Fairness for Beneficiaries Act of 2013

Fairness for Beneficiaries Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act to revise requirements for Medicare coverage for extended care services which are not post-hospital extended care services (that is, without regard to the requirement for a 3-day prior hospitalization).

Limits such coverage to extended care services in a skilled nursing facility (SNF), but only if, before the individual is admitted to the SNF, a physician or other qualified health care practitioner determines and certifies that extended care services for the individual are medically necessary.

[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3144 Introduced in House (IH)]

113th CONGRESS
  1st Session
                                H. R. 3144

  To amend title XVIII of the Social Security Act to provide Medicare 
coverage of extended care services without regard to a requirement for 
         a 3-day prior hospitalization, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 19, 2013

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

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to provide Medicare 
coverage of extended care services without regard to a requirement for 
         a 3-day prior hospitalization, 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.

    This Act may be cited as the ``Fairness for Beneficiaries Act of 
2013''.

SEC. 2. MEDICARE COVERAGE OF EXTENDED CARE SERVICES WITHOUT A 3-DAY 
              PRIOR HOSPITALIZATION.

    (a) In General.--Subsection (f) of section 1812 of the Social 
Security Act (42 U.S.C. 1395d) is amended to read as follows:
    ``(f) Coverage of Extended Care Services Without a 3-Day Prior 
Hospitalization.--
            ``(1) In general.--Coverage shall be provided under this 
        part for an individual for extended care services in a skilled 
        nursing facility that are not post-hospital extended care 
        services if, before the individual is admitted to the skilled 
        nursing facility, a physician or other qualified health care 
        practitioner described in section 1814(a)(2) makes a 
        determination that the provision of extended care services to 
        the individual is medically necessary and has made the 
        certification described in subparagraph (B) of such section 
        with respect to such services (and continues to have such a 
        certification made in the same manner as for post-hospital 
        extended care services).
            ``(2) Continued application of certification and other 
        requirements and provisions.--The requirements of paragraphs 
        (2) and (6) of section 1814(a) and the provisions of 
        subsections (b)(2) and (e) and sections 1852(l), 
        1861(v)(1)(G)(i), 1861(v)(2)(A), 1861(v)(3), 1861(y), 
        1861(tt)(1)(B), 1862(a)(18), 1866(a)(1)(H)(ii)(I), 1883(d), 
        1883(f), and 1888(e) shall apply to extended care services 
        provided under this subsection in the same manner as they apply 
        to post-hospital extended care services.
            ``(3) MAC determinations.--
                    ``(A) Publication of requirements for 
                determinations.--Not later than 6 months after the date 
                of the enactment of this paragraph, the Secretary shall 
                publish a set of uniform requirements that will enable 
                the medicare administrative contractors to make 
                determinations as to whether an admission described in 
                paragraph (1) is medically necessary.
                    ``(B) MAC audits.--A medicare administrative 
                contractor may audit determinations described in 
                paragraph (1) based on the uniform requirements 
                established under subparagraph (A). In any 
                administrative proceeding to review such 
                determinations, the uniform requirements established by 
                the Secretary shall be binding on administrative law 
                judges.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to extended care services furnished on or after the date that is 
1 year after the date of the enactment of this Act.
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