A bill to amend title XVIII of the Social Security Act to provide that payment under the Medicare program to a long-term care hospital for inpatient services shall not be made at the applicable site neutral payment rate for certain discharges involving severe wounds, and for other purposes.

Summary: This bill amends title XVIII (Medicare) of the Social Security Act to prohibit payment at the applicable site neutral payment rate for discharges in a cost reporting period beginning before October 1, 2017, from subsection (d) hospitals and certain long-term care hospitals that involve certain severe wounds. (Generally, a subsection [d] hospital is an acute care hospital, particularly one that receives payments under Medicare's inpatient prospective payment system when providing covered inpatient services to eligible beneficiaries.) The Secretary of Health and Human Services shall study the treatment needs of individuals entitled to benefits under Medicare part A (Hospital Insurance), or enrolled under Medicare part B (Supplementary Medical Insurance), requiring specialized wound care, and the cost, for such individual, and the Medicare program of treating severe wounds in rural and urban areas.

SECTION 1. TEMPORARY EXCEPTION TO SITE NEUTRAL PAYMENT RATE FOR CERTAIN 
              DISCHARGES INVOLVING 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 ``subparagraph (C)'' 
        and inserting ``subparagraphs (C), (E), and (F)''; and
            (2) by adding at the end the following new subparagraphs:
                    ``(E) Temporary exception for certain severe wound 
                discharges from subsection (d) hospitals.--
                            ``(i) In general.--For a discharge 
                        occurring in a cost reporting period beginning 
                        prior to October 1, 2017, subparagraph (A)(i) 
                        shall not apply (and payment shall be made to a 
                        long-term care hospital without regard to this 
                        paragraph) if--
                                    ``(I) the individual discharged has 
                                a severe wound during the stay in the 
                                long-term care hospital ending with 
                                such discharge;
                                    ``(II) the individual discharged 
                                meets the severe wound criterion; and
                                    ``(III) the stay in the long-term 
                                care hospital ending with such 
                                discharge was immediately preceded by a 
                                discharge from a stay in a subsection 
                                (d) hospital.
                            ``(ii) Severe wound defined.--In this 
                        paragraph, the term `severe wound' means a 
                        stage 3 wound, stage 4 wound, unstageable 
                        wound, non-healing surgical wound, infected 
                        wound, fistula, osteomyelitis, or wound with 
                        morbid obesity, as identified in the claim from 
                        the long-term care hospital.
                            ``(iii) Severe wound criterion.--In this 
                        subparagraph, the term `severe wound criterion' 
                        means that the individual discharged--
                                    ``(I) received an excisional 
                                debridement or total parenteral 
                                nutrition during the stay in the long-
                                term care hospital referred to in 
                                clause (i)(III); or
                                    ``(II) has at least one major 
                                system organ failure (lung, liver, 
                                kidney, or heart) as identified in the 
                                claim from the immediately preceding 
                                stay in a subsection (d) hospital 
                                referred to in clause (i)(III).
                    ``(F) Temporary exception for certain severe wound 
                discharges from certain long-term care hospitals.--For 
                a discharge occurring in a cost reporting period 
                beginning prior to October 1, 2017, 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 amendment made by section 
                        4417(a) of the Balanced Budget Act of 1997 (42 
                        U.S.C. 1395ww note, Public Law 105-33); and
                            ``(ii) the individual discharged has a 
                        severe wound (as defined in subparagraph 
                        (E)(ii)).''.
    (b) Study and Report to Congress.--
            (1) Study.--The Secretary of Health and Human Services 
        shall, in consultation with relevant stakeholders, conduct a 
        study on the treatment needs of individuals entitled to 
        benefits under part A of such title, or enrolled under part B 
        of such title, requiring specialized wound care, and the cost, 
        for such individuals and the Medicare program, 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 the Social Security 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, 2016, the Secretary 
        of Health and Human Services shall submit to Congress a report 
        on the study conducted under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines appropriate.