I 
114TH CONGRESS 
2D SESSION 
H. R. 5723 
To amend title XVIII of the Social Security Act to provide for a temporary 
exception to the site neutral payment rate for certain discharges from 
long-term care hospitals that involve severe wounds. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 11, 2016 
Mr. LEVIN introduced the following bill; which was referred to the Committee 
on Ways and Means, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for a temporary exception to the site neutral payment 
rate for certain discharges from long-term care hospitals 
that involve severe wounds. 
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. TEMPORARY EXCEPTION TO SITE NEUTRAL 
PAYMENT RATE FOR CERTAIN DISCHARGES 
FROM LONG-TERM CARE HOSPITALS THAT 
INVOLVE SEVERE WOUNDS. 
(a) IN GENERAL.—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 ‘‘sub-
paragraphs (C) and (E)’’ and inserting ‘‘subpara-
graphs (C), (E), and (F)’’; 
(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: 
‘‘(F) 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— 
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‘‘(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.’’. 
(b) STUDY AND REPORT TO CONGRESS.— 
(1) STUDY.—The Comptroller General of the 
United States shall, in consultation with relevant 
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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. 
Æ 
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