Hospital infection prevention programs

(a)

Regulations

(1)

In general

Not later than 150 days 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)provide a list of best practices for preventing MRSA infections and such other antibiotic resistant pathogens as the Secretary determines appropriate; (B)define the term high risk hospital departments for purposes of applying the best practices provided for under subparagraph (A), which may include surgical, burn, neonatal, and such other departments as the Secretary determines; (C)define the term serious source of morbidity and mortality in quantitative terms for purposes of determining the applicability of this Act to other infections, except that such definition shall not require morbidity and mortality rates of more than 1 percent of the estimated patient population at risk for a particular infection in order for an infection to qualify as a serious source of morbidity and mortality; and (D)provide screening, recordkeeping, and other requirements as they relate to reductions in MRSA infections. (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 30 days after the date on which such regulations are published in the Federal Register, but in no case later than 180 days after the date of enactment of this Act. (b)

Screening requirements

(1)

In general

Not later than 180 days after the date of enactment of this Act, each acute care hospital shall screen each patient entering an intensive care unit or other high risk hospital department (as defined in the regulations promulgated under subsection (a)(1)(B)). (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, 2014. (C)

Waiver

The Secretary may waive the requirements of this paragraph if the Secretary determines, at the recommendation of the Director of the Centers for Disease Control and Prevention and after public hearing, that the rate of MRSA infections or other infections has declined to a level at which further screening is no longer needed. (3)

Medicare

(A)

Requirement

(i)

In general

Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended— (I)by striking and at the end of subparagraph (U); (II)by striking the period at the end of subparagraph (V) and inserting , and; and (III)by inserting after subparagraph (V) the following:

(W)in the case of an acute care hospital (as defined in section 2(1) of the MRSA Infection Prevention and Patient Protection Act), to comply with the screening requirements described in section 3 of such Act.

(ii)

Effective date

The amendments made by clause (i) shall apply to agreements entered into or renewed on or after the date that is 180 days after the enactment of this Act. (B)

Medicare payment adjustments

Not later than January 1, 2011, 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 infections (or other 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)(1)(A), each hospital 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 shall 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, or notify patients in which the infected patient may room with that such patient has tested positive for 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 who test positive for MRSA shall be informed of the results. All MRSA test results shall be noted in the patient's medical record. (4)Each hospital shall, by January 1, 2010, adopt a policy requiring any patient who has a MRSA infection to receive oral and written instructions regarding aftercare and precautions to prevent the spread of the infection to others. (5)Patients being discharged from intensive care units shall be tested again for MRSA, and those patients testing positive shall be informed of their status, and that status shall be noted in the patient's medical records in case of readmittance to a hospital. (6)A hospital shall educate its staff concerning modes of transmission of MRSA, use of protective equipment, disinfection policies and procedures, and other preventive measures. (7)A hospital shall provide other interventions, as the Secretary determines to be necessary, for control of MRSA infection. (d)

Reporting

(1)

In general

Not later than January 1, 2011, each hospital shall, using the National Healthcare Safety Network of the Centers for Disease Control and Prevention, report hospital-acquired MRSA and other infections 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 infection rates, including the rate of MRSA infections. (e)

Non-hospital medicare providers

(1)

MRSA infection reporting

The Secretary, using the MRSA infection and other infection information identified under subsection (b) and such other billing and coding information as necessary, shall promulgate regulations to— (A)define the term infected transferred patient, to describe a patient who, after discharge from, or treatment at, a non-hospital Medicare provider, is admitted to the hospital with MRSA infection (or other infection); (B)establish a system for identifying infected transferred patients; (C)establish a system to promptly inform any facility that has transferred an infected patient; and (D)establish requirements that any non-hospital Medicare provider that treats an infected transferred patient described under subparagraph (A) and that cannot provide a reasonable explanation that the infection was not acquired in the facility, submit to the Secretary an action plan describing how such provider plans to reduce the incidence of 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)(A) in order to assist in preventing subsequent MRSA infections. (3)

Publication of certain information

If a non-hospital Medicare provider identified using the system established under paragraph (1) fails to take steps, as required by the regulations promulgated under subparagraph (1)(D), 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 180 days 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.