H.R.3962 - Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010

[Final as Passed Both House and Senate] - ENR)

SEC. 102. CLARIFICATION OF 3-DAY PAYMENT WINDOW.

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

           (1) by adding at the end of subsection (a)(4) the following new sentence: `In applying the first sentence of this paragraph, the term `other services related to the admission' includes all services that are not diagnostic services (other than ambulance and maintenance renal dialysis services) for which payment may be made under this title that are provided by a hospital (or an entity wholly owned or operated by the hospital) to a patient--

                  `(A) on the date of the patient's inpatient admission; or

                  `(B) during the 3 days (or, in the case of a hospital that is not a subsection (d) hospital, during the 1 day) immediately preceding the date of such admission unless the hospital demonstrates (in a form and manner, and at a time, specified by the Secretary) that such services are not related (as determined by the Secretary) to such admission.'; and

         (2) in subsection (d)(7)--

                    (A) in subparagraph (A), by striking `and' at the end;

                    (B) in subparagraph (B), by striking the period and inserting `, and'; and

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

                  `(C) the determination of whether services provided prior to a patient's inpatient admission are related to the admission (as described in subsection (a)(4)).'.

(b) Effective Date- The amendments made by subsection (a) shall apply to services furnished on or after the date of the enactment of this Act.

(c) No Reopening of Previously Bundled Claims-

       (1) IN GENERAL- The Secretary of Health and Human Services may not reopen a claim, adjust a claim, or make a payment pursuant to any request for payment under title XVIII of the Social Security Act, submitted by an entity (including a hospital or an entity wholly owned or operated by the hospital) for services described in paragraph (2) for purposes of treating, as unrelated to a patient's inpatient admission, services provided during the 3 days (or, in the case of a hospital that is not a subsection (d) hospital, during the 1 day) immediately preceding the date of the patient's inpatient admission.

       (2) SERVICES DESCRIBED- For purposes of paragraph (1), the services described in this paragraph are other services related to the admission (as described in section 1886(a)(4) of the Social Security Act (42 U.S.C. 1395ww(a)(4)), as amended by subsection (a)) which were previously included on a claim or request for payment submitted under part A of title XVIII of such Act for which a reopening, adjustment, or request for payment under part B of such title, was not submitted prior to the date of the enactment of this Act.

(d) Implementation- Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the provisions of this section (and amendments made by this section) by program instruction or otherwise.

(e) Rule of Construction- Nothing in the amendments made by this section shall be construed as changing the policy described in section 1886(a)(4) of the Social Security Act (42 U.S.C. 1395ww(a)(4)), as applied by the Secretary of Health and Human Services before the date of the enactment of this Act, with respect to diagnostic services.

 

Source: http://thomas.loc.gov