[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3442 Introduced in House (IH)]

112th CONGRESS
  1st Session
                                H. R. 3442

To amend title XVIII of the Social Security Act with respect to payment 
    for partial hospitalization services under the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 16, 2011

  Ms. Eddie Bernice Johnson of Texas (for herself, Ms. Jackson Lee of 
 Texas, and Mr. Frank of Massachusetts) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
    addition to the Committee on Ways and Means, for a period to be 
subsequently determined by the Speaker, in each case for consideration 
  of such provisions as fall within the jurisdiction of the committee 
                               concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act with respect to payment 
    for partial hospitalization services under the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Partial Hospitalization 
Stabilization and Integrity Act of 2011''.

SEC. 2. MEDICARE PAYMENT FOR PARTIAL HOSPITALIZATION SERVICES.

    (a) Establishment of New Payment Methodology.--Section 1833 of the 
Social Security Act (42 U.S.C. 1395l) is amended--
            (1) in subsection (a)(2)--
                    (A) in subparagraph (B), by striking ``or (E)'' and 
                inserting ``(E), or (I)'';
                    (B) in subparagraph (G), by striking ``and'' at the 
                end;
                    (C) in subparagraph (H), by striking the comma at 
                the end and inserting ``; and''; and
                    (D) by inserting after subparagraph (H) the 
                following new subparagraph:
                    ``(I) with respect to partial hospitalization 
                services, the amount determined under subsection 
                (z);'';
            (2) in subsection (t)(2)(B)--
                    (A) in clause (iii), by striking ``but'';
                    (B) in clause (iv), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new clause:
                            ``(v) does not include partial 
                        hospitalization services.''; and
            (3) by adding at the end the following new subsection:
    ``(z) Payment for Partial Hospitalization Services.--
            ``(1) In general.--The Secretary shall establish consistent 
        with this subsection a payment system for partial 
        hospitalization services. Such payment system shall be designed 
        to provide for the same payment rates without regard to whether 
        the services are furnished by a hospital or by a community 
        mental health center, to minimize annual fluctuations in 
        overall rates, and to result in an aggregate amount of payment 
        under this part for such services during the first 5 years in 
        which this subsection is effective equal to the aggregate 
        amount of payment that would have been made under this part for 
        such services during such period if the Partial Hospitalization 
        Stabilization and Integrity Act of 2011 had not been enacted.
            ``(2) Description of system.--Under such payment system--
                    ``(A) payments shall be made based on a per diem 
                rate (computed consistent with subparagraph (B)) and 
                subject to an annual increase (consistent with 
                subparagraphs (C) and (D) and paragraph (1));
                    ``(B) the base per diem rate for services furnished 
                in 2011 under this subparagraph shall be deemed to be 
                $238.33 for partial hospitalization services (including 
                mental health services composite), $82.73 with respect 
                to brief individual psychotherapy, $113.05 for extended 
                individual psychotherapy, $128.82 for extended 
                individual psychotherapy, and $54.87 for group 
                psychotherapy;
                    ``(C) the annual adjustment under this subparagraph 
                shall be, subject to subparagraph (D) and paragraph 
                (1), a uniform inflation factor, such as the consumer 
                price index for all urban consumers, to be specified by 
                the Secretary;
                    ``(D) such annual adjustment--
                            ``(i) if an increase, shall be--
                                    ``(I) provided in full only for 
                                those providers of partial 
                                hospitalization services that meet 
                                performance standards specified by the 
                                Secretary consistent with the quality 
                                service criteria established under 
                                paragraph (3) and paragraph (4); and
                                    ``(II) reduced for those providers 
                                of such services that fail to meet such 
                                performance standards; and
                            ``(ii) if a decrease, shall be--
                                    ``(I) provided in full for those 
                                providers of such services that fail to 
                                meet such standards; and
                                    ``(II) reduced for those providers 
                                of such services that meet such 
                                standards; and
                    ``(E) payment shall not be made for partial 
                hospitalization services with a level of care of fewer 
                than 4 services per service day.
            ``(3) Establishment of quality service criteria to judge 
        performance.--In order to carry out paragraph (2)(D), the 
        Secretary shall establish criteria to measure performance of 
        providers of partial hospitalization services. Such criteria 
        shall include criteria relating to at least the following:
                    ``(A) Access.--The number of program days of 
                scheduled operation from the time of a request for 
                services to the first scheduled day of service.
                    ``(B) Treatment intensity.--The percentage of 
                scheduled attendance consistent with a minimum 
                attendance average of 4 days per calendar week over an 
                episode of care.
                    ``(C) Discharge planning.--The percentage of 
                patients with a scheduled follow-up appointment within 
                14 days after the date of discharge (as needed).
                    ``(D) Continuity of care.--The percentage of post-
                discharge continuity of care plans provided to next 
                level of care providers upon discharge.
            ``(4) Requirement for accreditation.--Effective 2 years 
        after the date of the enactment of this subsection, a provider 
        of partial hospitalization services shall not be considered to 
        meet performance standards under paragraph (2)(D) unless the 
        provider is accredited by the Joint Commission on Accreditation 
        of Healthcare Organizations, the Commission on Accreditation of 
        Rehabilitation Facilities, or such other accreditation body as 
        may be recognized by the Secretary.''.
    (b) Conforming Coverage of Mental Health Services Composite 
Furnished by Community Mental Health Centers.--Under section 
1861(ff)(2)(I) of the Social Security Act (42 U.S.C. 1395x(ff)(2)(I)), 
the Secretary of Health and Human Services shall include such items and 
services as would result in the same scope of items and services 
covered under partial hospitalization services if furnished by a 
community mental health center as would be covered as partial 
hospitalization services if furnished by a hospital.
    (c) Effective Date.--This section, and the amendments made by this 
section, shall apply to services furnished on or after January 1, 2012.
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