114 HR 5713 EH: Sustaining Healthcare Integrity and Fair Treatment Act of 2016
U.S. House of Representatives
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents
(a)This Act may be cited as the Sustaining Healthcare Integrity and Fair Treatment Act of 2016
. (b)This table of contents of this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—Medicare Part A Provisions
Sec. 101. Extension of certain LTCH Medicare payment rules.
Sec. 102. Application of rules on the calculation of hospital length of stay to all LTCHs.
Sec. 103. Change in Medicare classification for certain hospitals.
Sec. 104. Temporary exception to the application of the Medicare LTCH site neutral provisions for certain spinal cord specialty hospitals.
Sec. 105. Temporary extension to the application of the Medicare LTCH site neutral provisions for certain discharges with severe wounds.
Title II—Other Provisions
Sec. 201. No payment for items and services furnished by newly enrolled providers or suppliers within a temporary moratorium area.
<enum>I</enum><header>Medicare Part A Provisions</header>
<section id="H382AFEF7F26A476C857ED4091B72EB6A"><enum>101.</enum><header>Extension of certain LTCH Medicare payment rules</header>
<subsection id="HC6690D82566E4B8A87EF4AF14124D5CF"><enum>(a)</enum><header>25–Percent patient threshold payment adjustment</header><text>Section 114(c)(1)(A) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww</external-xref> note), as amended by section 4302(a) of division B of the American Recovery and Reinvestment Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/5">Public Law 111–5</external-xref>), sections 3106(a) and 10312(a) of <external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>, and section 1206(b)(1)(B) of the Pathway for SGR Reform Act of 2013 (division B of <external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>), is amended by striking <quote>for a 9-year period</quote> and inserting <quote>through June 30, 2016, and for discharges occurring on or after October 1, 2016, and before July 1, 2017</quote>.</text></subsection> <subsection id="H8C208EC7E5EA4236A72B2A706442F010"><enum>(b)</enum><header>Payment for hospitals-Within-Hospitals</header><text display-inline="yes-display-inline">Section 114(c)(2) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww</external-xref> note), as amended by section 4302(a) of division B of the American Recovery and Reinvestment Act (<external-xref legal-doc="public-law" parsable-cite="pl/111/5">Public Law 111–5</external-xref>), sections 3106(a) and 10312(a) of <external-xref legal-doc="public-law" parsable-cite="pl/111/148">Public Law 111–148</external-xref>, and section 1206(b)(1)(A) of the Pathway for SGR Reform Act of 2013 (division B of <external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>), is amended—</text>
<paragraph id="H0DEF4AF389684C47928AD37F45273A7C"><enum>(1)</enum><text>in subparagraph (A), by inserting <quote>or any similar provision,</quote> after <quote>Regulations,</quote>;</text></paragraph> <paragraph id="HA46506FBE641412083AC1BD550DBBFA2"><enum>(2)</enum><text>in subparagraph (B)—</text>
<subparagraph id="H08553C2F7BED45DE8D4101902ACA3C64"><enum>(A)</enum><text>in clause (i), by inserting <quote>or any similar provision,</quote> after <quote>Regulations,</quote>; and</text></subparagraph> <subparagraph id="HADEBA8DE2B1B4C589B21536D86700A02"><enum>(B)</enum><text>in clause (ii), by inserting <quote>, or any similar provision,</quote> after <quote>Regulations</quote>; and </text></subparagraph></paragraph>
<paragraph id="HDA1D16D230884358A2E2E99802960B7A"><enum>(3)</enum><text display-inline="yes-display-inline">in subparagraph (C), by striking <quote>for a 9-year period</quote> and inserting <quote>through June 30, 2016, and for discharges occurring on or after October 1, 2016, and before July 1, 2017</quote>.</text></paragraph></subsection></section> <section id="H0B3E5B675B034D24AD23B5ADE92002A6" section-type="subsequent-section"><enum>102.</enum><header>Application of rules on the calculation of hospital length of stay to all LTCHs</header> <subsection id="H11F1869940EA4ED5B747D7815E0B5191"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1206(a)(3) of the Pathway for SGR Reform Act of 2013 (division B of <external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww</external-xref> note) is amended—</text>
<paragraph id="H8AE0411D2FFD4221A800D802CAD3F431"><enum>(1)</enum><text>by striking subparagraph (B);</text></paragraph> <paragraph id="H01ED5033B551427FA5721A2CA591F48C"><enum>(2)</enum><text>by striking <quote><header-in-text level="paragraph" style="OLC">site neutral basis.—</header-in-text></quote> and all that follows through <quote>For discharges occurring</quote> and inserting <quote><header-in-text level="paragraph" style="OLC">site neutral basis.—</header-in-text>For discharges occurring</quote>; </text></paragraph>
<paragraph id="H0AF74F6EFBEC4F378BEEC8556EB5EAE8"><enum>(3)</enum><text>by striking <quote>subject to subparagraph (B),</quote>; and</text></paragraph> <paragraph id="H5B91B5582BA74E8F891AB33777D05F03"><enum>(4)</enum><text>by redesignating clauses (i) and (ii) as subparagraphs (A) and (B), respectively, and moving each of such subparagraphs (as so redesignated) 2 ems to the left.</text></paragraph></subsection>
<subsection id="H1952EBBB6BF44226A61D500D1CB9471F"><enum>(b)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendments made by subsection (a) shall be effective as if included in the enactment of section 1206(a)(3) of the Pathway for SGR Reform Act of 2013 (division B of <external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww</external-xref> note).</text></subsection></section> <section id="HD6F7F6119DC0494A94AE166E01774B05" section-type="subsequent-section"><enum>103.</enum><header>Change in Medicare classification for certain hospitals</header> <subsection id="HB81CD1E31E614195B0C4D8C9C5E103F4"><enum>(a)</enum><header>In general</header><text>Subsection (d)(1)(B) of section 1886 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww</external-xref>) is amended—</text>
<paragraph id="H96211D244B8645958B972CE8FDEA735F"><enum>(1)</enum><text>in clause (iv)—</text> <subparagraph id="H7835BE1C530B47B6902853BB733BD442"><enum>(A)</enum><text>in subclause (I), by striking <quote>or</quote> at the end;</text></subparagraph>
<subparagraph id="HE816190FB70C424EBD8EA78D7998BB49"><enum>(B)</enum><text>in subclause (II)—</text> <clause id="H5306FB26F9F24A4193C07BA2CDEFCC30"><enum>(i)</enum><text>by striking <quote>, or</quote> at the end and inserting a semicolon;</text></clause>
<clause id="H273592A35BDC40BAB2BF23BCE70DA41C"><enum>(ii)</enum><text>by redesignating such subclause as clause (vi) and by moving it to immediately follow clause (v); and</text></clause> <clause id="H9BBA1FD6AC6D473C8A8D71F845285CB8"><enum>(iii)</enum><text>in clause (v), by striking the semicolon at the end and inserting <quote>, or</quote>; and</text></clause></subparagraph>
<subparagraph id="H19F7F94A41B54BDAB6653095AF28FE26"><enum>(C)</enum><text>by striking <quote><header-in-text level="clause" style="OLC"><enum-in-header>(iv)<header-in-text level="subclause" style="OLC"><enum-in-header>(I) </enum-in-header></header-in-text></enum-in-header></header-in-text>a hospital</quote> and inserting <quote><header-in-text level="clause" style="OLC"><enum-in-header>(iv) </enum-in-header></header-in-text>a hospital</quote>. </text></subparagraph></paragraph></subsection> <subsection id="HC4C3961A2EA049C4BAAA7CB7CE72BBAC"><enum>(b)</enum><header>Conforming payment references</header><text>The second sentence of subsection (d)(1)(B) of such section is amended—</text>
<paragraph id="H6C60EAAC75564DDD87561BA751E2F81F"><enum>(1)</enum><text>by inserting <quote>(as in effect as of such date)</quote> after <quote>clause (iv)</quote>; and</text></paragraph> <paragraph id="H85F3E7649F004D82BEA5326EEDCA0EE0"><enum>(2)</enum><text>by inserting <quote>(or, in the case of a hospital described in clause (iv)(II), as so in effect, shall be classified under clause (vi) on and after the effective date of such clause (vi) and for cost reporting periods beginning on or after January 1, 2015, shall not be subject to subsection (m) as of the date of such classification)</quote> after <quote>so classified</quote>.</text></paragraph></subsection>
<subsection id="H123C9983BE55420193FAFB4C99270925"><enum>(c)</enum><header>Application</header>
<paragraph id="H31519F65A9FB4532B8A5DD405855F2B4"><enum>(1)</enum><header>In general</header><text>For cost reporting periods beginning on or after January 1, 2015, in the case of an applicable hospital (as defined in paragraph (3)), the following shall apply:</text> <subparagraph id="H98F939B5FBEF43CA8AF8C53EC004A38A"><enum>(A)</enum><text>Payment for inpatient operating costs shall be made on a reasonable cost basis in the manner provided in section 412.526(c)(3) of title 42, Code of Federal Regulations (as in effect on January 1, 2015) and in any subsequent modifications.</text></subparagraph>
<subparagraph id="HA276829B765049A081526C75A25ADCC9"><enum>(B)</enum><text>Payment for capital costs shall be made in the manner provided by section 412.526(c)(4) of title 42, Code of Federal Regulations (as in effect on such date).</text></subparagraph> <subparagraph id="H1806624F219F4479A4D597168E02D12B"><enum>(C)</enum><text>Claims for payment for Medicare beneficiaries who are discharged on or after January 1, 2017, shall be processed as claims which are paid on a reasonable cost basis as described in section 412.526(c) of title 42, Code of Federal Regulations (as in effect on such date).</text></subparagraph></paragraph>
<paragraph id="HB84BE135BE724B1DB59C1F99D374E0BE"><enum>(2)</enum><header>Applicable hospital defined</header><text>In this subsection, the term <term>applicable hospital</term> means a hospital that is classified under clause (iv)(II) of section 1886(d)(1)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(1)(B)</external-xref>) on the day before the date of the enactment of this Act and which is classified under clause (vi) of such section, as redesignated and moved by subsection (a), on or after such date of enactment.</text></paragraph></subsection> <subsection id="H74FF888ACC374384A4FC9C733A1FD93E"><enum>(d)</enum><header>Conforming technical amendments</header> <paragraph id="H4B349389715942F1866904CE2ABFD98A"><enum>(1)</enum><text display-inline="yes-display-inline">Section 1899B(a)(2)(A)(iv) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395lll">42 U.S.C. 1395lll(a)(2)(A)(iv)</external-xref>) is amended by striking <quote>1886(d)(1)(B)(iv)(II)</quote> and inserting <quote>1886(d)(1)(B)(vi)</quote>.</text></paragraph>
<paragraph id="H7612659CC7B24ADD8A908075E39045EB"><enum>(2)</enum><text display-inline="yes-display-inline">Section 1886(m)(5)(F) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(m)(5)(F)</external-xref>) is amended in each of clauses (i) and (ii) by striking <quote>(d)(1)(B)(iv)(II)</quote> and inserting <quote>(d)(1)(B)(vi)</quote>.</text></paragraph></subsection></section> <section id="HF11AEA54B57747609D991605BC3102EF" section-type="subsequent-section"><enum>104.</enum><header>Temporary exception to the application of the Medicare LTCH site neutral provisions for certain spinal cord specialty hospitals</header> <subsection id="H7CAFCA3F118E4BF685AC4EF1A4CC6046"><enum>(a)</enum><header>Exception</header><text>Section 1886(m)(6) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(m)(6)</external-xref>) is amended—</text>
<paragraph id="H22B5739D66F348388843729E407CE76E"><enum>(1)</enum><text>in subparagraph (A)(i), by striking <quote>and (E)</quote> and inserting <quote>, (E), and (F)</quote>; and</text></paragraph> <paragraph id="HCA9B44FFEDFE469FB6577AA3FF2B3D61"><enum>(2)</enum><text>by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H62DEC27789BA47AA93665A54B8D04318" style="OLC">
<subparagraph id="H169E7BC823F74B57B45FFA0178B2502B"><enum>(F)</enum><header>Temporary exception for certain spinal cord specialty hospitals</header><text>For discharges in cost reporting periods beginning during fiscal years 2018 and 2019, subparagraph (A)(i) shall not apply (and payment shall be made to a long-term care hospital without regard to this paragraph) if such discharge is from a long-term care hospital that meets each of the following requirements:</text> <clause id="HFA01DAE6D93A48A1886A1084EBE92D1D"><enum>(i)</enum><header>Not-for-profit</header><text>The long-term care hospital was a not-for-profit long-term care hospital on June 1, 2014, as determined by cost report data.</text></clause>
<clause id="H98FC0DFE381B4235BA7590E6CE29702F"><enum>(ii)</enum><header>Primarily providing treatment for catastrophic spinal cord or acquired brain injuries or other paralyzing neuromuscular conditions</header><text display-inline="yes-display-inline">Of the discharges in calendar year 2013 from the long-term care hospital for which payment was made under this section, at least 50 percent were classified under MS–LTCH–DRGs 28, 29, 52, 57, 551, 573, and 963.</text></clause> <clause id="H6093C0B73EAC491B8BEE53ACC2C7680A"><enum>(iii)</enum><header>Significant out-of-State admissions</header> <subclause id="H10D9F639364F43B4B542A9B40B2DE1AB"><enum>(I)</enum><header>In general</header><text display-inline="yes-display-inline">The long-term care hospital discharged inpatients (including both individuals entitled to, or enrolled for, benefits under this title and individuals not so entitled or enrolled) during fiscal year 2014 who had been admitted from at least 20 of the 50 States, determined by the States of residency of such inpatients and based on such data submitted by the hospital to the Secretary as the Secretary may require.</text></subclause>
<subclause id="H88BE668D63E745188898C503BA9B39A9"><enum>(II)</enum><header>Implementation</header><text>Notwithstanding any other provision of law, the Secretary may implement subclause (I) by program instruction or otherwise.</text></subclause> <subclause id="HEF221842EB5D49BEB42FB0742E9BE1E5"><enum>(III)</enum><header>Non-application of Paperwork Reduction Act</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/44/35">Chapter 35</external-xref> of title 44, United States Code, shall not apply to data collected under this clause.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection id="H9670A417EA8B41ABA6134854EF02E995"><enum>(b)</enum><header>Study and report on the status and viability of certain spinal cord specialty long-Term care hospitals</header>
<paragraph id="HB2D4815C797B41FFB8A17ECB706ABB18"><enum>(1)</enum><header>Study</header><text>The Comptroller General of the United States shall conduct a study on long-term care hospitals described in section 1886(m)(6)(F) of the Social Security Act, as added by subsection (a). Such report shall include an analysis of the following:</text> <subparagraph id="H4172893DCD374E16A128658A894D5FBF"><enum>(A)</enum><text>The impact on such hospitals of the classification and facility licensure by State agencies of such hospitals.</text></subparagraph>
<subparagraph id="H10AB6C42C2514CD4A80012DB9E640B10"><enum>(B)</enum><text>The Medicare payment rates for such hospitals.</text></subparagraph> <subparagraph id="HCFD561DA2ADC47CBB84B63F309C66F7C"><enum>(C)</enum><text>Data on the number and health care needs of Medicare beneficiaries who have been diagnosed with catastrophic spinal cord or acquired brain injuries or other paralyzing neuromuscular conditions (as described within the discharge classifications specified in clause (ii) of such section) who are receiving services from such hospitals.</text></subparagraph></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H0B5E9CAD9CB1424AB516D100349258FB"><enum>(2)</enum><header>Report</header><text>Not later than October 1, 2018, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1), including recommendations for such legislation and administrative action as the Comptroller General determines appropriate.</text></paragraph></subsection></section> <section id="H0414061C7362463DA5C3C74DB014319D" section-type="subsequent-section"><enum>105.</enum><header>Temporary extension to the application of the Medicare LTCH site neutral provisions for certain discharges with severe wounds</header> <subsection id="H6FFBC8A70FE14ED7B24CD44BC741AADA"><enum>(a)</enum><header>In general</header><text>Section 1886(m)(6) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(m)(6)</external-xref>), as amended by section 104, is further amended—</text>
<paragraph id="H6D33FE97CFCB4A3B91140F065F554D57"><enum>(1)</enum><text>in subparagraph (A)(i) by striking <quote>and (F)</quote> and inserting <quote>(F), and (G)</quote>;</text></paragraph> <paragraph id="H2EAA6D23218C4BBEB00C59DA72287FA8"><enum>(2)</enum><text>in subparagraph (E)(i)(I)(aa), by striking <quote>the amendment made</quote> and all that follows before the semicolon and inserting <quote>the last sentence of subsection (d)(1)(B)</quote>; and</text></paragraph>
<paragraph id="HAD9DD7B588354ADCB302FDACF3484172"><enum>(3)</enum><text>by adding at the end the following new subparagraph:</text> <quoted-block id="HF3EB8347B7034946A45CD1660BDD9AF5" style="OLC"> <subparagraph id="HEC7655A0A776485D9305F99822F1F9D8"><enum>(G)</enum><header>Additional temporary exception for certain severe wound discharges from certain long-term care hospitals</header> <clause id="H9A113FCBB63247109782B696EC75915F"><enum>(i)</enum><header>In general</header><text>For a discharge occurring in a cost reporting period beginning during fiscal year 2018, subparagraph (A)(i) shall not apply (and payment shall be made to a long-term care hospital without regard to this paragraph) if such discharge—</text>
<subclause id="H6C8FC8A19E8748E5B735FD551C94D162"><enum>(I)</enum><text>is from a long-term care hospital identified by the last sentence of subsection (d)(1)(B);</text></subclause> <subclause id="HB33C47DAF012402D805FD2AB61884174"><enum>(II)</enum><text>is classified under MS–LTCH–DRG 602, 603, 539, or 540; and</text></subclause>
<subclause id="H579050303192432EAB0A7D0FD4C56096"><enum>(III)</enum><text>is with respect to an individual treated by a long-term care hospital for a severe wound.</text></subclause></clause> <clause id="HDF3C49865A914CCB93252F9A5F2D2141"><enum>(ii)</enum><header>Severe wound defined</header><text>In this subparagraph, the term <term>severe wound</term> means a wound which is a stage 3 wound, stage 4 wound, unstageable wound, non-healing surgical wound, or fistula as identified in the claim from the long-term care hospital.</text></clause>
<clause id="H4814C5C5073144A8A82872F008DD7557"><enum>(iii)</enum><header>Wound defined</header><text>In this subparagraph, the term <term>wound</term> means an injury involving division of tissue or rupture of the integument or mucous membrane with exposure to the external environment.</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="H51FC1B806CB04D82A2362A1EFF8BAB75"><enum>(c)</enum><header>Study and report to Congress</header> <paragraph id="H375FE200CBD04712A1BB28D705169977"><enum>(1)</enum><header>Study</header><text>The Comptroller General of the United States shall, in consultation with relevant stakeholders, conduct a study on the treatment needs of individuals entitled to benefits under part A of title XVIII of the Social Security Act or enrolled under part B of such title who require specialized wound care, and the cost, for such individuals and the Medicare program under such title, of treating severe wounds in rural and urban areas. Such study shall include an assessment of—</text>
<subparagraph id="HA875F9E4FFD34125A128FCF461595C55"><enum>(A)</enum><text>access of such individuals to appropriate levels of care for such cases;</text></subparagraph> <subparagraph id="H827BDF8C627B4C1DA006D66DAAA221E8"><enum>(B)</enum><text>the potential impact that section 1886(m)(6)(A)(i) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(m)(6)(A)(i)</external-xref>) will have on the access, quality, and cost of care for such individuals; and</text></subparagraph>
<subparagraph id="HEE39F8611F7E4BA7844BE398B14AC545"><enum>(C)</enum><text>how to appropriately pay for such care under the Medicare program under such title.</text></subparagraph></paragraph> <paragraph id="HF46C6F500CCA4E0FBE51253FF336C3A4"><enum>(2)</enum><header>Report</header><text>Not later than October 1, 2020, the Comptroller General shall submit to Congress a report on the study conducted under paragraph (1), including recommendations for such legislation and administrative action as the Comptroller General determines appropriate.</text></paragraph></subsection></section>
<enum>II</enum><header>Other Provisions</header>
<section id="H7F10DEB6C3D94BD4A02BFFB203050EDD" section-type="subsequent-section"><enum>201.</enum><header>No payment for items and services furnished by newly enrolled providers or suppliers within a temporary moratorium area</header>
<subsection id="H1E938834A4CA46BCB2E62F9103C6B843"><enum>(a)</enum><header>Medicare</header><text display-inline="yes-display-inline">Section 1866(j)(7) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(j)(7)</external-xref>) is amended—</text> <paragraph id="HFED60B18693F4FF18093B6F0D52CBFEC"><enum>(1)</enum><text display-inline="yes-display-inline">in the paragraph heading, by inserting <quote><header-in-text level="paragraph" style="OLC">; Nonpayment</header-in-text></quote> before the period; and</text></paragraph>
<paragraph id="H295B49FBEF3F40149468314DBD7818E3"><enum>(2)</enum><text>by adding at the end the following new subparagraph:</text> <quoted-block style="OLC" id="HAF14F9610C934BFD8943FC463EDAFE79" display-inline="no-display-inline"> <subparagraph id="HC5D6FEB13C794F13A968A0AFC6C07D4E"><enum>(C)</enum><header>Nonpayment</header> <clause id="H38B5CA11563849C1AA0036F3CC89761F"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">No payment may be made under this title or under a program described in subparagraph (A) with respect to an item or service described in clause (ii) furnished on or after October 1, 2017.</text></clause>
<clause id="H131A68698DF74DA0A519FF5616080A88"><enum>(ii)</enum><header>Item or service described</header><text display-inline="yes-display-inline">An item or service described in this clause is an item or service furnished—</text> <subclause id="H6CBA087C7C5D460AA35716B01A86BC88"><enum>(I)</enum><text>within a geographic area with respect to which a temporary moratorium imposed under subparagraph (A) is in effect; and </text></subclause>
<subclause id="H02C9F464D35A43EA91D4ACC1F7B0EDA5"><enum>(II)</enum><text>by a provider of services or supplier that meets the requirements of clause (iii).</text></subclause></clause> <clause id="H69459746FE1F48199D9126C66162FD8C"><enum>(iii)</enum><header>Requirements</header><text>For purposes of clause (ii), the requirements of this clause are that a provider of services or supplier—</text>
<subclause id="H3DF161BC7AA0497FB3640EA360E99306"><enum>(I)</enum><text>enrolls under this title on or after the effective date of such temporary moratorium; and</text></subclause> <subclause id="H5715457E1E18410786493B26D60ECF37"><enum>(II)</enum><text>is within a category of providers of services and suppliers (as described in subparagraph (A)) subject to such temporary moratorium.</text></subclause></clause>
<clause id="H15E04C2EAC7E4CCC8890F78898A07843"><enum>(iv)</enum><header>Prohibition on charges for specified items or services</header><text display-inline="yes-display-inline">In no case shall a provider of services or supplier described in clause (ii)(II) charge an individual or other person for an item or service described in clause (ii) furnished on or after October 1, 2017, to an individual entitled to benefits under part A or enrolled under part B or an individual under a program specified in subparagraph (A). </text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="H9B30D3FBCE8B46F9A1A760E6C72C433A"><enum>(b)</enum><header>Conforming amendments</header> <paragraph id="H9369CCF851D74F0E94DE96E22ADD6C57"><enum>(1)</enum><header>Medicaid</header> <subparagraph id="HDF1AA7EAB75B4DA79E4DB0C2D9CC959C"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1903(i)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(i)(2)</external-xref>) is amended—</text>
<clause id="HFE5B7E1CB28945F9968F40B08A7F7299"><enum>(i)</enum><text display-inline="yes-display-inline">in subparagraph (A), by striking the comma at the end and inserting a semicolon;</text></clause> <clause id="H316B0910141B4BF98A41A76364FE6733"><enum>(ii)</enum><text>in subparagraph (B), by striking <quote>or</quote> at the end; and</text></clause>
<clause id="H81127EEDEFE847D187400BD9A7B1DE96"><enum>(iii)</enum><text display-inline="yes-display-inline">by adding at the end the following new subparagraph:</text> <quoted-block style="OLC" id="H952D09C6ADF347858F11760661F1E708" display-inline="no-display-inline"> <subparagraph id="HAF84319B10B24341A75900F77076E719"><enum>(D)</enum><text>with respect to any amount expended for such an item or service furnished during calendar quarters beginning on or after October 1, 2017, subject to section 1902(kk)(4)(A)(ii)(II), within a geographic area that is subject to a moratorium imposed under section 1866(j)(7) by a provider or supplier that meets the requirements specified in subparagraph (C)(iii) of such section, during the period of such moratorium; or</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></clause></subparagraph>
<subparagraph id="HC68A95EB4D4D4BB59B98FC2335F7649F"><enum>(B)</enum><header>Exception with respect to access</header><text display-inline="yes-display-inline">Section 1902(kk)(4)(A)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(kk)(4)(A)(ii)</external-xref>) is amended to read as follows: </text> <quoted-block style="OLC" id="H75B22F10B0F249D4AA8F27B48BED2AE4" display-inline="no-display-inline"> <clause id="H018300E772654D26BADF54EE3DC48E4D" commented="no"><enum>(ii)</enum><header>Exceptions</header> <subclause id="H42421903E8BE4C8CB8E8A1512968ECFD" commented="no"><enum>(I)</enum><header>Compliance with moratorium</header><text display-inline="yes-display-inline">A State shall not be required to comply with a temporary moratorium described in clause (i) if the State determines that the imposition of such temporary moratorium would adversely impact beneficiaries’ access to medical assistance.</text></subclause>
<subclause id="H6E0B94C2AB784AA8A2CA3A32A6DF3BDF" commented="no"><enum>(II)</enum><header>FFP available</header><text display-inline="yes-display-inline">Notwithstanding section 1903(i)(2)(D), payment may be made to a State under this title with respect to amounts expended for items and services described in such section if the Secretary, in consultation with the State agency administering the State plan under this title (or a waiver of the plan), determines that denying payment to the State pursuant to such section would adversely impact beneficiaries’ access to medical assistance. <italic></italic></text></subclause></clause><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph> <subparagraph id="HFBA888EE68084CBF953112D0DF074259"><enum>(C)</enum><header>State plan requirement with respect to limitation on charges to beneficiaries</header><text>Section 1902(kk)(4)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(kk)(4)(A)</external-xref>) is amended by adding at the end the following new clause: </text>
<quoted-block style="OLC" id="H0DA2F6AB862448B0823283E7A23BDB9D" display-inline="no-display-inline">
<clause id="H5995C6D943764B2EBC5047E492694550"><enum>(iii)</enum><header>Limitation on charges to beneficiaries</header><text display-inline="yes-display-inline">With respect to any amount expended for items or services furnished during calendar quarters beginning on or after October 1, 2017, the State prohibits, during the period of a temporary moratorium described in clause (i), a provider meeting the requirements specified in subparagraph (C)(iii) of section 1866(j)(7) from charging an individual or other person eligible to receive medical assistance under the State plan under this title (or a waiver of the plan) for an item or service described in section 1903(i)(2)(D) furnished to such an individual.</text></clause><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="HB03F3F66E7644D0CB6FEF1B238E6239A"><enum>(2)</enum><header>Correcting amendments to related provisions</header> <subparagraph id="HF241920FC7034F81B7FF789F46F993D1"><enum>(A)</enum><header>Section 1866(j)</header><text>Section 1866(j) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(j)</external-xref>) is amended—</text>
<clause id="H5ABF72FA84C44A59902EB31B1F643A60"><enum>(i)</enum><text>in paragraph (1)(A)—</text> <subclause id="HEE40092774B842DDB8F3267C59037C12"><enum>(I)</enum><text>by striking <quote>paragraph (4)</quote> and inserting <quote>paragraph (5)</quote>;</text></subclause>
<subclause id="H990E27A6447F4A0DA26DE9DFDD3577FA"><enum>(II)</enum><text>by striking <quote>moratoria in accordance with paragraph (5)</quote> and inserting <quote>moratoria in accordance with paragraph (7)</quote>; and</text></subclause> <subclause id="H816AD5AD58BB4E0C80FC5BA1FE056C15"><enum>(III)</enum><text>by striking <quote>paragraph (6)</quote> and inserting <quote>paragraph (9)</quote>; and</text></subclause></clause>
<clause id="H3A4B2C272B5C46D9BAAC5C5F56BCD446"><enum>(ii)</enum><text>by redesignating the second paragraph (8) (added by section 1304(1) of <external-xref legal-doc="public-law" parsable-cite="pl/111/152">Public Law 111–152</external-xref>) as paragraph (9).</text></clause></subparagraph> <subparagraph id="H0B3A0057663D4936B7142F83040F4AB2"><enum>(B)</enum><header>Section 1902(kk)</header><text>Section 1902(kk) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(kk)</external-xref>) is amended—</text>
<clause id="H61AC8F76594349A1A97B0AB469E5FA59"><enum>(i)</enum><text>in paragraph (1), by striking <quote>section 1886(j)(2)</quote> and inserting <quote>section 1866(j)(2)</quote>;</text></clause> <clause id="HDD664146C1084735B934547F8B951463"><enum>(ii)</enum><text>in paragraph (2), by striking <quote>section 1886(j)(3)</quote> and inserting <quote>section 1866(j)(3)</quote>;</text></clause>
<clause id="HE8016407A5334D53A86F6A47E11D0AF7"><enum>(iii)</enum><text display-inline="yes-display-inline">in paragraph (3), by striking <quote>section 1886(j)(4)</quote> and inserting <quote>section 1866(j)(5)</quote>; and</text></clause> <clause id="H42ECA4E717864140AC6D2DBA3FAFDFD0"><enum>(iv)</enum><text display-inline="yes-display-inline">in paragraph (4)(A), by striking <quote>section 1886(j)(6)</quote> and inserting <quote>section 1866(j)(7)</quote>.</text></clause></subparagraph></paragraph></subsection></section>
Passed the House of Representatives September 21, 2016.Karen L. Haas,Clerk.