Creating Access to Rehabilitation for Every Senior (CARES) Act of 2013 - Amends title XVIII (Medicare) of the Social Security Act with respect to coverage of extended care services without regard to the three-day prior hospitalization requirement (non-post-hospital extended care services).
Restricts such coverage to non-post-hospital extended care services in a qualified skilled nursing facility.
Directs the Medicare Payment Advisory Commission (MEDPAC) to study the cost of impact of this Act.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3531 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 3531
To amend title XVIII of the Social Security Act to eliminate the 3-day
prior hospitalization requirement for Medicare coverage of skilled
nursing facility services in qualified skilled nursing facilities, and
for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
November 19, 2013
Mr. Renacci (for himself, Mr. Price of Georgia, Mr. Webster of Florida,
Mr. Kelly of Pennsylvania, Mr. Stivers, Mr. Carney, Mr. Barber, Ms.
Fudge, Mr. Bucshon, and Mr. Kilmer) 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 eliminate the 3-day
prior hospitalization requirement for Medicare coverage of skilled
nursing facility services in qualified skilled nursing facilities, 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 ``Creating Access to Rehabilitation
for Every Senior (CARES) Act of 2013''.
SEC. 2. ELIMINATION OF MEDICARE 3-DAY PRIOR HOSPITALIZATION REQUIREMENT
FOR COVERAGE OF SKILLED NURSING FACILITY SERVICES IN
QUALIFIED SKILLED NURSING FACILITIES.
(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 for Qualified Skilled Nursing Facility.--
``(1) In general.--Effective for extended care services
furnished pursuant to an admission to a skilled nursing
facility that occurs more than 90 days after the date of the
enactment of the Creating Access to Rehabilitation for Every
Senior (CARES) Act of 2013, coverage shall be provided under
this part for an individual for such services in a qualified
skilled nursing facility that are not post-hospital extended
care services.
``(2) Continued application of certification and other
requirements and provisions.--The requirements of the following
provisions shall apply to extended care services provided under
paragraph (1) in the same manner as they apply to post-hospital
extended care services:
``(A) Paragraphs (2) and (6) of section 1814(a),
except that the requirement of paragraph (2)(B) of such
section shall not apply insofar as it relates to any
required prior receipt of inpatient hospital services.
``(B) Subsections (b)(2) and (e) of this section.
``(C) Paragraphs (1)(G)(i), (2)(A), and (3) of
section 1861(v).
``(D) Section 1861(y).
``(E) Section 1862(a)(18).
``(F) Section 1866(a)(1)(H)(ii)(I).
``(G) Subsections (d) and (f) of section 1883.
``(H) Section 1888(e).
``(3) Qualified skilled nursing facility defined.--
``(A) In general.--In this subsection, the term
`qualified skilled nursing facility' means a skilled
nursing facility that the Secretary determines--
``(i) subject to subparagraphs (B) and (C),
based upon the most recent ratings under the
system established for purposes of rating
skilled nursing facilities under the Medicare
Nursing Home Compare program, has an overall
rating of 3 or more stars or a score of 4 stars
or higher on the individual quality domain or
on the staffing quality domain; and
``(ii) is not subject to a quality-of-care
corporate integrity agreement (relating to one
or more programs under this Act) that is in
effect with the Inspector General of the
Department of Health and Human Services and
that requires the facility to retain an
independent quality monitor.
The Secretary may make a determination under clause
(ii) based upon the most current information contained
in the website of the Inspector General.
``(B) Waiver of ratings to ensure access.--The
Secretary may, upon application, waive the requirement
of subparagraph (A)(i) for a skilled nursing facility
in order to ensure access to extended care services
that are not post-hospital extended care services in
particular underserved geographic areas.
``(C) Grace period for correction of ratings.--In
the case of a skilled nursing facility that qualifies
as a qualified skilled nursing facility for a period
and that would be disqualified under subparagraph
(A)(i) because of a decline in its star rating, before
disqualifying the facility the Secretary shall provide
the facility with a grace period of 1 year during which
the facility seeks to improve its ratings based on a
plan of correction approved by the Secretary.
``(D) Holding beneficiaries harmless in case of
disqualification of a facility.--In the case of a
skilled nursing facility that qualifies as a qualified
skilled nursing facility for a period and that is
disqualified under subparagraph (A), such
disqualification shall not apply to or affect
individuals who are admitted to the facility at the
time of the disqualification.''.
(b) MedPAC Study of Cost of Implementation.--The Medicare Payment
Advisory Commission shall conduct a study of, and submit a report to
Congress and the Secretary of Health and Human Services on, the cost of
impact of the amendment made by subsection (a), no later than June 1,
2016.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Ways and Means.
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