[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5713 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 5713

    To provide for the extension of certain long-term care hospital 
    Medicare payment rules, clarify the application of rules on the 
 calculation of hospital length of stay to certain moratorium-excepted 
           long-term care hospitals, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 11, 2016

  Mr. Tiberi (for himself and Mr. Pascrell) introduced the following 
  bill; which was referred to the Committee on Ways and Means, and in 
 addition to the Committee on Energy and Commerce, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
    To provide for the extension of certain long-term care hospital 
    Medicare payment rules, clarify the application of rules on the 
 calculation of hospital length of stay to certain moratorium-excepted 
           long-term care hospitals, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Sustaining 
Healthcare Integrity and Fair Treatment Act of 2016''.
    (b) Table of Contents.--This table of contents for 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 exception to site neutral payment rate for certain 
                            discharges from long-term care hospitals 
                            that involve 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.

                  TITLE I--MEDICARE PART A PROVISIONS

SEC. 101. EXTENSION OF CERTAIN LTCH MEDICARE PAYMENT RULES.

    (a) 25-Percent Patient Threshold Payment Adjustment.--Section 
114(c)(1)(A) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 
(42 U.S.C. 1395ww note), as amended by section 4302(a) of division B of 
the American Recovery and Reinvestment Act (Public Law 111-5), sections 
3106(a) and 10312(a) of Public Law 111-148 and section 1206(b)(1)(B) of 
the Pathway for SGR Reform Act of 2013 (division B of Public Law 113-
67), is amended by striking ``for a 9-year period'' and inserting 
``through June 30, 2016, and for discharges occurring on or after 
October 1, 2016, and before July 1, 2017,''.
    (b) Payment for Hospitals-within-Hospitals.--Section 114(c)(2) of 
the Medicare, Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 
1395ww note), as amended by section 4302(a) of division B of the 
American Recovery and Reinvestment Act (Public Law 111-5), sections 
3106(a) and 10312(a) of Public Law 111-148, and section 1206(b)(1)(A) 
of the Pathway for SGR Reform Act of 2013 (division B of Public Law 
113-67), is amended--
            (1) in subparagraph (A), by inserting ``or any similar 
        provision,'' after ``Regulations,'';
            (2) in subparagraph (B)--
                    (A) in clause (i), by inserting ``or any similar 
                provision,'' after ``Regulations,''; and
                    (B) in clause (ii), by inserting ``, or any similar 
                provision,'' after ``Regulations''; and
            (3) in subparagraph (C), by striking ``for a 9-year 
        period'' and inserting ``through June 30, 2016, and for 
        discharges occurring on or after October 1, 2016, and before 
        July 1, 2017''.

SEC. 102. APPLICATION OF RULES ON THE CALCULATION OF HOSPITAL LENGTH OF 
              STAY TO ALL LTCHS.

    (a) In General.--Section 1206(a)(3) of the Pathway for SGR Reform 
Act of 2013 (division B of Public Law 113-67; 42 U.S.C. 1395ww note) is 
amended--
            (1) by striking subparagraph (B);
            (2) by striking ``site neutral basis.--'' and all that 
        follows through ``For discharges occurring'' and inserting 
        ``site neutral basis.--For discharges occurring'';
            (3) by striking ``subject to subparagraph (B),''; and
            (4) 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.
    (b) Effective Date.--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 Public Law 113-67; 42 
U.S.C. 1395ww note).

SEC. 103. CHANGE IN MEDICARE CLASSIFICATION FOR CERTAIN HOSPITALS.

    (a) In General.--Subsection (d)(1)(B) of section 1886 of the Social 
Security Act (42 U.S.C. 1395ww) is amended--
            (1) in clause (iv)--
                    (A) in subclause (I), by striking ``or'' at the 
                end;
                    (B) in subclause (II)--
                            (i) by striking ``, or'' at the end and 
                        inserting a semicolon; and
                            (ii) by redesignating such subclause as 
                        clause (vi) and by moving it to immediately 
                        follow clause (v); and
                            (iii) in clause (v), by striking the 
                        semicolon at the end and inserting ``, or''; 
                        and
                    (C) by striking ``(iv)(i) a hospital'' and 
                inserting ``(iv) a hospital''.
    (b) Conforming Payment References.--The second sentence of 
subsection (d)(1)(B) of such section is amended--
            (1) by inserting ``(as in effect as of such date)'' after 
        ``clause (iv)''; and
            (2) by inserting ``(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)'' after ``so classified''.
    (c) Application.--
            (1) In general.--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:
                    (A) 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.
                    (B) 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).
                    (C) 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).
            (2) Applicable hospital defined.--In this subsection, the 
        term ``applicable hospital'' means a hospital that is 
        classified under clause (iv)(II) of section 1886(d)(1)(B) of 
        the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)) 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.
    (d) Conforming Technical Amendment.--Clauses (i) and (ii) of 
section 1886(m)(5)(F) and section 1899B(a)(2)(A)(iv) of the Social 
Security Act (42 U.S.C. 1395ww(m)(5)(F) and 42 U.S.C. 
1395lll(a)(2)(A)(iv)) are each amended by striking 
``1886(d)(1)(B)(iv)(II)'' and inserting ``1886(d)(1)(B)(vi)''.

SEC. 104. TEMPORARY EXCEPTION TO THE APPLICATION OF THE MEDICARE LTCH 
              SITE NEUTRAL PROVISIONS FOR CERTAIN SPINAL CORD SPECIALTY 
              HOSPITALS.

    (a) Exception.--Section 1886(m)(6) of the Social Security Act (42 
U.S.C. 1395ww(m)(6)) is amended--
            (1) in subparagraph (A)(i), by striking ``and (E)'' and 
        inserting ``, (E), and (F)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(F) Temporary exception for certain spinal cord 
                specialty hospitals.--For discharges in cost-reporting 
                periods 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 is from a long-term care 
                hospital that meets each of the following requirements:
                            ``(i) Not-for-profit.--The long-term care 
                        hospital was a not-for-profit long-term care 
                        hospital on June 1, 2014, as determined by cost 
                        report data.
                            ``(ii) Primarily providing treatment for 
                        catastrophic spinal cord or acquired brain 
                        injuries or other paralyzing neuromuscular 
                        conditions.--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.
                            ``(iii) Significant out-of-state 
                        admissions.--
                                    ``(I) In general.--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.
                                    ``(II) Implementation.--
                                Notwithstanding any other provision of 
                                law, the Secretary may implement 
                                subclause (I) by program instruction or 
                                otherwise.
                                    ``(III) Non-application of 
                                paperwork reduction act.--Chapter 35 of 
                                title 44, United States Code, shall not 
                                apply to data collected under this 
                                clause.''.
    (b) Study and Report on the Status and Viability of Certain Spinal 
Cord Specialty Long-Term Care Hospitals.--
            (1) Study.--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:
                    (A) The impact on such hospitals of the 
                classification and facility licensure by State agencies 
                of such hospitals.
                    (B) The Medicare payment rates for such hospitals.
                    (C) 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.
            (2) Report.--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.

SEC. 105. TEMPORARY EXCEPTION TO SITE NEUTRAL PAYMENT RATE FOR CERTAIN 
              DISCHARGES FROM LONG-TERM CARE HOSPITALS THAT INVOLVE 
              SEVERE WOUNDS.

    (a) In General.--Section 1886(m)(6) of the Social Security Act (42 
U.S.C. 1395ww(m)(6)), as amended by section 104, is further amended--
            (1) in subparagraph (A)(i) by striking ``and (F)'' and 
        inserting ``(F), and (G)'';
            (2) in subparagraph (E)(i)(I)(aa), by striking ``the 
        amendment made'' and all that follows before the semicolon and 
        inserting ``the last sentence of subsection (d)(1)(B)''; and
            (3) by adding at the end the following new subparagraph:
                    ``(G) Additional temporary exception for certain 
                severe wound discharges from certain long-term care 
                hospitals.--
                            ``(i) In general.--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--
                                    ``(I) is from a long-term care 
                                hospital identified by the last 
                                sentence of subsection (d)(1)(B);
                                    ``(II) is classified under MS-LTCH-
                                DRG 602, 603, 539, or 540; and
                                    ``(III) is with respect to an 
                                individual treated by a long-term care 
                                hospital for a severe wound.
                            ``(ii) Severe wound defined.--In this 
                        subparagraph, the term `severe wound' 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.
                            ``(iii) Wound defined.--In this 
                        subparagraph, the term `wound' means an injury 
                        involving division of tissue or rupture of the 
                        integument or mucous membrane with exposure to 
                        the external environment.''.
    (b) Study and Report to Congress.--
            (1) Study.--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--
                    (A) access of such individuals to appropriate 
                levels of care for such cases;
                    (B) the potential impact that section 
                1886(m)(6)(A)(i) of such Act (42 U.S.C. 
                1395ww(m)(6)(A)(i)) will have on the access, quality, 
                and cost of care for such individuals; and
                    (C) how to appropriately pay for such care under 
                the Medicare program under such title.
            (2) Report.--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.

                       TITLE II--OTHER PROVISIONS

SEC. 201. NO PAYMENT FOR ITEMS AND SERVICES FURNISHED BY NEWLY ENROLLED 
              PROVIDERS OR SUPPLIERS WITHIN A TEMPORARY MORATORIUM 
              AREA.

    (a) Medicare.--Section 1866(j)(7) of the Social Security Act (42 
U.S.C. 1395cc(j)(7)) is amended--
            (1) in the paragraph heading, by inserting ``; nonpayment'' 
        before the period; and
            (2) by adding at the end the following new subparagraph:
                    ``(C) Nonpayment.--
                            ``(i) In general.--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).
                            ``(ii) Item or service described.--An item 
                        or service described in this clause is an item 
                        or service furnished--
                                    ``(I) within a geographic area with 
                                respect to which a temporary moratorium 
                                imposed under subparagraph (A) is in 
                                effect; and
                                    ``(II) by a provider of services or 
                                supplier that meets the requirements of 
                                clause (iii).
                            ``(iii) Requirements.--For purposes of 
                        clause (ii), the requirements of this clause 
                        are that a provider of services or supplier--
                                    ``(I) enrolls under this title on 
                                or after the effective date of such 
                                temporary moratorium; and
                                    ``(II) is within a category of 
                                providers of services and suppliers (as 
                                described in subparagraph (A)) subject 
                                to such temporary moratorium.
                            ``(iv) Prohibition on charges for specified 
                        items or services.--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 to an individual entitled to benefits 
                        under part A or enrolled under part B or an 
                        individual under a program specified in 
                        subparagraph (A).''.
    (b) Conforming Amendments.--
            (1) Medicaid.--
                    (A) In general.--Section 1903(i)(2) of the Social 
                Security Act (42 U.S.C. 1396b(i)(2)) is amended--
                            (i) in subparagraph (A), by striking the 
                        comma at the end and inserting a semicolon;
                            (ii) in subparagraph (B), by striking 
                        ``or'' at the end; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(D) 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''.
                    (B) Exception with respect to access.--Section 
                1902(kk)(4)(A)(ii) of the Social Security Act (42 
                U.S.C. 1396a(kk)(4)(A)(ii)) is amended to read as 
                follows:
                            ``(ii) Exceptions.--
                                    ``(I) Compliance with moratorium.--
                                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.
                                    ``(II) FFP available.--
                                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. ''.
                    (C) State plan requirement with respect to 
                limitation on charges to beneficiaries.--Section 
                1902(kk)(4)(A) of the Social Security Act (42 U.S.C. 
                1396a(kk)(4)(A)) is amended by adding at the end the 
                following new clause:
                            ``(iii) Limitation on charges to 
                        beneficiaries.--The State prohibits, during the 
                        period of such a moratorium, 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.''.
            (2) Correcting amendments to related provisions.--
                    (A) Section 1866(j).--Section 1866(j) of the Social 
                Security Act (42 U.S.C. 1395cc(j)) is amended--
                            (i) in paragraph (1)(A)--
                                    (I) by striking ``paragraph (4)'' 
                                and inserting ``paragraph (5)'';
                                    (II) by striking ``moratoria in 
                                accordance with paragraph (5)'' and 
                                inserting ``moratoria in accordance 
                                with paragraph (7)''; and
                                    (III) by striking ``paragraph (6)'' 
                                and inserting ``paragraph (9)''; and
                            (ii) by redesignating the second paragraph 
                        (8) (added by section 1304(1) of Public Law 
                        111-152) as paragraph (9).
                    (B) Section 1902(kk).--Section 1902(kk) of such Act 
                (42 U.S.C. 1396a(kk)) is amended--
                            (i) in paragraph (1), by striking ``section 
                        1886(j)(2)'' and inserting ``section 
                        1866(j)(2)'';
                            (ii) in paragraph (2), by striking 
                        ``section 1886(j)(3)'' and inserting ``section 
                        1866(j)(3)'';
                            (iii) in paragraph (3), by striking 
                        ``section 1866(j)(4)'' and inserting ``section 
                        1866(j)(5)''; and
                            (iv) in paragraph (4)(A), by striking 
                        ``section 1886(j)(6)'' and inserting ``section 
                        1866(j)(7)''.
    (c) Effective Date.--The amendments made by this section (other 
than subsection (b)(2)) shall apply with respect to items and services 
furnished on or after the date that is one year after the date of 
enactment of this section.
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