Page:United States Statutes at Large Volume 100 Part 3.djvu/183

 PUBLIC LAW 99-509-OCT. 21, 1986

100 STAT. 1991

(e) STUDY OF PAYMENT FOR ADMINISTRATIVELY NECESSARY DAYS.—

(1) IN GENERAL.—The Secretary of Health and Human Services shall conduct a study to determine whether a payment should be made (in a budget-neutral manner under title XVIII of such Act to hospitals receiving payments under section 1886(d) of such Act) to a hospital for administratively necessary days, separate from the per-discharge and outlier payments made under such section. (2) ADMINISTRATIVELY NECESSARY DAYS DEFINED.—In this subsection, an "administratively necessary day" is a day of continued inpatient hospital stay, for an individual entitled to benefits under part A of title XVIII of the Social Security Act, necessitated by a delay in obtaining placement for the individual in a skilled nursing facility. (3) CONSIDERATIONS IN CONDUCTING STUDY.—In conducting the study, the Secretary shall consider— (A) the need for such a payment in order to minimize— (i) the disproportionate financial impact of current
 * law on certain hospitals (or hospitals in certain locations) due to difficulties in arranging for appropriate

post-hospital care, such as difficulties resulting from a shortage of beds in skilled nursing facilities where those hospitals are located and from the source of payment for such care, and /•' ' (ii) the risk of inappropriate discharge to a nonf• institutional or inappropriate institutional setting of individuals who need post-hospital services in a skilled nursing facility, and (B) the administrative mechanisms that can be used to prevent inappropriate payments for administratively necessary days. (4) REPORT ON STUDY.—The Secretary shall report to Congress on the results of the study not later than January 1, 1989. (f) EXTENDING WAIVER OF LIABILITY PROVISIONS TO HOSPICE PROGRAMS.—

Health care facilities. 42 USC 1395.

42 USC 1935c

42 USC 1395y note.

(1) IN GENERAL.—The Secretary of Health and Human Services shall, for purposes of determining whether payments to a hospice program should be denied pursuant to section 1862(a)(1)(C) of the Social Security Act, apply (under section 42 USC 1395y. 1879(a) of such Act) a presumption of compliance of 2.5 percent Infra. (based on the number of days of hospice care billed) in a manner substantially similar to that provided to home health agencies under policies in effect as of July 1, 1985. (2) EFFECTIVE DATE.—Paragraph (1) shall apply to hospice care furnished on or after the first day of the first month that begins at least 6 months after the date of the enactment of this Act and before November 1, 1988. (g) EXTENSION OF WAIVER OF LIABILITY PROVISIONS TO CERTAIN COVERAGE DENIALS FOR HOME HEALTH SERVICES.—

c )1 lii

(1) IN GENERAL.—Section 1879 of the Social Security Act (42 U.S.C. 1395pp) is amended— (A) in subsection (a)(D, by inserting "or by reason of a coverage denial described in subsection (g)" after "section 1862(a)(l) or (9)"; (B) in the first sentence of subsection (a), by inserting "and as though the coverage denial described in subsection (g) had not occurred" before the period at the end;

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