I 

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. 

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 ‘‘Creating Access to Re5 habilitation for Every Senior (CARES) Act of 2015’’. 


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1 SEC. 2. ELIMINATION OF MEDICARE 3-DAY PRIOR HOS2 PITALIZATION REQUIREMENT FOR COV3 ERAGE OF SKILLED NURSING FACILITY SERV4 ICES IN QUALIFIED SKILLED NURSING FA5 CILITIES. 

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

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

8 read as follows: 

9 ‘‘(f) COVERAGE OF EXTENDED CARE SERVICES

10 WITHOUT A 3-DAY PRIOR HOSPITALIZATION FOR QUALI11 FIED SKILLED NURSING FACILITY.— 

12 ‘‘(1) IN GENERAL.—Effective for extended care 

13 services furnished pursuant to an admission to a 

14 skilled nursing facility that occurs more than 90 

15 days after the date of the enactment of the Creating 

16 Access to Rehabilitation for Every Senior (CARES) 

17 Act of 2015, coverage shall be provided under this 

18 part for an individual for such services in a qualified 

19 skilled nursing facility that are not post-hospital ex20 tended care services. 

21 ‘‘(2) CONTINUED APPLICATION OF CERTIFI22 CATION AND OTHER REQUIREMENTS AND PROVI23 SIONS.—The requirements of the following provi24 sions shall apply to extended care services provided 

25 under paragraph (1) in the same manner as they 

26 apply to post-hospital extended care services: 


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1 ‘‘(A) Paragraphs (2) and (6) of section 

2 1814(a), except that the requirement of para3 graph (2)(B) of such section shall not apply in4 sofar as it relates to any required prior receipt 

5 of inpatient hospital services. 

6 ‘‘(B) Subsections (b)(2) and (e) of this sec7 tion. 

8 ‘‘(C) Paragraphs (1)(G)(i), (2)(A), and (3) 

9 of section 1861(v). 

10 ‘‘(D) Section 1861(y). 

11 ‘‘(E) Section 1862(a)(18). 

12 ‘‘(F) Section 1866(a)(1)(H)(ii)(I). 

13 ‘‘(G) Subsections (d) and (f) of section 

14 1883. 

15 ‘‘(H) Section 1888(e). 

16 ‘‘(3) QUALIFIED SKILLED NURSING FACILITY

17 DEFINED.— 

18 ‘‘(A) IN GENERAL.—In this subsection, the 

19 term ‘qualified skilled nursing facility’ means a 

20 skilled nursing facility that the Secretary deter21 mines— 

22 ‘‘(i) subject to subparagraphs (B) and 

23 (C), based upon the most recent ratings 

24 under the system established for purposes 

25 of rating skilled nursing facilities under 


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1 the Medicare Nursing Home Compare pro2 gram, has an overall rating of 3 or more 

3 stars or a score of 4 stars or higher on the 

4 individual quality domain or on the staff5 ing quality domain; and 

6 ‘‘(ii) is not subject to a quality-of-care 

7 corporate integrity agreement (relating to 

8 one or more programs under this Act) that 

9 is in effect with the Inspector General of 

10 the Department of Health and Human 

11 Services and that requires the facility to 

12 retain an independent quality monitor. 

13 The Secretary may make a determination under 

14 clause (ii) based upon the most current infor15 mation contained in the website of the Inspec16 tor General. 

17 ‘‘(B) WAIVER OF RATINGS TO ENSURE AC18 CESS.—The Secretary may, upon application, 

19 waive the requirement of subparagraph (A)(i) 

20 for a skilled nursing facility in order to ensure 

21 access to extended care services that are not 

22 post-hospital extended care services in par23 ticular underserved geographic areas. 

24 ‘‘(C) GRACE PERIOD FOR CORRECTION OF

25 RATINGS.—In the case of a skilled nursing faVerDate Sep 11 2014 20:25 Jan 20, 2015 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H290.IH H290

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1 cility that qualifies as a qualified skilled nursing 

2 facility for a period and that would be disquali3 fied under subparagraph (A)(i) because of a de4 cline in its star rating, before disqualifying the 

5 facility the Secretary shall provide the facility 

6 with a grace period of 1 year during which the 

7 facility seeks to improve its ratings based on a 

8 plan of correction approved by the Secretary. 

9 ‘‘(D) HOLDING BENEFICIARIES HARMLESS

10 IN CASE OF DISQUALIFICATION OF A FACIL11 ITY.—In the case of a skilled nursing facility 

12 that qualifies as a qualified skilled nursing fa13 cility for a period and that is disqualified under 

14 subparagraph (A), such disqualification shall 

15 not apply to or affect individuals who are ad16 mitted to the facility at the time of the disquali17 fication.’’. 

18 (b) MEDPAC STUDY OF COST OF IMPLEMENTA19 TION.—The Medicare Payment Advisory Commission shall 

20 conduct a study of, and submit a report to Congress and 

21 the Secretary of Health and Human Services on, the cost 

22 of impact of the amendment made by subsection (a), no 

23 later than June 1, 2018. 

Æ 


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