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[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 290 Introduced in House (IH)]

114th CONGRESS
  1st Session
                                H. R. 290

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

                            January 13, 2015

   Mr. Renacci (for himself, Mr. Joyce, Mr. Nugent, Mr. Rothfus, Mr. 
Gibbs, Mr. Kelly of Pennsylvania, Mr. Turner, Mr. Ribble, Mr. Bucshon, 
Mr. Carney, Mr. Delaney, Ms. Fudge, Mr. Kilmer, Mr. Webster of Florida, 
   and Mr. Heck of Nevada) 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 2015''.

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 2015, 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, 
2018.
                                 <all>
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