H.R. 5713 — what changed
Sustaining Healthcare Integrity and Fair Treatment Act of 2016
From Introduced in House to Reported in House. 6 sections amended between Introduced in House and Reported in House.
Section 1 Short title; table of contents
Short title— This Act may be cited as the “Sustaining Healthcare Integrity and Fair Treatment Act of 2016”.
changed
Table of contents— This table of contents for of this Act is as follows:
Sec. 101 Extension of certain LTCH Medicare payment rules
changed
25-Percent 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 111–148 111–148, 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,”.2017”.
changed
Payment for hospitals-within-Hospitals—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—
in subparagraph (A), by inserting “or any similar provision,” after “Regulations,”;
in subparagraph (B)—
in clause (i), by inserting “or any similar provision,” after “Regulations,”; and
in clause (ii), by inserting “, or any similar provision,” after “Regulations”; and
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. 103 Change in Medicare classification for certain hospitals
In general— Subsection (d)(1)(B) of section 1886 of the Social Security Act (42 U.S.C. 1395ww) is amended—
in clause (iv)—
in subclause (I), by striking “or” at the end;
in subclause (II)—
by striking “, or” at the end and inserting a semicolon; and
by redesignating such subclause as clause (vi) and by moving it to immediately follow clause (v); and
in clause (v), by striking the semicolon at the end and inserting “, or”; and
by striking “(iv)(I) a hospital” and inserting “(iv) a hospital”.
Conforming payment references— The second sentence of subsection (d)(1)(B) of such section is amended—
by inserting “(as in effect as of such date)” after “clause (iv)”; and
changed
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 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”.
Application—
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In general— For cost-reporting 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:
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.
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).
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).
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.
added
Conforming technical amendments—
added
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)”.
added
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)”.
removed
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
Exception— Section 1886(m)(6) of the Social Security Act (42 U.S.C. 1395ww(m)(6)) is amended—
in subparagraph (A)(i), by striking “and (E)” and inserting “, (E), and (F)”; and
by adding at the end the following new subparagraph:
changed
“(F) Temporary exception for certain spinal cord specialty hospitals—For discharges in cost-reporting cost reporting periods beginning during fiscal year 2018, 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.”
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Study and report on the status and viability of certain spinal cord specialty long-Term long-term care hospitals—
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:
The impact on such hospitals of the classification and facility licensure by State agencies of such hospitals.
The Medicare payment rates for such hospitals.
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.
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
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—
in subparagraph (A)(i) by striking “and (F)” and inserting “(F), and (G)”;
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
by adding at the end the following new subparagraph:
“(G) Additional temporary exception for certain severe wound discharges from certain long-term care hospitals
changed
“(i) In general—For a discharge occurring in a cost-reporting 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.”
Study and report to Congress—
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—
access of such individuals to appropriate levels of care for such cases;
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
how to appropriately pay for such care under the Medicare program under such title.
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.
Sec. 201 No payment for items and services furnished by newly enrolled providers or suppliers within a temporary moratorium area
Medicare— Section 1866(j)(7) of the Social Security Act (42 U.S.C. 1395cc(j)(7)) is amended—
in the paragraph heading, by inserting “; Nonpayment” before the period; and
by adding at the end the following new subparagraph:
“(C) Nonpayment
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“(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) 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.
changed “(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).”
Conforming amendments—
Medicaid—
In general— Section 1903(i)(2) of the Social Security Act (42 U.S.C. 1396b(i)(2)) is amended—
in subparagraph (A), by striking the comma at the end and inserting a semicolon;
in subparagraph (B), by striking “or” at the end; and
changed
“(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 adding at a provider or supplier that meets the end requirements specified in subparagraph (C)(iii) of such section, during the following new subparagraph:period of such moratorium; or”
removed
“(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”
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. ”
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:
changed
“(iii) Limitation on charges to beneficiaries—The 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 such a moratorium, 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.”
Correcting amendments to related provisions—
Section 1866(j)— Section 1866(j) of the Social Security Act (42 U.S.C. 1395cc(j)) is amended—
in paragraph (1)(A)—
by striking “paragraph (4)” and inserting “paragraph (5)”;
by striking “moratoria in accordance with paragraph (5)” and inserting “moratoria in accordance with paragraph (7)”; and
by striking “paragraph (6)” and inserting “paragraph (9)”; and
by redesignating the second paragraph (8) (added by section 1304(1) of Public Law 111–152) as paragraph (9).
Section 1902(kk)— Section 1902(kk) of such Act (42 U.S.C. 1396a(kk)) is amended—
in paragraph (1), by striking “section 1886(j)(2)” and inserting “section 1866(j)(2)”;
in paragraph (2), by striking “section 1886(j)(3)” and inserting “section 1866(j)(3)”;
changed
in paragraph (3), by striking “section 1866(j)(4)” 1886(j)(4)” and inserting “section 1866(j)(5)”; and
in paragraph (4)(A), by striking “section 1886(j)(6)” and inserting “section 1866(j)(7)”.
removed
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.