Sec. 425. Study of DSH payments to ensure hospital access for low-income patients

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Not later than January 1, 2019, the Comptroller General of the United States shall conduct a study on how amendments made by the Patient Protection and Affordable Care Act ( Public Law 111–148 ) and the Health Care and Education Reconciliation Act of 2010 ( Public Law 111–152 ) to titles XVIII and XIX of the Social Security Act ( 42 U.S.C. 1395 et seq., 1396 et seq.) relating to disproportionate share hospital adjustment payments under Medicare and Medicaid (and subsequent amendments made with respect to such payments) affect the timely access to health care services for low-income patients.

Such study shall— evaluate and examine whether States electing to make medical assistance available under section 1902(a)(10)(A)(i)(VIII) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(A)(i)(VIII) ) (including States making such an election through a waiver of the State plan) to individuals described in such section mitigate the need for payments to disproportionate share hospitals under section 1886(d)(5)(F) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(F) ) and section 1923 of such Act ( 42 U.S.C. 1396r–4 ), including the impact of such States electing to make medical assistance available to such individuals on— the number of individuals in the United States who are without health insurance and the distribution of such individuals in relation to areas primarily served by disproportionate share hospitals; and the low-income utilization rate of such hospitals and the resulting fiscal sustainability of such hospitals; evaluate the appropriate level and distribution of such payments among such disproportionate share hospitals for purposes of— sufficiently accounting for the level of uncompensated care provided by such hospitals to low-income patients; and providing timely access to health services for individuals in medically underserved areas; and assess, with respect to such disproportionate share hospitals— the role played by such hospitals in providing critical access to emergency, inpatient, and outpatient health services, as well as the location of such hospitals in relation to medically underserved areas; and the extent to which such hospitals satisfy the requirements established for charitable hospital organizations under section 501(r) of the Internal Revenue Code of 1986 with respect to community health needs assessments, financial assistance policy requirements, limitations on charges, and billing and collection requirements.

Not later than 180 days after the date on which the study under subsection

(a)is completed, the Comptroller General of the United States shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report that contains— the results of the study; recommendations to Congress for any legislative changes to the payments to disproportionate share hospitals under section 1886(d)(5)(F) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5)(F) ) and section 1923 of such Act ( 42 U.S.C. 1396r–4 ) that are needed to ensure access to health services for low-income patients that— are based on the number of individuals without health insurance, the amount of uncompensated care provided by such hospitals, and the impact of reduced payment levels on low-income communities; and takes into account any reports submitted by the Secretary of the Treasury, in consultation with the Secretary of Health and Human Services, to Congressional committees regarding the costs incurred by charitable hospital organizations for charity care, bad debt, nonreimbursed expenses for services provided to individuals under the Medicare program under title XVIII of the Social Security Act and the Medicaid program under title XIX of such Act, and any community benefit activities provided by such organizations. Not later than 180 days after the date on which the study under subsection

(a)is completed, the Comptroller General of the United States shall submit to the Secretary of Health and Human Services a report that contains— the results of the study; and any recommendations for purposes of assisting in the development of the methodology for the adjustment of payments to disproportionate share hospitals, as required under section 1886(r) of the Social Security Act ( 42 U.S.C. 1395ww(r) ) and the reduction of such payments under section 1923(f)(7) of such Act ( 42 U.S.C. 1396r–4(f)(7) ), taking into account the reports referred to in paragraph (1)(B)(ii).

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