IIB 
114TH CONGRESS 
2D SESSION 
H. R. 5713 
IN THE SENATE OF THE UNITED STATES 
SEPTEMBER 22, 2016 
Received; read twice and referred to the Committee on Finance 
AN ACT 
To provide for the extension of certain long-term care hos-
pital 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. 
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. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Sustaining Healthcare Integrity and Fair Treatment Act 
of 2016’’. 
(b) TABLE OF CONTENTS.—This table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—MEDICARE PART A PROVISIONS 
Sec. 101. Extension of certain LTCH Medicare payment rules. 
Sec. 102. Application of rules on the calculation of hospital length of stay to 
all LTCHs. 
Sec. 103. Change in Medicare classification for certain hospitals. 
Sec. 104. Temporary exception to the application of the Medicare LTCH site 
neutral provisions for certain spinal cord specialty hospitals. 
Sec. 105. Temporary extension to the application of the Medicare LTCH site 
neutral provisions for certain discharges with severe wounds. 
TITLE II—OTHER PROVISIONS 
Sec. 201. No payment for items and services furnished by newly enrolled pro-
viders or suppliers within a temporary moratorium area. 
TITLE I—MEDICARE PART A 
PROVISIONS 
SEC. 101. EXTENSION OF CERTAIN LTCH MEDICARE PAY-
MENT RULES. 
(a) 25–PERCENT PATIENT THRESHOLD PAYMENT 
ADJUSTMENT.—Section 114(c)(1)(A) of the Medicare, 
Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 
1395ww note), as amended by section 4302(a) of division 
B of the American Recovery and Reinvestment Act (Public 
Law 111–5), sections 3106(a) and 10312(a) of Public 
Law 111–148, and section 1206(b)(1)(B) of the Pathway 
for SGR Reform Act of 2013 (division B of Public Law 
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113–67), is amended by striking ‘‘for a 9-year period’’ and 
inserting ‘‘through June 30, 2016, and for discharges oc-
curring on or after October 1, 2016, and before July 1, 
2017’’. 
(b) 
PAYMENT
FOR
HOSPITALS-WITHIN-HOS-
PITALS.—Section 114(c)(2) of the Medicare, Medicaid, 
and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww 
note), as amended by section 4302(a) of division B of the 
American Recovery and Reinvestment Act (Public Law 
111–5), sections 3106(a) and 10312(a) of Public Law 
111–148, and section 1206(b)(1)(A) of the Pathway for 
SGR Reform Act of 2013 (division B of Public Law 113– 
67), is amended— 
(1) in subparagraph (A), by inserting ‘‘or any 
similar provision,’’ after ‘‘Regulations,’’; 
(2) in subparagraph (B)— 
(A) in clause (i), by inserting ‘‘or any simi-
lar provision,’’ after ‘‘Regulations,’’; and 
(B) in clause (ii), by inserting ‘‘, or any 
similar provision,’’ after ‘‘Regulations’’; and 
(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 July 1, 2017’’. 
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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 Path-
way 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 dis-
charges 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 
subsection (a) shall be effective as if included in the enact-
ment of section 1206(a)(3) of the Pathway for SGR Re-
form 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 
CERTAIN 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; 
(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 
semicolon 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 sec-
ond sentence of subsection (d)(1)(B) of such section is 
amended— 
(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 
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classified under clause (vi) on and after the effective 
date of such clause (vi) and for cost reporting peri-
ods beginning on or after January 1, 2015, shall not 
be subject to subsection (m) as of the date of such 
classification)’’ after ‘‘so classified’’. 
(c) APPLICATION.— 
(1) IN GENERAL.—For cost reporting periods 
beginning 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 ef-
fect on January 1, 2015) and in any subse-
quent modifications. 
(B) Payment for capital costs shall be 
made in the manner provided by section 
412.526(c)(4) of title 42, Code of Federal Reg-
ulations (as in effect 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 
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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 enactment. 
(d) CONFORMING TECHNICAL AMENDMENTS.— 
(1) Section 1899B(a)(2)(A)(iv) of the Social 
Security Act (42 U.S.C. 1395lll(a)(2)(A)(iv)) is 
amended by striking ‘‘1886(d)(1)(B)(iv)(II)’’ and in-
serting ‘‘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)’’. 
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SEC. 104. 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 
Security 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
CER-
TAIN
SPINAL
CORD
SPECIALTY
HOSPITALS.— 
For discharges in cost reporting periods begin-
ning during fiscal years 2018 and 2019, sub-
paragraph (A)(i) shall not apply (and payment 
shall be made to a long-term care hospital with-
out regard to this paragraph) if such discharge 
is from a long-term care hospital that meets 
each of the following requirements: 
‘‘(i) 
NOT-FOR-PROFIT.—The 
long- 
term care hospital was a not-for-profit 
long-term care hospital on June 1, 2014, 
as determined by cost report data. 
‘‘(ii) PRIMARILY
PROVIDING
TREAT-
MENT
FOR
CATASTROPHIC
SPINAL
CORD 
OR ACQUIRED BRAIN INJURIES OR OTHER 
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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 inpa-
tients (including both individuals enti-
tled to, or enrolled for, benefits under 
this title and individuals not so enti-
tled or enrolled) during fiscal year 
2014 who had been admitted from at 
least 20 of the 50 States, determined 
by the States of residency of such in-
patients and based on such data sub-
mitted by the hospital to the Sec-
retary as the Secretary may require. 
‘‘(II) 
IMPLEMENTATION.—Not-
withstanding any other provision of 
law, the Secretary may implement 
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subclause (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 VIA-
BILITY
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 fol-
lowing: 
(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 
diagnosed with catastrophic spinal cord or ac-
quired brain injuries or other paralyzing neuro-
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