I 

113TH CONGRESS 

1ST SESSION H. R. 3599 

To amend title XVIII of the Social Security Act with respect to payments 

to long-term care hospitals, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 21, 2013 

Mr. FORTENBERRY (for himself and Mr. HALL) 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 with respect 

to payments to long-term care hospitals, 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. RELIEF FOR MEDICARE PAYMENTS TO LONG4 TERM CARE HOSPITALS. 

5 (a) APPLICATION OF 25 PERCENT RULE PATIENT

6 THRESHOLD PAYMENT ADJUSTMENT.— 

7 (1) EXTENSION OF RELIEF.—In implementing 

8 sections 412.534 and 412.536 of title 42, Code of 

9 Federal Regulations, for a 12-month cost reporting 

10 period beginning on or after October 1, 2013, the 


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1 Secretary of Health and Human Services shall con2 tinue the same threshold payment adjustment per3 centages and exemptions as were established for the 

4 12-month cost reporting periods beginning on or 

5 after October 1, 2012, in the same manner as was 

6 provided for in the rule published on August 31, 

7 2012 (77 Federal Register 53258). 

8 (2) NO APPLICATION OF RULE TO GRAND9 FATHERED LTCHS.—The Secretary of Health and 

10 Human Services shall not apply sections 412.534 

11 and 412.536 of title 42, Code of Federal Regula12 tions, or any similar provisions to a long-term care 

13 hospital described in the second sentence of section 

14 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 

15 1395ww(d)(1)(B)). 

16 (3) NEW EXCLUSION FROM CALCULATION OF

17 THE 25 PERCENT RULE.—Medicare beneficiaries who 

18 were inpatients in a subsection (d) hospital within 1 

19 day prior to their admission to a long-term care hos20 pital described in section 1886(d)(1)(B)(iv)(I) of the 

21 Social Security Act (42 U.S.C. 

22 1395ww(d)(1)(B)(iv)(I)) and who had a stay of 

23 more than 7 days in an intensive care unit identified 

24 in section 413.53(d) of title 42, Code of Federal 

25 Regulations, shall be excluded from the numerator 


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1 of the 25 percent threshold applied under sections 

2 412.534 and 412.536 of such title. 

3 (4) EFFECTIVE DATE.—This subsection shall be 

4 effective on October 1, 2013. 

5 (b) CLARIFICATION OF PAYMENTS PAID TO LONG6 TERM CARE HOSPITALS ON AN IPPS BASIS.— 

7 (1) SITE NEUTRAL PAYMENTS.—For discharges 

8 occurring on or after October 1, 2014, payments 

9 made to long-term care hospitals described in section 

10 1886(d)(1)(B)(iv)(I) of the Social Security Act (42 

11 U.S.C. 1395ww(d)(1)(B)(iv)(I)) at amounts that are 

12 comparable or equivalent to amounts that are pay13 able to a subsection (d) hospital, for short stay pa14 tients and under the 25 percent rules established 

15 under sections 412.529(d)(4), 412.534, and 412.536 

16 of title 42, Code of Federal Regulations, shall be at 

17 amounts that are not less than would be paid to a 

18 subsection (d) hospital had it performed the same 

19 services. 

20 (2) CALCULATION OF LENGTH OF STAY EX21 CLUDING CASES PAID ON AN IPPS BASIS.—For dis22 charges occurring on or after the date of the enact23 ment of this Act, in calculating the length of stay re24 quirement applicable to a long-term care hospital or 

25 satellite facility under section 1886(d)(1)(B)(iv)(I) 


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1 of the Social Security Act (42 U.S.C. 

2 1395ww(d)(1)(B)(iv)(I)) and section 1861(ccc)(2) of 

3 such Act (42 U.S.C. 1395x(ccc)(2)), the Secretary of 

4 Health and Human Services shall exclude any pa5 tient for whom payment is based on an amount that 

6 is comparable or equivalent to the amount payable 

7 to a subsection (d) hospital had such a hospital pro8 vided the same services. 

9 (3) SUBSECTION (D) HOSPITAL DEFINED.—In 

10 this subsection, the term ‘‘subsection (d) hospital’’ 

11 has the meaning given such term in section 

12 1886(d)(1)(B) of the Social Security Act (42 U.S.C. 

13 1395ww(d)(1)(B)). 

Æ 


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