756 
(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 October 1, 2017’’. 
SEC. 15007. 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
757 
of 2013 (division B of Public Law 113–67; 42 U.S.C. 
1395ww note). 
SEC. 15008. CHANGE IN MEDICARE CLASSIFICATION FOR 
CERTAIN HOSPITALS. 
(a) IN GENERAL.—Subsection (d)(1)(B)(iv) of section 
1886 of the Social Security Act (42 U.S.C. 1395ww) is 
amended— 
(1) in subclause (I), by striking ‘‘or’’ at the end; 
(2) in subclause (II)— 
(A) by striking ‘‘, or’’ at the end and insert-
ing a semicolon; 
(B) by redesignating such subclause as 
clause (vi) and by moving it to immediately fol-
low clause (v); and 
(C) in clause (v), by striking the semicolon 
at the end and inserting ‘‘, or’’; and 
(3) by striking ‘‘(iv)(I) a hospital’’ and inserting 
‘‘(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
758 
classified under clause (vi) on and after the effective 
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
759 
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 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)’’.
760 
SEC. 15009. 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 Se-
curity 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 
(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
761 
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. 
‘‘(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-
762 
clause (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.’’. 
(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-
763 
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 
report on the study conducted under paragraph (1), 
including recommendations for such legislation and 
administrative action as the Comptroller General de-
termines appropriate. 
SEC. 15010. TEMPORARY EXTENSION TO THE APPLICATION 
OF THE MEDICARE LTCH SITE NEUTRAL PRO-
VISIONS 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 15009, 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:
764 
‘‘(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 
(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-
765 
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.’’. 
(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
766 
(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 
administrative action as the Comptroller General de-
termines appropriate. 
TITLE XVI—PROVISIONS 
RELATING TO MEDICARE PART B 
SEC. 16001. CONTINUING MEDICARE PAYMENT UNDER 
HOPD PROSPECTIVE PAYMENT SYSTEM FOR 
SERVICES FURNISHED BY MID-BUILD OFF- 
CAMPUS 
OUTPATIENT 
DEPARTMENTS 
OF 
PROVIDERS. 
(a) IN GENERAL.—Section 1833(t)(21) of the Social 
Security Act (42 U.S.C. 1395l(t)(21)) is amended— 
(1) in subparagraph (B)— 
(A) in clause (i), by striking ‘‘clause (ii)’’ 
and inserting ‘‘the subsequent provisions of this 
subparagraph’’; and 
(B) by adding at the end the following new 
clauses: 
‘‘(iii) 
DEEMED
TREATMENT
FOR 
2017.—For purposes of applying clause (ii)
767 
with respect to applicable items and services 
furnished during 2017, a department of a 
provider (as so defined) not described in 
such clause is deemed to be billing under 
this subsection with respect to covered OPD 
services furnished prior to November 2, 
2015, if the Secretary received from the pro-
vider prior to December 2, 2015, an attesta-
tion (pursuant to section 413.65(b)(3) of 
title 42 of the Code of Federal Regulations) 
that such department was a department of 
a provider (as so defined). 
‘‘(iv) ALTERNATIVE EXCEPTION BEGIN-
NING
WITH
2018.—For purposes of para-
graph (1)(B)(v) and this paragraph with 
respect to applicable items and services fur-
nished during 2018 or a subsequent year, 
the term ‘off-campus outpatient department 
of a provider’ also shall not include a de-
partment of a provider (as so defined) that 
is not described in clause (ii) if— 
‘‘(I) the Secretary receives from 
the provider an attestation (pursuant 
to such section 413.65(b)(3)) not later 
than December 31, 2016 (or, if later,
768 
60 days after the date of the enactment 
of this clause), that such department 
met the requirements of a department 
of a provider specified in section 
413.65 of title 42 of the Code of Fed-
eral Regulations; 
‘‘(II) the provider includes such 
department as part of the provider on 
its enrollment form in accordance with 
the enrollment process under section 
1866(j); and 
‘‘(III) the department met the 
mid-build requirement of clause (v) 
and the Secretary receives, not later 
than 60 days after the date of the en-
actment of this clause, from the chief 
executive officer or chief operating offi-
cer of the provider a written certifi-
cation that the department met such 
requirement. 
‘‘(v) MID-BUILD
REQUIREMENT
DE-
SCRIBED.—The mid-build requirement of 
this clause is, with respect to a department 
of a provider, that before November 2, 2015, 
the provider had a binding written agree-
769 
ment with an outside unrelated party for 
the actual construction of such department. 
‘‘(vii) AUDIT.—Not later than Decem-
ber 31, 2018, the Secretary shall audit the 
compliance with requirements of clause (iv) 
with respect to each department of a pro-
vider to which such clause applies. If the 
Secretary finds as a result of an audit 
under this clause that the applicable re-
quirements were not met with respect to 
such department, the department shall not 
be excluded from the term ‘off-campus out-
patient department of a provider’ under 
such clause. 
‘‘(viii) IMPLEMENTATION.—For pur-
poses of implementing clauses (iii) through 
(vii): 
‘‘(I) Notwithstanding any other 
provision of law, the Secretary may 
implement such clauses by program in-
struction or otherwise. 
‘‘(II) Subchapter I of chapter 35 
of title 44, United States Code, shall 
not apply.
770 
‘‘(III) For purposes of carrying 
out this subparagraph with respect to 
clauses (iii) and (iv) (and clause (vii) 
insofar as it relates to clause (iv)), 
$10,000,000 shall be available from the 
Federal Supplementary Medical Insur-
ance Trust Fund under section 1841, 
to remain available until December 31, 
2018.’’; and 
(2) in subparagraph (E), by adding at the end 
the following new clause: 
‘‘(iv) The determination of an audit 
under subparagraph (B)(vii).’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section shall be effective as if included in the enactment of 
section 603 of the Bipartisan Budget Act of 2015 (Public 
Law 114–74). 
SEC. 16002. TREATMENT OF CANCER HOSPITALS IN OFF- 
CAMPUS OUTPATIENT DEPARTMENT OF A 
PROVIDER POLICY. 
(a) IN GENERAL.—Section 1833(t)(21)(B) of the So-
cial Security Act (42 U.S.C. 1395l(t)(21)(B)), as amended 
by section 16001(a), is amended— 
(1) by inserting after clause (v) the following 
new clause:
771 
‘‘(vi) EXCLUSION FOR CERTAIN CANCER 
HOSPITALS.—For purposes of paragraph 
(1)(B)(v) and this paragraph with respect 
to applicable items and services furnished 
during 2017 or a subsequent year, the term 
‘off-campus outpatient department of a pro-
vider’ also shall not include a department of 
a provider (as so defined) that is not de-
scribed in clause (ii) if the provider is a 
hospital 
described 
in 
section 
1886(d)(1)(B)(v) and— 
‘‘(I) in the case of a department 
that met the requirements of section 
413.65 of title 42 of the Code of Fed-
eral Regulations after November 1, 
2015, and before the date of the enact-
ment of this clause, the Secretary re-
ceives from the provider an attestation 
that such department met such require-
ments not later than 60 days after 
such date of enactment; or 
‘‘(II) in the case of a department 
that meets such requirements after such 
date of enactment, the Secretary re-
ceives from the provider an attestation
772 
that such department meets such re-
quirements not later than 60 days 
after the date such requirements are 
first met with respect to such depart-
ment.’’; 
(2) in clause (vii), by inserting after the first 
sentence the following: ‘‘Not later than 2 years after 
the date the Secretary receives an attestation under 
clause (vi) relating to compliance of a department of 
a provider with requirements referred to in such 
clause, the Secretary shall audit the compliance with 
such requirements with respect to the department.’’; 
and 
(3) in clause (viii)(III), by adding at the end the 
following: ‘‘For purposes of carrying out this sub-
paragraph with respect to clause (vi) (and clause 
(vii) insofar as it relates to such clause), $2,000,000 
shall be available from the Federal Supplementary 
Medical Insurance Trust Fund under section 1841, to 
remain available until expended.’’. 
(b) OFFSETTING SAVINGS.—Section 1833(t)(18) of the 
Social Security Act (42 U.S.C. 1395l(t)(18)) is amended— 
(1) in subparagraph (B), by inserting ‘‘, subject 
to subparagraph (C),’’ after ‘‘shall’’; and
773 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) TARGET PCR ADJUSTMENT.—In apply-
ing section 419.43(i) of title 42 of the Code of 
Federal Regulations to implement the appro-
priate adjustment under this paragraph for serv-
ices furnished on or after January 1, 2018, the 
Secretary shall use a target PCR that is 1.0 per-
centage points less than the target PCR that 
would otherwise apply. In addition to the per-
centage point reduction under the previous sen-
tence, the Secretary may consider making an ad-
ditional percentage point reduction to such tar-
get PCR that takes into account payment rates 
for applicable items and services described in 
paragraph (21)(C) other than for services fur-
nished 
by 
hospitals 
described 
in 
section 
1886(d)(1)(B)(v). In making any budget neu-
trality adjustments under this subsection for 
2018 or a subsequent year, the Secretary shall 
not take into account the reduced expenditures 
that result from the application of this subpara-
graph.’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall be effective as if included in the enactment of