I 
113TH CONGRESS 
1ST SESSION H. R. 3599 
To amend title XVIII of the Social Security Act with respect to payments 
to long-term care hospitals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 21, 2013 
Mr. FORTENBERRY (for himself and Mr. HALL) 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 with respect 
to payments to 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, 
SECTION 1. RELIEF FOR MEDICARE PAYMENTS TO LONG- 
TERM CARE HOSPITALS. 
(a) APPLICATION OF 25 PERCENT RULE PATIENT 
THRESHOLD PAYMENT ADJUSTMENT.— 
(1) EXTENSION OF RELIEF.—In implementing 
sections 412.534 and 412.536 of title 42, Code of 
Federal Regulations, for a 12-month cost reporting 
period beginning on or after October 1, 2013, the 
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Secretary of Health and Human Services shall con-
tinue the same threshold payment adjustment per-
centages and exemptions as were established for the 
12-month cost reporting periods beginning on or 
after October 1, 2012, in the same manner as was 
provided for in the rule published on August 31, 
2012 (77 Federal Register 53258). 
(2) NO
APPLICATION
OF
RULE
TO
GRAND-
FATHERED LTCHS.—The Secretary of Health and 
Human Services shall not apply sections 412.534 
and 412.536 of title 42, Code of Federal Regula-
tions, or any similar provisions to a long-term care 
hospital described in the second sentence of section 
1886(d)(1)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(1)(B)). 
(3) NEW EXCLUSION FROM CALCULATION OF 
THE 25 PERCENT RULE.—Medicare beneficiaries who 
were inpatients in a subsection (d) hospital within 1 
day prior to their admission to a long-term care hos-
pital described in section 1886(d)(1)(B)(iv)(I) of the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(1)(B)(iv)(I)) and who had a stay of 
more than 7 days in an intensive care unit identified 
in section 413.53(d) of title 42, Code of Federal 
Regulations, shall be excluded from the numerator 
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of the 25 percent threshold applied under sections 
412.534 and 412.536 of such title. 
(4) EFFECTIVE DATE.—This subsection shall be 
effective on October 1, 2013. 
(b) CLARIFICATION OF PAYMENTS PAID TO LONG- 
TERM CARE HOSPITALS ON AN IPPS BASIS.— 
(1) SITE NEUTRAL PAYMENTS.—For discharges 
occurring on or after October 1, 2014, payments 
made to long-term care hospitals described in section 
1886(d)(1)(B)(iv)(I) of the Social Security Act (42 
U.S.C. 1395ww(d)(1)(B)(iv)(I)) at amounts that are 
comparable or equivalent to amounts that are pay-
able to a subsection (d) hospital, for short stay pa-
tients and under the 25 percent rules established 
under sections 412.529(d)(4), 412.534, and 412.536 
of title 42, Code of Federal Regulations, shall be at 
amounts that are not less than would be paid to a 
subsection (d) hospital had it performed the same 
services. 
(2) CALCULATION
OF
LENGTH
OF
STAY
EX-
CLUDING CASES PAID ON AN IPPS BASIS.—For dis-
charges occurring on or after the date of the enact-
ment of this Act, in calculating the length of stay re-
quirement applicable to a long-term care hospital or 
satellite facility under section 1886(d)(1)(B)(iv)(I) 
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