II 

114TH CONGRESS 

1ST SESSION S. 1211 

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. 

IN THE SENATE OF THE UNITED STATES 

MAY 6, 2015 

Mr. COCHRAN (for himself, Mr. WICKER, Mr. MURPHY, and Ms. STABENOW) 

introduced the following bill; which was read twice and referred to the 

Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to provide 

that payment under the Medicare program to a longterm 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. 

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


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1 SECTION 1. TEMPORARY EXCEPTION TO SITE NEUTRAL 

2 PAYMENT RATE FOR CERTAIN DISCHARGES 

3 INVOLVING SEVERE WOUNDS. 

4 (a) IN GENERAL.—Section 1886(m)(6) of the Social 

5 Security Act (42 U.S.C. 1395ww(m)(6)) is amended— 

6 (1) in subparagraph (A)(i) by striking ‘‘sub7 paragraph (C)’’ and inserting ‘‘subparagraphs (C), 

8 (E), and (F)’’; and 

9 (2) by adding at the end the following new sub10 paragraphs: 

11 ‘‘(E) TEMPORARY EXCEPTION FOR CER12 TAIN SEVERE WOUND DISCHARGES FROM SUB13 SECTION (d) HOSPITALS.— 

14 ‘‘(i) IN GENERAL.—For a discharge 

15 occurring in a cost reporting period begin16 ning prior to October 1, 2017, subpara17 graph (A)(i) shall not apply (and payment 

18 shall be made to a long-term care hospital 

19 without regard to this paragraph) if— 

20 ‘‘(I) the individual discharged 

21 has a severe wound during the stay in 

22 the long-term care hospital ending 

23 with such discharge; 

24 ‘‘(II) the individual discharged 

25 meets the severe wound criterion; and 


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1 ‘‘(III) the stay in the long-term 

2 care hospital ending with such dis3 charge was immediately preceded by a 

4 discharge from a stay in a subsection 

5 (d) hospital. 

6 ‘‘(ii) SEVERE WOUND DEFINED.—In 

7 this paragraph, the term ‘severe wound’ 

8 means a stage 3 wound, stage 4 wound, 

9 unstageable wound, non-healing surgical 

10 wound, infected wound, fistula, osteomy11 elitis, or wound with morbid obesity, as 

12 identified in the claim from the long-term 

13 care hospital. 

14 ‘‘(iii) SEVERE WOUND CRITERION.— 

15 In this subparagraph, the term ‘severe 

16 wound criterion’ means that the individual 

17 discharged— 

18 ‘‘(I) received an excisional 

19 debridement or total parenteral nutri20 tion during the stay in the long-term 

21 care hospital referred to in clause 

22 (i)(III); or 

23 ‘‘(II) has at least one major sys24 tem organ failure (lung, liver, kidney, 

25 or heart) as identified in the claim 


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1 from the immediately preceding stay 

2 in a subsection (d) hospital referred to 

3 in clause (i)(III). 

4 ‘‘(F) TEMPORARY EXCEPTION FOR CER5 TAIN SEVERE WOUND DISCHARGES FROM CER6 TAIN LONG-TERM CARE HOSPITALS.—For a dis7 charge occurring in a cost reporting period be8 ginning prior to October 1, 2017, subparagraph 

9 (A)(i) shall not apply (and payment shall be 

10 made to a long-term care hospital without re11 gard to this paragraph) if such discharge— 

12 ‘‘(i) is from a long-term care hospital 

13 identified by the amendment made by sec14 tion 4417(a) of the Balanced Budget Act 

15 of 1997 (42 U.S.C. 1395ww note, Public 

16 Law 105–33); and 

17 ‘‘(ii) the individual discharged has a 

18 severe wound (as defined in subparagraph 

19 (E)(ii)).’’. 

20 (b) STUDY AND REPORT TO CONGRESS.— 

21 (1) STUDY.—The Secretary of Health and 

22 Human Services shall, in consultation with relevant 

23 stakeholders, conduct a study on the treatment 

24 needs of individuals entitled to benefits under part 

25 A of such title, or enrolled under part B of such 


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1 title, requiring specialized wound care, and the cost, 

2 for such individuals and the Medicare program, of 

3 treating severe wounds in rural and urban areas. 

4 Such study shall include an assessment of— 

5 (A) access of such individuals to appro6 priate levels of care for such cases; 

7 (B) the potential impact that section 

8 1886(m)(6)(A)(i) of the Social Security Act (42 

9 U.S.C. 1395ww(m)(6)(A)(i)) will have on the 

10 access, quality, and cost of care for such indi11 viduals; and 

12 (C) how to appropriately pay for such care 

13 under the Medicare program under such title. 

14 (2) REPORT.—Not later than October 1, 2016, 

15 the Secretary of Health and Human Services shall 

16 submit to Congress a report on the study conducted 

17 under paragraph (1), together with recommenda18 tions for such legislation and administrative action 

19 as the Secretary determines appropriate. 

Æ 


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