II 110th CONGRESS 1st Session S. 2525 IN THE SENATE OF THE UNITED STATES December 19, 2007 Mr. Menendez (for himself and Mr. Durbin) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To prevent health care facility-acquired infections.

1.

Short title

This Act may be cited as the MRSA Infection Prevention and Patient Protection Act.

2.

Definitions

In this Act: (1)

Acute care hospital

The term acute care hospital means a hospital that maintains and operates an emergency room (including a trauma or burn center), surgical unit, birthing facility, and such other unit that is highly susceptible to acquiring or transmitting infections, as determined by the Secretary through regulations. (2)

Hospital

The term hospital has the meaning given such term in section 1861(e) of the Social Security Act (42 U.S.C. 1395x(e)) and includes critical access hospitals (as defined in section 1861(mm) of such Act) and other entities determined to be hospitals by the Secretary. (3)

MRSA

The term MRSA means Methicillin-Resistant Staphylococcus aureus. (4)

Secretary

The term Secretary means the Secretary of Health and Human Services.

3.

Hospital infection prevention programs

(a)

Regulations

(1)

In general

Not later than 5 months after the date of enactment of this Act, the Secretary, in consultation with the Director of the Centers for Disease Control and Prevention and such independent experts as the Secretary determines appropriate, shall promulgate regulations that— (A)define the term MRSA; (B)provide a list of best practices for MRSA and such other antibiotic resistant staphylococcus as the Secretary determines appropriation; (C)define the term high risk hospital departments for purposes of applying the best practices provided for under subparagraph (B), which may include surgical, burn, neonatal, and such other department as the Secretary may designate; (D)provide screening, record keeping, and other requirements as they relate to reductions in MRSA. (2)

Consistency

The regulations promulgated under this subsection shall be consistent with the requirements of this Act. (3)

Effective date

The regulations promulgated under paragraph (1) shall take effect on the date that is 1 month after the date on which such regulations are published in the Federal Register, but in no case later than 6 months after the date of enactment of this Act. (b)

Screening requirements

(1)

In general

Not later than 6 months after the date of enactment of this Act, all acute care hospitals shall screen all patients entering intensive care units and other high risk hospital departments (as defined in the regulations promulgated under subsection (a)(1)). (2)

Extension of requirements

(A)

In general

The Secretary, in consultation with the Director of the Centers for Disease Control and Prevention, shall establish a process and a timetable for extending the screening requirements of paragraph (1) to all patients admitted to all hospitals. (B)

Requirements fully applied

The timetable established under subparagraph (A), shall require that all patients be covered by the screening requirements under paragraph (1) by not later than January 1, 2012. (C)

Waivers

The Secretary may waive the requirements of this paragraph— (i)if the Secretary determines that the rate of MRSA (or similar infections) is declining; or (ii)if the Secretary determines that such requirements should not apply to certain hospitals or units of hospitals because the danger of acquiring or transmitting MRSA (or similar infections) is no greater than it is of acquiring MRSA in the community. (3)

Medicare payment adjustments

Not later than January 1, 2009, the Secretary shall submit to the appropriate committees of Congress, a report on whether payment adjustments should be made under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to assist certain hospitals in defraying the cost of screening for, and the subsequent treatment of, MRSA (or similar infections). In preparing such report, the Secretary shall give special consideration to the needs of rural, critical access, sole community, and Medicare dependent hospitals, and disproportionate share hospitals and other hospitals with a disproportionate share of immune compromised patients. (c)

Best practices

In addition to any other best practices contained in the regulations promulgated under subsection (a), all hospitals shall comply with the following: (1)A hospital shall require contact (barrier) precautions, as determined by the Secretary, be taken when treating patients who test positive for MRSA colonization (as defined by the Centers for Disease Control and Prevention). (2)Where possible, a hospital will isolate, with the same staffing ratio per bed as in the non-isolated beds of the hospital, or cohort patients colonized or infected with MRSA, control and monitor the movements of such patients within the hospital, and take whatever steps are needed to stop the transmission of MRSA bacteria to patients who did not come into the hospital infected or colonized with such bacteria. The Secretary may suspend the application of this paragraph in the case of an emergency. (3)All patients tested for MRSA shall be informed of the results and such results shall be noted in the patient's medical records. (4)Patients being discharged from intensive care units shall be tested again for MRSA, and those patients testing positive will be informed of their status, and that status will be noted in the patient's medical records in case of readmittance to a hospital. (5)A hospital shall educate their staff concerning modes of transmission of MRSA, use of protective equipment, disinfection policies and procedures, and other preventive measures. (d)

Reporting

(1)

In general

Not later than January 1, 2009, all hospitals shall, using the National Healthcare Safety Network of the Centers for Disease Control and Prevention, report the number of cases of hospital-acquired MRSA and other resistant infection rates that occur in the hospital facility. The Secretary shall develop a process for the risk adjustment of such reports by hospitals. (2)

Publication

The Secretary shall develop a system for the publication of hospital-specific MRSA and other infection rates. (e)

Non-Hospital Medicare Providers

(1)

MRSA infection reporting

The Secretary, using the MRSA and other infection information identified under section (b) and such other billing and coding information as necessary, shall develop a system of identifying infected transferred patients. The Secretary shall define by regulation the term infected transferred patient, and such term shall include any patient who, after discharge from, or treatment at, a non-hospital Medicare provider (including, but not limited to, a skilled nursing facility, end stage renal disease program, or ambulatory surgical center), is admitted directly (or within 5 days of such discharge or treatment) to the hospital with MRSA (or other infection). The Secretary shall establish a system to promptly inform any facility that has transferred an infected patient. Unless such facility can provide a reasonable explanation that the infection was not acquired in that facility, the facility shall submit to the Secretary a MRSA infection action plan to reduce such infections. (2)

Assistance

The Secretary shall promulgate regulations to develop a program to provide technical assistance and educational materials to non-hospital Medicare providers described in paragraph (1) in order to assist in preventing subsequent MRSA infections. (3)

Publication of certain information

If a non-hospital Medicare provider identified in a report submitted under paragraph (1) fails to take steps, as described in the action plan submitted under such paragraph, to combat MRSA infections, the Secretary shall publish the name of the provider and the number of MRSA infections from such provider in the previous year. (f)

Assistance

(1)

In general

To provide for the rapid implementation of MRSA screening programs and initiatives through the installation of certified MRSA screening equipment and the provision of necessary support services, a hospital may submit an application to the Secretary for a 1-year increase in the amount of the capital-related costs payment made to the hospital under the prospective payment system under section 1886(g) of the Social Security Act (42 U.S.C. 1395ww(g)). The Secretary shall approve all requests that the Secretary determines are reasonable and necessary. (2)

Repayment

A hospital that receives an increase under paragraph (1) shall, not later than 4 years after the date of receipt of such increase, reimburse the Secretary for the costs of such increase. Such costs shall include the accrual of interest at the rate payable for Federal Treasury notes. Such reimbursement may be in the form of reduced capital-related costs payments to the hospital under the system described in paragraph (1) for the years following the year in which the increase was received. (3)

Certification system

Not later than 6 months after the date of enactment of this Act, the Secretary shall promulgate regulations for the development of a system to certify appropriate MRSA screening and support services for purposes of this subsection.