[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5713 Reported in House (RH)]
<DOC>
Union Calendar No. 594
114th CONGRESS
2d Session
H. R. 5713
[Report No. 114-761, Part I]
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
September 20, 2016
Reported from the Committee on Ways and Means with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
September 20, 2016
The Committee on Energy and Commerce discharged; committed to the
Committee of the Whole House on the State of the Union and ordered to
be printed
[For text of introduced bill, see copy of bill as introduced on July
11, 2016]
_______________________________________________________________________
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 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.
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 Amendments.--
(1) Section 1899B(a)(2)(A)(iv) of the Social Security Act
(42 U.S.C. 1395lll(a)(2)(A)(iv)) is amended by striking
``1886(d)(1)(B)(iv)(II)'' and inserting ``1886(d)(1)(B)(vi)''.
(2) Section 1886(m)(5)(F) of such Act (42 U.S.C.
1395ww(m)(5)(F)) is amended in each of clauses (i) and (ii) by
striking ``(d)(1)(B)(iv)(II)'' and inserting ``(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 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:
``(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 EXTENSION TO THE APPLICATION OF THE MEDICARE LTCH
SITE NEUTRAL PROVISIONS FOR CERTAIN DISCHARGES WITH
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.''.
(c) 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) furnished on
or after October 1, 2017.
``(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 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).''.
(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)
``(D) 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''.
(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.--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.''.
(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 1886(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)''.
Union Calendar No. 594
114th CONGRESS
2d Session
H. R. 5713
[Report No. 114-761, Part I]
_______________________________________________________________________
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.
_______________________________________________________________________
September 20, 2016
Reported from the Committee on Ways and Means with an amendment
September 20, 2016
The Committee on Energy and Commerce discharged; committed to the
Committee of the Whole House on the State of the Union and ordered to
be printed