H.R.3222 - Stopping Medicare Abuses to Restore Trust in Health Care Act; SMART Health Care Act (119th Congress)
Summary
H.R. 3222, also known as the SMART Health Care Act, aims to amend Title XVIII of the Social Security Act, focusing on improving risk adjustment under Medicare Advantage and promoting site-neutral payments. The bill also seeks to increase Medicare access for rural communities by physician-owned hospitals and make drugs more affordable for Medicare patients. Additionally, it addresses the quality of care at skilled nursing facilities.
Expected Effects
The bill's passage would likely lead to changes in how Medicare Advantage plans are reimbursed, potentially reducing overpayments and encouraging more efficient care. Site-neutral payments could shift services from hospital outpatient departments to physician offices, affecting hospital revenues and patient access. Changes to the 340B drug pricing program could lower drug costs for some Medicare patients, while adjustments to skilled nursing facility payments might impact the quality of care provided.
Potential Benefits
- Reduced Medicare Advantage overpayments through improved risk adjustment.
- Lower drug costs for Medicare patients through 340B program modifications.
- Increased access to care in rural areas through physician-owned hospitals.
- More efficient use of healthcare resources through site-neutral payments.
- Improved quality of care at skilled nursing facilities.
Potential Disadvantages
- Potential reduction in revenue for hospitals, particularly those with on-campus outpatient departments.
- Possible decreased access to certain services if hospitals reduce outpatient offerings.
- Increased administrative burden for covered entities to comply with 340B drug pricing requirements.
- Uncertainty regarding the Secretary's determination of appropriate percentage point adjustments for skilled nursing facilities.
- Potential for unintended consequences related to risk adjustment methodologies.
Constitutional Alignment
The bill primarily amends existing statutes related to Medicare and healthcare financing, falling under the purview of Congress's power to tax and spend for the general welfare, as outlined in Article I, Section 8 of the Constitution. The specific provisions related to healthcare access and payment mechanisms are within the scope of Congress's authority to regulate interstate commerce and provide for the common defense and general welfare.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).