114TH CONGRESS 
2D SESSION 
H. R. 5713 
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,
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
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).
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
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
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)’’.
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
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
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-
muscular conditions (as described within the 
discharge classifications specified in clause (ii) 
of such section) who are receiving services from 
such hospitals. 
(2) REPORT.—Not later than October 1, 2018, 
the Comptroller General shall submit to Congress a 
report on the study conducted under paragraph (1), 
including recommendations for such legislation and 
administrative action as the Comptroller General de-
termines appropriate. 
SEC. 105. TEMPORARY EXTENSION TO THE APPLICATION 
OF THE MEDICARE LTCH SITE NEUTRAL PRO-
VISIONS FOR CERTAIN DISCHARGES WITH SE-
VERE WOUNDS. 
(a) IN GENERAL.—Section 1886(m)(6) of the Social 
Security Act (42 U.S.C. 1395ww(m)(6)), as amended by 
section 104, is further amended— 
(1) in subparagraph (A)(i) by striking ‘‘and 
(F)’’ and inserting ‘‘(F), and (G)’’; 
(2) in subparagraph (E)(i)(I)(aa), by striking 
‘‘the amendment made’’ and all that follows before 
the semicolon and inserting ‘‘the last sentence of 
subsection (d)(1)(B)’’; and 
(3) by adding at the end the following new sub-
paragraph:
‘‘(G) ADDITIONAL TEMPORARY EXCEPTION 
FOR
CERTAIN
SEVERE
WOUND
DISCHARGES 
FROM CERTAIN LONG-TERM CARE HOSPITALS.— 
‘‘(i) IN
GENERAL.—For a discharge 
occurring in a cost reporting period begin-
ning during fiscal year 2018, subpara-
graph (A)(i) shall not apply (and payment 
shall be made to a long-term care hospital 
without regard to this paragraph) if such 
discharge— 
‘‘(I) is from a long-term care 
hospital identified by the last sentence 
of subsection (d)(1)(B); 
‘‘(II) is classified under MS– 
LTCH–DRG 602, 603, 539, or 540; 
and 
‘‘(III) is with respect to an indi-
vidual treated by a long-term care 
hospital for a severe wound. 
‘‘(ii) SEVERE
WOUND
DEFINED.—In 
this subparagraph, the term ‘severe wound’ 
means a wound which is a stage 3 wound, 
stage 4 wound, unstageable wound, non- 
healing surgical wound, or fistula as identi-
fied in the claim from the long-term care 
hospital. 
‘‘(iii) WOUND DEFINED.—In this sub-
paragraph, the term ‘wound’ means an in-
jury involving division of tissue or rupture 
of the integument or mucous membrane 
with exposure to the external environ-
ment.’’. 
(c) STUDY AND REPORT TO CONGRESS.— 
(1) STUDY.—The Comptroller General of the 
United States shall, in consultation with relevant 
stakeholders, conduct a study on the treatment 
needs of individuals entitled to benefits under part 
A of title XVIII of the Social Security Act or en-
rolled under part B of such title who require special-
ized wound care, and the cost, for such individuals 
and the Medicare program under such title, of treat-
ing 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 such Act (42 U.S.C. 
1395ww(m)(6)(A)(i)) will have on the access,
quality, and cost of care for such individuals; 
and 
(C) how to appropriately pay for such care 
under the Medicare program under such title. 
(2) REPORT.—Not later than October 1, 2020, 
the Comptroller General shall submit to Congress a 
report on the study conducted under paragraph (1), 
including recommendations for such legislation and 
administrative action as the Comptroller General de-
termines appropriate. 
TITLE II—OTHER PROVISIONS 
SEC. 201. NO PAYMENT FOR ITEMS AND SERVICES FUR-
NISHED BY NEWLY ENROLLED PROVIDERS 
OR SUPPLIERS WITHIN A TEMPORARY MORA-
TORIUM AREA. 
(a) MEDICARE.—Section 1866(j)(7) of the Social Se-
curity Act (42 U.S.C. 1395cc(j)(7)) is amended— 
(1) in the paragraph heading, by inserting ‘‘; 
NONPAYMENT’’ before the period; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) NONPAYMENT.— 
‘‘(i) IN GENERAL.—No payment may 
be made under this title or under a pro-
gram described in subparagraph (A) with
respect to an item or service described in 
clause (ii) furnished on or after October 1, 
2017. 
‘‘(ii) ITEM OR SERVICE DESCRIBED.— 
An item or service described in this clause 
is an item or service furnished— 
‘‘(I) within a geographic area 
with respect to which a temporary 
moratorium imposed under subpara-
graph (A) is in effect; and 
‘‘(II) by a provider of services or 
supplier that meets the requirements 
of clause (iii). 
‘‘(iii) REQUIREMENTS.—For purposes 
of clause (ii), the requirements of this 
clause are that a provider of services or 
supplier— 
‘‘(I) enrolls under this title on or 
after the effective date of such tem-
porary moratorium; and 
‘‘(II) is within a category of pro-
viders of services and suppliers (as de-
scribed in subparagraph (A)) subject 
to such temporary moratorium.
‘‘(iv) PROHIBITION ON CHARGES FOR 
SPECIFIED
ITEMS
OR
SERVICES.—In no 
case shall a provider of services or supplier 
described in clause (ii)(II) charge an indi-
vidual or other person for an item or serv-
ice described in clause (ii) furnished on or 
after October 1, 2017, to an individual en-
titled to benefits under part A or enrolled 
under part B or an individual under a pro-
gram specified in subparagraph (A).’’. 
(b) CONFORMING AMENDMENTS.— 
(1) MEDICAID.— 
(A) IN GENERAL.—Section 1903(i)(2) of 
the Social Security Act (42 U.S.C. 1396b(i)(2)) 
is amended— 
(i) in subparagraph (A), by striking 
the comma at the end and inserting a 
semicolon; 
(ii) in subparagraph (B), by striking 
‘‘or’’ at the end; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) with respect to any amount expended 
for such an item or service furnished during 
calendar quarters beginning on or after October
1, 
2017, 
subject 
to 
section 
1902(kk)(4)(A)(ii)(II), within a geographic area 
that is subject to a moratorium imposed under 
section 1866(j)(7) by a provider or supplier 
that meets the requirements specified in sub-
paragraph (C)(iii) of such section, during the 
period of such moratorium; or’’. 
(B) EXCEPTION
WITH
RESPECT
TO
AC-
CESS.—Section 1902(kk)(4)(A)(ii) of the Social 
Security Act (42 U.S.C. 1396a(kk)(4)(A)(ii)) is 
amended to read as follows: 
‘‘(ii) EXCEPTIONS.— 
‘‘(I) COMPLIANCE WITH MORATO-
RIUM.—A State shall not be required 
to comply with a temporary morato-
rium described in clause (i) if the 
State determines that the imposition 
of such temporary moratorium would 
adversely impact beneficiaries’ access 
to medical assistance. 
‘‘(II) 
FFP 
AVAILABLE.—Not-
withstanding section 1903(i)(2)(D), 
payment may be made to a State 
under this title with respect to 
amounts expended for items and serv-
ices described in such section if the 
Secretary, in consultation with the 
State agency administering the State 
plan under this title (or a waiver of 
the plan), determines that denying 
payment to the State pursuant to 
such section would adversely impact 
beneficiaries’ access to medical assist-
ance. ’’. 
(C) STATE PLAN REQUIREMENT WITH RE-
SPECT TO LIMITATION ON CHARGES TO BENE-
FICIARIES.—Section 1902(kk)(4)(A) of the So-
cial Security Act (42 U.S.C. 1396a(kk)(4)(A)) 
is amended by adding at the end the following 
new clause: 
‘‘(iii) LIMITATION
ON
CHARGES
TO 
BENEFICIARIES.—With 
respect 
to 
any 
amount expended for items or services fur-
nished during calendar quarters beginning 
on or after October 1, 2017, the State pro-
hibits, during the period of a temporary 
moratorium described in clause (i), a pro-
vider meeting the requirements specified in 
subparagraph (C)(iii) of section 1866(j)(7) 
from charging an individual or other per-
son eligible to receive medical assistance 
under the State plan under this title (or a 
waiver of the plan) for an item or service 
described in section 1903(i)(2)(D) fur-
nished to such an individual.’’. 
(2) CORRECTING
AMENDMENTS
TO
RELATED 
PROVISIONS.— 
(A) SECTION 1866(J).—Section 1866(j) of 
the Social Security Act (42 U.S.C. 1395cc(j)) is 
amended— 
(i) in paragraph (1)(A)— 
(I) by striking ‘‘paragraph (4)’’ 
and inserting ‘‘paragraph (5)’’; 
(II) by striking ‘‘moratoria in ac-
cordance with paragraph (5)’’ and in-
serting ‘‘moratoria in accordance with 
paragraph (7)’’; and 
(III) by striking ‘‘paragraph (6)’’ 
and inserting ‘‘paragraph (9)’’; and 
(ii) by redesignating the second para-
graph (8) (added by section 1304(1) of 
Public Law 111–152) as paragraph (9). 
(B) SECTION 1902(KK).—Section 1902(kk) 
of such Act (42 U.S.C. 1396a(kk)) is amend-
ed—
(i) in paragraph (1), by striking ‘‘sec-
tion 1886(j)(2)’’ and inserting ‘‘section 
1866(j)(2)’’; 
(ii) in paragraph (2), by striking ‘‘sec-
tion 1886(j)(3)’’ and inserting ‘‘section 
1866(j)(3)’’; 
(iii) in paragraph (3), by striking 
‘‘section 1886(j)(4)’’ and inserting ‘‘section 
1866(j)(5)’’; and 
(iv) in paragraph (4)(A), by striking 
‘‘section 1886(j)(6)’’ and inserting ‘‘section 
1866(j)(7)’’. 
Passed the House of Representatives September 21, 
2016. 
Attest: 
Clerk.
114TH CONGRESS 
2D SESSION 
H. R. 5713 
AN ACT 
To provide for the extension of certain long-term 
care hospital 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.