H.R. 5713, Sustaining Healthcare Integrity and Fair Treatment Act of 2016

H.R. 5713

Sustaining Healthcare Integrity and Fair Treatment Act of 2016

Sponsor
Rep. Pat Tiberi

Committee
Ways and Means

Date
September 20, 2016 (114th Congress, 2nd Session)

Staff Contact
John Huston

Floor Situation

On­­­­ Tuesday, September 20, 2016, the House will consider H.R.5713, Sustaining Healthcare Integrity and Fair Treatment Act of 2016, under suspension of the rules. H.R. 5713 was introduced on July 11, 2016, by Rep. Patrick Tiberi (R-OH) and was referred to the Committee on Ways and Means, and in addition, the Committee on Energy and Commerce. The Committee on Ways and Means ordered the bill reported by voice vote on July 13, 2016.

Bill Summary

H.R. 5713 would modify Medicare’s payments to Long-Term Care Hospitals (LTCHs) and would prohibit Medicare from paying for items or services furnished by certain newly enrolled providers in select areas of the country.

Background

Long-Term Care Hospitals—Under current law, certain hospitals that treat patients considered to be medically complex with an average length of stay that exceeds 25 days are designated as LTCHs. Medicare payments for care provided in LTCHs are either made at rates determined in the prospective payment system for LTCHs, or at a so-called “site-neutral” rate. Through 2017, the site-neutral rate is a blend of the LTCH rates and the substantially lower rates that would be paid under the inpatient prospective payment system (IPPS). Beginning in 2018 all payments will be at the IPPS payment rate. Generally, discharges that involve specific conditions for patients with a stay of at least three days in an intensive care unit before being admitted to the LTCH are paid based on the LTCH system. Other discharges are paid at the site-neutral rate. Beginning on July 1, 2016, if more than 25 percent of Medicare patients in an LTCH are admitted from a single hospital, the site-neutral payment rate will be applied to all cases admitted from that hospital in excess of that 25 percent threshold.[1]

H.R 5713 would suspend the application of site-neutral payments for cases that exceed that 25 percent threshold between October 1, 2016 and June 30, 2017. It also would exempt inpatient services furnished to Medicare beneficiaries who are treated during fiscal years 2018 and 2019 for certain conditions, including spinal and traumatic brain injuries, that are treated at not-for-profit LTCHs that specialize in the treatment of those conditions, and fiscal year 2018 for certain kinds of severe wounds.

Moratorium On Certain New Providers—Under current law, the Secretary of Health and Human Services (HHS) may temporarily prevent individuals and firms from enrolling to furnish services in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) if the prohibition would reduce the occurrence of fraud, waste, and abuse. The authority is specific to certain geographic areas and, since it became available, the Secretary has imposed temporary moratoria for home health providers in six metropolitan areas and for ambulance providers in two metropolitan areas.[2]

H.R.5713 would prohibit newly enrolled providers and suppliers located outside an area with such a moratorium from billing for services provided within a region covered by a moratorium, which would prevent providers and suppliers from evading the intent of the moratorium in certain areas.

According to the bill sponsor, “H.R. 5713, the Sustaining Healthcare Integrity and Fair Treatment Act, the SHIFT Act, will give relief to all LTCHs from the 25 percent rule. This CMS rule, which has been delayed for ten years, allows for no more than 25 percent of patients to come from one inpatient acute hospital in one quarter. My bill will reinstate the 50 percent threshold that was in effect prior to July 1, 2016 and delay the rule for nine months. During a time when patients and health care providers are facing increasing burdens and higher costs, I am pleased that this committee came to an agreement that will help over 400 hospitals across the country. This bill will also provide relief for four specific groups of LTCHs that treat a highly unique group of patients.”[3]
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[1] See CBO Cost Estimate, H.R. 5713 Sustaining Healthcare Integrity and Fair Treatment Act of 2016
[2] Id.
[3] See Rep. Tiberi Press Release, “Two Tiberi Bills Approved by Ways and Means in Today’s Markup,” July 13, 2016.

Cost

The Congressional Budget Office (CBO) estimates that enacting the bill would, on net, increase direct spending by $25 million over the 2017-2021 period but would have no net effect over the 2017-2026 period.

Additional Information

For questions or further information please contact John Huston with the House Republican Policy Committee by email or at 6-5539.