To amend title XVIII of the Social Security Act to provide for a temporary exception to the site neutral payment rate for certain discharges from long-term care hospitals that involve severe wounds.

This bill amends title XVIII (Medicare) of the Social Security Act to, with respect to certain discharges involving severe wounds, extend and expand a temporary exception from certain Medicare payment limits for long-term care hospital (LTCH) inpatient services. Current law generally applies payment limits to inpatient services for LTCHs that do not meet specified discharge requirements.

[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5723 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 5723

   To amend title XVIII of the Social Security Act to provide for a 
   temporary exception to the site neutral payment rate for certain 
  discharges from long-term care hospitals that involve severe wounds.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 11, 2016

  Mr. Levin 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 amend title XVIII of the Social Security Act to provide for a 
   temporary exception to the site neutral payment rate for certain 
  discharges from long-term care hospitals that involve severe wounds.

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

SECTION 1. 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)) is amended--
            (1) in subparagraph (A)(i) by striking ``subparagraphs (C) 
        and (E)'' and inserting ``subparagraphs (C), (E), and (F)'';
            (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:
                    ``(F) 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.
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