I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Fairness for Bene5 ficiaries Act of 2013’’. 


tkelley on DSK3SPTVN1PROD with BILLS
2 

•HR 3144 IH

1 SEC. 2. MEDICARE COVERAGE OF EXTENDED CARE SERV2 ICES WITHOUT A 3-DAY PRIOR HOSPITALIZA3 TION. 

4 (a) IN GENERAL.—Subsection (f) of section 1812 of 

5 the Social Security Act (42 U.S.C. 1395d) is amended to 

6 read as follows: 

7 ‘‘(f) COVERAGE OF EXTENDED CARE SERVICES

8 WITHOUT A 3-DAY PRIOR HOSPITALIZATION.— 

9 ‘‘(1) IN GENERAL.—Coverage shall be provided 

10 under this part for an individual for extended care 

11 services in a skilled nursing facility that are not 

12 post-hospital extended care services if, before the in13 dividual is admitted to the skilled nursing facility, a 

14 physician or other qualified health care practitioner 

15 described in section 1814(a)(2) makes a determina16 tion that the provision of extended care services to 

17 the individual is medically necessary and has made 

18 the certification described in subparagraph (B) of 

19 such section with respect to such services (and con20 tinues to have such a certification made in the same 

21 manner as for post-hospital extended care services). 

22 ‘‘(2) CONTINUED APPLICATION OF CERTIFI23 CATION AND OTHER REQUIREMENTS AND PROVI24 SIONS.—The requirements of paragraphs (2) and (6) 

25 of section 1814(a) and the provisions of subsections 

26 (b)(2) and (e) and sections 1852(l), 


tkelley on DSK3SPTVN1PROD with BILLS
3 

•HR 3144 IH

1 1861(v)(1)(G)(i), 1861(v)(2)(A), 1861(v)(3), 

2 1861(y), 1861(tt)(1)(B), 1862(a)(18), 

3 1866(a)(1)(H)(ii)(I), 1883(d), 1883(f), and 1888(e) 

4 shall apply to extended care services provided under 

5 this subsection in the same manner as they apply to 

6 post-hospital extended care services. 

7 ‘‘(3) MAC DETERMINATIONS.— 

8 ‘‘(A) PUBLICATION OF REQUIREMENTS

9 FOR DETERMINATIONS.—Not later than 6 

10 months after the date of the enactment of this 

11 paragraph, the Secretary shall publish a set of 

12 uniform requirements that will enable the medi13 care administrative contractors to make deter14 minations as to whether an admission described 

15 in paragraph (1) is medically necessary. 

16 ‘‘(B) MAC AUDITS.—A medicare adminis17 trative contractor may audit determinations de18 scribed in paragraph (1) based on the uniform 

19 requirements established under subparagraph 

20 (A). In any administrative proceeding to review 

21 such determinations, the uniform requirements 

22 established by the Secretary shall be binding on 

23 administrative law judges.’’. 

24 (b) EFFECTIVE DATE.—The amendment made by 

25 subsection (a) shall apply to extended care services furVerDate Mar 15 2010 22:47 Sep 20, 2013 Jkt 029200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3144.IH H3144

tkelley on DSK3SPTVN1PROD with BILLS
4 

•HR 3144 IH

1 nished on or after the date that is 1 year after the date 

2 of the enactment of this Act. 

Æ 


tkelley on DSK3SPTVN1PROD with BILLS