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 Pathway 
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 discharges 
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 sub-
section (a) shall be effective as if included in the enactment 
of section 1206(a)(3) of the Pathway for SGR Reform Act 
of 2013 (division B of Public Law 113–67; 42 U.S.C. 
1395ww note). 
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SEC. 103. CHANGE IN MEDICARE CLASSIFICATION FOR CER-
TAIN HOSPITALS. 
(a) IN GENERAL.—Subsection (d)(1)(B) of section 
1886 of the Social Security Act (42 U.S.C. 1395ww) is 
amended— 
(1) in clause (iv)— 
(A) in subclause (I), by striking ‘‘or’’ at the 
end; 
(B) in subclause (II)— 
(i) by striking ‘‘, or’’ at the end and 
inserting a semicolon; and 
(ii) by redesignating such subclause as 
clause (vi) and by moving it to immediately 
follow clause (v); and 
(iii) in clause (v), by striking the semi-
colon at the end and inserting ‘‘, or’’; and 
(C) by striking ‘‘(iv)(I) a hospital’’ and in-
serting ‘‘(iv) a hospital’’. 
(b) CONFORMING PAYMENT REFERENCES.—The second 
sentence of subsection (d)(1)(B) of such section is amend-
ed— 
(1) by inserting ‘‘(as in effect as of such date)’’ 
after ‘‘clause (iv)’’; and 
(2) by inserting ‘‘(or, in the case of a hospital 
described in clause (iv)(II), as so in effect, shall be 
classified under clause (vi) on and after the effective 
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date of such clause (vi) and for cost reporting periods 
beginning on or after January 1, 2015, shall not be 
subject to subsection (m) as of the date of such classi-
fication)’’ after ‘‘so classified’’. 
(c) APPLICATION.— 
(1) IN GENERAL.—For cost reporting periods be-
ginning 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 effect on 
January 1, 2015) and in any subsequent modi-
fications. 
(B) Payment for capital costs shall be made 
in the manner provided by section 412.526(c)(4) 
of title 42, Code of Federal Regulations (as in ef-
fect 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 
section 412.526(c) of title 42, Code of Federal 
Regulations (as in effect on such date). 
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(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 en-
actment. 
(d) CONFORMING TECHNICAL AMENDMENTS.— 
(1) Section 1899B(a)(2)(A)(iv) of the Social Se-
curity Act (42 U.S.C. 1395lll(a)(2)(A)(iv)) is amend-
ed by striking ‘‘1886(d)(1)(B)(iv)(II)’’ and inserting 
‘‘1886(d)(1)(B)(vi)’’. 
(2) Section 1886(m)(5)(F) of such Act (42 
U.S.C. 1395ww(m)(5)(F)) is amended in each of 
clauses (i) and (ii) by striking ‘‘(d)(1)(B)(iv)(II)’’ 
and inserting ‘‘(d)(1)(B)(vi)’’. 
SEC. 104. TEMPORARY EXCEPTION TO THE APPLICATION OF 
THE MEDICARE LTCH SITE NEUTRAL PROVI-
SIONS FOR CERTAIN SPINAL CORD SPE-
CIALTY HOSPITALS. 
(a) EXCEPTION.—Section 1886(m)(6) of the Social Se-
curity Act (42 U.S.C. 1395ww(m)(6)) is amended— 
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(1) in subparagraph (A)(i), by striking ‘‘and 
(E)’’ and inserting ‘‘, (E), and (F)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(F) TEMPORARY EXCEPTION FOR CERTAIN 
SPINAL CORD SPECIALTY HOSPITALS.—For dis-
charges in cost reporting periods beginning dur-
ing fiscal years 2018 and 2019, 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 is from a 
long-term care hospital that meets each of the fol-
lowing requirements: 
‘‘(i) NOT-FOR-PROFIT.—The long-term 
care hospital was a not-for-profit long-term 
care hospital on June 1, 2014, as deter-
mined 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 
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under MS–LTCH–DRGs 28, 29, 52, 57, 
551, 573, and 963. 
‘‘(iii) SIGNIFICANT OUT-OF-STATE AD-
MISSIONS.— 
‘‘(I) IN GENERAL.—The long-term 
care hospital discharged inpatients (in-
cluding both individuals entitled to, or 
enrolled for, benefits under this title 
and individuals not so entitled or en-
rolled) during fiscal year 2014 who 
had been admitted from at least 20 of 
the 50 States, determined by the States 
of residency of such inpatients and 
based on such data submitted by the 
hospital to the Secretary as the Sec-
retary may require. 
‘‘(II) 
IMPLEMENTATION.—Not-
withstanding any other provision of 
law, the Secretary may implement sub-
clause (I) by program instruction or 
otherwise. 
‘‘(III) NON-APPLICATION
OF
PA-
PERWORK
REDUCTION
ACT.—Chapter 
35 of title 44, United States Code, shall 
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not apply to data collected under this 
clause.’’. 
(b) STUDY AND REPORT ON THE STATUS AND VIABIL-
ITY
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 following: 
(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 di-
agnosed with catastrophic spinal cord or ac-
quired brain injuries or other paralyzing neuro-
muscular conditions (as described within the dis-
charge 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 
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report on the study conducted under paragraph (1), 
including recommendations for such legislation and 
administrative action as the Comptroller General de-
termines appropriate. 
SEC. 105. TEMPORARY EXTENSION TO THE APPLICATION OF 
THE MEDICARE LTCH SITE NEUTRAL PROVI-
SIONS FOR CERTAIN DISCHARGES WITH SE-
VERE 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 sub-
section (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 oc-
curring in a cost reporting period begin-
ning during fiscal year 2018, subparagraph 
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(A)(i) shall not apply (and payment shall 
be made to a long-term care hospital with-
out regard to this paragraph) if such dis-
charge— 
‘‘(I) is from a long-term care hos-
pital 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 hos-
pital 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 environment.’’. 
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(c) 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 enrolled under 
part B of such title who require specialized wound 
care, and the cost, for such individuals and the Medi-
care program under such title, of treating 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 MORATO-
RIUM AREA. 
(a) MEDICARE.—Section 1866(j)(7) of the Social Secu-
rity 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) furnished on or after October 1, 
2017. 
‘‘(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 de-
scribed in clause (ii)(II) charge an indi-
vidual or other person for an item or service 
described in clause (ii) furnished on or after 
October 1, 2017, to an individual entitled to 
benefits under part A or enrolled under part 
B or an individual under a program speci-
fied in subparagraph (A).’’. 
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(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 semi-
colon; 
(ii) in subparagraph (B), by striking 
‘‘or’’ at the end; and 
(iii) 
‘‘(D) with respect to any amount expended 
for such an item or service furnished during cal-
endar quarters beginning on or after October 1, 
2017, subject to section 1902(kk)(4)(A)(ii)(II), 
within a geographic area that is subject to a 
moratorium imposed under section 1866(j)(7) by 
a provider or supplier that meets the require-
ments specified in subparagraph (C)(iii) of such 
section, during the period 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: 
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‘‘(ii) EXCEPTIONS.— 
‘‘(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 ad-
versely impact beneficiaries’ access to 
medical assistance. 
‘‘(II) FFP AVAILABLE.—Notwith-
standing section 1903(i)(2)(D), pay-
ment may be made to a State under 
this title with respect to amounts ex-
pended for items and services described 
in such section if the Secretary, in con-
sultation with the State agency admin-
istering the State plan under this title 
(or a waiver of the plan), determines 
that denying payment to the State 
pursuant to such section would ad-
versely impact beneficiaries’ access to 
medical assistance. ’’. 
(C) STATE PLAN REQUIREMENT WITH RE-
SPECT TO LIMITATION ON CHARGES TO BENE-
FICIARIES.—Section 1902(kk)(4)(A) of the Social 
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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.—With 
respect 
to 
any 
amount expended for items or services fur-
nished during calendar quarters beginning 
on or after October 1, 2017, the State pro-
hibits, during the period of a temporary 
moratorium described in clause (i), a pro-
vider meeting the requirements specified in 
subparagraph (C)(iii) of section 1866(j)(7) 
from charging an individual or other per-
son eligible to receive medical assistance 
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 individual.’’. 
(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)— 
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(I) by striking ‘‘paragraph (4)’’ 
and inserting ‘‘paragraph (5)’’; 
(II) by striking ‘‘moratoria in ac-
cordance with paragraph (5)’’ and in-
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 Pub-
lic Law 111–152) as paragraph (9). 
(B) SECTION 1902(KK).—Section 1902(kk) of 
such Act (42 U.S.C. 1396a(kk)) is amended— 
(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 1886(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)’’. 
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Union Calendar No. 594 
114TH CONGRESS 
2D SESSION 
H. R. 5713 
[Report No. 114–761, Part I] 
A BILL 
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. 
SEPTEMBER 20, 2016 
Reported from the Committee on Ways and Means with 
an amendment 
SEPTEMBER 20, 2016 
The Committee on Energy and Commerce discharged; 
committed to the Committee of the Whole House on 
the State of the Union and ordered to be printed 
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