[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 688 Introduced in Senate (IS)]
114th CONGRESS
1st Session
S. 688
To amend title XVIII of the Social Security Act to adjust the Medicare
hospital readmission reduction program to respond to patient
disparities, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 10, 2015
Mr. Manchin (for himself, Mr. Portman, Mr. Wicker, Mr. Kirk, Mr.
Nelson, and Mr. Brown) 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 adjust the Medicare
hospital readmission reduction program to respond to patient
disparities, and for other purposes.
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 ``Establishing Beneficiary Equity in
the Hospital Readmission Program Act of 2015''.
SEC. 2. ESTABLISHING BENEFICIARY EQUITY IN THE MEDICARE HOSPITAL
READMISSION PROGRAM.
(a) Transitional Adjustment for Dual Eligible Population and
Socioeconomic Status.--Section 1886(q)(4)(C) of the Social Security Act
(42 U.S.C. 1395ww(q)(4)(C)) is amended by adding at the end the
following new clause:
``(iii) Transitional adjustment for dual
eligible population and socioeconomic status.--
``(I) In general.--In determining a
hospital's excess readmission ratio
under clause (i) for purposes of making
payments for discharges occurring
during fiscal years 2016 and 2017, and
before the initial application of
clause (iv), and in order to ensure
that hospitals that treat the most
vulnerable populations are not unfairly
penalized by the program under this
subsection, the Secretary shall provide
for such risk adjustment as will take
into account both a hospital's
proportion of inpatients who are full-
benefit dual eligible individuals (as
defined in section 1935(c)(6)) and the
socioeconomic status of the patients
served by the hospital.
``(II) Quantitative method.--For
purposes of applying subclause (I)(bb),
the Secretary, to the maximum extent
practicable, shall utilize the most
recent data available from the Bureau
of the Census in order to develop a
quantitative method to adjust for
socioeconomic status. In developing
such quantitative method, the
Secretary--
``(aa) shall, to the
maximum extent practicable, use
inputs that address at least
income, education level, or
poverty rate; and
``(bb) may include inputs
that address other
socioeconomic and
sociodemographic factors
determined appropriate by the
Secretary.
``(III) Patients served by the
hospital.--For purposes of subclause
(I)(bb), the Secretary shall, to the
maximum extent practicable, measure the
socioeconomic status for all patients
served by each hospital. The Secretary
may supplement incomplete or
inaccessible patient-level data with
data related to the geographic region
of the patients served by the hospital.
``(IV) Minimizing reporting burden
on hospitals.--In carrying out this
clause, the Secretary shall not impose
any additional reporting requirements
on hospitals.''.
(b) Subsequent Adjustments Based on IMPACT and MedPAC Reports.--
Section 1886(q)(4)(C) of the Social Security Act (42 U.S.C.
1395ww(q)(4)(C)) is further amended by adding at the end the following
new clause:
``(iv) Risk adjustments under readmission
program based on impact and medpac reports.--In
making recommendations under subparagraph (D)
of section 2(d)(1) of the IMPACT Act of 2014
(Public Law 113-185; 42 U.S.C. 1395lll note)
with respect to the application of risk
adjustment under this subsection, the Secretary
is required to base such risk adjustment on the
reports submitted under subparagraphs (A)(ii)
and (B)(ii) of such section as well as on the
report submitted by the Medicare Payment
Advisory Commission under section 2(c) of the
Establishing Beneficiary Equity in the Hospital
Readmission Program Act of 2015. The
Administrator of the Centers for Medicare &
Medicaid Services shall incorporate such
recommendations in carrying out risk adjustment
under this subsection for discharges occurring
in fiscal years after fiscal year 2017 in order
to ensure that hospitals that treat the most
vulnerable populations are not unfairly
penalized by the program under this subsection.
For fiscal years beginning more than 5 years
after the date of submission of the report
under section 2(d)(1)(B)(ii) of the IMPACT Act
of 2014, the Secretary may use alternative
adjustment mechanisms under this subsection to
account for socioeconomic factors if the
Secretary finds that such measures are better
at accounting for socioeconomic factors than
the mechanisms that would otherwise apply.''.
(c) MedPAC Study on 30-Day Readmission Threshold.--The Medicare
Payment Advisory Commission shall conduct a study on the
appropriateness of using a threshold of 30 days for readmissions under
section 1886(q)(5)(E) of the Social Security Act (42 U.S.C.
1395ww(q)(5)(E)). The Commission shall submit to Congress a report on
such study in its report to Congress in June 2016.
(d) Addressing Issue of Noncompliant Patients.--Section
1886(q)(4)(C) of the Social Security Act (42 U.S.C. 1395ww(q)(4)(C)),
as amended by subsections (b) and (c), is further amended by adding at
the end the following new clause:
``(v) Consideration of exclusion of
noncompliant patient cases based on v or other
appropriate codes.--In promulgating regulations
to carry out this subsection for the applicable
period with respect to fiscal year 2017, the
Secretary shall consider the use of V or other
ICD-related codes for potential exclusions of
cases in order to address the issue of
noncompliant patients.''.
(e) Excluding Certain Clinical Conditions.--
(1) Study.--
(A) In general.--The Secretary of Health and Human
Services shall conduct a study, consistent with this
paragraph, that assesses and makes recommendations with
respect to excluding patients whose clinical conditions
or diagnoses may require frequent hospitalizations,
from the calculation of excess readmissions under
section 1886(q)(5)(E) of the Social Security Act (42
U.S.C. 1395ww(q)(5)(E)).
(B) Use of a technical expert panel.--The Secretary
shall convene a multi-stakeholder technical expert
panel comprised of individuals knowledgeable about
clinical care of hospitalized patients and quality
measurement, to provide input and recommendations on
the study conducted under this paragraph.
(C) Clinical conditions to be considered.--In
conducting the study, the Secretary shall consider
exclusions for patients with transplants, burns,
psychosis, and substance abuse disorders. The Secretary
may include additional clinical conditions where
appropriate care may require frequent hospitalizations.
(D) Transparency.--The Secretary shall make a draft
of report on such study available for public comment
for a period of not less than 30 days. The final study
and recommendations shall address the Secretary's
response to public comments.
(E) Deadline.--The Secretary shall submit a final
report on the study to Congress no later than Oct. 1,
2016. Such final report shall include recommendations
regarding the relevant clinical conditions that should
be excluded from the calculation of excess readmissions
described in subparagraph (A).
(2) Application to calculation of excess readmissions.--
Beginning with fiscal year 2018, the Secretary shall exclude
any relevant clinical conditions identified in the
recommendations made in the final report under paragraph (1)(E)
in determining a hospital's publicly reported readmission rate
and excess readmissions ratio under section 1886(q)(4)(C) of
the Social Security Act (42 U.S.C. 1395ww(q)(4)(C)). The
Secretary also is encouraged to consider applying the
exclusions so identified to other Medicare public reporting and
pay-for-performance programs in which readmission measures are
used.
(f) Budget Neutral Implementation.--The Secretary of Health and
Human Services shall make such payment adjustment to subsection (d)
hospitals under the inpatient prospective payment system under section
1886 of the Social Security Act (42 U.S.C. 1395ww) as may be necessary
to ensure that the implementation of the this section (including the
amendments made by this section) does not result in an increase in
aggregate expenditures under such section 1886.
<all>