H. R. 34—278 
including criminal justice, mental health, sub-
stance abuse, emergency room, healthcare, law 
enforcement, corrections, and housing personnel; 
‘‘(III) develop or support alternatives to hos-
pital and jail admissions for frequent users of crisis 
services that provide treatment, stabilization, and 
other appropriate supports in the least restrictive, 
yet appropriate, environment; and 
‘‘(IV) develop protocols and systems among law 
enforcement, mental health, substance abuse, 
housing, corrections, and emergency medical 
service operations to provide coordinated assist-
ance to frequent users of crisis services.’’. 
SEC. 14024. LAW ENFORCEMENT TRAINING. 
Section 2991(h) of title I of the Omnibus Crime Control and 
Safe Streets Act of 1968 (42 U.S.C. 3797aa(h)) is amended— 
(1) in paragraph (1), by adding at the end the following: 
‘‘(F) ACADEMY
TRAINING.—To provide support for 
academy curricula, law enforcement officer orientation pro-
grams, continuing education training, and other programs 
that teach law enforcement personnel how to identify and 
respond to incidents involving persons with mental health 
disorders or co-occurring mental health and substance 
abuse disorders.’’; and 
(2) by adding at the end the following: 
‘‘(4) PRIORITY CONSIDERATION.—The Attorney General, in 
awarding grants under this subsection, shall give priority to 
programs that law enforcement personnel and members of the 
mental health and substance abuse professions develop and 
administer cooperatively.’’. 
SEC. 14025. FEDERAL LAW ENFORCEMENT TRAINING. 
Not later than 1 year after the date of enactment of this 
Act, the Attorney General shall provide direction and guidance 
for the following: 
(1) TRAINING PROGRAMS.—Programs that offer specialized 
and comprehensive training, in procedures to identify and 
appropriately respond to incidents in which the unique needs 
of individuals who have a mental illness are involved, to first 
responders and tactical units of— 
(A) Federal law enforcement agencies; and 
(B) other Federal criminal justice agencies such as 
the Bureau of Prisons, the Administrative Office of the 
United States Courts, and other agencies that the Attorney 
General determines appropriate. 
(2) IMPROVED
TECHNOLOGY.—The establishment of, or 
improvement of existing, computerized information systems to 
provide timely information to employees of Federal law enforce-
ment agencies, and Federal criminal justice agencies to improve 
the response of such employees to situations involving individ-
uals who have a mental illness. 
SEC. 14026. GAO REPORT. 
No later than 1 year after the date of enactment of this Act, 
the Comptroller General of the United States, in coordination with 
the Attorney General, shall submit to Congress a report on—
H. R. 34—279 
(1) the practices that Federal first responders, tactical 
units, and corrections officers are trained to use in responding 
to individuals with mental illness; 
(2) procedures to identify and appropriately respond to 
incidents in which the unique needs of individuals who have 
a mental illness are involved, to Federal first responders and 
tactical units; 
(3) the application of evidence-based practices in criminal 
justice settings to better address individuals with mental ill-
nesses; and 
(4) recommendations on how the Department of Justice 
can expand and improve information sharing and dissemination 
of best practices. 
SEC. 14027. EVIDENCE BASED PRACTICES. 
Section 2991(c) of title I of the Omnibus Crime Control and 
Safe Streets Act of 1968 (42 U.S.C. 3797aa(c)) is amended— 
(1) in paragraph (3), by striking ‘‘or’’ at the end; 
(2) by redesignating paragraph (4) as paragraph (6); and 
(3) by inserting after paragraph (3), the following: 
‘‘(4) propose interventions that have been shown by empir-
ical evidence to reduce recidivism; 
‘‘(5) when appropriate, use validated assessment tools to 
target preliminarily qualified offenders with a moderate or 
high risk of recidivism and a need for treatment and services; 
or’’. 
SEC. 
14028. 
TRANSPARENCY, 
PROGRAM 
ACCOUNTABILITY, 
AND 
ENHANCEMENT OF LOCAL AUTHORITY. 
(a) IN GENERAL.—Section 2991(a) of title I of the Omnibus 
Crime Control and Safe Streets Act of 1968 (42 U.S.C. 3797aa(a)) 
is amended— 
(1) in paragraph (7)— 
(A) in the heading, by striking ‘‘MENTAL ILLNESS’’ and 
inserting ‘‘MENTAL
ILLNESS; MENTAL
HEALTH
DISORDER’’; 
and 
(B) by striking ‘‘term ‘mental illness’ means’’ and 
inserting ‘‘terms ‘mental illness’ and ‘mental health dis-
order’ mean’’; and 
(2) by striking paragraph (9) and inserting the following: 
‘‘(9) PRELIMINARILY QUALIFIED OFFENDER.— 
‘‘(A) IN
GENERAL.—The term ‘preliminarily qualified 
offender’ means an adult or juvenile accused of an offense 
who— 
‘‘(i)(I) previously or currently has been diagnosed 
by a qualified mental health professional as having 
a mental illness or co-occurring mental illness and 
substance abuse disorders; 
‘‘(II) manifests obvious signs of mental illness or 
co-occurring mental illness and substance abuse dis-
orders during arrest or confinement or before any court; 
or 
‘‘(III) in the case of a veterans treatment court 
provided under subsection (i), has been diagnosed with, 
or manifests obvious signs of, mental illness or a sub-
stance abuse disorder or co-occurring mental illness 
and substance abuse disorder;
H. R. 34—280 
‘‘(ii) has been unanimously approved for participa-
tion in a program funded under this section by, when 
appropriate— 
‘‘(I) the relevant— 
‘‘(aa) prosecuting attorney; 
‘‘(bb) defense attorney; 
‘‘(cc) probation or corrections official; and 
‘‘(dd) judge; and 
‘‘(II) a representative from the relevant mental 
health agency described in subsection (b)(5)(B)(i); 
‘‘(iii) has been determined, by each person 
described in clause (ii) who is involved in approving 
the adult or juvenile for participation in a program 
funded under this section, to not pose a risk of violence 
to any person in the program, or the public, if selected 
to participate in the program; and 
‘‘(iv) has not been charged with or convicted of— 
‘‘(I) any sex offense (as defined in section 111 
of the Sex Offender Registration and Notification 
Act (42 U.S.C. 16911)) or any offense relating to 
the sexual exploitation of children; or 
‘‘(II) murder or assault with intent to commit 
murder. 
‘‘(B) DETERMINATION.—In determining whether to des-
ignate a defendant as a preliminarily qualified offender, 
the relevant prosecuting attorney, defense attorney, proba-
tion or corrections official, judge, and mental health or 
substance abuse agency representative shall take into 
account— 
‘‘(i) whether the participation of the defendant in 
the program would pose a substantial risk of violence 
to the community; 
‘‘(ii) the criminal history of the defendant and the 
nature and severity of the offense for which the defend-
ant is charged; 
‘‘(iii) the views of any relevant victims to the 
offense; 
‘‘(iv) the extent to which the defendant would ben-
efit from participation in the program; 
‘‘(v) the extent to which the community would 
realize cost savings because of the defendant’s partici-
pation in the program; and 
‘‘(vi) whether the defendant satisfies the eligibility 
criteria for program participation unanimously estab-
lished by the relevant prosecuting attorney, defense 
attorney, probation or corrections official, judge and 
mental health or substance abuse agency representa-
tive.’’. 
(b) TECHNICAL AND CONFORMING AMENDMENT.—Section 2927(2) 
of title I of the Omnibus Crime Control and Safe Streets Act 
of 1968 (42 U.S.C. 3797s–6(2)) is amended by striking ‘‘has the 
meaning given that term in section 2991(a).’’ and inserting ‘‘means 
an offense that— 
‘‘(A) does not have as an element the use, attempted 
use, or threatened use of physical force against the person 
or property of another; or
H. R. 34—281 
‘‘(B) is not a felony that by its nature involves a 
substantial risk that physical force against the person or 
property of another may be used in the course of commit-
ting the offense.’’. 
SEC. 14029. GRANT ACCOUNTABILITY. 
Section 2991 of title I of the Omnibus Crime Control and 
Safe Streets Act of 1968 (42 U.S.C. 3797aa) is amended by inserting 
after subsection (l), as added by section 14022, the following: 
‘‘(m) ACCOUNTABILITY.—All grants awarded by the Attorney 
General under this section shall be subject to the following account-
ability provisions: 
‘‘(1) AUDIT REQUIREMENT.— 
‘‘(A) DEFINITION.—In this paragraph, the term ‘unre-
solved audit finding’ means a finding in the final audit 
report of the Inspector General of the Department of Justice 
that the audited grantee has utilized grant funds for an 
unauthorized expenditure or otherwise unallowable cost 
that is not closed or resolved within 12 months from the 
date when the final audit report is issued. 
‘‘(B) AUDITS.—Beginning in the first fiscal year begin-
ning after the date of enactment of this subsection, and 
in each fiscal year thereafter, the Inspector General of 
the Department of Justice shall conduct audits of recipients 
of grants under this section to prevent waste, fraud, and 
abuse of funds by grantees. The Inspector General shall 
determine the appropriate number of grantees to be audited 
each year. 
‘‘(C) MANDATORY
EXCLUSION.—A recipient of grant 
funds under this section that is found to have an unresolved 
audit finding shall not be eligible to receive grant funds 
under this section during the first 2 fiscal years beginning 
after the end of the 12-month period described in subpara-
graph (A). 
‘‘(D) PRIORITY.—In awarding grants under this section, 
the Attorney General shall give priority to eligible 
applicants that did not have an unresolved audit finding 
during the 3 fiscal years before submitting an application 
for a grant under this section. 
‘‘(E) REIMBURSEMENT.—If an entity is awarded grant 
funds under this section during the 2-fiscal-year period 
during which the entity is barred from receiving grants 
under subparagraph (C), the Attorney General shall— 
‘‘(i) deposit an amount equal to the amount of 
the grant funds that were improperly awarded to the 
grantee into the General Fund of the Treasury; and 
‘‘(ii) seek to recoup the costs of the repayment 
to the fund from the grant recipient that was erro-
neously awarded grant funds. 
‘‘(2) NONPROFIT ORGANIZATION REQUIREMENTS.— 
‘‘(A) DEFINITION.—For purposes of this paragraph and 
the grant programs under this part, the term ‘nonprofit 
organization’ means an organization that is described in 
section 501(c)(3) of the Internal Revenue Code of 1986 
and is exempt from taxation under section 501(a) of such 
Code.
H. R. 34—282 
‘‘(B) PROHIBITION.—The Attorney General may not 
award a grant under this part to a nonprofit organization 
that holds money in offshore accounts for the purpose of 
avoiding paying the tax described in section 511(a) of the 
Internal Revenue Code of 1986. 
‘‘(C) DISCLOSURE.—Each nonprofit organization that is 
awarded a grant under this section and uses the procedures 
prescribed in regulations to create a rebuttable presump-
tion of reasonableness for the compensation of its officers, 
directors, trustees, and key employees, shall disclose to 
the Attorney General, in the application for the grant, 
the process for determining such compensation, including 
the independent persons involved in reviewing and 
approving such compensation, the comparability data used, 
and contemporaneous substantiation of the deliberation 
and decision. Upon request, the Attorney General shall 
make the information disclosed under this subparagraph 
available for public inspection. 
‘‘(3) CONFERENCE EXPENDITURES.— 
‘‘(A) LIMITATION.—No amounts made available to the 
Department of Justice under this section may be used 
by the Attorney General, or by any individual or entity 
awarded discretionary funds through a cooperative agree-
ment under this section, to host or support any expenditure 
for conferences that uses more than $20,000 in funds made 
available by the Department of Justice, unless the head 
of the relevant agency or department, provides prior writ-
ten authorization that the funds may be expended to host 
the conference. 
‘‘(B) WRITTEN
APPROVAL.—Written approval under 
subparagraph (A) shall include a written estimate of all 
costs associated with the conference, including the cost 
of all food, beverages, audio-visual equipment, honoraria 
for speakers, and entertainment. 
‘‘(C) REPORT.—The Deputy Attorney General shall 
submit an annual report to the Committee on the Judiciary 
of the Senate and the Committee on the Judiciary of the 
House of Representatives on all conference expenditures 
approved under this paragraph. 
‘‘(4) ANNUAL CERTIFICATION.—Beginning in the first fiscal 
year beginning after the date of enactment of this subsection, 
the Attorney General shall submit, to the Committee on the 
Judiciary and the Committee on Appropriations of the Senate 
and the Committee on the Judiciary and the Committee on 
Appropriations of the House of Representatives, an annual 
certification— 
‘‘(A) indicating whether— 
‘‘(i) all audits issued by the Office of the Inspector 
General under paragraph (1) have been completed and 
reviewed by the appropriate Assistant Attorney Gen-
eral or Director; 
‘‘(ii) all mandatory exclusions required under para-
graph (1)(C) have been issued; and 
‘‘(iii) all reimbursements required under paragraph 
(1)(E) have been made; and 
‘‘(B) that includes a list of any grant recipients excluded 
under paragraph (1) from the previous year.
H. R. 34—284 
manual and software shall be in the public domain and 
available for use and redistribution without charge. 
‘‘(B) USE OF PREVIOUS ANALYSIS DONE BY MEDPAC.— 
In developing the HCPCS MS–DRG definitions manual 
and software under subparagraph (A), the Secretary shall 
consult with the Medicare Payment Advisory Commission 
and shall consider the analysis done by such Commission 
in translating outpatient surgical claims into inpatient sur-
gical MS–DRGs in preparing chapter 7 (relating to hospital 
short-stay policy issues) of its ‘Medicare and the Health 
Care Delivery System’ report submitted to Congress in 
June 2015. 
‘‘(4) DEFINITION AND REFERENCE.—In this subsection: 
‘‘(A) HCPCS.—The term ‘HCPCS’ means, with respect 
to hospital items and services, the code under the 
Healthcare Common Procedure Coding System (HCPCS) 
(or a successor code) for such items and services. 
‘‘(B) ICD–10–PCS.—The term ‘ICD–10–PCS’ means the 
International Classification of Diseases, 10th Revision, 
Procedure Coding System, and includes any subsequent 
revision of such International Classification of Diseases, 
Procedure Coding System.’’. 
SEC. 15002. ESTABLISHING BENEFICIARY EQUITY IN THE MEDICARE 
HOSPITAL READMISSION PROGRAM. 
(a) TRANSITIONAL ADJUSTMENT
FOR DUAL ELIGIBLE POPU-
LATION.—Section 1886(q)(3) of the Social Security Act (42 U.S.C. 
1395ww(q)(3)) is amended— 
(1) in subparagraph (A), by inserting ‘‘subject to subpara-
graph (D),’’ after ‘‘purposes of paragraph (1),’’; and 
(2) by adding at the end the following new subparagraph: 
‘‘(D) TRANSITIONAL ADJUSTMENT FOR DUAL ELIGIBLES.— 
‘‘(i) IN
GENERAL.—In determining a hospital’s 
adjustment factor under this paragraph for purposes 
of making payments for discharges occurring during 
and after fiscal year 2019, and before the application 
of clause (i) of subparagraph (E), the Secretary shall 
assign hospitals to groups (as defined by the Secretary 
under clause (ii)) and apply the applicable provisions 
of this subsection using a methodology in a manner 
that allows for separate comparison of hospitals within 
each such group, as determined by the Secretary. 
‘‘(ii) DEFINING
GROUPS.—For purposes of this 
subparagraph, the Secretary shall define groups of hos-
pitals, based on their overall proportion, of the 
inpatients who are entitled to, or enrolled for, benefits 
under part A, and who are full-benefit dual eligible 
individuals (as defined in section 1935(c)(6)). In 
defining groups, the Secretary shall consult the Medi-
care Payment Advisory Commission and may consider 
the analysis done by such Commission in preparing 
the portion of its report submitted to Congress in June 
2013 relating to readmissions. 
‘‘(iii) MINIMIZING
REPORTING
BURDEN
ON
HOS-
PITALS.—In carrying out this subparagraph, the Sec-
retary shall not impose any additional reporting 
requirements on hospitals.
H. R. 34—285 
‘‘(iv) BUDGET
NEUTRAL
DESIGN
METHODOLOGY.— 
The Secretary shall design the methodology to imple-
ment this subparagraph so that the estimated total 
amount of reductions in payments under this sub-
section equals the estimated total amount of reductions 
in payments that would otherwise occur under this 
subsection if this subparagraph did not apply.’’. 
(b) CHANGES IN RISK ADJUSTMENT.—Section 1886(q)(3) of the 
Social Security Act (42 U.S.C. 1395ww(q)(3)), as amended by sub-
section (a), is further amended by adding at the end the following 
new subparagraph: 
‘‘(E) CHANGES IN RISK ADJUSTMENT.— 
‘‘(i) CONSIDERATION
OF
RECOMMENDATIONS
IN 
IMPACT REPORTS.—The Secretary may take into account 
the studies conducted and the recommendations made 
by the Secretary under section 2(d)(1) of the IMPACT 
Act of 2014 (Public Law 113–185; 42 U.S.C. 1395lll 
note) with respect to the application under this sub-
section of risk adjustment methodologies. Nothing in 
this clause shall be construed as precluding consider-
ation of the use of groupings of hospitals. 
‘‘(ii) CONSIDERATION
OF
EXCLUSION
OF
PATIENT 
CASES BASED ON V OR OTHER APPROPRIATE CODES.— 
In promulgating regulations to carry out this sub-
section with respect to discharges occurring after fiscal 
year 2018, the Secretary may consider the use of V 
or other ICD-related codes for removal of a readmis-
sion. The Secretary may consider modifying measures 
under this subsection to incorporate V or other ICD- 
related codes at the same time as other changes are 
being made under this subparagraph. 
‘‘(iii) REMOVAL
OF
CERTAIN
READMISSIONS.—In 
promulgating regulations to carry out this subsection, 
with respect to discharges occurring after fiscal year 
2018, the Secretary may consider removal as a 
readmission of an admission that is classified within 
one or more of the following: transplants, end-stage 
renal disease, burns, trauma, psychosis, or substance 
abuse. The Secretary may consider modifying measures 
under this subsection to remove readmissions at the 
same time as other changes are being made under 
this subparagraph.’’. 
(c) MEDPAC STUDY ON READMISSIONS PROGRAM.—The Medicare 
Payment Advisory Commission shall conduct a study to review 
overall hospital readmissions described in section 1886(q)(5)(E) of 
the Social Security Act (42 U.S.C. 1395ww(q)(5)(E)) and whether 
such readmissions are related to any changes in outpatient and 
emergency services furnished. The Commission shall submit to 
Congress a report on such study in its report to Congress in June 
2018. 
SEC. 15003. FIVE-YEAR EXTENSION OF THE RURAL COMMUNITY HOS-
PITAL DEMONSTRATION PROGRAM. 
(a) EXTENSION.—Section 410A of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Public Law 
108–173; 42 U.S.C. 1395ww note) is amended—
H. R. 34—286 
(1) in subsection (a)(5), by striking ‘‘5-year extension period’’ 
and inserting ‘‘10-year extension period’’; and 
(2) in subsection (g)— 
(A) in the subsection heading, by striking ‘‘FIVE-YEAR’’ 
and inserting ‘‘TEN-YEAR’’; 
(B) in paragraph (1), by striking ‘‘additional 5-year’’ 
and inserting ‘‘additional 10-year’’; 
(C) by striking ‘‘5-year extension period’’ and inserting 
‘‘10-year extension period’’ each place it appears; 
(D) in paragraph (4)(B)— 
(i) in the matter preceding clause (i), by inserting 
‘‘each 5-year period in’’ after ‘‘hospital during’’; and 
(ii) in clause (i), by inserting ‘‘each applicable 5- 
year period in’’ after ‘‘the first day of’’; and 
(E) by adding at the end the following new paragraphs: 
‘‘(5) OTHER
HOSPITALS
IN
DEMONSTRATION
PROGRAM.— 
During the second 5 years of the 10-year extension period, 
the Secretary shall apply the provisions of paragraph (4) to 
rural community hospitals that are not described in paragraph 
(4) but are participating in the demonstration program under 
this section as of December 30, 2014, in a similar manner 
as such provisions apply to rural community hospitals described 
in paragraph (4). 
‘‘(6) EXPANSION
OF
DEMONSTRATION
PROGRAM
TO
RURAL 
AREAS IN ANY STATE.— 
‘‘(A) IN
GENERAL.—The Secretary shall, notwith-
standing subsection (a)(2) or paragraph (2) of this sub-
section, not later than 120 days after the date of the 
enactment of this paragraph, issue a solicitation for applica-
tions to select up to the maximum number of additional 
rural community hospitals located in any State to partici-
pate in the demonstration program under this section for 
the second 5 years of the 10-year extension period without 
exceeding the limitation under paragraph (3) of this sub-
section. 
‘‘(B) PRIORITY.—In determining which rural community 
hospitals that submitted an application pursuant to the 
solicitation under subparagraph (A) to select for participa-
tion in the demonstration program, the Secretary— 
‘‘(i) shall give priority to rural community hospitals 
located in one of the 20 States with the lowest popu-
lation densities (as determined by the Secretary using 
the 2015 Statistical Abstract of the United States); 
and 
‘‘(ii) may consider— 
‘‘(I) closures of hospitals located in rural areas 
in the State in which the rural community hospital 
is located during the 5-year period immediately 
preceding the date of the enactment of this para-
graph; and 
‘‘(II) the population density of the State in 
which the rural community hospital is located.’’. 
(b) CHANGE IN TIMING FOR REPORT.—Subsection (e) of such 
section 410A is amended— 
(1) by striking ‘‘Not later than 6 months after the comple-
tion of the demonstration program under this section’’ and 
inserting ‘‘Not later than August 1, 2018’’; and
H. R. 34—287 
(2) by striking ‘‘such program’’ and inserting ‘‘the dem-
onstration program under this section’’. 
SEC. 15004. REGULATORY RELIEF FOR LTCHS. 
(a) TECHNICAL CHANGE TO THE MEDICARE LONG-TERM CARE 
HOSPITAL MORATORIUM EXCEPTION.— 
(1) IN GENERAL.—Section 114(d)(7) of the Medicare, Med-
icaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww 
note), as amended by sections 3106(b) and 10312(b) of Public 
Law 111–148, section 1206(b)(2) of the Pathway for SGR Reform 
Act of 2013 (division B of Public Law 113–67), and section 
112 of the Protecting Access to Medicare Act of 2014 (Public 
Law 113–93), is amended by striking ‘‘The moratorium under 
paragraph (1)(A)’’ and inserting ‘‘Any moratorium under para-
graph (1)’’. 
(2) EFFECTIVE DATE.—The amendment made by paragraph 
(1) shall take effect as if included in the enactment of section 
112 of the Protecting Access to Medicare Act of 2014. 
(b) MODIFICATION TO MEDICARE LONG-TERM CARE HOSPITAL 
HIGH COST OUTLIER PAYMENTS.—Section 1886(m) of the Social 
Security Act (42 U.S.C. 1395ww(m)) is amended by adding at the 
end the following new paragraph: 
‘‘(7) TREATMENT OF HIGH COST OUTLIER PAYMENTS.— 
‘‘(A) ADJUSTMENT TO THE STANDARD FEDERAL PAYMENT 
RATE
FOR
ESTIMATED
HIGH
COST
OUTLIER
PAYMENTS.— 
Under the system described in paragraph (1), for fiscal 
years beginning on or after October 1, 2017, the Secretary 
shall reduce the standard Federal payment rate as if the 
estimated aggregate amount of high cost outlier payments 
for standard Federal payment rate discharges for each 
such fiscal year would be equal to 8 percent of estimated 
aggregate payments for standard Federal payment rate 
discharges for each such fiscal year. 
‘‘(B) LIMITATION
ON
HIGH
COST
OUTLIER
PAYMENT 
AMOUNTS.—Notwithstanding subparagraph (A), the Sec-
retary shall set the fixed loss amount for high cost outlier 
payments such that the estimated aggregate amount of 
high cost outlier payments made for standard Federal pay-
ment rate discharges for fiscal years beginning on or after 
October 1, 2017, shall be equal to 99.6875 percent of 8 
percent of estimated aggregate payments for standard Fed-
eral payment rate discharges for each such fiscal year. 
‘‘(C) WAIVER OF BUDGET NEUTRALITY.—Any reduction 
in payments resulting from the application of subparagraph 
(B) shall not be taken into account in applying any budget 
neutrality provision under such system. 
‘‘(D) NO EFFECT ON SITE NEUTRAL HIGH COST OUTLIER 
PAYMENT
RATE.—This paragraph shall not apply with 
respect to the computation of the applicable site neutral 
payment rate under paragraph (6).’’. 
SEC. 15005. SAVINGS FROM IPPS MACRA PAY-FOR THROUGH NOT 
APPLYING 
DOCUMENTATION 
AND 
CODING 
ADJUST-
MENTS. 
Section 7(b)(1)(B) of the TMA, Abstinence Education, and QI 
Programs Extension Act of 2007 (Public Law 110–90), as amended 
by section 631(b) of the American Taxpayer Relief Act of 2012 
(Public Law 112–240) and section 414(1)(B)(iii) of the Medicare
H. R. 34—288 
Access and CHIP Reauthorization Act of 2015 (Public Law 114– 
10), is amended in clause (iii) by striking ‘‘an increase of 0.5 percent-
age points for discharges occurring during each of fiscal years 
2018 through 2023’’ and inserting ‘‘an increase of 0.4588 percentage 
points for discharges occurring during fiscal year 2018 and 0.5 
percentage points for discharges occurring during each of fiscal 
years 2019 through 2023’’. 
SEC. 15006. EXTENSION OF CERTAIN LTCH MEDICARE PAYMENT 
RULES. 
(a) 25–PERCENT PATIENT THRESHOLD PAYMENT ADJUSTMENT.— 
Section 114(c)(1)(A) of the Medicare, Medicaid, and SCHIP Exten-
sion 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 113–67), is amended 
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 October 1, 2017’’. 
(b) 
PAYMENT
FOR
HOSPITALS-WITHIN-HOSPITALS.—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 provi-
sion,’’ after ‘‘Regulations,’’; 
(2) in subparagraph (B)— 
(A) in clause (i), by inserting ‘‘or any similar provision,’’ 
after ‘‘Regulations,’’; and 
(B) in clause (ii), by inserting ‘‘, or any similar provi-
sion,’’ after ‘‘Regulations’’; and 
(3) in subparagraph (C), by striking ‘‘for a 9-year period’’ 
and inserting ‘‘through June 30, 2016, and for discharges occur-
ring on or after October 1, 2016, and before October 1, 2017’’. 
SEC. 15007. APPLICATION OF RULES ON THE CALCULATION OF HOS-
PITAL LENGTH OF STAY TO ALL LTCHS. 
(a) IN GENERAL.—Section 1206(a)(3) of the Pathway 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 discharges occurring’’; 
(3) by striking ‘‘subject to subparagraph (B),’’; and 
(4) by redesignating clauses (i) and (ii) as subparagraphs 
(A) and (B), respectively, and moving each of such subpara-
graphs (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 enactment of section 
1206(a)(3) of the Pathway for SGR Reform Act of 2013 (division 
B of Public Law 113–67; 42 U.S.C. 1395ww note).
H. R. 34—289 
SEC. 15008. CHANGE IN MEDICARE CLASSIFICATION FOR CERTAIN 
HOSPITALS. 
(a) IN GENERAL.—Subsection (d)(1)(B)(iv) of section 1886 of 
the Social Security Act (42 U.S.C. 1395ww) is amended— 
(1) in subclause (I), by striking ‘‘or’’ at the end; 
(2) in subclause (II)— 
(A) by striking ‘‘, or’’ at the end and inserting a semi-
colon; 
(B) by redesignating such subclause as clause (vi) and 
by moving it to immediately follow clause (v); and 
(C) in clause (v), by striking the semicolon at the 
end and inserting ‘‘, or’’; and 
(3) by striking ‘‘(iv)(I) a hospital’’ and inserting ‘‘(iv) a 
hospital’’. 
(b) CONFORMING PAYMENT REFERENCES.—The second 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 periods 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 effect on January 1, 2015) and in any subsequent modi-
fications. 
(B) Payment for capital costs shall be made in the 
manner provided by section 412.526(c)(4) of title 42, Code 
of Federal Regulations (as in effect on such date). 
(C) Claims for payment for Medicare beneficiaries who 
are discharged on or after January 1, 2017, shall be proc-
essed as claims which are paid on a reasonable cost basis 
as described in section 412.526(c) of title 42, Code of Fed-
eral 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 section 1886(d)(1)(B) of the Social Secu-
rity 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 sub-
section (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 inserting ‘‘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)’’.
H. R. 34—290 
SEC. 15009. TEMPORARY EXCEPTION TO THE APPLICATION OF THE 
MEDICARE LTCH SITE NEUTRAL PROVISIONS FOR CER-
TAIN SPINAL CORD SPECIALTY 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 subparagraph: 
‘‘(F) TEMPORARY EXCEPTION FOR CERTAIN SPINAL CORD 
SPECIALTY
HOSPITALS.—For discharges in cost reporting 
periods beginning during fiscal years 2018 and 2019, 
subparagraph (A)(i) shall not apply (and payment shall 
be made to a long-term care hospital without 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 TREATMENT FOR CATA-
STROPHIC SPINAL CORD OR ACQUIRED BRAIN INJURIES 
OR OTHER PARALYZING NEUROMUSCULAR CONDITIONS.— 
Of the discharges in calendar year 2013 from the long- 
term care hospital for which payment was made under 
this section, at least 50 percent were classified under 
MS–LTCH–DRGs 28, 29, 52, 57, 551, 573, and 963. 
‘‘(iii) SIGNIFICANT OUT-OF-STATE ADMISSIONS.— 
‘‘(I) IN GENERAL.—The long-term care hospital 
discharged inpatients (including both individuals 
entitled to, or enrolled for, benefits under this 
title and individuals not so entitled 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 inpatients and 
based on such data submitted by the hospital to 
the Secretary as the Secretary may require. 
‘‘(II) IMPLEMENTATION.—Notwithstanding any 
other provision of law, the Secretary may imple-
ment subclause (I) by program instruction or other-
wise. 
‘‘(III) NON-APPLICATION OF PAPERWORK REDUC-
TION 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 VIABILITY OF CER-
TAIN 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 following: 
(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 cata-
strophic spinal cord or acquired brain injuries or other 
paralyzing neuromuscular conditions (as described within
H. R. 34—291 
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 Comp-
troller 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 determines appropriate. 
SEC. 15010. TEMPORARY EXTENSION TO THE APPLICATION OF THE 
MEDICARE LTCH SITE NEUTRAL PROVISIONS FOR CER-
TAIN DISCHARGES WITH SEVERE WOUNDS. 
(a) IN GENERAL.—Section 1886(m)(6) of the Social Security 
Act (42 U.S.C. 1395ww(m)(6)), as amended by section 15009, 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 amend-
ment 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 subparagraph: 
‘‘(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 beginning during fiscal year 2018, 
subparagraph (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 individual treated 
by a long-term care hospital for a severe wound. 
‘‘(ii) SEVERE
WOUND
DEFINED.—In this subpara-
graph, 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 identified 
in the claim from the long-term care hospital. 
‘‘(iii) WOUND DEFINED.—In this subparagraph, the 
term ‘wound’ means an injury involving division of 
tissue or rupture of the integument or mucous mem-
brane with exposure to the external environment.’’. 
(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 enrolled 
under part B of such title who require specialized wound care, 
and the cost, for such individuals and the Medicare program 
under such title, of treating severe wounds in rural and urban 
areas. Such study shall include an assessment of— 
(A) access of such individuals to appropriate 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
H. R. 34—292 
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 Comp-
troller 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 determines appropriate. 
TITLE XVI—PROVISIONS RELATING TO 
MEDICARE PART B 
SEC. 16001. CONTINUING MEDICARE PAYMENT UNDER HOPD PROSPEC-
TIVE PAYMENT SYSTEM FOR SERVICES FURNISHED BY 
MID-BUILD OFF-CAMPUS OUTPATIENT DEPARTMENTS 
OF PROVIDERS. 
(a) IN GENERAL.—Section 1833(t)(21) of the Social Security 
Act (42 U.S.C. 1395l(t)(21)) is amended— 
(1) in subparagraph (B)— 
(A) in clause (i), by striking ‘‘clause (ii)’’ and inserting 
‘‘the subsequent provisions of this subparagraph’’; and 
(B) by adding at the end the following new clauses: 
‘‘(iii) DEEMED TREATMENT FOR 2017.—For purposes 
of applying clause (ii) with respect to applicable items 
and services furnished during 2017, a department of 
a provider (as so defined) not described in such clause 
is deemed to be billing under this subsection with 
respect to covered OPD services furnished prior to 
November 2, 2015, if the Secretary received from the 
provider prior to December 2, 2015, an attestation 
(pursuant to section 413.65(b)(3) of title 42 of the Code 
of Federal Regulations) that such department was a 
department of a provider (as so defined). 
‘‘(iv) ALTERNATIVE
EXCEPTION
BEGINNING
WITH 
2018.—For purposes of paragraph (1)(B)(v) and this 
paragraph with respect to applicable items and services 
furnished during 2018 or a subsequent year, the term 
‘off-campus outpatient department of a provider’ also 
shall not include a department of a provider (as so 
defined) that is not described in clause (ii) if— 
‘‘(I) the Secretary receives from the provider 
an 
attestation 
(pursuant 
to 
such 
section 
413.65(b)(3)) not later than December 31, 2016 
(or, if later, 60 days after the date of the enactment 
of this clause), that such department met the 
requirements of a department of a provider speci-
fied in section 413.65 of title 42 of the Code of 
Federal Regulations; 
‘‘(II) the provider includes such department 
as part of the provider on its enrollment form 
in accordance with the enrollment process under 
section 1866(j); and 
‘‘(III) the department met the mid-build 
requirement of clause (v) and the Secretary 
receives, not later than 60 days after the date