A bill 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.

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. 1. Temporary exception to site neutral payment rate for certain discharges involving severe wounds (a) In General Section 1886(m)(6) of the Social Security Act ( 42 U.S.C. 1395ww(m)(6) (1) in subparagraph (A)(i) by striking subparagraph (C) subparagraphs (C), (E), and (F) (2) by adding at the end the following new subparagraphs: (E) Temporary exception for certain severe wound discharges from subsection ( d (i) In general For a discharge occurring in a cost reporting period beginning prior to October 1, 2017, subparagraph (A)(i) shall not apply (and payment shall be made to a long-term care hospital without regard to this paragraph) if— (I) the individual discharged has a severe wound during the stay in the long-term care hospital ending with such discharge; (II) the individual discharged meets the severe wound criterion; and (III) the stay in the long-term care hospital ending with such discharge was immediately preceded by a discharge from a stay in a subsection (d) hospital. (ii) Severe wound defined In this paragraph, the term severe wound (iii) Severe wound criterion In this subparagraph, the term severe wound criterion (I) received an excisional debridement or total parenteral nutrition during the stay in the long-term care hospital referred to in clause (i)(III); or (II) has at least one major system organ failure (lung, liver, kidney, or heart) as identified in the claim from the immediately preceding stay in a subsection (d) hospital referred to in clause (i)(III). (F) Temporary exception for certain severe wound discharges from certain long-term care hospitals For a discharge occurring in a cost reporting period beginning prior to October 1, 2017, subparagraph (A)(i) shall not apply (and payment shall be made to a long-term care hospital without regard to this paragraph) if such discharge— (i) is from a long-term care hospital identified by the amendment made by section 4417(a) of the Balanced Budget Act of 1997 ( 42 U.S.C. 1395ww Public Law 105–33 (ii) the individual discharged has a severe wound (as defined in subparagraph (E)(ii)). . (b) Study and report to Congress (1) Study The Secretary of Health and Human Services shall, in consultation with relevant stakeholders, conduct a study on the treatment needs of individuals entitled to benefits under part A of such title, or enrolled under part B of such title, requiring specialized wound care, and the cost, for such individuals and the Medicare program, of treating severe wounds in rural and urban areas. Such study shall include an assessment of— (A) access of such individuals to appropriate levels of care for such cases; (B) the potential impact that section 1886(m)(6)(A)(i) of the Social Security Act ( 42 U.S.C. 1395ww(m)(6)(A)(i) (C) how to appropriately pay for such care under the Medicare program under such title. (2) Report Not later than October 1, 2016, the Secretary of Health and Human Services shall submit to Congress a report on the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Secretary determines appropriate.

Summary: This bill amends title XVIII (Medicare) of the Social Security Act to prohibit payment at the applicable site neutral payment rate for discharges in a cost reporting period beginning before October 1, 2017, from subsection (d) hospitals and certain long-term care hospitals that involve certain severe wounds. (Generally, a subsection [d] hospital is an acute care hospital, particularly one that receives payments under Medicare's inpatient prospective payment system when providing covered inpatient services to eligible beneficiaries.) The Secretary of Health and Human Services shall study the treatment needs of individuals entitled to benefits under Medicare part A (Hospital Insurance), or enrolled under Medicare part B (Supplementary Medical Insurance), requiring specialized wound care, and the cost, for such individual, and the Medicare program of treating severe wounds in rural and urban areas.