I 
113TH CONGRESS 
1ST SESSION H. R. 3531 
To amend title XVIII of the Social Security Act to eliminate the 3-day 
prior hospitalization requirement for Medicare coverage of skilled nursing 
facility services in qualified skilled nursing facilities, and for other pur-
poses. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 19, 2013 
Mr. RENACCI (for himself, Mr. PRICE of Georgia, Mr. WEBSTER of Florida, 
Mr. KELLY of Pennsylvania, Mr. STIVERS, Mr. CARNEY, Mr. BARBER, 
Ms. FUDGE, Mr. BUCSHON, and Mr. KILMER) 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 eliminate 
the 3-day prior hospitalization requirement for Medicare 
coverage of skilled nursing facility services in qualified 
skilled nursing facilities, 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 ‘‘Creating Access to Re-
habilitation for Every Senior (CARES) Act of 2013’’. 
VerDate Mar 15 2010 
00:51 Nov 21, 2013
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3531.IH
H3531
pwalker on DSK7TPTVN1PROD with BILLS
SEC. 2. ELIMINATION OF MEDICARE 3-DAY PRIOR HOS-
PITALIZATION 
REQUIREMENT 
FOR 
COV-
ERAGE OF SKILLED NURSING FACILITY SERV-
ICES IN QUALIFIED SKILLED NURSING FA-
CILITIES. 
(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 FOR QUALI-
FIED SKILLED NURSING FACILITY.— 
‘‘(1) IN GENERAL.—Effective for extended care 
services furnished pursuant to an admission to a 
skilled nursing facility that occurs more than 90 
days after the date of the enactment of the Creating 
Access to Rehabilitation for Every Senior (CARES) 
Act of 2013, coverage shall be provided under this 
part for an individual for such services in a qualified 
skilled nursing facility that are not post-hospital ex-
tended care services. 
‘‘(2) CONTINUED
APPLICATION
OF
CERTIFI-
CATION
AND
OTHER
REQUIREMENTS
AND
PROVI-
SIONS.—The requirements of the following provi-
sions shall apply to extended care services provided 
under paragraph (1) in the same manner as they 
apply to post-hospital extended care services: 
VerDate Mar 15 2010 
00:51 Nov 21, 2013
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3531.IH
H3531
pwalker on DSK7TPTVN1PROD with BILLS
‘‘(A) Paragraphs (2) and (6) of section 
1814(a), except that the requirement of para-
graph (2)(B) of such section shall not apply in-
sofar as it relates to any required prior receipt 
of inpatient hospital services. 
‘‘(B) Subsections (b)(2) and (e) of this sec-
tion. 
‘‘(C) Paragraphs (1)(G)(i), (2)(A), and (3) 
of section 1861(v). 
‘‘(D) Section 1861(y). 
‘‘(E) Section 1862(a)(18). 
‘‘(F) Section 1866(a)(1)(H)(ii)(I). 
‘‘(G) Subsections (d) and (f) of section 
1883. 
‘‘(H) Section 1888(e). 
‘‘(3) QUALIFIED
SKILLED
NURSING
FACILITY 
DEFINED.— 
‘‘(A) IN GENERAL.—In this subsection, the 
term ‘qualified skilled nursing facility’ means a 
skilled nursing facility that the Secretary deter-
mines— 
‘‘(i) subject to subparagraphs (B) and 
(C), based upon the most recent ratings 
under the system established for purposes 
of rating skilled nursing facilities under 
VerDate Mar 15 2010 
00:51 Nov 21, 2013
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3531.IH
H3531
pwalker on DSK7TPTVN1PROD with BILLS
the Medicare Nursing Home Compare pro-
gram, has an overall rating of 3 or more 
stars or a score of 4 stars or higher on the 
individual quality domain or on the staff-
ing quality domain; and 
‘‘(ii) is not subject to a quality-of-care 
corporate integrity agreement (relating to 
one or more programs under this Act) that 
is in effect with the Inspector General of 
the Department of Health and Human 
Services and that requires the facility to 
retain an independent quality monitor. 
The Secretary may make a determination under 
clause (ii) based upon the most current infor-
mation contained in the website of the Inspec-
tor General. 
‘‘(B) WAIVER OF RATINGS TO ENSURE AC-
CESS.—The Secretary may, upon application, 
waive the requirement of subparagraph (A)(i) 
for a skilled nursing facility in order to ensure 
access to extended care services that are not 
post-hospital extended care services in par-
ticular underserved geographic areas. 
‘‘(C) GRACE PERIOD FOR CORRECTION OF 
RATINGS.—In the case of a skilled nursing fa-
VerDate Mar 15 2010 
00:51 Nov 21, 2013
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3531.IH
H3531
pwalker on DSK7TPTVN1PROD with BILLS
cility that qualifies as a qualified skilled nursing 
facility for a period and that would be disquali-
fied under subparagraph (A)(i) because of a de-
cline in its star rating, before disqualifying the 
facility the Secretary shall provide the facility 
with a grace period of 1 year during which the 
facility seeks to improve its ratings based on a 
plan of correction approved by the Secretary. 
‘‘(D) HOLDING BENEFICIARIES HARMLESS 
IN
CASE
OF
DISQUALIFICATION
OF
A
FACIL-
ITY.—In the case of a skilled nursing facility 
that qualifies as a qualified skilled nursing fa-
cility for a period and that is disqualified under 
subparagraph (A), such disqualification shall 
not apply to or affect individuals who are ad-
mitted to the facility at the time of the disquali-
fication.’’. 
(b) MEDPAC STUDY
OF COST
OF IMPLEMENTA-
TION.—The Medicare Payment Advisory Commission shall 
conduct a study of, and submit a report to Congress and 
the Secretary of Health and Human Services on, the cost 
of impact of the amendment made by subsection (a), no 
later than June 1, 2016. 
Æ 
VerDate Mar 15 2010 
00:51 Nov 21, 2013
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6301
E:\BILLS\H3531.IH
H3531
pwalker on DSK7TPTVN1PROD with BILLS