I 
113TH CONGRESS 
1ST SESSION H. R. 3144 
To amend title XVIII of the Social Security Act to provide Medicare coverage 
of extended care services without regard to a requirement for a 3- 
day prior hospitalization, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 19, 2013 
Mr. MCDERMOTT introduced the following bill; which was referred to the 
Committee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to provide 
Medicare coverage of extended care services without re-
gard to a requirement for a 3-day prior hospitalization, 
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. 
This Act may be cited as the ‘‘Fairness for Bene-
ficiaries Act of 2013’’. 
VerDate Mar 15 2010 
22:47 Sep 20, 2013
Jkt 029200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3144.IH
H3144
tkelley on DSK3SPTVN1PROD with BILLS
SEC. 2. MEDICARE COVERAGE OF EXTENDED CARE SERV-
ICES WITHOUT A 3-DAY PRIOR HOSPITALIZA-
TION. 
(a) IN GENERAL.—Subsection (f) of section 1812 of 
the Social Security Act (42 U.S.C. 1395d) is amended to 
read as follows: 
‘‘(f) COVERAGE
OF EXTENDED CARE SERVICES 
WITHOUT A 3-DAY PRIOR HOSPITALIZATION.— 
‘‘(1) IN GENERAL.—Coverage shall be provided 
under this part for an individual for extended care 
services in a skilled nursing facility that are not 
post-hospital extended care services if, before the in-
dividual is admitted to the skilled nursing facility, a 
physician or other qualified health care practitioner 
described in section 1814(a)(2) makes a determina-
tion that the provision of extended care services to 
the individual is medically necessary and has made 
the certification described in subparagraph (B) of 
such section with respect to such services (and con-
tinues to have such a certification made in the same 
manner as for post-hospital extended care services). 
‘‘(2) CONTINUED
APPLICATION
OF
CERTIFI-
CATION
AND
OTHER
REQUIREMENTS
AND
PROVI-
SIONS.—The requirements of paragraphs (2) and (6) 
of section 1814(a) and the provisions of subsections 
(b)(2) 
and 
(e) 
and 
sections 
1852(l), 
VerDate Mar 15 2010 
22:47 Sep 20, 2013
Jkt 029200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3144.IH
H3144
tkelley on DSK3SPTVN1PROD with BILLS
1861(v)(1)(G)(i), 
1861(v)(2)(A), 
1861(v)(3), 
1861(y), 
1861(tt)(1)(B), 
1862(a)(18), 
1866(a)(1)(H)(ii)(I), 1883(d), 1883(f), and 1888(e) 
shall apply to extended care services provided under 
this subsection in the same manner as they apply to 
post-hospital extended care services. 
‘‘(3) MAC DETERMINATIONS.— 
‘‘(A) PUBLICATION
OF
REQUIREMENTS 
FOR
DETERMINATIONS.—Not later than 6 
months after the date of the enactment of this 
paragraph, the Secretary shall publish a set of 
uniform requirements that will enable the medi-
care administrative contractors to make deter-
minations as to whether an admission described 
in paragraph (1) is medically necessary. 
‘‘(B) MAC AUDITS.—A medicare adminis-
trative contractor may audit determinations de-
scribed in paragraph (1) based on the uniform 
requirements established under subparagraph 
(A). In any administrative proceeding to review 
such determinations, the uniform requirements 
established by the Secretary shall be binding on 
administrative law judges.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to extended care services fur-
VerDate Mar 15 2010 
22:47 Sep 20, 2013
Jkt 029200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3144.IH
H3144
tkelley on DSK3SPTVN1PROD with BILLS