I 
114TH CONGRESS 
1ST SESSION H. R. 1250 
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 HOUSE OF REPRESENTATIVES 
MARCH 4, 2015 
Mr. HARPER (for himself and Mr. THOMPSON of Mississippi) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 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)) is amended— 
(1) in subparagraph (A)(i) by striking ‘‘sub-
paragraph (C)’’ and inserting ‘‘subparagraphs (C), 
(E), and (F)’’; and 
(2) by adding at the end the following new sub-
paragraphs: 
‘‘(E) TEMPORARY
EXCEPTION
FOR
CER-
TAIN SEVERE WOUND DISCHARGES FROM SUB-
SECTION (d) HOSPITALS.— 
‘‘(i) IN
GENERAL.—For a discharge 
occurring in a cost reporting period begin-
ning prior to October 1, 2017, subpara-
graph (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 
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‘‘(III) the stay in the long-term 
care hospital ending with such dis-
charge 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’ 
means a stage 3 wound, stage 4 wound, 
unstageable wound, non-healing surgical 
wound, infected wound, fistula, osteomy-
elitis, or wound with morbid obesity, as 
identified in the claim from the long-term 
care hospital. 
‘‘(iii) SEVERE
WOUND
CRITERION.— 
In this subparagraph, the term ‘severe 
wound criterion’ means that the individual 
discharged— 
‘‘(I) 
received 
an 
excisional 
debridement or total parenteral nutri-
tion during the stay in the long-term 
care hospital referred to in clause 
(i)(III); or 
‘‘(II) has at least one major sys-
tem organ failure (lung, liver, kidney, 
or heart) as identified in the claim 
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from the immediately preceding stay 
in a subsection (d) hospital referred to 
in clause (i)(III). 
‘‘(F) TEMPORARY
EXCEPTION
FOR
CER-
TAIN SEVERE WOUND DISCHARGES FROM CER-
TAIN LONG-TERM CARE HOSPITALS.—For a dis-
charge occurring in a cost reporting period be-
ginning prior to October 1, 2017, 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— 
‘‘(i) is from a long-term care hospital 
identified by the amendment made by sec-
tion 4417(a) of the Balanced Budget Act 
of 1997 (42 U.S.C. 1395ww note, Public 
Law 105–33); and 
‘‘(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 
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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 appro-
priate 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)) will have on the 
access, quality, and cost of care for such indi-
viduals; and 
(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 recommenda-
tions for such legislation and administrative action 
as the Secretary determines appropriate. 
Æ 
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