I 112th CONGRESS 1st Session H. R. 3442 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.

1.

Short title

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

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.