I
104TH CONGRESS
2D SESSION
H. R. 4244
To require the Secretary of Health and Human Services to waive the 3-
day prior hospitalization requirement for coverage of skilled nursing
facility services in the case of individuals classified within certain diag-
nosis-related groups.
IN THE HOUSE OF REPRESENTATIVES
SEPTEMBER 27, 1996
Mr. DURBIN (for himself and Mr. ENSIGN) introduced the following bill; which
was referred to the Committee on Ways and Means
A BILL
To require the Secretary of Health and Human Services
to waive the 3-day prior hospitalization requirement for
coverage of skilled nursing facility services in the case
of individuals classified within certain diagnosis-related
groups.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. WAIVER OF 3-DAY PRIOR HOSPITALIZATION RE-
QUIREMENT FOR COVERAGE OF SKILLED
NURSING FACILITY SERVICES FOR CERTAIN
DRGS.
(a) IN GENERAL.—By not later than October 1,
1997, the Secretary of Health and Human Services shall
provide for coverage, under section 1812(f) of the Social
Security Act, of extended care services for individuals with
a condition that is classifiable within a diagnosis-related
group selected under subsection (b).
(b) SELECTION OF DIAGNOSIS-RELATED GROUPS.—
For purposes of subsection (a) and subject to subsections
(c) and (d), the Secretary—
(1) beginning with fiscal year 1998, shall select
at least 5 diagnosis-related groups (as established
for purposes of section 1886(d)(4)(A) of the Social
Security Act) that—
(A) relate to conditions that do not require
treatment through receipt of inpatient hospital
services, and
(B) are not likely (or are least likely) to re-
sult in any net increased expenditures under
title XVIII of such Act; and
(2) for subsequent fiscal years may select addi-
tional diagnosis-related groups that meet the re-
quirements of subparagraphs (A) and (B) of para-
graph (1).
(c) RECOVERY OF EXCESS EXPENDITURES.—If the
Secretary determines that the application of this section
in a fiscal year has resulted in any increase in aggregate
expenditures under such title for the fiscal year above the
amount of such expenditures that would have occurred in
the fiscal year if this section did not apply (taking into
account any reductions in expenditures resulting from the
elimination of or a reduction in the length of hospitaliza-
tion), the Secretary—
(1) shall, notwithstanding any other provision
of law, provide for a reduction in the amounts other-
wise payable under part A of such title for post-hos-
pital extended care services in the following fiscal
year by such proportion as will reduce aggregate
Federal expenditures in such fiscal year under such
part by the aggregate amount of such an increase in
the previous fiscal year, and
(2) may rescind the selection of any diagnosis-
related group if the application of this section with
respect to such group has resulted in such an in-
crease in expenditures under such title.
(d) CONSIDERATION OF ADDITIONAL SELECTIONS.—
The Secretary shall actively consider the selection of addi-
tional groups under subsection (b)(2) if the Secretary de-
termines that the application of this section has resulted
in a net reduction in expenditures under such title.
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