PROHIBITION ON EXPANSION OF FACILITY CAPACITY (more junk from the obama death care bill)

‘‘(C) PROHIBITION ON EXPANSION OF FA22 CILITY CAPACITY.—Except as provided in para23 graph (2), the number of operating rooms, pro24 cedure rooms, or beds of the hospital at any 25 time on or after the date of the enactment of

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1 this subsection are no greater than the number 2 of operating rooms, procedure rooms, or beds, 3 respectively, as of such date.

4 ‘‘(D) ENSURING BONA FIDE OWNERSHIP 5 AND INVESTMENT.— 6 ‘‘(i) Any ownership or investment in7 terests that the hospital offers to a physi8 cian are not offered on more favorable 9 terms than the terms offered to a person 10 who is not in a position to refer patients 11 or otherwise generate business for the hos12 pital. 13 ‘‘(ii) The hospital (or any investors in 14 the hospital) does not directly or indirectly 15 provide loans or financing for any physi16 cian owner or investor in the hospital. 17 ‘‘(iii) The hospital (or any investors in 18 the hospital) does not directly or indirectly 19 guarantee a loan, make a payment toward 20 a loan, or otherwise subsidize a loan, for 21 any physician owner or investor or group 22 of physician owners or investors that is re23 lated to acquiring any ownership or invest24 ment interest in the hospital.

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1 ‘‘(iv) Ownership or investment returns 2 are distributed to each owner or investor in 3 the hospital in an amount that is directly 4 proportional to the ownership or invest5 ment interest of such owner or investor in 6 the hospital. 7 ‘‘(v) The investment interest of the 8 owner or investor is directly proportional 9 to the owner’s or investor’s capital con10 tributions made at the time the ownership 11 or investment interest is obtained. 12 ‘‘(vi) Physician owners and investors 13 do not receive, directly or indirectly, any 14 guaranteed receipt of or right to purchase 15 other business interests related to the hos16 pital, including the purchase or lease of 17 any property under the control of other 18 owners or investors in the hospital or lo19 cated near the premises of the hospital. 20 ‘‘(vii) The hospital does not offer a 21 physician owner or investor the oppor22 tunity to purchase or lease any property 23 under the control of the hospital or any 24 other owner or investor in the hospital on 25 more favorable terms than the terms of-

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1 fered to a person that is not a physician 2 owner or investor. 3 ‘‘(viii) The hospital does not condition 4 any physician ownership or investment in5 terests either directly or indirectly on the 6 physician owner or investor making or in7 fluencing referrals to the hospital or other8 wise generating business for the hospital. 9 ‘‘(E) PATIENT SAFETY.—In the case of a 10 hospital that does not offer emergency services, 11 the hospital has the capacity to— 12 ‘‘(i) provide assessment and initial 13 treatment for medical emergencies; and 14 ‘‘(ii) if the hospital lacks additional 15 capabilities required to treat the emergency 16 involved, refer and transfer the patient 17 with the medical emergency to a hospital 18 with the required capability. 19 ‘‘(F) LIMITATION ON APPLICATION TO 20 CERTAIN CONVERTED FACILITIES.—The hos21 pital was not converted from an ambulatory 22 surgical center to a hospital on or after the date 23 of enactment of this subsection.

24 ‘‘(2) EXCEPTION TO PROHIBITION ON EXPAN25 SION OF FACILITY CAPACITY.— VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00320 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC July 14, 2009 (12:51 p.m.) F:\P11\NHI\TRICOMM\AAHCA09_001.XML f:\VHLC\071409\071409.140.xml (444390|2) 321

1 ‘‘(A) PROCESS.— 2 ‘‘(i) ESTABLISHMENT.—The Secretary 3 shall establish and implement a process 4 under which a hospital may apply for an 5 exception from the requirement under 6 paragraph (1)(C). 7 ‘‘(ii) OPPORTUNITY FOR COMMUNITY 8 INPUT.—The process under clause (i) shall 9 provide persons and entities in the commu10 nity in which the hospital applying for an 11 exception is located with the opportunity to 12 provide input with respect to the applica13 tion. 14 ‘‘(iii) TIMING FOR IMPLEMENTA15 TION.—The Secretary shall implement the 16 process under clause (i) on the date that is 17 one month after the promulgation of regu18 lations described in clause (iv). 19 ‘‘(iv) REGULATIONS.—Not later than 20 the first day of the month beginning 18 21 months after the date of the enactment of 22 this subsection, the Secretary shall promul23 gate regulations to carry out the process 24 under clause (i). The Secretary may issue

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1 such regulations as interim final regula2 tions. 3 ‘‘(B) FREQUENCY.—The process described 4 in subparagraph (A) shall permit a hospital to 5 apply for an exception up to once every 2 years. 6 ‘‘(C) PERMITTED INCREASE.— 7 ‘‘(i) IN GENERAL.—Subject to clause 8 (ii) and subparagraph (D), a hospital 9 granted an exception under the process de10 scribed in subparagraph (A) may increase 11 the number of operating rooms, procedure 12 rooms, or beds of the hospital above the 13 baseline number of operating rooms, proce14 dure rooms, or beds, respectively, of the 15 hospital (or, if the hospital has been grant16 ed a previous exception under this para17 graph, above the number of operating 18 rooms, procedure rooms, or beds, respec19 tively, of the hospital after the application 20 of the most recent increase under such an 21 exception). 22 ‘‘(ii) 100 PERCENT INCREASE LIMITA23 TION.—The Secretary shall not permit an 24 increase in the number of operating rooms, 25 procedure rooms, or beds of a hospital

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1 under clause (i) to the extent such increase 2 would result in the number of operating 3 rooms, procedure rooms, or beds of the 4 hospital exceeding 200 percent of the base5 line number of operating rooms, procedure 6 rooms, or beds of the hospital.

7 ‘‘(iii) BASELINE NUMBER OF OPER8 ATING ROOMS, PROCEDURE ROOMS, OR 9 BEDS.—In this paragraph, the term ‘base10 line number of operating rooms, procedure 11 rooms, or beds’ means the number of oper12 ating rooms, procedure rooms, or beds of a 13 hospital as of the date of enactment of this 14 subsection. 15 ‘‘(D) INCREASE LIMITED TO FACILITIES 16 ON THE MAIN CAMPUS OF THE HOSPITAL.— 17 Any increase in the number of operating rooms, 18 procedure rooms, or beds of a hospital pursuant 19 to this paragraph may only occur in facilities on 20 the main campus of the hospital. 21 ‘‘(E) CONDITIONS FOR APPROVAL OF AN 22 INCREASE IN FACILITY CAPACITY.—The Sec23 retary may grant an exception under the proc24 ess described in subparagraph (A) only to a 25 hospital—

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1 ‘‘(i) that is located in a county in 2 which the percentage increase in the popu3 lation during the most recent 5-year period 4 for which data are available is estimated to 5 be at least 150 percent of the percentage 6 increase in the population growth of the 7 State in which the hospital is located dur8 ing that period, as estimated by Bureau of 9 the Census and available to the Secretary; 10 ‘‘(ii) whose annual percent of total in11 patient admissions that represent inpatient 12 admissions under the program under title 13 XIX is estimated to be equal to or greater 14 than the average percent with respect to 15 such admissions for all hospitals located in 16 the county in which the hospital is located; 17 ‘‘(iii) that does not discriminate 18 against beneficiaries of Federal health care 19 programs and does not permit physicians 20 practicing at the hospital to discriminate 21 against such beneficiaries; 22 ‘‘(iv) that is located in a State in 23 which the average bed capacity in the 24 State is estimated to be less than the na25 tional average bed capacity;

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1 ‘‘(v) that has an average bed occu2 pancy rate that is estimated to be greater 3 than the average bed occupancy rate in the 4 State in which the hospital is located; and 5 ‘‘(vi) that meets other conditions as 6 determined by the Secretary. 7 ‘‘(F) PROCEDURE ROOMS.—In this sub8 section, the term ‘procedure rooms’ includes 9 rooms in which catheterizations, angiographies, 10 angiograms, and endoscopies are furnished, but 11 such term shall not include emergency rooms or 12 departments (except for rooms in which cath13 eterizations, angiographies, angiograms, and 14 endoscopies are furnished).

15 ‘‘(G) PUBLICATION OF FINAL DECI16 SIONS.—Not later than 120 days after receiving 17 a complete application under this paragraph, 18 the Secretary shall publish on the public Inter19 net website of the Centers for Medicare & Med20 icaid Services the final decision with respect to 21 such application. 22 ‘‘(H) LIMITATION

Am I reading this right? The government will forbid hospitals from expanding the number of beds, operating rooms, procedure rooms, etc. And if the facility needs the expansion, it has to go to the government to get permission?

And the government will grant exceptions depending on the Census???

22 INCREASE IN FACILITY CAPACITY.—The Sec23 retary may grant an exception under the proc24 ess described in subparagraph (A) only to a 25 hospital— VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC July 14, 2009 (12:51 p.m.) F:\P11\NHI\TRICOMM\AAHCA09_001.XML f:\VHLC\071409\071409.140.xml (444390|2) 324 1 ‘‘(i) that is located in a county in 2 which the percentage increase in the popu3 lation during the most recent 5-year period 4 for which data are available is estimated to 5 be at least 150 percent of the percentage 6 increase in the population growth of the 7 State in which the hospital is located dur8 ing that period, as estimated by Bureau of 9 the Census

Looks like you read it exactly right. That would explain why ACORN is taking the census.

Just how long have the US Commies had this crap planned anyway? They are working fast and sure, as if it was already wrapped up years ago.

PLEASE ping me when you discover additional disastrous provisions.

I am trying to mount an email/phone calling personal campaign to educate some people I know who are still ignorant about what Zerocare will mean to them and to their loved ones.

An idea: With all of these LONG, LONG bills, maybe we should form an unofficial FReeper Task Force to examine each and every page. It could work if, for each section or designated set of consecutive pages, 1-2 FReepers were responsible for reading that section thoroughly and reporting the highlights or lowlights. I suggest 1-2 FReepers per section—preferably 2—in case there are misunderstandings, given the legalese.

Our damned “representatives” don’t even read the entire bills before voting.

But if we, as a group, could cover the whole bill in question and then compile our findings and send them off to our reps and everyone else?

This is an idea off the top of my head, and could surely use some refinement.

Thoughts?

Someone mentioned transferring assets to his children - and that reminded me about the asset limitation when an elderly person has to go into a care facility. Oh my gosh, that’s part of the end game, as well as everything else. Confiscation. This makes the death tax look like a toll fee.

Good idea.....but we are a freedom loving bunch of people here - hard to herd as cats.

There are or should be legions of liberty lovers at work at places like the Cato INstitute, the Heritage Foundation, and several others doing just that thing - going through page by page and posting the findings.

lowbridge is doing this now here - God bless you, LB.....

Just how long have the US Commies had this crap planned anyway? They are working fast and sure, as if it was already wrapped up years ago.

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I've noticed the same thing. There is nothing tentative about the way these huge spending bills and freedom grabs are taking place.

Worse, Zero wants all of these bills passed NOW ... QUICKLY ... before they're even written or anybody has a chance to read them. Then the parade moves on to the next big change in our way of life.

These people are following some kind of agenda and I have a growing sense of dread about this whole thing.

Many states have a certificate of need permit process for health care facility expansion and or new equipment purchases. In these states, health care facilities and providers have to justify to the state there is a need or demand for the service before being allowed to proceed with the project. On the surface, this is nothing new, but the wording leaves interpretation loopholes that a semi could be driven through, hence the danger in the proposal.

Another thing, there is an oversupply of hospital beds and surgical facilities in the country. Building more capacity that will be under utilized will do nothing but to drive up costs. The trouble, though, is that the over capacity is not equally distributed across the country. The Sun Belt has a shortage while the Midwest has too much capacity.

It MUST be no business of the government to try to warp effective economic communication. Beds will be built where they are needed without the government mucking things up. This bill is evil incarnate, but then so is much of what we accept as “government” in the United States of America, the new Soviet Union.

... there is an oversupply of hospital beds and surgical facilities in the country. Building more capacity that will be under utilized will do nothing but to drive up costs....

I believe this is a fallacious argument propounded first during the Carter administration when the Certificate of Need (CON) idea was hatched. The idea was that by restricting "facilities" healthcare costs would be restrained. In practice, however, all it accomplished was to give existing facilities (usually hospitals) the ability to prevent potential competitors, under the guise of a lack of "need". This prevented competition, of course, which eliminated the need for established institutions to become more efficient or cost-effective.

The proof that this concept doesn't work is that there has been more competition and, therefore, a slower increase in healthcare costs in states without a CON law than in those which have had one for decades.

If there were any validity to the CON theory, there would have been runaway cost increases in state without a CON law and cost containment in states with CON laws. After almost 30 years experience, of course this has not happened. Hundreds of millions (maybe billions) of dollars have been wasted fighting silly CON battles, though, and that money can never be recovered or put to use delivering medical care.

Just another stupid liberal, Jimmy Carter idea that refuses to die no matter how much it's discredited.

I agree with your sentiments. I was just trying to point out that health care facilities are already highly regulated by the states, thus the industry is not subject
to classic free market forces. In many states, a hospital must apply for permission from the authority to even take beds out of service.

I have no problem with counties and even states determining if they require more facilities. They are already in the business of issuing permits for buildings and limiting growth in their areas.

The federal government has no business determining this. It is just another layer of bureaucracy that will cause delays and restrict local growth, not to mention that the federal government will have to grow in size in order to establish the agency that will handle all this.

When Obama said he was going to work on national infrastructure, he wasn’t kidding. Though some didn’t quite understand what he meant. He is laying the groundwork, the infrastructure for an entirely different United States. One completely controlled by the Feds. The spinning in Thomas Jefferson’s grave could probably power NYC for a year. I doubt even Hamilton ever envisioned this.

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