,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #ceca  ,,in ,,the ,,house ,,of  
,,representatives  ,november #ai1       
#bjac,mr4 ,renacci 7for himself1 ,mr4   
,price of ,georgia1 ,mr4 ,webster of    
,florida1 ,mr4 ,kelly of ,pennsylvania1 
,mr4 ,stivers1 ,mr4 ,carney1 ,mr4       
,barber1 ,ms4 ,fudge1 ,mr4 ,bucshon1 and
 ,mr4 ,kilmer7 introduced the following 
bill2 which was referred to the         
,committee on ,ways and ,means  ,a      
,,bill  ,to amend title ,,xviii of the  
,social ,security ,act to eliminate the 
#c-;day prior hospitalization           
requirement for ,medicare coverage of   
skilled nursing facility services in    
qualified skilled nursing facilities1   
and for other purposes4  #a4 ,short     
title ,this ,act may be cited as the    
,creating ,access to ,rehabilitation for
 ,every ,senior 7,,cares7 ,act of #bjac4
  #b4 ,elimination of ,medicare #c-;day 
prior hospitalization requirement for   
coverage of skilled nursing facility    
services in qualified skilled nursing   

facilities  7a7 ,in general ,subsection 
7f7 of section #ahab of the ,social     
,security ,act 7#db ,u4,s4,c4 #acie;d7  
is amended to read as follows3  7f7     
,coverage of extended care services     
without a #c-;,day prior hospitalization
 for qualified skilled nursing facility 
7#a7 ,in general ,effective for extended
 care services furnished pursuant to an 
admission to a skilled nursing facility 
that occurs more than #ij days after the
 date of the enactment of the ,creating 
,access to ,rehabilitation for ,every   
,senior 7,,cares7 ,act of #bjac1        
coverage shall be provided under this   
part for an individual for such services
 in a qualified skilled nursing facility
 that are not post-hospital extended    
care services4  7#b7 ,continued         
application of certification and other  
requirements and provisions ,the        
requirements of the following provisions
 shall apply to extended care services  
provided under paragraph 7#a7 in the    
same manner as they apply to            

post-hospital extended care services3   
7,a7 ,paragraphs 7#b7 and 7#f7 of       
section #ahad7;a71 except that the      
requirement of paragraph 7#b77;,b7 of   
such section shall not apply insofar as 
it relates to any required prior receipt
 of inpatient hospital services4  7,b7  
,subsections 7b77#b7 and 7e7 of this    
section4  7,c7 ,paragraphs 7#a77;,g77i71
 7#b77;,a71 and 7#c7 of section         
#ahfa7v74  7,d7 ,section #ahfa7y74  7,e7
 ,section #ahfb7;a77#ah74  7,f7 ,section
 #ahff7;a77#a77;,h77ii77,i74  7,g7      
,subsections 7d7 and 7f7 of section     
#ahhc4  7,h7 ,section #ahhh7;e74  7#c7  
,qualified skilled nursing facility     
defined  7,a7 ,in general ,in this      
subsection1 the term qualified skilled  
nursing facility means a skilled nursing
 facility that the ,secretary           
determines-- 7i7 subject to             
subparagraphs 7,b7 and 7,c71 based upon 
the most recent ratings under the system
 established for purposes of rating     
skilled nursing facilities under the    

,medicare ,nursing ,home ,compare       
program1 has an overall rating of #c or 
more stars or a score of #d stars or    
higher on the individual quality domain 
or on the staffing quality domain2 and  
7ii7 is not subject to a quality-of-care
 corporate integrity agreement 7relating
 to one or more programs under this     
,act7 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 monitor4  ,the      
,secretary may make a determination     
under clause 7ii7 based upon the most   
current information contained in the    
website of the ,inspector ,general4     
7,b7 ,waiver of ratings to ensure access
 ,the ,secretary may1 upon application1 
waive the requirement of subparagraph   
7,a77i7 for a skilled nursing facility  
in order to ensure access to extended   
care services that are not post-hospital
 extended care services in particular   
underserved geographic areas4  7,c7     

,grace period for correction of ratings 
,in the case of a skilled nursing       
facility that qualifies as a qualified  
skilled nursing facility for a period   
and that would be disqualified under    
subparagraph 7,a77i7 because of a       
decline in its star rating1 before      
disqualifying the facility the          
,secretary shall provide the facility   
with a grace period of #a year during   
which the facility seeks to improve its 
ratings based on a plan of correction   
approved by the ,secretary4  7,d7       
,holding beneficiaries harmless in case 
of disqualification of a facility ,in   
the case of a skilled nursing facility  
that qualifies as a qualified skilled   
nursing facility for a period and that  
is disqualified under subparagraph 7,a71
 such disqualification shall not apply  
to or affect individuals who are        
admitted to the facility at the time of 
the disqualification4  4  7b7 ,med,p,a,c
 study of cost of implementation ,the   
,medicare ,payment ,advisory ,commission

 shall conduct a study of1 and submit a 
report to ,congress and the ,secretary  
of ,health and ,human ,services on1 the 
cost of impact of the amendment made by 
subsection 7a71 no later than ,june #a1 
#bjaf4