[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3790 Introduced in House (IH)]






108th CONGRESS
  2d Session
                                H. R. 3790

 To impose a moratorium on payments for inpatient hospital services in 
  additional long-term care hospital beds under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 10, 2004

  Mr. Stark introduced the following bill; which was referred to the 
                      Committee on Ways and Means

_______________________________________________________________________

                                 A BILL


 
 To impose a moratorium on payments for inpatient hospital services in 
  additional long-term care hospital beds under the Medicare Program.

    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 ``Long-term Care Hospital Moratorium 
Act of 2004''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Long-term care hospitals are one of four types of post-
        acute care settings that are reimbursed under the Medicare 
        program.
            (2) There has been substantial growth in the number of 
        these hospitals over the past decade. Since 1993, the number of 
        long-term care hospitals has increased over 275 percent from 
        109 to 300 facilities.
            (3) Corresponding to the increase in number of these 
        facilities is a rapid increase in Medicare spending on long-
        term care hospitals. Medicare spending has jumped over 500 
        percent from $398 million in 1993 to an anticipated 2.3 billion 
        in 2005.
            (4) Long-term care hospitals are the most expensive on 
        average of all the post acute alternatives, currently costing 
        approximately $35,700 per patient episode. Current earnings and 
        margins for these hospitals are significantly higher than for 
        comparable Medicare reimbursed clinical service programs.
            (5) There is evidence that patients are being admitted into 
        long-term care hospitals when services can be provided in other 
        less expensive post-acute care settings.
            (6) These trends raise questions about--
                    (A) the clinical need to support the rapid growth 
                in long-term care hospitals;
                    (B) the appropriateness of the current Medicare 
                payment system for long-term care hospital services; 
                and
                    (C) the extent to which clinical admissions 
                criteria for long-term care hospital patients can be 
                modified so as to minimize the acceptance of patients 
                into these settings that can be appropriately treated 
                in alternative, less costly post-acute settings.
            (7) A temporary moratorium on recognizing additional long-
        term care hospital beds is appropriate until these questions 
        are answered, in order to ensure that beneficiaries are 
        receiving the treatment they require and that Medicare funds 
        are being prudently spent.

SEC. 3. MORATORIUM ON MEDICARE PAYMENT FOR INPATIENT HOSPITAL SERVICES 
              IN ADDITIONAL LONG-TERM CARE HOSPITAL BEDS.

    (a) In General.--Notwithstanding any other provision of law, except 
as provided in subsection (b), no payment shall be made under section 
1886 of the Social Security Act (42 U.S.C. 1395ww) for inpatient 
hospital services provided in a long-term care hospital unless such 
services were provided for services furnished for a patient in a bed 
which was either in operation or in development (as determined by the 
Secretary) as of the date of the introduction of the Long-term Care 
Hospital Moratorium Act of 2004.
    (b) Termination of Moratorium.--
            (1) In general.--The Secretary may terminate the moratorium 
        under subsection (a) if the Secretary determines that adequate 
        information is obtained and any appropriate interventions are 
        implemented to ensure that beneficiaries within long-term care 
        hospitals are receiving the treatment they require and that 
        Medicare funds allocated to these hospitals are being prudently 
        spent.
            (2) Condition.-- The Secretary shall only make such 
        determination based on the Secretary judgment that there is 
        adequate evidence--
                    (A) of a clinical need for a growth in the number 
                of beds in long-term care hospitals;
                    (B) that an appropriate reimbursement system and 
                rate is in place for Medicare payment for inpatient 
                hospital services in such hospitals; and
                    (C) of a clinical admission policy for such 
                hospitals that minimizes the acceptance of patients 
                into these settings that can be appropriately treated 
                in alternative, less costly post acute settings.
    (c) Prior Report to Congress.--If the Secretary intends to 
terminate the moratorium under subsection (b), the Secretary shall 
submit to Congress a report at least 1 month before the date of such 
termination. Such report shall include the rationale for the 
termination and shall specify the evidence described in subsection 
(b)(2) that supports the termination of the moratorium.
    (d) Definitions.--For purposes of this section:
            (1) The term ``long-term care hospital'' means a hospital 
        described in section 1886(d)(1)(B)(iv) of the Social Security 
        Act (42 U.S.C. 1395ww(d)(1)(B)(iv)).
            (2) The term ``Secretary '' means the Secretary of Health 
        and Human Services.
                                 <all>