 U.S.C. 1320b-4) is 
                amended in the matter preceding paragraph (1) by 
                striking ``or critical access hospitals'' in each place 
                it appears and inserting ``, critical access hospitals, 
                or territorial safety net hospitals'' in each such 
                place.
                    (D) Hospital protocols for organ procurement and 
                standards for organ procurement agencies.--Section 1138 
                of the Social Security Act (42 U.S.C. 1320b-8) is 
                amended by striking ``or critical access hospital'' in 
                each place it appears and inserting ``, critical access 
                hospital, or territorial safety net hospital'' in each 
                such place.
            (2) Title xviii.--
                    (A) Definition of a hospital.--Section 1861(e) of 
                the Social Security Act (42 U.S.C. 1395x(e)) is amended 
                in the flush left matter at the end by striking ``or a 
                rural emergency hospital (as defined in subsection 
                (kkk)(2))'' and inserting ``, a rural emergency 
                hospital (as defined in subsection (kkk)(2)), or a 
                territorial safety net hospital (as defined in 
                subsection (nnn)(1))''.
                    (B) Definition of provider of services.--Section 
                1861(u) of the Social Security Act (42 U.S.C. 1395x(u)) 
                is amended by inserting ``territorial safety net 
                hospital,'' after ``critical access hospital,''.
                    (C) Definition of reasonable costs.--Section 
                1861(v)(1)(S)(ii)(III) of the Social Security Act (42 
                U.S.C. 1395x(v)(1)(S)(ii)(III)) is amended by striking 
                ``or a critical access hospital (as defined in section 
                1861(mm)(1))'' and inserting ``, a critical access 
                hospital (as defined in section 1861(mm)(1)), or a 
                territorial safety net hospital (as defined in 
                subsection (nnn) of such section)''.
                    (D) Definition of arrangements.--Section 1861(w) of 
                the Social Security Act (42 U.S.C. 1395x(w)) is 
                amended--
                            (i) in paragraph (1), by inserting 
                        ``territorial safety net hospital,'' after 
                        ``critical access hospital,''; and
                            (ii) in paragraph (2), by striking ``or 
                        critical access hospital'' in each place it 
                        appears and inserting ``, critical access 
                        hospital, or territorial safety net hospital'' 
                        in each such place.
                    (E) Definition of post-institutional home health 
                services; home health spell of illness.--Section 
                1861(tt) of the Social Security Act (42 U.S.C. 
                1395x(tt)) is amended--
                            (i) in paragraph (1)(A), by striking ``or 
                        critical access hospital'' and inserting ``, 
                        critical access hospital, or territorial safety 
                        net hospital''; and
                            (ii) in paragraph (2)(B), by striking ``or 
                        critical access hospital'' and inserting ``, 
                        critical access hospital, or territorial safety 
                        net hospital''.
                    (F) Exclusion from coverage.--Section 1862(a)(14) 
                of the Social Security Act (42 U.S.C. 1395y(a)(14)) is 
                amended by striking ``or critical access hospital'' in 
                each place it appears and inserting ``, critical access 
                hospital, or territorial safety net hospital'' in each 
                such place.
                    (G) Use of state agencies to determine compliance 
                by providers of services with conditions of 
                participation.--Section 1864 of the Social Security Act 
                (42 U.S.C. 1395aa) is amended--
                            (i) in subsection (a), by inserting 
                        ``territorial safety net hospital, as defined 
                        in section 1861(nnn)(1),'' after ``a critical 
                        access hospital, as defined in section 
                        1861(mm)(1),''; and
                            (ii) by adding at the end the following new 
                        subparagraph:
    ``(f) For purposes of this section, the term `State' means the 50 
States and includes the District of Columbia, Puerto Rico, the Virgin 
Islands, Guam, American Samoa, and the Northern Mariana Islands.''.
                    (H) Agreements with providers of services.--Section 
                1866(a) of the Social Security Act (42 U.S.C. 
                1395cc(a)) is amended--
                            (i) in paragraph (1)--
                                    (I) in subparagraph (F)(ii), by 
                                inserting ``territorial safety net 
                                hospitals,'' after ``critical access 
                                hospitals,'';
                                    (II) in subparagraph (H), by 
                                striking ``and in the case of critical 
                                access hospitals which provide critical 
                                access hospital services'' and 
                                inserting ``, in the case of critical 
                                access hospitals which provide critical 
                                access hospital services, and in the 
                                case of territorial safety net 
                                hospitals which provide territorial 
                                safety net hospital services'';
                                    (III) in subparagraph (I), by 
                                inserting ``territorial safety net 
                                hospital,'' after ``critical access 
                                hospital,'' in each place it appears;
                                    (IV) in subparagraph (N), by 
                                inserting ``territorial safety net 
                                hospital,'' after ``critical access 
                                hospital,'' in each place it appears;
                                    (V) in subparagraph (T), by 
                                striking ``and critical access 
                                hospitals'' and inserting ``, critical 
                                access hospitals, and territorial 
                                safety net hospitals''; and
                                    (VI) in subparagraph (Y), by 
                                striking ``or critical access 
                                hospital'' each place it appears and 
                                inserting ``, critical access hospital, 
                                or territorial safety net hospital'' in 
                                each such place; and
                            (ii) in paragraph (3)--
                                    (I) in subparagraph (A), by 
                                inserting ``territorial safety net 
                                hospital,'' after ``critical access 
                                hospital,'';
                                    (II) in subparagraph (B), by 
                                inserting ``territorial safety net 
                                hospital,'' after ``critical access 
                                hospital,'' in each place it appears; 
                                and
                                    (III) in subparagraph (C)(ii)(II), 
                                by inserting ``territorial safety net 
                                hospitals,'' after ``critical access 
                                hospitals,'' in each place it appears.
                    (I) Examination and treatment for emergency medical 
                conditions and women in labor.--Section 1867(e)(5) of 
                the Social Security Act (42 U.S.C. 1395dd(e)(5)) is 
                amended by inserting ``, territorial safety net 
                hospital (as defined in section 1861(nnn)(1)),'' after 
                ``(as defined in section 1861(mm)(1))''.
                    (J) Hospital providers of extended care services.--
                Section 1883(a)(3) of the Social Security Act (42 
                U.S.C. 1395tt(a)(3)) is amended by inserting ``or a 
                territorial safety net hospital'' after ``critical 
                access hospital''.
                    (K) Payment to skilled nursing facilities for 
                routine care.--Section 1888(e)(6)(B) of the Social 
                Security Act (42 U.S.C. 1395yy(e)(6)(B)) is amended--
                            (i) in clause (i), by inserting ``or a 
                        territorial safety net hospital'' after 
                        ``critical access hospital''; and
                            (ii) in clause (ii), by inserting ``or a 
                        territorial safety net hospital'' after 
                        ``critical access hospital''.
                    (L) Standardized post-acute care (pac) assessment 
                data for quality, payment, and discharge planning.--
                Section 1899B of the Social Security Act (42 U.S.C. 
                1395lll) is amended--
                            (i) in subsection (c)(1)(E)--
                                    (I) in clause (i), by striking ``or 
                                critical access hospital'' and 
                                inserting ``, critical access hospital, 
                                or territorial safety net hospital''; 
                                and
                                    (II) in clause (ii), by inserting 
                                ``territorial safety net hospital,'' 
                                after ``critical access hospital,''; 
                                and
                            (ii) in subsection (i)(1)--
                                    (I) in the first sentence, by 
                                striking ``and critical access 
                                hospitals'' and inserting ``, critical 
                                access hospitals, and territorial 
                                safety net hospitals''; and
                                    (II) in the third sentence, by 
                                inserting ``territorial safety net 
                                hospitals,'' after ``critical access 
                                hospitals,''.

SEC. 3. INCLUSION OF TERRITORIAL SAFETY NET HOSPITALS AS 340B COVERED 
              ENTITIES.

    Section 340B(a)(4) of the Public Health Service Act (42 U.S.C. 
256b(a)(4)) is amended by adding at the end the following new 
subparagraph:
                    ``(P) An entity that is a territorial safety net 
                hospital (as defined in section 1861(nnn) of the Social 
                Security Act), and that meets the requirements of 
                subparagraph (L)(i).''.

SEC. 4. ELIMINATING MEDICARE SEQUESTRATION FOR TERRITORIAL SAFETY NET 
              HOSPITALS.

    (a) Eliminating Medicare Sequestration for Territorial Safety Net 
Hospitals.--
            (1) In general.--Section 256(d)(7) of the Balanced Budget 
        and Emergency Deficit Control Act of 1985 (2 U.S.C. 906(d)(7)) 
        is amended by adding at the end the following:
                    ``(D) Territorial safety net hospitals.--Payments 
                under part A or part B of title XVIII of the Social 
                Security Act with respect to items and services 
                furnished by a territorial safety net hospital (as 
                defined in section 1861(nnn)(1) of such Act).''.
            (2) Applicability.--The amendment made by this section 
        applies with respect to orders of sequestration effective on or 
        after the date that is 60 days after the date of the enactment 
        of this Act.
    (b) Reversing Cuts to Reimbursement of Bad Debt for Territorial 
Safety Net Hospitals.--
            (1) Territorial safety net hospitals.--Section 
        1861(v)(1)(W)(ii) of the Social Security Act (42 U.S.C. 
        1395x(v)(1)(W)(ii)) is amended by inserting after ``or (V)'' 
        the following: ``, a territorial safety net hospital''.
            (2) Applicability.--The amendments made by this section 
        apply with respect to cost reporting periods beginning more 
        than 60 days after the date of the enactment of this Act.
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