P.L. 113–67, Approved December 26, 2013 (127Stat. 1165)

Bipartisan Budget Act of 2013

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SECTION 1. [2 USC 900 note]  Bipartisan Budget Act of 2013

This Act may be cited as the “Bipartisan Budget Act of 2013”.

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SEC 201.  IMPROVING THE COLLECTION OF UNEMPLOYMENT INSURANCE OVERPAYMENTS

(a)  In General.— Section 303 of the Social Security Act (42 U.S.C. 503) is amended by adding at the end the following:

“(m)  In the case of a covered unemployment compensation debt (as defined under section 6402(f)(4) of the Internal Revenue Code of 1986) that remains uncollected as of the date that is 1 year after the debt was finally determined to be due and collected, the State to which such debt is owed shall take action to recover such debt under section 6402(f) of the Internal Revenue Code of 1986.”.

(b)  Effective Date.— The amendment made by subsection (a) shall take effect upon the date of enactment of this Act.

(b)  Other Benefits.— Section 202(n) of such Act (42 U.S.C. 402(n)) is amended by adding at the end the following:

“(4)  In the case of any individual described in paragraph (3) whose monthly benefits are terminated under paragraph (1)—

“(A)  no benefits otherwise available under section 202 based on the wages and self-employment income of any other individual shall be paid to such individual for any month after such termination; and

“(B)  no supplemental security income benefits under title XVI shall be paid to such individual for any such month, including supplementary payments pursuant to an agreement for Federal administration under section 1616(a) and payments pursuant to an agreement entered into under section 212(b) of Public Law 93-66”.

Sec 202.  STRENGTHENING MEDICAID THIRD-PARTY LIABILITY

(a)  Payment for Prenatal and Preventive Pediatric Care and in Cases Involving Medical Support.— Section 1902(a)(25) of the Social Security Act (42 U.S.C. 1396a(a)(25)) is amended—

(1)  in subparagraph (E)(i), by inserting before the semicolon at the end the following: “, except that the State may, if the State determines doing so is cost-effective and will not adversely affect access to care, only make such payment if a third party so liable has not made payment within 90 days after the date the provider of such services has initially submitted a claim to such third party for payment for such services”; and

(2)  in subparagraph (F)(i), by striking “30 days after such services are furnished” and inserting “90 days after the date the provider of such services has initially submitted a claim to such third party for payment for such services, except that the State may make such payment within 30 days after such date if the State determines doing so is cost-effective and necessary to ensure access to care.”.

(1)  State plan requirements.—Section 1902(a)(25) of the Social Security Act (42 U.S.C. 1396a(a)(25)) is amended—

(A)  in subparagraph (B), by striking “to the extent of such legal liability”; and

(B)  in subparagraph (H), by striking “payment by any other party for such health care items or services” and inserting “any payments by such third party”.

(2)  Assignment of rights of payment.— Section 1912(a)(1)(A) of such Act (42 U.S.C. 1396k(a)(1)(A)) is amended by striking “payment for medical care from any third party” and inserting “any payment from a third party that has a legal liability to pay for care and services available under the plan”.

(3)  Liens.— Section 1917(a)(1)(A) of such Act (42 U.S.C. 1396p(a)(1)(A)) is amended to read as follows:

“(A)  pursuant to—

“(i)  the judgment of a court on account of benefits incorrectly paid on behalf of such individual, or

“(ii)  rights acquired by or assigned to the State in accordance with section 1902(a)(25)(H) or section 1912(a)(1)(A), or”.

(c)  Effective Date.— The amendments made by this section shall take effect on October 1, 2014.

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Sec. 204  IDENTIFICATION OF INMATES REQUESTING OR RECEIVING IMPROPER PAYMENTS

(1)  Section 202(x)(3)(b)(i)(i) .—Section 202(x)(3)(B)(i)(I) of the Social Security Act (42 U.S.C. 402(x)(3)(B)(i)(I)) is amended by—

(A)  inserting “first, middle, and last” before “names”;

(B)  striking the comma after the words “social security account numbers” and inserting “or taxpayer identification numbers, prison assigned inmate numbers, last known addresses,”;

(C)  inserting “dates of release or anticipated dates of release, dates of work release,” before “and, to the extent available”; and

(D)  by inserting “and clause (iv) of this subparagraph” after “paragraph (1)”.

(2)  Section 1611(e)(1)(i)(i)(i).— Section 1611(e)(1)(I)(i)(I) of the Social Security Act (42 U.S.C. 1382(e)(1)(I)(i)(I)) is amended by—

(A)  inserting “first, middle, and last” before “names”;

(B)  striking the comma after the words “social security account numbers” and inserting “or taxpayer identification numbers, prison assigned inmate numbers, last known addresses,”;

(C)  inserting “dates of release or anticipated dates of release, dates of work release,” before “and, to the extent available”; and

(D)  by inserting “and clause (iv) of this subparagraph” after “this paragraph”.

(1)  Section 202(x)(3)(b).— Section 202(x)(3)(B) of the Social Security Act (42 U.S.C. 402(x)(3)(B)) is amended—

(A)  in clause (iv), by inserting before the period the following: “, for statistical and research activities conducted by Federal and State agencies, and to the Secretary of the Treasury for the purposes of tax administration, debt collection, and identifying, preventing, and recovering improper payments under federally funded programs”; and

(B)  by adding at the end the following:

“(v)(I)  The Commissioner may disclose information received pursuant to this paragraph to any officer, employee, agent, or contractor of the Department of the Treasury whose official duties require such information to assist in the identification, prevention, and recovery of improper payments or in the collection of delinquent debts owed to the United States, including payments certified by the head of an executive, judicial, or legislative paying agency, and payments made to individuals whose eligibility, or continuing eligibility, to participate in a Federal program (including those administered by a State or political subdivision thereof) is being reviewed.

“(II)  Notwithstanding the provisions of section 552a of title 5, United States Code, or any other provision of Federal or State law, the Secretary of the Treasury may compare information disclosed under subclause (I) with any other personally identifiable information derived from a Federal system of records or similar records maintained by a Federal contractor, a Federal grantee, or an entity administering a Federal program or activity, and may redisclose such comparison of information to any paying or administering agency and to the head of the Federal Bureau of Prisons and the head of any State agency charged with the administration of prisons with respect to inmates whom the Secretary of the Treasury has determined may have been issued, or facilitated in the issuance of, an improper payment.

“(III)  The comparison of information disclosed under subclause (I) shall not be considered a matching program for purposes of section 552a of title 5, United States Code.”.

(2)  Section 1611(e)(1)(i).— Section 1611(e)(1)(I) of the Social Security Act (42 U.S.C. 1382(e)(1)(I)) is amended—

(A)  in clause (iii), by inserting before the period the following: “, for statistical and research activities conducted by Federal and State agencies, and to the Secretary of the Treasury for the purposes of tax administration, debt collection, and identifying, preventing, and recovering improper payments under federally funded programs”; and

(B)  by adding at the end the following:

“(v)(I)  The Commissioner may disclose information received pursuant to this paragraph to any officer, employee, agent, or contractor of the Department of the Treasury whose official duties require such information to assist in the identification, prevention, and recovery of improper payments or in the collection of delinquent debts owed to the United States, including payments certified by the head of an executive, judicial, or legislative paying agency, and payments made to individuals whose eligibility, or continuing eligibility, to participate in a Federal program (including those administered by a State or political subdivision thereof) is being reviewed.

“(II)  Notwithstanding the provisions of section 552a of title 5, United States Code, or any other provision of Federal or State law, the Secretary of the Treasury may compare information disclosed under subclause (I) with any other personally identifiable information derived from a Federal system of records or similar records maintained by a Federal contractor, a Federal grantee, or an entity administering a Federal program or activity and may redisclose such comparison of information to any paying or administering agency and to the head of the Federal Bureau of Prisons and the head of any State agency charged with the administration of prisons with respect to inmates whom the Secretary of the Treasury has determined may have been issued, or facilitated in the issuance of, an improper payment.

“(III)  The comparison of information disclosed under subclause (I) shall not be considered a matching program for purposes of section 552a of title 5, United States Code.”.

(c)  Conforming Amendment to the Do Not Pay Initiative .—Section 5(a)(2) of the Improper Payments Elimination and Recovery Improvement Act of 2012 (31 U.S.C. 3321 note) is amended by adding at the end the following:

“(F)  Information regarding incarcerated individuals maintained by the Commissioner of Social Security under sections 202(x) and 1611(e) of the Social Security Act.”.

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Sec. 1101  PHYSICIAN PAYMENT UPDATE

Section 1848(d) of the Social Security Act (42 U.S.C. 10 1395w-4(d)) is amended by adding at the end the following new paragraph:

“(A)  In general.— Subject to paragraphs (7)(B), (8)(B), (9)(B), (10)(B), (11)(B), (12)(B), (13)(B), and (14)(B), in lieu of the update to the single conversion factor established in paragraph (1)(C) that would otherwise apply for 2014 for the period beginning on January 1, 2014, and ending on March 31, 2014, the update to the single conversion factor shall be 0.5 percent.

“(B)  No effect on computation of conversion factor for remaining portion of 2014 and subsequent years.— The conversion factor under this subsection shall be computed under paragraph (1)(A) for the period beginning on April 1, 2014, and ending on December 31, 2014, and for 2015 and subsequent years as if subparagraph (A) had never applied.”.

Sec. 1102  EXTENSION OF WORK GPCI FLOOR

Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w- 4(e)(1)(E)) is amended by striking “January 1, 2014” and inserting “April 1, 2014”.

Sec. 1103  EXTENSION OF THERAPY CAP EXCEPTIONS PROCESS

Section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) is amended—

(1)  in paragraph (5)(A), in the first sentence, by striking “December 31, 2013” and inserting “March 31, 2014”; and

(2)  in paragraph (6)(A)—

(A)  by striking “December 31, 2013” and inserting “March 31, 2014”; and

(B)  by striking “or 2013” and inserting “, 2013, or the first three months of 2014”.

Sec. 1104  EXTENSION OF AMBULANCE ADD-ONS

(a)  Ground Ambulance .—Section 1834(l)(13)(A) of the Social Security Act (42 U.S.C. 1395m(l)(13)(A)) is amended—

(1)  in the matter preceding clause (i), by striking “January 1, 2014” and inserting “April 1, 2014”; and

(2)  in each of clauses (i) and (ii), by striking “January 1, 2014” and inserting “April 1, 2014” each place it appears.

(b)  Super Rural Ground Ambulance.— Section 1834(l)(12)(A) of the Social Security Act (42 U.S.C. 1395m(l)(12)(A)) is amended by striking “January 1, 2014” and inserting “April 1, 2014”.

Sec. 1105  MEDICARE INPATIENT HOSPITAL PAYMENT ADJUSTMENT FOR LOW-VOLUME HOSPITALS

Section 1886(d)(12) of the Social Security Act (42 U.S.C. 1395ww(d)(12)) is amended—

(1)  in subparagraph (B), in the matter preceding clause (i), by striking “fiscal year 2014 and subsequent fiscal years” and inserting “the portion of fiscal year 2014 beginning on April 1, 2014, fiscal year 2015, and subsequent fiscal years”;

(2)  in subparagraph (C)(i)—

(A)  by inserting “and the portion of fiscal year 2014 before” after “and 2013,” each place it appears; and

(B)  by inserting “or portion of fiscal year” after “during the fiscal year”; and

(3)  in subparagraph (D)—

(A)  by inserting “and the portion of fiscal year 2014 before April 1, 2014,” after “and 2013,”; and

(B)  by inserting “or the portion of fiscal year” after “in the fiscal year”.

Sec. 1106  MEDICARE-DEPENDENT HOSPITAL (MDH) PROGRAM

(a)  In General.— Section 1886(d)(5)(G) of the Social Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended—

(1)  in clause (i), by striking “October 1, 2013” and inserting “April 1, 2014”; and

(2)  in clause (ii)(II), by striking “October 1, 2013” and inserting “April 1, 2014”.

(1)  Extension of target amount.— Section 1886(b)(3)(D) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is amended—

(A)  in the matter preceding clause (i), by striking “October 1, 2013” and inserting “April 1, 2014”; and

(B)  in clause (iv), by inserting “and the portion of fiscal year 2014 before April 1, 2014” after “through fiscal year 2013”.

(2)  Permitting hospitals to decline reclassification.— Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 (42 U.S.C. 1395ww note) is amended by striking “through fiscal year 2013” and inserting “through the first 2 quarters of fiscal year 2014”.

Sec. 1107  1-YEAR EXTENSION OF AUTHORIZATION FOR SPECIAL NEEDS PLANS

Section 1859(f)(1) of the Social Security Act (42 U.S.C. 1395w-28(f)(1)) is amended by striking “2015” and inserting “2016”.

Sec. 1108  1-YEAR EXTENSION OF MEDICARE REASONABLE COST CONTRACTS

Section 1876(h)(5)(C)(ii) of the Social Security Act (42 U.S.C. 1395mm(h)(5)(C)(ii)) is amended, in the matter preceding subclause (I), by striking “January 1, 2014” and inserting “January 1, 2015”.

Sec. 1109  EXTENSION OF EXISTING FUNDING FOR CONTRACT WITH CONSENSUS-BASED ENTITY

Section 1890(d) of the Social Security Act (42 U.S.C. 1395aaa(d)) is amended by adding at the end the following new sentence: “Amounts transferred under the preceding sentence shall remain available until expended.”.

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Sec. 1201  EXTENSION OF THE QUALIFYING INDIVIDUAL (QI) PROGRAM

(a)  Extension.— Section 1902(a)(10)(E)(iv) of the Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iv)) is amended by striking “December 2013” and inserting “March 2014”.

(b)  Extending Total Amount Available for Allocation.— Section 1933(g) of the Social Security Act (42 U.S.C. 1396u-3(g)) is amended—

(1)  in paragraph (2)—

(A)  in subparagraph (S), by striking “and” after the semicolon;

(B)  in subparagraph (T), by striking the period at the end and inserting “; and”; and

(C)  by adding at the end the following new subparagraph:

“(U)   for the period that begins on January 1, 2014, and ends on March 31, 2014, the total allocation amount is $200,000,000.”.

Sec. 1202  TEMPORARY EXTENSION OF TRANSITIONAL MEDICAL ASSISTANCE (TMA)

Sections 1902(e)(1)(B) and 1925(f) of the Social Security Act (42 U.S.C. 1396a(e)(1)(B), 1396r-6(f)) are each amended by striking “December 31, 2013” and inserting “March 31, 2014”.

Sec. 1203  EXTENSION OF FUNDING FOR FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS

Section 501(c)(1)(A) of the Social Security Act (42 U.S.C. 701(c)(1)(A)) is amended—

(1)  in clause (ii), by striking at the end “and”;

(2)  in clause (iii), by striking the period at the end and inserting “; and”; and

(3)  by adding at the end the following new clause:

“(iv)  $2,500,000 for the portion of fiscal year 2014 before April 1, 2014.”.

Sec. 1204  DELAY OF REDUCTIONS TO MEDICAID DSH ALLOTMENTS

(a)  In General.— Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-4(f)) is amended—

(1)  in paragraph (7)(A)—

(A)  in clause (i), by striking “2014” and inserting “2016”; and

(B)  in clause (ii)—

(i)  by striking subclauses (I) and (II);

(ii)  by redesignating subclauses (III) through (VII) as subclauses (I) through (V), respectively; and

(iii)  in subclause (I) (as redesignated by clause (ii)), by striking “$600,000,000” and inserting “$1,200,000,000”; and

(2)  in paragraph (8)—

(A)  by redesignating subparagraph (C) as subparagraph (D);

(B)  by inserting after subparagraph (B) the following new subparagraph:

“(C)  Fiscal year 2023.— Only with respect to fiscal year 2023, the DSH allotment for a State, in lieu of the amount determined under paragraph (3) for the State for that year, shall be equal to the DSH allotment for the State for fiscal year 2022, as determined under subparagraph (B), increased, subject to subparagraphs (B) and (C) of paragraph (3), and paragraph (5), by the percentage change in the consumer price index for all urban consumers (all items; U.S. city average), for fiscal year 2022.”; and

(C)  in subparagraph (D) (as redesignated by subparagraph (A)), by striking “fiscal year 2022” and inserting “fiscal year 2023”.

(b)  Effective Date.— The amendments made by subsection (a) shall be effective as of October 1, 2013.

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Sec. 1206  PAYMENT FOR INPATIENT SERVICES IN LONG-TERM CARE HOSPITALS (LTCHS)

(1)  In general.— Section 1886(m) of the Social Security Act (42 U.S.C. 1395ww(m)) is amended by adding at the end the following:

“(6)   Application of site neutral ipps payment rate in certain cases.—

“(A)  General application of site neutral ipps payment amount for discharges failing to meet applicable criteria.—

“(i)  In general.— For a discharge in cost reporting periods beginning on or after October 1, 2015, except as provided in clause (ii) and subparagraph (C), payment under this title to a long-term care hospital for inpatient hospital services shall be made at the applicable site neutral payment rate (as defined in subparagraph (B)).

“(ii)  Exception for certain discharges meeting criteria.—Clause (i) shall not apply (and payment shall be made to a long-term care hospital without regard to this paragraph) for a discharge if—

“(I)  the discharge meets the ICU criterion under clause (iii) or the ventilator criterion under clause (iv); and

“(II)  the discharge does not have a principal diagnosis relating to a psychiatric diagnosis or to rehabilitation.

“(I)  In general.— The criterion specified in this clause (in this paragraph referred to as the ‘ICU criterion’), for a discharge from a long-term care hospital, is that the stay in the long- term care hospital ending with such discharge was immediately preceded by a discharge from a stay in a subsection (d) hospital that included at least 3 days in an intensive care unit (ICU), as determined by the Secretary.

(II)   Determining icu days.— In determining intensive care unit days under subclause (I), the Secretary shall use data from revenue center codes 020x or 021x (or such successor codes as the Secretary may establish).

“(iv)   Ventilator criterion.—The criterion specified in this clause (in this paragraph referred to as the ‘ventilator criterion’), for a discharge from a long-term care hospital, is that—

“(I)  the stay in the long-term care hospital ending with such discharge was immediately preceded by a discharge from a stay in a subsection (d) hospital; and

“(II)  the individual discharged was assigned to a Medicare-Severity-Long-Term-Care-Diagnosis-Related-Group (MS- LTC-DRG) based on the receipt of ventilator services of at least 96 hours.

“(i)  In general.— In this paragraph, the term `applicable site neutral payment rate' means—

“(I)  for discharges in cost reporting periods beginning during fiscal year 2016 or fiscal year 2017, the blended payment rate specified in clause (iii); and

“(II)  for discharges in cost reporting periods beginning during fiscal year 2018 or a subsequent fiscal year, the site neutral payment rate (as defined in clause (ii)).

“(ii)  Site neutral payment rate defined.— In this paragraph, the term `site neutral payment rate' means the lower of—

“(I)  the IPPS comparable per diem amount determined under paragraph (d)(4) of section 412.529 of title 42, Code of Federal Regulations, including any applicable outlier payments under section 412.525 of such title; or

“(II)  100 percent of the estimated cost for the services involved.

“(iii)  Blended payment rate.— The blended payment rate specified in this clause, for a long- term care hospital for inpatient hospital services for a discharge, is comprised of—

“(I)  half of the site neutral payment rate (as defined in clause (ii)) for the discharge; and

“(II)  half of the payment rate that would otherwise be applicable to such discharge without regard to this paragraph, as determined by the Secretary.

“(i)  Notice of ltch discharge payment percentage.— For cost reporting periods beginning during or after fiscal year 2016, the Secretary shall inform each long-term care hospital of its LTCH discharge payment percentage (as defined in clause (iv)) for such period.

“(ii)  Limitation.— For cost reporting periods beginning during or after fiscal year 2020, if the Secretary determines for a long-term care hospital that its LTCH discharge payment percentage for the period is not at least 50 percent—

“(I)  the Secretary shall inform the hospital of such fact; and

“(II)  subject to clause (iii), for all discharges in the hospital in each succeeding cost reporting period, the payment amount under this subsection shall be the payment amount that would apply under subsection (d) for the discharge if the hospital were a subsection (d) hospital.

“(iii)  Process for reinstatement.— The Secretary shall establish a process whereby a long-term care hospital may seek to and have the provisions of subclause (II) of clause (ii) discontinued with respect to that hospital.

“(iv)  LTCH discharge payment percentage.— In this subparagraph, the term ‘LTCH discharge payment percentage’ means, with respect to a long-term care hospital for a cost reporting period beginning during or after fiscal year 2020, the ratio (expressed as a percentage) of—

“(I)  the number of discharges for such hospital and period for which payment is not made at the site neutral payment rate, to

“(II)  the total number of discharges for such hospital and period.

“(D)  Inclusion of subsection (d) puerto rico hospitals.— In this paragraph, any reference in this paragraph to a subsection (d) hospital shall be deemed to include a reference to a subsection (d) Puerto Rico hospital.”.

(A)  Study.—The Medicare Payment Assessment Commission shall examine the effect of applying section 1886(m)(6) of the Social Security Act, as added by the amendment made by paragraph (1), on—

(i)  the quality of patient care in long-term care hospitals;

(ii)  the use of hospice care and post-acute care settings;

(iii)  different types of long-term care hospitals; and

(iv)  the growth in Medicare spending for services in such hospitals.

(B)  Report.— Not later than June 30, 2019, the Commission shall submit to Congress a report on such study. The Commission shall include in such report such recommendations for changes in the application of such section as the Commission deems appropriate as well as the impact of the application of such section on the need to continue applying the 25 percent rule described under sections 412.534 and 412.536 of title 42, Code of Federal Regulations.

(3)  Calculation of length of stay excluding cases paid on a site neutral basis.—

(A)  In general.— For discharges occurring in cost reporting periods beginning on or after October 1, 2015, subject to subparagraph (B), in calculating the length of stay requirement applicable to a long-term care hospital or satellite facility under section 1886(d)(1)(B)(iv)(I) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)(iv)(I)) and section 1861(ccc)(2) of such Act (42 U.S.C. 1395x(ccc)(2)), the Secretary of Health and Human Services shall exclude the following:

(i)  Site neutral payment.— Any patient for whom payment is made at the site neutral payment rate (as defined in section 1886(m)(6)(B)(ii)) of such Act, as added by paragraph (1)).

(ii)  Medicare advantage.— Any patient for whom payment is made under a Medicare Advantage plan under part C of title XVIII of such Act.

(B)  Limitation on converting subsection (d) hospitals .—Subparagraph (A) shall not apply to a hospital that is classified as of December 10, 2013, as a subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Social Security Act, 42 U.S.C. 1395ww(d)(1)(B)) for purposes of determining whether the requirements of section 1886(d)(1)(B)(iv)(I) or 1861(ccc)(2) of such Act (42 U.S.C. 1395ww(d)(1)(B)(iv)(I), 1395x(ccc)(2)) are met.

(A)  Payment for hospitals-within-hospitals.— Paragraph (2)(C) of section 114(c) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww note), as amended by sections 3106(a) and 10312(a) of Public Law 111-148, is amended by striking “5-year period” and inserting “9-year period”.

(B)  25 percent patient threshold payment adjustment; making the grandfathered exemption for long-term care hospitals permanent.—Section 114(c)(1) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww note), as amended by sections 3106(a) and 10312(a) of Public Law 111-148, is amended—

(i)  in the matter preceding subparagraph (A), by striking “for a 5-year period”; and

(ii)  in subparagraph (A), by inserting “for a 9-year period,” before “section 412.536”.

(C)  Report assessing continued suspension of 25 percent rule.— Not later than 1 year before the end of the 9-year period referred to in section 114(c)(1) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww note), as amended by subparagraph (B), the Secretary of Health and Human Services shall submit to Congress a report on the need for any further extensions (or modifications of the extensions) of the 25 percent rule described in sections 412.534 and 412.536 of title 42, Code of Federal Regulations, particularly taking into account the application of section 1886(m)(6) of the Social Security Act, as added by subsection (a)(1).

(2)  Extension of moratorium on establishment of and increase in beds for ltchs.— Section 114(d) of the Medicare, Medicaid, 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, is amended—

(A)  in paragraph (1), in the matter preceding subparagraph (A), by inserting after “5-year period” the following: “(and for the period beginning January 1, 2015, and ending September 30, 2017)”; and

(B)  by adding at the end the following new paragraph:

“(6)  Limitation on application of exceptions.— Paragraphs (2) and (3) shall not apply during the period beginning January 1, 2015, and ending September 30, 2017.”.

(c)  Additional Quality Measure.— Section 1886(m)(5)(D) of the Social Security Act (42 U.S.C. 1395ww(m)(5)(D)) is amended by adding at the end the following new clause:

“(iv)  Additional quality measures.— Not later than October 1, 2015, the Secretary shall establish a functional status quality measure for change in mobility among inpatients requiring ventilator support.”.

(1)  Evaluation.— As part of the annual rulemaking for fiscal year 2015 or fiscal year 2016 to carry out the payment rates under subsection (d) of section 1886 of the Social Security Act (42 U.S.C. 1395ww), the Secretary shall evaluate both the payment rates and regulations governing hospitals which are classified under subclause (II) of subsection (d)(1)(B)(iv) of such section.

(2)  Adjustment authority.— Based upon such evaluation, the Secretary may adjust payment rates under subsection (b)(3) of section 1886 of the Social Security Act (42 U.S.C. 1395ww) for a hospital so classified (such as payment based upon the TEFRA- payment model) and may adjust the regulations governing such hospitals, including applying the regulations governing hospitals which are classified under clause (I) of subsection (d)(1)(B) of such section.

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