#aadth ,,congress  #b;d ,session  ,h4   
,r4 #egac  ,,an ,,act  ,to provide for  
the extension of certain long-term care 
hospital ,medicare payment rules1       
clarify the application of rules on the 
calculation of hospital length of stay  
to certain moratorium-excepted long-term
 care hospitals1 and for other purposes4
  #a4 ,short title2 table of contents   
7a7 ,short title ,this ,act may be cited
 as the ,sustaining ,healthcare         
,integrity and ,fair ,treatment ,act of 
#bjaf4  7b7 ,table of contents ,this    
table of contents of this ,act is as    
follows3  ,sec4 #a4 ,short title2 table 
of contents4 ,title ,i--,medicare ,part 
,a ,provisions ,sec4 #aja4 ,extension of
 certain ,,ltch ,medicare payment rules4
 ,sec4 #ajb4 ,application of rules on   
the calculation of hospital length of   
stay to all ,l,t,c,hs4 ,sec4 #ajc4      
,change in ,medicare classification for 
certain hospitals4 ,sec4 #ajd4          
,temporary exception to the application 
of the ,medicare ,,ltch site neutral    

provisions for certain spinal cord      
specialty hospitals4 ,sec4 #aje4        
,temporary extension to the application 
of the ,medicare ,,ltch site neutral    
provisions for certain discharges with  
severe wounds4 ,title ,,ii--,other      
,provisions ,sec4 #bja4 ,no payment for 
items and services furnished by newly   
enrolled providers or suppliers within a
 temporary moratorium area4  ,i         
,medicare ,part ,a ,provisions  #aja4   
,extension of certain ,,ltch ,medicare  
payment rules  7a7 #be-,percent patient 
threshold payment adjustment ,section   
#aad7;c77#a77;,a7 of the ,medicare1     
,medicaid1 and ,,schip ,extension ,act  
of #bjjg 7#db ,u4,s4,c4 #acieww note71  
as amended by section #dcjb7;a7 of      
division ,b of the ,american ,recovery  
and ,reinvestment ,act 7,public ,law    
#aaa-e71 sections #cajf7;a7 and         
#ajcab7;a7 of ,public ,law #aaa-adh1 and
 section #abjf7;b77#a77;,b7 of the      
,pathway for ,,sgr ,reform ,act of #bjac
 7division ,b of ,public ,law #aac-fg71 

is amended by striking for a #i-year    
period and inserting through ,june #cj1 
#bjaf1 and for discharges occurring on  
or after ,october #a1 #bjaf1 and before 
,july #a1 #bjag4  7b7 ,payment for      
hospitals-,within-,hospitals ,section   
#aad7;c77#b7 of the ,medicare1          
,medicaid1 and ,,schip ,extension ,act  
of #bjjg 7#db ,u4,s4,c4 #acieww note71  
as amended by section #dcjb7;a7 of      
division ,b of the ,american ,recovery  
and ,reinvestment ,act 7,public ,law    
#aaa-e71 sections #cajf7;a7 and         
#ajcab7;a7 of ,public ,law #aaa-adh1 and
 section #abjf7;b77#a77;,a7 of the      
,pathway for ,,sgr ,reform ,act of #bjac
 7division ,b of ,public ,law #aac-fg71 
is amended--  7#a7 in subparagraph 7,a71
 by inserting or any similar provision1 
after ,regulations12  7#b7 in           
subparagraph 7,b7--  7,a7 in clause 7i71
 by inserting or any similar provision1 
after ,regulations12 and  7,b7 in clause
 7ii71 by inserting 1 or any similar    
provision1 after ,regulations2 and  7#c7

 in subparagraph 7,c71 by striking for a
 #i-year period and inserting through   
,june #cj1 #bjaf1 and for discharges    
occurring on or after ,october #a1      
#bjaf1 and before ,july #a1 #bjag4      
#ajb4 ,application of rules on the      
calculation of hospital length of stay  
to all ,l,t,c,hs  7a7 ,in general       
,section #abjf7;a77#c7 of the ,pathway  
for ,,sgr ,reform ,act of #bjac         
7division ,b of ,public ,law #aac-fg2   
#db ,u4,s4,c4 #acieww note7 is amended--
  7#a7 by striking subparagraph 7,b72   
7#b7 by striking site neutral basis4--  
and all that follows through ,for       
discharges occurring and inserting site 
neutral basis4--,for discharges         
occurring2  7#c7 by striking subject to 
subparagraph 7,b712 and  7#d7 by        
redesignating clauses 7i7 and 7ii7 as   
subparagraphs 7,a7 and 7,b71            
respectively1 and moving each of such   
subparagraphs 7as so redesignated7 #b   
ems to the left4  7b7 ,effective date   
,the amendments made by subsection 7a7  

shall be effective as if included in the
 enactment of section #abjf7;a77#c7 of  
the ,pathway for ,,sgr ,reform ,act of  
#bjac 7division ,b of ,public ,law      
#aac-fg2 #db ,u4,s4,c4 #acieww note74   
#ajc4 ,change in ,medicare              
classification for certain hospitals    
7a7 ,in general ,subsection 7d77#a77;,b7
 of section #ahhf of the ,social        
,security ,act 7#db ,u4,s4,c4 #acieww7  
is amended--  7#a7 in clause 7iv7-- 7,a7
 in subclause 7,i71 by striking or at   
the end2  7,b7 in subclause 7,,ii7-- 7i7
 by striking 1 or at the end and        
inserting a semicolon2  7ii7 by         
redesignating such subclause as clause  
7vi7 and by moving it to immediately    
follow clause 7v72 and  7iii7 in clause 
7v71 by striking the semicolon at the   
end and inserting 1 or2 and  7,c7 by    
striking 7iv77,i7 a hospital and        
inserting 7iv7 a hospital4  7b7         
,conforming payment references ,the     
second sentence of subsection           
7d77#a77;,b7 of such section is         

amended--  7#a7 by inserting 7as in     
effect as of such date7 after clause    
7iv72 and  7#b7 by inserting 7or1 in the
 case of a hospital described in clause 
7iv77,,ii71 as so in effect1 shall be   
classified under clause 7vi7 on and     
after the effective date of such clause 
7vi7 and for cost reporting periods     
beginning on or after ,january #a1      
#bjae1 shall not be subject to          
subsection 7m7 as of the date of such   
classification7 after so classified4    
7c7 ,application  7#a7 ,in general ,for 
cost reporting periods beginning on or  
after ,january #a1 #bjae1 in the case of
 an applicable hospital 7as defined in  
paragraph 7#c771 the following shall    
apply3 7,a7 ,payment for inpatient      
operating costs shall be made on a      
reasonable cost basis in the manner     
provided in section #dab4ebf7;c77#c7 of 
title #db1 ,code of ,federal            
,regulations 7as in effect on ,january  
#a1 #bjae7 and in any subsequent        
modifications4  7,b7 ,payment for       

capital costs shall be made in the      
manner provided by section              
#dab4ebf7;c77#d7 of title #db1 ,code of 
,federal ,regulations 7as in effect on  
such date74  7,c7 ,claims for payment   
for ,medicare beneficiaries who are     
discharged on or after ,january #a1     
#bjag1 shall be processed as claims     
which are paid on a reasonable cost     
basis as described in section           
#dab4ebf7;c7 of title #db1 ,code of     
,federal ,regulations 7as in effect on  
such date74  7#b7 ,applicable hospital  
defined ,in this subsection1 the term   
applicable hospital means a hospital    
that is classified under clause         
7iv77,,ii7 of section #ahhf7;d77#a77;,b7
 of the ,social ,security ,act 7#db     
,u4,s4,c4 #acieww7d77#a77;,b77 on the   
day before the date of the enactment of 
this ,act and which is classified under 
clause 7vi7 of such section1 as         
redesignated and moved by subsection    
7a71 on or after such date of enactment4
  7d7 ,conforming technical amendments  

7#a7 ,section #ahii;,b7a77#b77;,a77iv7  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acielll7a77#b77;,a77iv77 is  
amended by striking                     
#ahhf7;d77#a77;,b77iv77,,ii7 and        
inserting #ahhf7;d77#a77;,b77vi74  7#b7 
,section #ahhf7m77#e77;,f7 of such ,act 
7#db ,u4,s4,c4 #acieww7m77#e77;,f77 is  
amended in each of clauses 7i7 and 7ii7 
by striking 7d77#a77;,b77iv77,,ii7 and  
inserting 7d77#a77;,b77vi74  #ajd4      
,temporary exception to the application 
of the ,medicare ,,ltch site neutral    
provisions for certain spinal cord      
specialty hospitals  7a7 ,exception     
,section #ahhf7m77#f7 of the ,social    
,security ,act 7#db ,u4,s4,c4           
#acieww7m77#f77 is amended--  7#a7 in   
subparagraph 7,a77i71 by striking and   
7,e7 and inserting 1 7,e71 and 7,f72 and
  7#b7 by adding at the end the         
following new subparagraph3  7,f7       
,temporary exception for certain spinal 
cord specialty hospitals ,for discharges
 in cost reporting periods beginning    

during fiscal years #bjah and #bjai1    
subparagraph 7,a77i7 shall not apply    
7and payment shall be made to a         
long-term care hospital without regard  
to this paragraph7 if such discharge is 
from a long-term care hospital that     
meets each of the following             
requirements3 7i7 ,not-for-profit ,the  
long-term care hospital was a           
not-for-profit long-term care hospital  
on ,june #a1 #bjad1 as determined by    
cost report data4  7ii7 ,primarily      
providing treatment for catastrophic    
spinal cord or acquired brain injuries  
or other paralyzing neuromuscular       
conditions ,of the discharges in        
calendar year #bjac from the long-term  
care hospital for which payment was made
 under this section1 at least #ej       
percent were classified under           
,,ms-,,ltch-,d,r,gs #bh1 #bi1 #eb1 #eg1 
#eea1 #egc1 and #ifc4  7iii7            
,significant out-of-,state admissions   
7,i7 ,in general ,the long-term care    
hospital discharged inpatients          

7including both individuals entitled to1
 or enrolled for1 benefits under this   
title and individuals not so entitled or
 enrolled7 during fiscal year #bjad who 
had been admitted from at least #bj of  
the #ej ,states1 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 require4  7,,ii7         
,implementation ,notwithstanding any    
other provision of law1 the ,secretary  
may implement subclause 7,i7 by program 
instruction or otherwise4  7,,iii7      
,non-application of ,paperwork          
,reduction ,act ,chapter #ce of title   
#dd1 ,united ,states ,code1 shall not   
apply to data collected under this      
clause4  4  7b7 ,study and report on the
 status and viability of certain spinal 
cord specialty long-,term care hospitals
  7#a7 ,study ,the ,comptroller ,general
 of the ,united ,states shall conduct a 
study on long-term care hospitals       
described in section #ahhf7m77#f77;,f7  

of the ,social ,security ,act1 as added 
by subsection 7a74 ,such report shall   
include an analysis of the following3   
7,a7 ,the impact on such hospitals of   
the classification and facility         
licensure by ,state agencies of such    
hospitals4  7,b7 ,the ,medicare payment 
rates for such hospitals4  7,c7 ,data on
 the number and health care needs of    
,medicare beneficiaries who have been   
diagnosed with catastrophic spinal cord 
or acquired brain injuries or other     
paralyzing neuromuscular conditions 7as 
described within the discharge          
classifications specified in clause 7ii7
 of such section7 who are receiving     
services from such hospitals4  7#b7     
,report ,not later than ,october #a1    
#bjah1 the ,comptroller ,general shall  
submit to ,congress a report on the     
study conducted under paragraph 7#a71   
including recommendations for such      
legislation and administrative action as
 the ,comptroller ,general determines   
appropriate4  #aje4 ,temporary extension

 to the application of the ,medicare    
,,ltch site neutral provisions for      
certain discharges with severe wounds   
7a7 ,in general ,section #ahhf7m77#f7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acieww7m77#f771 as amended by
 section #ajd1 is further amended--     
7#a7 in subparagraph 7,a77i7 by striking
 and 7,f7 and inserting 7,f71 and 7,g72 
7#b7 in subparagraph 7,e77i77,i77aa71 by
 striking the amendment made and all    
that follows before the semicolon and   
inserting the last sentence of          
subsection 7d77#a77;,b72 and  7#c7 by   
adding at the end the following new     
subparagraph3  7,g7 ,additional         
temporary exception for certain severe  
wound discharges from certain long-term 
care hospitals  7i7 ,in general ,for a  
discharge occurring in a cost reporting 
period beginning during fiscal year     
#bjah1 subparagraph 7,a77i7 shall not   
apply 7and payment shall be made to a   
long-term care hospital without regard  
to this paragraph7 if such discharge--  

7,i7 is from a long-term care hospital  
identified by the last sentence of      
subsection 7d77#a77;,b72  7,,ii7 is     
classified under ,,ms-,,ltch-,,drg #fjb1
 #fjc1 #eci1 or #edj2 and  7,,iii7 is   
with respect to an individual treated by
 a long-term care hospital for a severe 
wound4  7ii7 ,severe wound defined ,in  
this subparagraph1 the term severe wound
 means a wound which is a stage #c      
wound1 stage #d wound1 unstageable      
wound1 non-healing surgical wound1 or   
fistula as identified in the claim from 
the long-term care hospital4  7iii7     
,wound defined ,in this subparagraph1   
the term wound means an injury involving
 division of tissue or rupture of the   
integument or mucous membrane with      
exposure to the external environment4  4
  7c7 ,study and report to ,congress    
7#a7 ,study ,the ,comptroller ,general  
of the ,united ,states shall1 in        
consultation with relevant stakeholders1
 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 care1 and the cost1   
for such individuals and the ,medicare  
program under such title1 of treating   
severe wounds in rural and urban areas4 
,such study shall include an assessment 
of--  7,a7 access of such individuals to
 appropriate levels of care for such    
cases2  7,b7 the potential impact that  
section #ahhf7m77#f77;,a77i7 of such    
,act 7#db ,u4,s4,c4                     
#acieww7m77#f77;,a77i77 will have on the
 access1 quality1 and cost of care for  
such individuals2 and  7,c7 how to      
appropriately pay for such care under   
the ,medicare program under such title4 
7#b7 ,report ,not later than ,october   
#a1 #bjbj1 the ,comptroller ,general    
shall submit to ,congress a report on   
the study conducted under paragraph     
7#a71 including recommendations for such
 legislation and administrative action  
as the ,comptroller ,general determines 

appropriate4  ,,ii ,other ,provisions   
#bja4 ,no payment for items and services
 furnished by newly enrolled providers  
or suppliers within a temporary         
moratorium area  7a7 ,medicare ,section 
#ahff7;j77#g7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #acie;cc7j77#g77 is 
amended-- 7#a7 in the paragraph heading1
 by inserting 2 ,nonpayment before the  
period2 and  7#b7 by adding at the end  
the following new subparagraph3  7,c7   
,nonpayment  7i7 ,in general ,no payment
 may be made under this title or under a
 program described in subparagraph 7,a7 
with respect to an item or service      
described in clause 7ii7 furnished on or
 after ,october #a1 #bjag4  7ii7 ,item  
or service described ,an item or service
 described in this clause is an item or 
service furnished-- 7,i7 within a       
geographic area with respect to which a 
temporary moratorium imposed under      
subparagraph 7,a7 is in effect2 and     
7,,ii7 by a provider of services or     
supplier that meets the requirements of 

clause 7iii74  7iii7 ,requirements ,for 
purposes of clause 7ii71 the            
requirements of this clause are that a  
provider of services or supplier--  7,i7
 enrolls under this title on or after   
the effective date of such temporary    
moratorium2 and  7,,ii7 is within a     
category of providers of services and   
suppliers 7as described in subparagraph 
7,a77 subject to such temporary         
moratorium4  7iv7 ,prohibition on       
charges for specified items or services 
,in no case shall a provider of services
 or supplier described in clause        
7ii77,,ii7 charge an individual or other
 person for an item or service described
 in clause 7ii7 furnished on or after   
,october #a1 #bjag1 to an individual    
entitled to benefits under part ,a or   
enrolled under part ,b or an individual 
under a program specified in            
subparagraph 7,a74  4  7b7 ,conforming  
amendments  7#a7 ,medicaid  7,a7 ,in    
general ,section #aijc7;i77#b7 of the   
,social ,security ,act 7#db ,u4,s4,c4   

#acif;b7i77#b77 is amended--  7i7 in    
subparagraph 7,a71 by striking the comma
 at the end and inserting a semicolon2  
7ii7 in subparagraph 7,b71 by striking  
or at the end2 and  7iii7 by adding at  
the end the following new subparagraph3 
7,d7 with respect to any amount expended
 for such an item or service furnished  
during calendar quarters beginning on or
 after ,october #a1 #bjag1 subject to   
section #aijb7kk77#d77;,a77ii77,,ii71   
within a geographic area that is subject
 to a moratorium imposed under section  
#ahff7;j77#g7 by a provider or supplier 
that meets the requirements specified in
 subparagraph 7,c77iii7 of such section1
 during the period of such moratorium2  
or  4  7,b7 ,exception with respect to  
access ,section #aijb7kk77#d77;,a77ii7  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acif;a7kk77#d77;,a77ii77 is  
amended to read as follows3  7ii7       
,exceptions  7,i7 ,compliance with      
moratorium ,a ,state shall not be       
required to comply with a temporary     

moratorium described in clause 7i7 if   
the ,state determines that the          
imposition of such temporary moratorium 
would adversely impact beneficiaries'   
access to medical assistance4  7,,ii7   
,,ffp available ,notwithstanding section
 #aijc7;i77#b77;,d71 payment may be made
 to a ,state under this title with      
respect to amounts expended for items   
and services described in such section  
if the ,secretary1 in consultation with 
the ,state agency administering the     
,state plan under this title 7or a      
waiver of the plan71 determines that    
denying payment to the ,state pursuant  
to such section would adversely impact  
beneficiaries' access to medical        
assistance4  4  7,c7 ,state plan        
requirement with respect to limitation  
on charges to beneficiaries ,section    
#aijb7kk77#d77;,a7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#acif;a7kk77#d77;,a77 is amended by     
adding at the end the following new     
clause3  7iii7 ,limitation on charges to

 beneficiaries ,with respect to any     
amount expended for items or services   
furnished during calendar quarters      
beginning on or after ,october #a1      
#bjag1 the ,state prohibits1 during the 
period of a temporary moratorium        
described in clause 7i71 a provider     
meeting the requirements specified in   
subparagraph 7,c77iii7 of section       
#ahff7;j77#g7 from charging an          
individual or other person eligible to  
receive medical assistance under the    
,state plan under this title 7or a      
waiver of the plan7 for an item or      
service described in section            
#aijc7;i77#b77;,d7 furnished to such an 
individual4  4  7#b7 ,correcting        
amendments to related provisions  7,a7  
,section #ahff7;j7 ,section #ahff7;j7 of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acie;cc7j77 is amended--  7i7
 in paragraph 7#a77;,a7-- 7,i7 by       
striking paragraph 7#d7 and inserting   
paragraph 7#e72  7,,ii7 by striking     
moratoria in accordance with paragraph  

7#e7 and inserting moratoria in         
accordance with paragraph 7#g72 and     
7,,iii7 by striking paragraph 7#f7 and  
inserting paragraph 7#i72 and  7ii7 by  
redesignating the second paragraph 7#h7 
7added by section #acjd7a7 of ,public   
,law #aaa-aeb7 as paragraph 7#i74  7,b7 
,section #aijb7kk7 ,section #aijb7kk7 of
 such ,act 7#db ,u4,s4,c4 #acif;a7kk77  
is amended--  7i7 in paragraph 7#a71 by 
striking section #ahhf7;j77#b7 and      
inserting section #ahff7;j77#b72  7ii7  
in paragraph 7#b71 by striking section  
#ahhf7;j77#c7 and inserting section     
#ahff7;j77#c72  7iii7 in paragraph 7#c71
 by striking section #ahhf7;j77#d7 and  
inserting section #ahff7;j77#e72 and    
7iv7 in paragraph 7#d77;,a71 by striking
 section #ahhf7;j77#f7 and inserting    
section #ahff7;j77#g74  ,passed the     
,house of ,representatives ,september   
#ba1 #bjaf4;,clerk4