,i  #aac? ,,congress  #a/ ,session  ,h4 
,r4 #ceca  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #ai1         
#bjac,mr4 ,r5acci 7= himself1 ,mr4      
,price ( ,georgia1 ,mr4 ,web/] (        
,florida1 ,mr4 ,kelly ( ,p5nsylvania1   
,mr4 ,/iv]s1 ,mr4 ,c>ney1 ,mr4 ,b>b]1   
,ms4 ,fudge1 ,mr4 ,buc%on1 & ,mr4       
,kilm]7 introduc$ ! foll[+ bill2 :i* 0  
ref]r$ to ! ,committee on ,ways & ,means
  ,a ,,bill  ,to am5d title ,,xviii ( ! 
,social ,security ,act to elim9ate !    
#c-;day prior hospitalization requirem5t
 = ,m$ic>e cov]age ( skill$ nurs+       
facility s]vices 9 qualifi$ skill$ nurs+
 facilities1 & = o!r purposes4  #a4     
,%ort title ,?is ,act may be cit$ z !   
,creat+ ,access to ,rehabilitation = ,e 
,s5ior 7,,c>es7 ,act ( #bjac4  #b4      
,elim9ation ( ,m$ic>e #c-;day prior     
hospitalization requirem5t = cov]age (  
skill$ nurs+ facility s]vices 9 qualifi$
 skill$ nurs+ facilities  7a7 ,9 g5]al  
,subsection 7f7 ( section #ahab ( !     
,social ,security ,act 7#db ,u4,s4,c4   

#acie;d7 is am5d$ to read z foll[s3  7f7
 ,cov]age ( ext5d$ c>e s]vices )\t a    
#c-;,day prior hospitalization =        
qualifi$ skill$ nurs+ facility  7#a7 ,9 
g5]al ,effective = ext5d$ c>e s]vices   
furni%$ pursuant to an admission to a   
skill$ nurs+ facility t occurs m ?an #ij
 days aft] ! date ( ! enactm5t ( !      
,creat+ ,access to ,rehabilitation = ,e 
,s5ior 7,,c>es7 ,act ( #bjac1 cov]age   
%all be provid$ "u ?is "p = an          
individual = su* s]vices 9 a qualifi$   
skill$ nurs+ facility t are n           
po/-hospital ext5d$ c>e s]vices4  7#b7  
,cont9u$ application ( c]tification &   
o!r requirem5ts & provisions ,!         
requirem5ts ( ! foll[+ provisions %all  
apply to ext5d$ c>e s]vices provid$ "u  
p>agraph 7#a7 9 ! same mann] z !y apply 
to po/-hospital ext5d$ c>e s]vices3 7,a7
 ,p>agraphs 7#b7 & 7#f7 ( section       
#ahad7;a71 except t ! requirem5t (      
p>agraph 7#b77;,b7 ( su* section %all n 
apply ins(> z x relates to any requir$  
prior receipt ( inpati5t hospital       

s]vices4  7,b7 ,subsections 7b77#b7 &   
7e7 ( ?is section4  7,c7 ,p>agraphs     
7#a77;,g77i71 7#b77;,a71 & 7#c7 (       
section #ahfa7v74  7,d7 ,section        
#ahfa7y74  7,e7 ,section #ahfb7;a77#ah74
  7,f7 ,section                         
#ahff7;a77#a77;,h77ii77,i74  7,g7       
,subsections 7d7 & 7f7 ( section #ahhc4 
7,h7 ,section #ahhh7;e74  7#c7 ,qualifi$
 skill$ nurs+ facility def9$  7,a7 ,9   
g5]al ,9 ?is subsection1 ! t]m qualifi$ 
skill$ nurs+ facility means a skill$    
nurs+ facility t ! ,secret>y det]m9es-- 
7i7 subject to subp>agraphs 7,b7 & 7,c71
 bas$ ^u ! mo/ rec5t rat+s "u ! sy/em   
e/abli%$ = purposes ( rat+ skill$ nurs+ 
facilities "u ! ,m$ic>e ,nurs+ ,home    
,comp>e program1 has an ov]all rat+ ( #c
 or m />s or a score ( #d />s or high]  
on ! individual quality doma9 or on !   
/aff+ quality doma92 &  7ii7 is n       
subject to a quality-(-c>e corporate    
integrity agreem5t 7relat+ to "o or m   
programs "u ?is ,act7 t is 9 effect ) ! 
,inspector ,g5]al ( ! ,dep>tm5t ( ,heal?

 & ,human ,s]vices & t requires !       
facility to reta9 an indep5d5t quality  
monitor4  ,! ,secret>y may make a       
det]m9ation "u clause 7ii7 bas$ ^u ! mo/
 curr5t in=mation conta9$ 9 ! website ( 
! ,inspector ,g5]al4  7,b7 ,waiv] (     
rat+s to ensure access ,! ,secret>y may1
 ^u application1 waive ! requirem5t (   
subp>agraph 7,a77i7 = a skill$ nurs+    
facility 9 ord] to ensure access to     
ext5d$ c>e s]vices t are n po/-hospital 
ext5d$ c>e s]vices 9 p>ticul> und]s]v$  
geographic areas4  7,c7 ,grace p]iod =  
correction ( rat+s ,9 ! case ( a skill$ 
nurs+ facility t qualifies z a qualifi$ 
skill$ nurs+ facility = a p]iod & t w\ld
 be disqualifi$ "u subp>agraph 7,a77i7  
because ( a decl9e 9 its /> rat+1 be=e  
disqualify+ ! facility ! ,secret>y %all 
provide ! facility ) a grace p]iod ( #a 
ye> dur+ :i* ! facility seeks to improve
 its rat+s bas$ on a plan ( correction  
approv$ by ! ,secret>y4  7,d7 ,hold+    
b5efici>ies h>mless 9 case (            
disqualification ( a facility ,9 ! case 

( a skill$ nurs+ facility t qualifies z 
a qualifi$ skill$ nurs+ facility = a    
p]iod & t is disqualifi$ "u subp>agraph 
7,a71 su* disqualification %all n apply 
to or affect individuals :o are admitt$ 
to ! facility at ! "t ( !               
disqualification4  4  7b7 ,med,p,a,c    
/udy ( co/ ( implem5tation ,! ,m$ic>e   
,paym5t ,advisory ,commission %all      
conduct a /udy (1 & submit a report to  
,congress & ! ,secret>y ( ,heal? &      
,human ,s]vices on1 ! co/ ( impact ( !  
am5dm5t made by subsection 7a71 no lat] 
?an ,june #a1 #bjaf4