I 
114TH CONGRESS 
2D SESSION 
H. R. 5713 
To provide for the extension of certain long-term care hospital Medicare 
payment rules, clarify the application of rules on the calculation of 
hospital length of stay to certain moratorium-excepted long-term care 
hospitals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 11, 2016 
Mr. TIBERI (for himself and Mr. PASCRELL) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addi-
tion to the Committee on Energy and Commerce, for a period to be sub-
sequently determined by the Speaker, in each case for consideration of 
such provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To provide for the extension of certain long-term care hos-
pital Medicare payment rules, clarify the application of 
rules on the calculation of hospital length of stay to 
certain moratorium-excepted long-term care hospitals, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Sustaining Healthcare Integrity and Fair Treatment Act 
of 2016’’. 
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(b) TABLE OF CONTENTS.—This table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—MEDICARE PART A PROVISIONS 
Sec. 101. Extension of certain LTCH Medicare payment rules. 
Sec. 102. Application of rules on the calculation of hospital length of stay to 
all LTCHs. 
Sec. 103. Change in Medicare classification for certain hospitals. 
Sec. 104. Temporary exception to the application of the Medicare LTCH site 
neutral provisions for certain spinal cord specialty hospitals. 
Sec. 105. Temporary exception to site neutral payment rate for certain dis-
charges from long-term care hospitals that involve severe 
wounds. 
TITLE II—OTHER PROVISIONS 
Sec. 201. No payment for items and services furnished by newly enrolled pro-
viders or suppliers within a temporary moratorium area. 
TITLE I—MEDICARE PART A 
PROVISIONS 
SEC. 101. EXTENSION OF CERTAIN LTCH MEDICARE PAY-
MENT RULES. 
(a) 25-PERCENT PATIENT THRESHOLD PAYMENT 
ADJUSTMENT.—Section 114(c)(1)(A) of the Medicare, 
Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 
1395ww note), as amended by section 4302(a) of division 
B of the American Recovery and Reinvestment Act (Public 
Law 111–5), sections 3106(a) and 10312(a) of Public 
Law 111–148 and section 1206(b)(1)(B) of the Pathway 
for SGR Reform Act of 2013 (division B of Public Law 
113–67), is amended by striking ‘‘for a 9-year period’’ and 
inserting ‘‘through June 30, 2016, and for discharges oc-
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curring on or after October 1, 2016, and before July 1, 
2017,’’. 
(b) 
PAYMENT
FOR
HOSPITALS-WITHIN-HOS-
PITALS.—Section 114(c)(2) of the Medicare, Medicaid, 
and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww 
note), as amended by section 4302(a) of division B of the 
American Recovery and Reinvestment Act (Public Law 
111–5), sections 3106(a) and 10312(a) of Public Law 
111–148, and section 1206(b)(1)(A) of the Pathway for 
SGR Reform Act of 2013 (division B of Public Law 113– 
67), is amended— 
(1) in subparagraph (A), by inserting ‘‘or any 
similar provision,’’ after ‘‘Regulations,’’; 
(2) in subparagraph (B)— 
(A) in clause (i), by inserting ‘‘or any simi-
lar provision,’’ after ‘‘Regulations,’’; and 
(B) in clause (ii), by inserting ‘‘, or any 
similar provision,’’ after ‘‘Regulations’’; and 
(3) in subparagraph (C), by striking ‘‘for a 9- 
year period’’ and inserting ‘‘through June 30, 2016, 
and for discharges occurring on or after October 1, 
2016, and before July 1, 2017’’. 
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SEC. 102. APPLICATION OF RULES ON THE CALCULATION 
OF HOSPITAL LENGTH OF STAY TO ALL 
LTCHS. 
(a) IN GENERAL.—Section 1206(a)(3) of the Path-
way for SGR Reform Act of 2013 (division B of Public 
Law 113–67; 42 U.S.C. 1395ww note) is amended— 
(1) by striking subparagraph (B); 
(2) by striking ‘‘SITE NEUTRAL BASIS.—’’ and 
all that follows through ‘‘For discharges occurring’’ 
and inserting ‘‘SITE
NEUTRAL
BASIS.—For dis-
charges occurring’’; 
(3) by striking ‘‘subject to subparagraph (B),’’; 
and 
(4) by redesignating clauses (i) and (ii) as sub-
paragraphs (A) and (B), respectively, and moving 
each of such subparagraphs (as so redesignated) 2 
ems to the left. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall be effective as if included in the enact-
ment of section 1206(a)(3) of the Pathway for SGR Re-
form Act of 2013 (division B of Public Law 113–67; 42 
U.S.C. 1395ww note). 
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classified under clause (vi) on and after the effective 
date of such clause (vi) and for cost-reporting peri-
ods beginning on or after January 1, 2015, shall not 
be subject to subsection (m) as of the date of such 
classification)’’ after ‘‘so classified’’. 
(c) APPLICATION.— 
(1) IN GENERAL.—For cost-reporting periods 
beginning on or after January 1, 2015, in the case 
of an applicable hospital (as defined in paragraph 
(3)), the following shall apply: 
(A) Payment for inpatient operating costs 
shall be made on a reasonable cost basis in the 
manner provided in section 412.526(c)(3) of 
title 42, Code of Federal Regulations (as in ef-
fect on January 1, 2015) and in any subse-
quent modifications. 
(B) Payment for capital costs shall be 
made in the manner provided by section 
412.526(c)(4) of title 42, Code of Federal Reg-
ulations (as in effect on such date). 
(C) Claims for payment for Medicare bene-
ficiaries who are discharged on or after January 
1, 2017, shall be processed as claims which are 
paid on a reasonable cost basis as described in 
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section 412.526(c) of title 42, Code of Federal 
Regulations (as in effect on such date). 
(2) APPLICABLE HOSPITAL DEFINED.—In this 
subsection, the term ‘‘applicable hospital’’ means a 
hospital that is classified under clause (iv)(II) of sec-
tion 1886(d)(1)(B) of the Social Security Act (42 
U.S.C. 1395ww(d)(1)(B)) on the day before the date 
of the enactment of this Act and which is classified 
under clause (vi) of such section, as redesignated 
and moved by subsection (a), on or after such date 
of enactment. 
(d) 
CONFORMING
TECHNICAL
AMENDMENT.— 
Clauses (i) and (ii) of section 1886(m)(5)(F) and section 
1899B(a)(2)(A)(iv) of the Social Security Act (42 U.S.C. 
1395ww(m)(5)(F) and 42 U.S.C. 1395lll(a)(2)(A)(iv)) are 
each amended by striking ‘‘1886(d)(1)(B)(iv)(II)’’ and in-
serting ‘‘1886(d)(1)(B)(vi)’’. 
SEC. 104. TEMPORARY EXCEPTION TO THE APPLICATION 
OF THE MEDICARE LTCH SITE NEUTRAL PRO-
VISIONS FOR CERTAIN SPINAL CORD SPE-
CIALTY HOSPITALS. 
(a) EXCEPTION.—Section 1886(m)(6) of the Social 
Security Act (42 U.S.C. 1395ww(m)(6)) is amended— 
(1) in subparagraph (A)(i), by striking ‘‘and 
(E)’’ and inserting ‘‘, (E), and (F)’’; and 
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(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) TEMPORARY
EXCEPTION
FOR
CER-
TAIN
SPINAL
CORD
SPECIALTY
HOSPITALS.— 
For discharges in cost-reporting periods begin-
ning during fiscal year 2018, subparagraph 
(A)(i) shall not apply (and payment shall be 
made to a long-term care hospital without re-
gard to this paragraph) if such discharge is 
from a long-term care hospital that meets each 
of the following requirements: 
‘‘(i) 
NOT-FOR-PROFIT.—The 
long- 
term care hospital was a not-for-profit 
long-term care hospital on June 1, 2014, 
as determined by cost report data. 
‘‘(ii) PRIMARILY
PROVIDING
TREAT-
MENT
FOR
CATASTROPHIC
SPINAL
CORD 
OR ACQUIRED BRAIN INJURIES OR OTHER 
PARALYZING
NEUROMUSCULAR
CONDI-
TIONS.—Of the discharges in calendar year 
2013 from the long-term care hospital for 
which payment was made under this sec-
tion, at least 50 percent were classified 
under MS–LTCH–DRGs 28, 29, 52, 57, 
551, 573, and 963. 
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‘‘(iii) SIGNIFICANT OUT-OF-STATE AD-
MISSIONS.— 
‘‘(I) IN
GENERAL.—The long- 
term care hospital discharged inpa-
tients (including both individuals enti-
tled to, or enrolled for, benefits under 
this title and individuals not so enti-
tled or enrolled) during fiscal year 
2014 who had been admitted from at 
least 20 of the 50 States, determined 
by the States of residency of such in-
patients and based on such data sub-
mitted by the hospital to the Sec-
retary as the Secretary may require. 
‘‘(II) 
IMPLEMENTATION.—Not-
withstanding any other provision of 
law, the Secretary may implement 
subclause (I) by program instruction 
or otherwise. 
‘‘(III) NON-APPLICATION OF PA-
PERWORK REDUCTION ACT.—Chapter 
35 of title 44, United States Code, 
shall not apply to data collected under 
this clause.’’. 
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(b) STUDY AND REPORT ON THE STATUS AND VIA-
BILITY
OF CERTAIN SPINAL CORD SPECIALTY LONG- 
TERM CARE HOSPITALS.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on long-term 
care hospitals described in section 1886(m)(6)(F) of 
the Social Security Act, as added by subsection (a). 
Such report shall include an analysis of the fol-
lowing: 
(A) The impact on such hospitals of the 
classification and facility licensure by State 
agencies of such hospitals. 
(B) The Medicare payment rates for such 
hospitals. 
(C) Data on the number and health care 
needs of Medicare beneficiaries who have been 
diagnosed with catastrophic spinal cord or ac-
quired brain injuries or other paralyzing neuro-
muscular conditions (as described within the 
discharge classifications specified in clause (ii) 
of such section) who are receiving services from 
such hospitals. 
(2) REPORT.—Not later than October 1, 2018, 
the Comptroller General shall submit to Congress a 
report on the study conducted under paragraph (1), 
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including recommendations for such legislation and 
administrative action as the Comptroller General de-
termines appropriate. 
SEC. 105. TEMPORARY EXCEPTION TO SITE NEUTRAL PAY-
MENT 
RATE 
FOR 
CERTAIN 
DISCHARGES 
FROM LONG-TERM CARE HOSPITALS THAT 
INVOLVE SEVERE WOUNDS. 
(a) IN GENERAL.—Section 1886(m)(6) of the Social 
Security Act (42 U.S.C. 1395ww(m)(6)), as amended by 
section 104, is further amended— 
(1) in subparagraph (A)(i) by striking ‘‘and 
(F)’’ and inserting ‘‘(F), and (G)’’; 
(2) in subparagraph (E)(i)(I)(aa), by striking 
‘‘the amendment made’’ and all that follows before 
the semicolon and inserting ‘‘the last sentence of 
subsection (d)(1)(B)’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(G) ADDITIONAL TEMPORARY EXCEPTION 
FOR
CERTAIN
SEVERE
WOUND
DISCHARGES 
FROM CERTAIN LONG-TERM CARE HOSPITALS.— 
‘‘(i) IN
GENERAL.—For a discharge 
occurring in a cost-reporting period begin-
ning during fiscal year 2018, subpara-
graph (A)(i) shall not apply (and payment 
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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 last sentence 
of subsection (d)(1)(B); 
‘‘(II) is classified under MS– 
LTCH–DRG 602, 603, 539, or 540; 
and 
‘‘(III) is with respect to an indi-
vidual treated by a long-term care 
hospital for a severe wound. 
‘‘(ii) SEVERE
WOUND
DEFINED.—In 
this subparagraph, the term ‘severe wound’ 
means a wound which is a stage 3 wound, 
stage 4 wound, unstageable wound, non- 
healing surgical wound, or fistula as identi-
fied in the claim from the long-term care 
hospital. 
‘‘(iii) WOUND DEFINED.—In this sub-
paragraph, the term ‘wound’ means an in-
jury involving division of tissue or rupture 
of the integument or mucous membrane 
with exposure to the external environ-
ment.’’. 
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(b) STUDY AND REPORT TO CONGRESS.— 
(1) STUDY.—The Comptroller General of the 
United States shall, in consultation with relevant 
stakeholders, conduct a study on the treatment 
needs of individuals entitled to benefits under part 
A of title XVIII of the Social Security Act or en-
rolled under part B of such title who require special-
ized wound care, and the cost, for such individuals 
and the Medicare program under such title, of treat-
ing severe wounds in rural and urban areas. Such 
study shall include an assessment of— 
(A) access of such individuals to appro-
priate levels of care for such cases; 
(B) the potential impact that section 
1886(m)(6)(A)(i) of such Act (42 U.S.C. 
1395ww(m)(6)(A)(i)) will have on the access, 
quality, and cost of care for such individuals; 
and 
(C) how to appropriately pay for such care 
under the Medicare program under such title. 
(2) REPORT.—Not later than October 1, 2020, 
the Comptroller General shall submit to Congress a 
report on the study conducted under paragraph (1), 
including recommendations for such legislation and 
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administrative action as the Comptroller General de-
termines appropriate. 
TITLE II—OTHER PROVISIONS 
SEC. 201. NO PAYMENT FOR ITEMS AND SERVICES FUR-
NISHED BY NEWLY ENROLLED PROVIDERS 
OR SUPPLIERS WITHIN A TEMPORARY MORA-
TORIUM AREA. 
(a) MEDICARE.—Section 1866(j)(7) of the Social Se-
curity Act (42 U.S.C. 1395cc(j)(7)) is amended— 
(1) in the paragraph heading, by inserting ‘‘; 
NONPAYMENT’’ before the period; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) NONPAYMENT.— 
‘‘(i) IN GENERAL.—No payment may 
be made under this title or under a pro-
gram described in subparagraph (A) with 
respect to an item or service described in 
clause (ii). 
‘‘(ii) ITEM OR SERVICE DESCRIBED.— 
An item or service described in this clause 
is an item or service furnished— 
‘‘(I) within a geographic area 
with respect to which a temporary 
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moratorium imposed under subpara-
graph (A) is in effect; and 
‘‘(II) by a provider of services or 
supplier that meets the requirements 
of clause (iii). 
‘‘(iii) REQUIREMENTS.—For purposes 
of clause (ii), the requirements of this 
clause are that a provider of services or 
supplier— 
‘‘(I) enrolls under this title on or 
after the effective date of such tem-
porary moratorium; and 
‘‘(II) is within a category of pro-
viders of services and suppliers (as de-
scribed in subparagraph (A)) subject 
to such temporary moratorium. 
‘‘(iv) PROHIBITION ON CHARGES FOR 
SPECIFIED
ITEMS
OR
SERVICES.—In no 
case shall a provider of services or supplier 
described in clause (ii)(II) charge an indi-
vidual or other person for an item or serv-
ice described in clause (ii) furnished to an 
individual entitled to benefits under part A 
or enrolled under part B or an individual 
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under a program specified in subparagraph 
(A).’’. 
(b) CONFORMING AMENDMENTS.— 
(1) MEDICAID.— 
(A) IN GENERAL.—Section 1903(i)(2) of 
the Social Security Act (42 U.S.C. 1396b(i)(2)) 
is amended— 
(i) in subparagraph (A), by striking 
the comma at the end and inserting a 
semicolon; 
(ii) in subparagraph (B), by striking 
‘‘or’’ at the end; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) subject to section 1902(kk)(4)(A)(ii)(II), 
within a geographic area that is subject to a morato-
rium imposed under section 1866(j)(7) by a provider 
or supplier that meets the requirements specified in 
subparagraph (C)(iii) of such section, during the pe-
riod of such moratorium; or’’. 
(B) EXCEPTION
WITH
RESPECT
TO
AC-
CESS.—Section 1902(kk)(4)(A)(ii) of the Social 
Security Act (42 U.S.C. 1396a(kk)(4)(A)(ii)) is 
amended to read as follows: 
‘‘(ii) EXCEPTIONS.— 
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‘‘(I) COMPLIANCE WITH MORATO-
RIUM.—A State shall not be required 
to comply with a temporary morato-
rium described in clause (i) if the 
State determines that the imposition 
of such temporary moratorium would 
adversely impact beneficiaries’ access 
to medical assistance. 
‘‘(II) 
FFP 
AVAILABLE.—Not-
withstanding section 1903(i)(2)(D), 
payment may be made to a State 
under this title with respect to 
amounts expended for items and serv-
ices described in such section if the 
Secretary, in consultation with the 
State agency administering the State 
plan under this title (or a waiver of 
the plan), determines that denying 
payment to the State pursuant to 
such section would adversely impact 
beneficiaries’ access to medical assist-
ance. ’’. 
(C) STATE PLAN REQUIREMENT WITH RE-
SPECT TO LIMITATION ON CHARGES TO BENE-
FICIARIES.—Section 1902(kk)(4)(A) of the So-
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cial Security Act (42 U.S.C. 1396a(kk)(4)(A)) 
is amended by adding at the end the following 
new clause: 
‘‘(iii) LIMITATION
ON
CHARGES
TO 
BENEFICIARIES.—The State prohibits, dur-
ing the period of such a moratorium, a 
provider meeting the requirements speci-
fied in subparagraph (C)(iii) of section 
1866(j)(7) from charging an individual or 
other person eligible to receive medical as-
sistance under the State plan under this 
title (or a waiver of the plan) for an item 
or 
service 
described 
in 
section 
1903(i)(2)(D) furnished to such an indi-
vidual.’’. 
(2) CORRECTING
AMENDMENTS
TO
RELATED 
PROVISIONS.— 
(A) SECTION 1866(j).—Section 1866(j) of 
the Social Security Act (42 U.S.C. 1395cc(j)) is 
amended— 
(i) in paragraph (1)(A)— 
(I) by striking ‘‘paragraph (4)’’ 
and inserting ‘‘paragraph (5)’’; 
(II) by striking ‘‘moratoria in ac-
cordance with paragraph (5)’’ and in-
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serting ‘‘moratoria in accordance with 
paragraph (7)’’; and 
(III) by striking ‘‘paragraph (6)’’ 
and inserting ‘‘paragraph (9)’’; and 
(ii) by redesignating the second para-
graph (8) (added by section 1304(1) of 
Public Law 111–152) as paragraph (9). 
(B) SECTION 1902(kk).—Section 1902(kk) 
of such Act (42 U.S.C. 1396a(kk)) is amend-
ed— 
(i) in paragraph (1), by striking ‘‘sec-
tion 1886(j)(2)’’ and inserting ‘‘section 
1866(j)(2)’’; 
(ii) in paragraph (2), by striking ‘‘sec-
tion 1886(j)(3)’’ and inserting ‘‘section 
1866(j)(3)’’; 
(iii) in paragraph (3), by striking 
‘‘section 1866(j)(4)’’ and inserting ‘‘section 
1866(j)(5)’’; and 
(iv) in paragraph (4)(A), by striking 
‘‘section 1886(j)(6)’’ and inserting ‘‘section 
1866(j)(7)’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section (other than subsection (b)(2)) shall apply with 
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respect to items and services furnished on or after the date 
that is one year after the date of enactment of this section. 
Æ 
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