II 110th CONGRESS 2d Session S. 3116 IN THE SENATE OF THE UNITED STATES June 11, 2008 Mr. Vitter introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to stabilize and modernize the provision of partial hospitalization services under the Medicare program, and for other purposes.

1.

Short title

This Act may be cited as the Outpatient Mental Health Modernization Act of 2008.

2.

Transitional freeze on certain Medicare hospital outpatient fee schedule amounts

Notwithstanding any other provision of law, effective for episodes and visits beginning on or after January 1, 2009, and before January 1, 2010, in the case of partial hospital services (as defined in section 1861(ff)(1) of the Social Security Act (42 U.S.C. 1395x(ff)(1)), the OPD fee schedule increase factor under section 1833(t)(3)(C)(iv) of the Social Security Act (42 U.S.C. 1395l(t)(3)(C)(iv)) for the medicare OPD fee schedule amount established for such services (as published in the Federal Register on November 27, 2007 (72 Fed. Reg. 66670)) shall be zero.

3.

Accreditation program for community mental health centers providing partial hospitalization services

Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)) is amended by adding at the end the following new paragraph: (18)

Accreditation program for community mental health centers providing partial hospitalization services

(A)

Definitions

In this section: (i)

Accreditation organization

The term accreditation organization means an organization designated by the Secretary under subparagraph (C)(i)(II) to accredit community mental health centers providing partial hospitalization services. (ii)

Partial hospitalization services

The term partial hospitalization services has the meaning given such term in section 1861(ff)(1). (iii)

Physician

Except as otherwise provided by the Secretary, the term physician means any individual who furnishes services for which payment may be made under the physician fee schedule under section 1848. (iv)

Physician specialty organization

The term physician specialty organization means a United States medical specialty society that represents diplomats certified by a board recognized by the American Board of Medical Specialties. (B)

Establishment

Not later than January 1, 2010, subject to the succeeding provisions of this paragraph, the Secretary shall, by regulation, establish an accreditation program which requires the accreditation of community mental health centers providing partial hospitalization services. (C)

Design of accreditation program

(i)

In general

Each community mental health center providing partial hospitalization services for which payment is made under the prospective payment system established under this subsection must be accredited for each program under which such services are furnished by the community mental health center by an accrediting organization designated by the Secretary under clause (ii). (ii)

Accreditation organizations

(I)

In general

The Secretary shall, by regulation, designate entities to accredit community mental health centers providing partial hospitalization services. The entities designated under the preceding sentence shall include the Joint Commission on Accreditation of Hospitals and the Commission on Accreditation of Rehabilitation Facilities. (II)

Consultation

In designating entities under subclause (I), the Secretary shall consult with academic medical centers, community mental health centers, hospitals, and other appropriate medical personnel (such as psychologists, social workers, and nurse specialists). (iii)

Considerations

In designating entities under clause (ii), the Secretary shall consider the following: (I)The ability of the entity to conduct timely reviews of accreditation applications. (II)Whether the entity has established a process for the timely integration of new services and clinical interventions for individuals who are furnished partial hospitalization services. (III)Any other factors the Secretary determines appropriate. (iv)

Use of criteria for accreditation

Accreditation organizations shall use appropriate criteria for evaluating community mental health centers providing partial hospitalization services for purposes of the accreditation of such community mental health centers, including criteria with respect to— (I)the qualifications of nonphysician medical personnel; (II)the qualifications and responsibilities of physicians, including supervising physicians; (III)the establishment of procedures for ensuring patient safety; and (IV)quality assurance reporting. (v)

Incorporation of quality measures

Not later than January 1, 2012, the Secretary shall provide for the incorporation of measures selected for purposes of quality reporting under paragraph (19) into the accreditation program established under this paragraph, including the use of such measures in the criteria for accreditation under clause (iv). (vi)

Review of accreditation organizations

The Secretary, in consultation with the entities and individuals described in clause (ii)(II)— (I)shall conduct an annual review of accreditation organizations designated under clause (ii); and (II)may, by regulation, expand the original list of accreditation organizations so designated. (D)

Evaluation and report

(i)

Evaluation

The Secretary shall contract with an independent, private organization or entity to evaluate the effect of the accreditation program established under this paragraph and other relevant questions involving access to and value of partial hospitalization services furnished to individuals under this part. Such evaluation shall examine the following: (I)The impact of accreditation requirements on the number, type, and quality of partial hospitalization services furnished to individuals under this part. (II)The cost of meeting such accreditation requirements, including an examination of compliance costs to community mental health centers providing partial hospitalization services and administrative costs to the Secretary. (III)The access of individuals under this part to partial hospitalization services, especially in rural areas, before and after implementation of the accreditation program. (IV)Any other matters the Secretary determines appropriate. (ii)

Report

Not later than December 31, 2012, the Secretary shall submit a report to Congress on the evaluation conducted under clause (i). (E)

Waiver authority

The Secretary shall waive compliance with the requirements of this title to such extent and for such period as the Secretary determines is necessary to carry out this paragraph. .

4.

Quality improvement for partial hospitalization services provided by community mental health centers

Section 1833(t) of the Social Security Act (42 U.S.C. 1395l(t)), as amended by section 3, is amended by adding at the end the following new paragraph: (19)

Quality reporting for partial hospitalization services provided by community mental health centers

(A)

Reduction in update for failure to report

For purposes of paragraph (3)(C)(iv) for 2009 and each subsequent year, in the case of a community mental health center providing partial hospitalization services (as defined in section 1861(ff)(1)) that does not submit, to the Secretary in accordance with this paragraph, data required to be submitted on measures selected under this paragraph with respect to such a calendar year, the OPD fee schedule increase factor under paragraph (3)(C)(iv) for such year shall be reduced by 1.0 percentage point. A reduction under the preceding sentence shall apply only with respect to the year involved and the Secretary shall not take into account such reduction in computing the OPD fee schedule increase factor for a subsequent calendar year. (B)

Form and manner of submission

(i)

In general

Subject to clause (ii), each community mental health center providing partial hospitalization services shall submit to the Secretary data on measures selected under this paragraph in a form and manner, and at a time, specified by the Secretary for purposes of this paragraph. (ii)

Grace period for submission in 2011

In the case of such data submitted with respect to 2011, the Secretary shall provide for a 30-day grace period for the submission of such data by a community mental health center providing partial hospitalization services. (C)

Development of measures

(i)

In general

The Secretary shall select measures that the Secretary determines appropriate for the measurement of the quality of care provided by community mental health centers providing partial hospitalization services, including, beginning with 2011, measures for a set of 5 indicators established by the Secretary. (ii)

Additional measures

The Secretary shall expand, beyond the measures selected under clause (i) and consistent with the succeeding provisions of this paragraph, the set of measures that the Secretary determines appropriate for the measurement of the quality of care provided by community mental health centers providing partial hospitalization services. (iii)

Consensus measures

Beginning with 2009, the Secretary shall add additional measures that reflect consensus among affected parties and, to the extent feasible and practicable, shall include measures set forth by 1 or more national consensus building entities. (D)

Replacement of measures

For purposes of this paragraph, the Secretary may replace any measures or indicators in appropriate cases, such as where all community mental health centers providing partial hospitalization services are effectively in compliance or the measures or indicators have been subsequently shown not to represent the best clinical practice. (E)

Availability of data

The Secretary shall establish procedures for making data submitted under this paragraph available to the public. Such procedures shall ensure that a community mental health center providing partial hospitalization services has the opportunity to review the data that are to be made public with respect to the community mental health center prior to such data being made public. The Secretary shall report quality measures of process, structure, outcome, patients’ perspectives on care, efficiency, and costs of care that relate to partial hospitalization services on the Internet website of the Centers for Medicare & Medicaid Services. .

5.

Establishing minimum number of service units

(a)

In general

Section 1861(ff)(3)(A) of the Social Security Act (42 U.S.C. 1395x(ff)(3)(A)) is amended— (1)by striking , and and inserting a comma; and (2)by inserting before the period at the end , and which provides a minimum of 4 units of items and services described in paragraph (2). (b)

Effective date

The amendments made by this section shall take effect on January 1, 2011.

6.

Cost-reports of providers of partial hospitalization services

(a)

In general

The Secretary shall require fiscal intermediaries under the Medicare program under title XVIII of the Social Security Act to file the cost reports of providers of partial hospitalization services (as defined in section 1861(ff)(1) of the Social Security Act (42 U.S.C. 1395x(ff)(1)) into the Healthcare Provider Cost Reporting Information System (HCRIS) maintained by the Centers for Medicare & Medicaid Services. (b)

Funding

Out of any funds in the Treasury not otherwise appropriated, there are appropriated $1,000,000 to the Secretary of Health and Human Services for calendar year 2009 to carry out this section.