[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4244 Introduced in House (IH)]







                                    


104th CONGRESS
  2d Session
                                H. R. 4244

 To require the Secretary of Health and Human Services to waive the 3-
 day prior hospitalization requirement for coverage of skilled nursing 
facility services in the case of individuals classified within certain 
                       diagnosis-related groups.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 27, 1996

Mr. Durbin (for himself and Mr. Ensign) introduced the following bill; 
         which was referred to the Committee on Ways and Means

_______________________________________________________________________

                                 A BILL


 
 To require the Secretary of Health and Human Services to waive the 3-
 day prior hospitalization requirement for coverage of skilled nursing 
facility services in the case of individuals classified within certain 
                       diagnosis-related groups.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. WAIVER OF 3-DAY PRIOR HOSPITALIZATION REQUIREMENT FOR 
              COVERAGE OF SKILLED NURSING FACILITY SERVICES FOR CERTAIN 
              DRGS.

    (a) In General.--By not later than October 1, 1997, the Secretary 
of Health and Human Services shall provide for coverage, under section 
1812(f) of the Social Security Act, of extended care services for 
individuals with a condition that is classifiable within a diagnosis-
related group selected under subsection (b).
    (b) Selection of Diagnosis-Related Groups.--For purposes of 
subsection (a) and subject to subsections (c) and (d), the Secretary--
            (1) beginning with fiscal year 1998, shall select at least 
        5 diagnosis-related groups (as established for purposes of 
        section 1886(d)(4)(A) of the Social Security Act) that--
                    (A) relate to conditions that do not require 
                treatment through receipt of inpatient hospital 
                services, and
                    (B) are not likely (or are least likely) to result 
                in any net increased expenditures under title XVIII of 
                such Act; and
            (2) for subsequent fiscal years may select additional 
        diagnosis-related groups that meet the requirements of 
        subparagraphs (A) and (B) of paragraph (1).
    (c) Recovery of Excess Expenditures.--If the Secretary determines 
that the application of this section in a fiscal year has resulted in 
any increase in aggregate expenditures under such title for the fiscal 
year above the amount of such expenditures that would have occurred in 
the fiscal year if this section did not apply (taking into account any 
reductions in expenditures resulting from the elimination of or a 
reduction in the length of hospitalization), the Secretary--
            (1) shall, notwithstanding any other provision of law, 
        provide for a reduction in the amounts otherwise payable under 
        part A of such title for post-hospital extended care services 
        in the following fiscal year by such proportion as will reduce 
        aggregate Federal expenditures in such fiscal year under such 
        part by the aggregate amount of such an increase in the 
        previous fiscal year, and
            (2) may rescind the selection of any diagnosis-related 
        group if the application of this section with respect to such 
        group has resulted in such an increase in expenditures under 
        such title.
    (d) Consideration of Additional Selections.--The Secretary shall 
actively consider the selection of additional groups under subsection 
(b)(2) if the Secretary determines that the application of this section 
has resulted in a net reduction in expenditures under such title.
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