[Congressional Record Volume 162, Number 89 (Tuesday, June 7, 2016)]
[House]
[Pages H3470-H3475]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
HELPING HOSPITALS IMPROVE PATIENT CARE ACT OF 2016
Mr. TIBERI. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 5273) to amend title XVIII of the Social Security Act to
provide for regulatory relief under the Medicare program for certain
providers of services and suppliers and increased transparency in
hospital coding and enrollment data, and for other purposes, as
amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 5273
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Helping
Hospitals Improve Patient Care Act of 2016''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I--PROVISIONS RELATING TO MEDICARE PART A
Sec. 101. Development of Medicare study for HCPCS version of MS-DRG
codes for similar hospital services.
Sec. 102. Establishing beneficiary equity in the Medicare hospital
readmission program.
Sec. 103. Five-year extension of the rural community hospital
demonstration program.
Sec. 104. Regulatory relief for LTCHs.
Sec. 105. Savings from IPPS MACRA pay-for through not applying
documentation and coding adjustments.
TITLE II--PROVISIONS RELATING TO MEDICARE PART B
Sec. 201. Continuing Medicare payment under HOPD prospective payment
system for services furnished by mid-build off-campus
outpatient departments of providers.
Sec. 202. Treatment of cancer hospitals in off-campus outpatient
department of a provider policy.
Sec. 203. Treatment of eligible professionals in ambulatory surgical
centers for meaningful use and MIPS.
TITLE III--OTHER MEDICARE PROVISIONS
Sec. 301. Delay in authority to terminate contracts for Medicare
Advantage plans failing to achieve minimum quality
ratings.
Sec. 302. Requirement for enrollment data reporting for Medicare.
Sec. 303. Updating the Welcome to Medicare package.
TITLE I--PROVISIONS RELATING TO MEDICARE PART A
SEC. 101. DEVELOPMENT OF MEDICARE STUDY FOR HCPCS VERSION OF
MS-DRG CODES FOR SIMILAR HOSPITAL SERVICES.
Section 1886 of the Social Security Act (42 U.S.C. 1395ww)
is amended by adding at the end the following new subsection:
``(t) Relating Similar Inpatient and Outpatient Hospital
Services.--
``(1) Development of hcpcs version of ms-drg codes.--
``(A) In general.--Not later than January 1, 2018, the
Secretary shall develop HCPCS versions for MS-DRGs that is
similar to the ICD-10-PCS for such MS-DRGs such that, to the
extent possible, the MS-DRG assignment shall be similar for a
claim coded with the HCPCS version as an identical claim
coded with a ICD-10-PCS code.
``(B) Coverage of surgical ms-drgs.--In carrying out
subparagraph (A), the Secretary shall develop HCPCS versions
of MS-DRG codes for not fewer than 10 surgical MS-DRGs.
``(C) Publication and dissemination of the hcpcs versions
of ms-drgs.--
``(i) In general.--The Secretary shall develop a HCPCS MS-
DRG definitions manual and software that is similar to the
definitions manual and software for ICD-10-PCS codes for such
MS-DRGs. The Secretary shall post the HCPCS MS-DRG
definitions manual and software on the Internet website of
the Centers for Medicare & Medicaid Services. The HCPCS MS-
DRG definitions manual and software shall be in the public
domain and available for use and redistribution without
charge.
``(ii) Use of previous analysis done by medpac.--In
developing the HCPCS MS-DRG definitions manual and software
under clause (i), the Secretary shall consult with the
Medicare Payment Advisory Commission and shall consider the
analysis done by such Commission in translating outpatient
surgical claims into inpatient surgical MS-DRGs in preparing
chapter 7 (relating to hospital short-stay policy issues) of
its `Medicare and the Health Care Delivery System' report
submitted to Congress in June 2015.
``(D) Definition and reference.--In this paragraph:
``(i) HCPCS.--The term `HCPCS' means, with respect to
hospital items and services, the code under the Healthcare
Common Procedure Coding System (HCPCS) (or a successor code)
for such items and services.
``(ii) ICD-10-PCS.--The term `ICD-10-PCS' means the
International Classification of Diseases, 10th Revision,
Procedure Coding System, and includes a subsequent revision
of such International Classification of Diseases, Procedure
Coding System.''.
SEC. 102. ESTABLISHING BENEFICIARY EQUITY IN THE MEDICARE
HOSPITAL READMISSION PROGRAM.
(a) Transitional Adjustment for Dual Eligible Population.--
Section 1886(q)(3) of the Social Security Act (42 U.S.C.
1395ww(q)(3)) is amended--
(1) in subparagraph (A), by inserting ``subject to
subparagraph (D),'' after ``purposes of paragraph (1),''; and
(2) by adding at the end the following new subparagraph:
``(D) Transitional adjustment for dual eligibles.--
``(i) In general.--In determining a hospital's adjustment
factor under this paragraph for purposes of making payments
for discharges occurring during and after fiscal
[[Page H3471]]
year 2019, and before the application of clause (i) of
subparagraph (E), the Secretary shall assign hospitals to
groups (as defined by the Secretary under clause (ii)) and
apply the applicable provisions of this subsection using a
methodology in a manner that allows for separate comparison
of hospitals within each such group, as determined by the
Secretary.
``(ii) Defining groups.--For purposes of this subparagraph,
the Secretary shall define groups of hospitals based on their
overall proportion, of the inpatients who are entitled to, or
enrolled for, benefits under part A, who are full-benefit
dual eligible individuals (as defined in section 1935(c)(6)).
In defining groups, the Secretary shall consult the Medicare
Payment Advisory Commission and may consider the analysis
done by such Commission in preparing the portion of its
report submitted to Congress in June 2013 relating to
readmissions.
``(iii) Minimizing reporting burden on hospitals.--In
carrying out this subparagraph, the Secretary shall not
impose any additional reporting requirements on hospitals.
``(iv) Budget neutral design methodology.--The Secretary
shall design the methodology to implement this subparagraph
so that the estimated total amount of reductions in payments
under this subsection equals the estimated total amount of
reductions in payments that would otherwise occur under this
subsection if this subparagraph did not apply.''.
(b) Subsequent Adjustments Based on IMPACT Reports.--
Section 1886(q)(3) of the Social Security Act (42 U.S.C.
1395ww(q)(3)), as amended by subsection (a), is further
amended by adding at the end the following new subparagraph:
``(E) Changes in risk adjustment.--
``(i) Consideration of recommendations in impact reports.--
The Secretary may take into account the studies conducted and
the recommendations made by the Secretary under 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 under
this subsection of risk adjustment methodologies. Nothing in
this clause shall be construed as precluding consideration of
the use of groupings of hospitals.''.
(c) MedPAC Study on Readmissions Program.--The Medicare
Payment Advisory Commission shall conduct a study to review
overall hospital readmissions described in section
1886(q)(5)(E) of the Social Security Act (42 U.S.C.
1395ww(q)(5)(E)) and whether such readmissions are related to
any changes in outpatient and emergency services furnished.
The Commission shall submit to Congress a report on such
study in its report to Congress in June 2017.
(d) Addressing Issue of Certain Patients.--Subparagraph (E)
of section 1886(q)(3) of the Social Security Act (42 U.S.C.
1395ww(q)(3)), as added by subsection (b), is further amended
by adding at the end the following new clause:
``(ii) Consideration of exclusion of patient cases based on
v or other appropriate codes.--In promulgating regulations to
carry out this subsection with respect to discharges
occurring after fiscal year 2018, the Secretary may consider
the use of V or other ICD-related codes for removal of a
readmission. The Secretary may consider modifying measures
under this subsection to incorporate V or other ICD-related
codes at the same time as other changes are being made under
this subparagraph.''.
(e) Removal of Certain Readmissions.--Subparagraph (E) of
section 1886(q)(3) of the Social Security Act (42 U.S.C.
1395ww(q)(3)), as added by subsection (b) and amended by
subsection (d), is further amended by adding at the end the
following new clause:
``(iii) Removal of certain readmissions.--In promulgating
regulations to carry out this subsection, with respect to
discharges occurring after fiscal year 2018, the Secretary
may consider removal as a readmission of an admission that is
classified within one or more of the following: transplants,
end-stage renal disease, burns, trauma, psychosis, or
substance abuse. The Secretary may consider modifying
measures under this subsection to remove readmissions at the
same time as other changes are being made under this
subparagraph.''.
SEC. 103. FIVE-YEAR EXTENSION OF THE RURAL COMMUNITY HOSPITAL
DEMONSTRATION PROGRAM.
(a) Extension.--Section 410A of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law
108-173; 42 U.S.C. 1395ww note), as amended by sections 3123
and 10313 of the Patient Protection and Affordable Care Act
(Public Law 111-148), is amended--
(1) in subsection (a)(5), by striking ``5-year extension
period'' and inserting ``10-year extension period''; and
(2) in subsection (g)--
(A) in the subsection heading, by striking ``Five-Year''
and inserting ``Ten-Year'';
(B) in paragraph (1), by striking ``additional 5-year'' and
inserting ``additional 10-year'';
(C) by striking ``5-year extension period'' and inserting
``10-year extension period'' each place it appears;
(D) in paragraph (4)(B)--
(i) in the matter preceding clause (i), by inserting ``each
5-year period in'' after ``hospital during''; and
(ii) in clause (i), by inserting ``each applicable 5-year
period in'' after ``the first day of''; and
(E) by adding at the end the following new paragraphs:
``(5) Other hospitals in demonstration program.--During the
second 5 years of the 10-year extension period, the Secretary
shall apply the provisions of paragraph (4) to rural
community hospitals that are not described in paragraph (4)
but are participating in the demonstration program under this
section as of December 30, 2014, in a similar manner as such
provisions apply to rural community hospitals described in
paragraph (4).
``(6) Expansion of demonstration program to rural areas in
any state.--
``(A) In general.--The Secretary shall, notwithstanding
subsection (a)(2) or paragraph (2) of this subsection, not
later than 120 days after the date of the enactment of this
paragraph, issue a solicitation for applications to select up
to the maximum number of additional rural community hospitals
located in any State to participate in the demonstration
program under this section for the second 5 years of the 10-
year extension period without exceeding the limitation under
paragraph (3) of this subsection.
``(B) Priority.--In determining which rural community
hospitals that submitted an application pursuant to the
solicitation under subparagraph (A) to select for
participation in the demonstration program, the Secretary--
``(i) shall give priority to rural community hospitals
located in one of the 20 States with the lowest population
densities (as determined by the Secretary using the 2015
Statistical Abstract of the United States); and
``(ii) may consider--
``(I) closures of hospitals located in rural areas in the
State in which the rural community hospital is located during
the 5-year period immediately preceding the date of the
enactment of this paragraph; and
``(II) the population density of the State in which the
rural community hospital is located.''.
(b) Change in Timing for Report.--Subsection (e) of such
section 410A is amended--
(1) by striking ``Not later than 6 months after the
completion of the demonstration program under this section''
and inserting ``Not later than August 1, 2018''; and
(2) by striking ``such program'' and inserting ``the
demonstration program under this section''.
SEC. 104. REGULATORY RELIEF FOR LTCHS.
(a) Technical Change to the Medicare Long-term Care
Hospital Moratorium Exception.--
(1) In general.--Section 114(d)(7) of the Medicare,
Medicaid, and SCHIP Extension Act of 2007 (42 U.S.C. 1395ww
note), as amended by sections 3106(b) and 10312(b) of Public
Law 111-148, section 1206(b)(2) of the Pathway for SGR Reform
Act of 2013 (division B of Public Law 113-67), and section
112 of the Protecting Access to Medicare Act of 2014, is
amended by striking ``The moratorium under paragraph (1)(A)''
and inserting ``Any moratorium under paragraph (1)''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect as if included in the enactment of section
112 of the Protecting Access to Medicare Act of 2014.
(b) Modification to Medicare Long-term Care Hospital High
Cost Outlier Payments.--Section 1886(m) of the Social
Security Act (42 U.S.C. 1395ww(m)) is amended by adding at
the end the following new paragraph:
``(7) Treatment of high cost outlier payments.--
``(A) Adjustment to the standard federal payment rate for
estimated high cost outlier payments.--Under the system
described in paragraph (1), for fiscal years beginning on or
after October 1, 2017, the Secretary shall reduce the
standard Federal payment rate as if the estimated aggregate
amount of high cost outlier payments for standard Federal
payment rate discharges for each such fiscal year would be
equal to 8 percent of estimated aggregate payments for
standard Federal payment rate discharges for each such fiscal
year.
``(B) Limitation on high cost outlier payment amounts.--
Notwithstanding subparagraph (A), the Secretary shall set the
fixed loss amount for high cost outlier payments such that
the estimated aggregate amount of high cost outlier payments
made for standard Federal payment rate discharges for fiscal
years beginning on or after October 1, 2017, shall be equal
to 99.6875 percent of 8 percent of estimated aggregate
payments for standard Federal payment rate discharges for
each such fiscal year.
``(C) Waiver of budget neutrality.--Any reduction in
payments resulting from the application of subparagraph (B)
shall not be taken into account in applying any budget
neutrality provision under such system.
``(D) No effect on site neutral high cost outlier payment
rate.--This paragraph shall not apply with respect to the
computation of the applicable site neutral payment rate under
paragraph (6).''.
SEC. 105. SAVINGS FROM IPPS MACRA PAY-FOR THROUGH NOT
APPLYING DOCUMENTATION AND CODING ADJUSTMENTS.
Section 7(b)(1)(B)(iii) of the TMA, Abstinence Education,
and QI Programs Extension Act of 2007 (Public Law 110-90), as
amended by section 631(b) of the American Taxpayer Relief Act
of 2012 (Public Law 122-240) and section 414(1)(B)(iii) of
the Medicare Access and CHIP Reauthorization Act of 2015
(Public Law 114-10), is amended by striking ``an increase of
0.5 percentage points for discharges occurring during each of
fiscal years 2018 through 2023'' and inserting ``an increase
[[Page H3472]]
of 0.4590 percentage points for discharges occurring during
fiscal year 2018 and 0.5 percentage points for discharges
occurring during each of fiscal years 2019 through 2023''.
TITLE II--PROVISIONS RELATING TO MEDICARE PART B
SEC. 201. CONTINUING MEDICARE PAYMENT UNDER HOPD PROSPECTIVE
PAYMENT SYSTEM FOR SERVICES FURNISHED BY MID-
BUILD OFF-CAMPUS OUTPATIENT DEPARTMENTS OF
PROVIDERS.
(a) In General.--Section 1833(t)(21) of the Social Security
Act (42 U.S.C. 1395l(t)(21)) is amended--
(1) in subparagraph (B)--
(A) in clause (i), by striking ``clause (ii)'' and
inserting ``the subsequent provisions of this subparagraph'';
and
(B) by adding at the end the following new clauses:
``(iii) Deemed treatment for 2017.--For purposes of
applying clause (ii) with respect to applicable items and
services furnished during 2017, a department of a provider
(as so defined) not described in such clause is deemed to be
billing under this subsection with respect to covered OPD
services furnished prior to November 2, 2015, if the
Secretary received from the provider prior to December 2,
2015, an attestation (pursuant to section 413.65(b)(3) of
title 42 of the Code of Federal Regulations) that such
department was a department of a provider (as so defined).
``(iv) Alternative exception beginning with 2018.--For
purposes of paragraph (1)(B)(v) and this paragraph with
respect to applicable items and services furnished during
2018 or a subsequent year, the term `off-campus outpatient
department of a provider' also shall not include a department
of a provider (as so defined) that is not described in clause
(ii) if--
``(I) the Secretary receives from the provider an
attestation (pursuant to such section 413.65(b)(3)) not later
than December 31, 2016 (or, if later, 60 days after the date
of the enactment of this clause), that such department met
the requirements of a department of a provider specified in
section 413.65 of title 42 of the Code of Federal
Regulations;
``(II) the provider includes such department as part of the
provider on its enrollment form in accordance with the
enrollment process under section 1866(j); and
``(III) the department met the mid-build requirement of
clause (v) and the Secretary receives, not later than 60 days
after the date of the enactment of this clause, from the
chief executive officer or chief operating officer of the
provider a written certification that the department met such
requirement.
``(v) Mid-build requirement described.--The mid-build
requirement of this clause is, with respect to a department
of a provider, that before November 2, 2015, the provider had
a binding written agreement with an outside unrelated party
for the actual construction of such department.
``(vii) Audit.--Not later than December 31, 2018, the
Secretary shall audit the compliance with requirements of
clause (iv) with respect to each department of a provider to
which such clause applies. If the Secretary finds as a result
of an audit under this clause that the applicable
requirements were not met with respect to such department,
the department shall not be excluded from the term `off-
campus outpatient department of a provider' under such
clause.
``(viii) Implementation.--For purposes of implementing
clauses (iii) through (vii):
``(I) Notwithstanding any other provision of law, the
Secretary may implement such clauses by program instruction
or otherwise.
``(II) Subchapter I of chapter 35 of title 44, United
States Code, shall not apply.
``(III) For purposes of carrying out this subparagraph with
respect to clauses (iii) and (iv) (and clause (vii) insofar
as it relates to clause (iv)), $10,000,000 shall be available
from the Federal Supplementary Medical Insurance Trust Fund
under section 1841, to remain available until December 31,
2018.''; and
(2) in subparagraph (E), by adding at the end the following
new clause:
``(iv) The determination of an audit under subparagraph
(B)(vii).''.
(b) Effective Date.--The amendments made by this section
shall be effective as if included in the enactment of section
603 of the Bipartisan Budget Act of 2015 (Public Law 114-74).
SEC. 202. TREATMENT OF CANCER HOSPITALS IN OFF-CAMPUS
OUTPATIENT DEPARTMENT OF A PROVIDER POLICY.
(a) In General.--Section 1833(t)(21)(B) of the Social
Security Act (42 U.S.C. 1395l(t)(21)(B)), as amended by
section 201(a), is amended--
(1) by inserting after clause (v) the following new clause:
``(vi) Exclusion for certain cancer hospitals.--For
purposes of paragraph (1)(B)(v) and this paragraph with
respect to applicable items and services furnished during
2017 or a subsequent year, the term `off-campus outpatient
department of a provider' also shall not include a department
of a provider (as so defined) that is not described in clause
(ii) if the provider is a hospital described in section
1886(d)(1)(B)(v) and--
``(I) in the case of a department that met the requirements
of section 413.65 of title 42 of the Code of Federal
Regulations after November 1, 2015, and before the date of
the enactment of this clause, the Secretary receives from the
provider an attestation that such department met such
requirements not later than 60 days after such date of
enactment; or
``(II) in the case of a department that meets such
requirements after such date of enactment, the Secretary
receives from the provider an attestation that such
department meets such requirements not later than 60 days
after the date such requirements are first met with respect
to such department.'';
(2) in clause (vii), by inserting after the first sentence
the following: ``Not later than 2 years after the date the
Secretary receives an attestation under clause (vi) relating
to compliance of a department of a provider with requirements
referred to in such clause, the Secretary shall audit the
compliance with such requirements with respect to the
department.''; and
(3) in clause (viii)(III), by adding at the end the
following: ``For purposes of carrying out this subparagraph
with respect to clause (vi) (and clause (vii) insofar as it
relates to such clause), $2,000,000 shall be available from
the Federal Supplementary Medical Insurance Trust Fund under
section 1841, to remain available until expended.''.
(b) Offsetting Savings.--Section 1833(t)(18) of the Social
Security Act (42 U.S.C. 1395l(t)(18)) is amended--
(1) in subparagraph (B), by inserting ``, subject to
subparagraph (C),'' after ``shall''; and
(2) by adding at the end the following new subparagraph:
``(C) Target pcr adjustment.--In applying section 419.43(i)
of title 42 of the Code of Federal Regulations to implement
the appropriate adjustment under this paragraph for services
furnished on or after January 1, 2018, the Secretary shall
use a target PCR that is 1.0 percentage points less than the
target PCR that would otherwise apply. In addition to the
percentage point reduction under the previous sentence, the
Secretary may consider making an additional percentage point
reduction to such target PCR that takes into account payment
rates for applicable items and services described in
paragraph (21)(C) other than for services furnished by
hospitals described in section 1886(d)(1)(B)(v). In making
any budget neutrality adjustments under this subsection for
2018 or a subsequent year, the Secretary shall not take into
account the reduced expenditures that result from the
application of this subparagraph.''.
(c) Effective Date.--The amendments made by this section
shall be effective as if included in the enactment of section
603 of the Bipartisan Budget Act of 2015 (Public Law 114-74).
SEC. 203. TREATMENT OF ELIGIBLE PROFESSIONALS IN AMBULATORY
SURGICAL CENTERS FOR MEANINGFUL USE AND MIPS.
(a) In General.--Section 1848(a)(7)(D) of the Social
Security Act (42 U.S.C. 1395w-4(a)(7)(D)) is amended--
(1) by striking ``hospital-based eligible professionals''
and all that follows through ``No payment'' and inserting the
following: ``hospital-based and ambulatory surgical center-
based eligible professionals.--
``(i) Hospital-based.--No payment''; and
(2) by adding at the end the following new clauses:
``(ii) Ambulatory surgical center-based.--Subject to clause
(iv), no payment adjustment may be made under subparagraph
(A) for 2017 and 2018 in the case of an eligible professional
with respect to whom substantially all of the covered
professional services furnished by such professional are
furnished in an ambulatory surgical center.
``(iii) Determination.--The determination of whether an
eligible professional is an eligible professional described
in clause (ii) may be made on the basis of--
``(I) the site of service (as defined by the Secretary); or
``(II) an attestation submitted by the eligible
professional.
Determinations made under subclauses (I) and (II) shall be
made without regard to any employment or billing arrangement
between the eligible professional and any other supplier or
provider of services.
``(iv) Sunset.--Clause (ii) shall no longer apply as of the
first year that begins more than 3 years after the date on
which the Secretary determines, through notice and comment
rulemaking, that certified EHR technology applicable to the
ambulatory surgical center setting is available.''.
(b) Continued Application of Certain Provisions Under
MIPS.--Section 1848(o)(2)(D) of the Social Security Act (42
U.S.C. 1395w-4(o)(2)(D)) is amended by adding at the end the
following new sentence: ``The provisions of subparagraphs (B)
and (D) of subsection (a)(7), including the application of
clause (iv) of such subparagraph (D), shall apply to
assessments of MIPS eligible professionals under subsection
(q) with respect to the performance category described in
subsection (q)(2)(A)(iv) in a manner similar to the manner in
which such provisions apply with respect to payment
adjustments made under subsection (a)(7)(A).''.
TITLE III--OTHER MEDICARE PROVISIONS
SEC. 301. DELAY IN AUTHORITY TO TERMINATE CONTRACTS FOR
MEDICARE ADVANTAGE PLANS FAILING TO ACHIEVE
MINIMUM QUALITY RATINGS.
(a) Findings.--Consistent with the studies provided under
the IMPACT Act of 2014 (Public Law 113-185), it is the intent
of Congress--
(1) to continue to study and request input on the effects
of socioeconomic status and dual-eligible populations on the
Medicare Advantage STARS rating system before reforming such
system with the input of stakeholders; and
(2) pending the results of such studies and input, to
provide for a temporary delay in
[[Page H3473]]
authority of the Centers for Medicare & Medicaid Services
(CMS) to terminate Medicare Advantage plan contracts solely
on the basis of performance of plans under the STARS rating
system.
(b) Delay in MA Contract Termination Authority for Plans
Failing To Achieve Minimum Quality Ratings.--Section 1857(h)
of the Social Security Act (42 U.S.C. 1395w-27(h)) is amended
by adding at the end the following new paragraph:
``(3) Delay in contract termination authority for plans
failing to achieve minimum quality rating.--During the period
beginning on the date of the enactment of this paragraph and
through the end of plan year 2018, the Secretary may not
terminate a contract under this section with respect to the
offering of an MA plan by a Medicare Advantage organization
solely because the MA plan has failed to achieve a minimum
quality rating under the 5-star rating system under section
1853(o)(4).''.
SEC. 302. REQUIREMENT FOR ENROLLMENT DATA REPORTING FOR
MEDICARE.
Section 1874 of the Social Security Act (42 U.S.C. 1395kk)
is amended by adding at the end the following new subsection:
``(g) Requirement for Enrollment Data Reporting.--
``(1) In general.--Each year (beginning with 2016), the
Secretary shall submit to the Committees on Ways and Means
and Energy and Commerce of the House of Representatives and
the Committee on Finance of the Senate a report on Medicare
enrollment data (and, in the case of part A, on data on
individuals receiving benefits under such part) as of a date
in such year specified by the Secretary. Such data shall be
presented--
``(A) by Congressional district and State; and
``(B) in a manner that provides for such data based on--
``(i) fee-for-service enrollment (as defined in paragraph
(2));
``(ii) enrollment under part C (including separate for
aggregate enrollment in MA-PD plans and aggregate enrollment
in MA plans that are not MA-PD plans); and
``(iii) enrollment under part D.
``(2) Fee-for-service enrollment defined.--For purpose of
paragraph (1)(B)(i), the term `fee-for-service enrollment'
means aggregate enrollment (including receipt of benefits
other than through enrollment) under--
``(A) part A only;
``(B) part B only; and
``(C) both part A and part B.''.
SEC. 303. UPDATING THE WELCOME TO MEDICARE PACKAGE.
(a) In General.--Not later than 12 months after the last
day of the period for the request of information described in
subsection (b), the Secretary of Health and Human Services
shall, taking into consideration information collected
pursuant to subsection (b), update the information included
in the Welcome to Medicare package to include information,
presented in a clear and simple manner, about options for
receiving benefits under the Medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.),
including through the original medicare fee-for-service
program under parts A and B of such title (42 U.S.C. 1395c et
seq., 42 U.S.C. 1395j et seq.), Medicare Advantage plans
under part C of such title (42 U.S.C. 1395w-21 et seq.), and
prescription drug plans under part D of such title (42 U.S.C.
1395w-101 et seq.)). The Secretary shall make subsequent
updates to the information included in the Welcome to
Medicare package as appropriate.
(b) Request for Information.--Not later than six months
after the date of the enactment of this Act, the Secretary of
Health and Human Services shall request information,
including recommendations, from stakeholders (including
patient advocates, issuers, and employers) on information
included in the Welcome to Medicare package, including
pertinent data and information regarding enrollment and
coverage for Medicare eligible individuals.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Ohio (Mr. Tiberi) and the gentleman from Washington (Mr. McDermott)
each will control 20 minutes.
The Chair recognizes the gentleman from Ohio.
General Leave
Mr. TIBERI. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days within which to revise and extend their remarks
and include extraneous material on H.R. 5273.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Ohio?
There was no objection.
Mr. TIBERI. Mr. Speaker, I yield myself such time as I may consume.
Today I rise in support of H.R. 5273, the Helping Hospitals Improve
Patient Care Act, or ``HIP-C'' Act. This bill truly represents a
bipartisan effort, and I want to thank the distinguished gentleman from
Washington State (Mr. McDermott) for working with me on this bill. The
bill also fully represents what the Speaker has often called true
regular order.
Prior to introducing H.R. 5273, the Ways and Means Committee held
three hearings on topics included in the bill during the 114th
Congress, and the committee recently marked up the bill in a unanimous
way.
H.R. 5273 strikes the right balance of preserving site-neutral
payment policy, which I support, and providing essential relief for
hospitals that were caught up in this policy change from last year's
budget deal. Specifically, this bill helps many hospitals around the
country and in my State of Ohio, including a facility by OhioHealth and
Nationwide Children's Hospital that was started a year ago, last
summer, and will benefit from full outpatient payments under the bill,
as they had planned to when they dug the hole for their facility.
Further, the James Cancer Hospital, part of my alma mater at Ohio
State University, will have their cancer designation protected under
the bill, along with other designated cancer centers.
The bill also touches on three very important themes in the Medicare
program: One, giving providers regulatory relief; two, ensuring access
in rural areas; and three, protecting Medicare beneficiaries' access to
that important service that people like my mom and dad count on.
Under the topic of regulatory relief, we have included three Ways and
Means member priorities:
Representative Diane Black's bill that provides physicians who
primarily practice medicine in ambulatory surgical centers relief in
the electronic health records program; Representative Vern Buchanan's
bill, ensuring full access to Medicare advantage plans; and finally,
Representative Mike Kelly's bill requiring fair and transparent
reporting by congressional district on the enrollment of beneficiaries
in both the traditional fee-for-service Medicare and Medicare Advantage
programs. All of these priorities have previously passed the House
during the 114th Session.
Under the topic of access in rural areas, the bill allows for
continuation and expansion of participation in the Rural Community
Hospital Demonstration Program. Championed by my colleagues, Senator
Grassley in the Senate and Chairman Don Young in the House, this policy
is a continuation from the Medicare Modernization Act of 2003.
Under the topic of beneficiary access in Medicare, the bill requires
the Secretary to revise the pre-Medicare eligibility notification,
adding greater transparency for beneficiaries, which was led by my
colleagues, Dr. McDermott and Representative Pat Meehan.
Finally, the bill includes two important Member priorities that
advance important Medicare hospital issues. The first requires the
Secretary to ensure there is proper adjustment for socioeconomic
factors. The gentleman from Ohio (Mr. Renacci) has championed this
issue for some time. Representative Jim Renacci's policy ensures that
the hospital readmissions program provides an apples-to-apples
comparison based on the specific patient population a hospital treats.
The second priority, led by our Speaker, Paul Ryan, is the
establishment of a crosswalk of hospital codes. Back when Speaker Ryan
was the chairman of the Ways and Means Committee, he actively pursued
Medicare hospital issues. His crosswalk is an important building block
of a future system that promises to streamline the operation of
hospital services.
I encourage my colleagues to pass this legislation, send it to the
Senate, and let's get this to the President's desk.
Mr. Speaker, I reserve the balance of my time.
Mr. McDERMOTT. Mr. Speaker, I yield myself such time as I may
consume.
I rise today in support of the Helping Hospitals Improve Patient Care
Act. This bill makes important changes that will help hospitals
continue to provide high-quality care to patients as they implement the
recent payment reforms. This is bipartisan legislation unique in itself
that I am happy to have introduced with the gentleman from Ohio (Mr.
Tiberi).
I thank the chairman for his willingness to collaborate on this bill.
I also thank the staff of the Ways and Means Committee for their hard
work in helping us come to an agreement on language that Members of
both parties
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can fully support. This final bill isn't perfect, but it is truly a
bipartisan product that reflects the spirit of compromise.
Whenever we head back to our districts, we all hear from our
hospitals about the effects that our policies are having back home.
Although we made a smart change to hospital payments when we passed the
Bipartisan Budget Act last year, we are beginning to recognize the
unintended consequences of the legislation. We did not really expect
everything that is happening.
Many hospitals that were in the process of constructing outpatient
departments will be hit with unexpected payment cuts due to the BBA. In
addition, many cancer hospitals would be harmed by the new payment
rules. This bill fixes these problems in a narrowly tailored way that
doesn't undermine the goals of the BBA.
Moving forward, hospitals will no longer be encouraged to consolidate
by buying up physician practices for the purpose of billing Medicare at
an inflated rate. This is a good policy that is consistent with the
recommendations of a GAO report that was released last year. But
facilities that were under development when we passed the BBA, as well
as cancer hospitals, will be protected from these changes. This isn't a
giveaway to hospitals. The industry will pay the full cost.
In addition, this bill makes refinements to the readmissions
reduction program. To ensure that hospitals that serve a large number
of low-income patients are not unfairly penalized, the bill will
require CMS to make apples-to-apples comparisons between similar
facilities. As we await additional data that will soon be available
thanks to the IMPACT Act, this will ensure that the hospitals are not
hit with undeserved penalties due to a flawed methodology.
Finally, I am happy that we are also able to come to an agreement on
a bipartisan improvement to the beneficiary enrollment process. Each
year, thousands of people enroll in Medicare; and thanks to this bill,
seniors will have more information about their benefit options when
they become eligible for Medicare. Providing complete and easy-to-
understand information is critical. The decisions that beneficiaries
make when they enroll in Medicare have serious, long-term implications,
including a potential lifetime penalty if they fail to sign up for part
B. This bill will also help beneficiaries make informed decisions by
improving the Welcome to Medicare package.
I, again, thank my colleagues on both sides of the aisle for working
together on this bill. I am pleased we were able to craft a bipartisan
compromise, and I look forward to continuing to work together on these
and other important issues in the weeks ahead.
I reserve the balance of my time.
Mr. TIBERI. Mr. Speaker, I yield 2 minutes to the gentleman from
Alaska (Mr. Young).
(Mr. YOUNG of Alaska asked and was given permission to revise and
extend his remarks.)
Mr. YOUNG of Alaska. Mr. Speaker, first I want to thank Chairman
Tiberi for his kind work. We will miss the gentleman from Washington
(Mr. McDermott), and I thank him for this bipartisan effort because
this is a good bill and I strongly support it.
This measure includes many important provisions as you have spoken
about. But especially important to Alaska is section 103 language from
legislation, H.R. 672, a 5-year extension of the Rural Community
Hospital Demonstration Program. This demonstration program has worked
well and has come to the aid of seniors in Alaska and healthcare
providers across rural America.
Congress created the program to provide increased Medicare
reimbursements for hospitals across the Nation that are too large to be
considered Critical Access Hospitals, but too small to be supported by
traditional low Medicare margins on inpatient services.
{time} 1615
This program has helped three hospitals in Alaska: Central Peninsula
of Soldotna, the Bartlett Regional Hospital in Juneau, and Mt.
Edgecumbe in Sitka. These hospitals serve a wide variety of patients
all across those vast areas.
I do believe this is one of the better bipartisan efforts. Go back to
the old days when we accomplished things together by talking with one
another. It is vital we pass this bipartisan legislation and that the
Senate act on it. I would suggest, respectfully, to both my chairman
and ranking member, let's talk to the Senate and see if we can't get
something done. Four hundred bills over there is wrong. This is one
that shouldn't be hung up.
I urge all my colleagues to support the passage of this legislation.
Mr. McDERMOTT. Mr. Speaker, I yield 3 minutes to the gentleman from
Illinois (Mr. Danny K. Davis).
Mr. DANNY K. DAVIS of Illinois. Mr. Speaker, I want to commend and
congratulate Chairman Tiberi and Ranking Member McDermott for having
put together an outstanding piece of legislation. While we applaud it
for being bipartisan, I applaud it because it is good. It actually
helps to meet needs that exist. It protects hospitals and gives them
the opportunity to provide a better level of patient care.
I attended, just last week, the opening of an outpatient center that
St. Bernard Hospital in the Englewood community of Chicago had put
together. Of course, everybody in the community was there because
everybody recognized that inner-city hospitals, disproportionate share
hospitals, and medical centers that are complex need all of the
protection that they can get, and we need to have a better
understanding of readmission policies and practices and why some are
different than others.
These gentlemen have put together a piece of legislation that all of
us can be proud of. I strongly support it and thank them for their
diligence, for their cooperation, and for their tremendous efforts to
do a good bill.
Mr. TIBERI. Mr. Speaker, I yield 3 minutes to the gentleman from
northeastern Ohio (Mr. Renacci), a good friend, an important member of
the Committee on Ways and Means, and a leader on the readmission policy
dealing with hospitalization.
Mr. RENACCI. Mr. Speaker, I rise in support of H.R. 5273, the Helping
Hospitals Improve Patient Care Act of 2016. I want to thank Chairman
Brady and my good friend and colleague, Subcommittee Chairman Tiberi,
for all their great work to advance this bill, which addresses many
concerns in payments to hospitals, and especially outpatient
departments.
I heard from many of the hospitals in northeast Ohio, including
MetroHealth, about the impact this payment policy had on their new
facility. I am happy we are able to correct these issues for those
facilities already under construction.
I also want to thank my colleague from Ohio for including my bill,
H.R. 1343--the Establishing Beneficiary Equity in Hospital Readmission
Program--in the underlying legislation. The Hospital Readmission
Program was created due to concerns that too few resources were being
spent on reducing acute care hospital readmissions.
While we do want to make sure hospitals are reducing acute care
readmissions, we also want to make sure we are not disproportionately
penalizing those who see a large number of our most vulnerable patient
populations, especially those teaching hospitals who see a large number
of dual-eligible beneficiaries, low-income seniors, or young people
with disabilities who are eligible for both Medicare and Medicaid who
would have been unintentionally hurt under the current program.
Again, I want to thank the chairman for working with me on this
readmission component of this bill, but also all of the other important
provisions included in this legislation. These are commonsense,
bipartisan reforms to improve our healthcare system.
I urge all Members to support the Helping Hospitals Improve Patient
Care Act of 2016.
Mr. McDERMOTT. Mr. Speaker, I reserve the balance of my time.
Mr. TIBERI. Mr. Speaker, I yield myself such time as I may consume to
tell you a little bit about some of the hospital networks in my State
of Ohio. Mr. Renacci talked about some in northeastern Ohio that
support this legislation. Let me just name a few hospitals in my State
of Ohio that are
[[Page H3475]]
supportive of this legislation: Aultman, headquartered in his district
in Canton; the Cleveland Clinic, Kettering Health Network in the Dayton
area; Mercy Canton Sisters of Charity; MetroHealth System in Cleveland;
OhioHealth, headquartered in Columbus; Ohio State University Wexner
Medical Center in Columbus; the University of Cincinnati Health System
in Cincinnati; and University Hospitals, headquartered in Cleveland. As
was mentioned, this legislation passed the Committee on Ways and Means
in a bipartisan manner.
Mr. Speaker, I reserve the balance of my time.
Mr. McDERMOTT. Mr. Speaker, occasionally we have an extra minute on
the floor, and it makes sense to acknowledge some people that we trust
and rely upon and we don't ever mention, so I would like to just say
thank you to the Democratic staff: Sarah Levin, Melanie Egorin, Daniel
Foster, JC Cannon, and Daniel Jackson; on the Republican side: Emily
Murry, Lisa Grabert, Nick Uehlecke, Taylor Trott; to the staff at the
CMS who helped put this bill together: Ira Burney, Anne Scott, Lisa
Yen. And to the staff at legislative counsel: Ed Grossman--Ed has been
there for as long as I have been here, so any bill that gets out of
here without Ed looking at it is a pretty rare bill--and Jessica
Shapiro is his assistant.
The Congressional Budget Office gets in on these deals as well: Tom
Bradley, Lori Housman, Kevin McNellis, and Jamease Kowalczyk. I am from
Chicago. I should be able to pronounce a Polish name. We appreciate
their hard work.
Mr. Speaker, I yield back the balance of my time.
Mr. TIBERI. Mr. Speaker, let me just close by saying thank you to Dr.
McDermott. It has been enjoyable to work with his team, led by Amy, and
we appreciate the bipartisanship. You mentioned all those names--stole
my thunder--Emily and her team, and my staff, Whitney Koch Daffner and
Abigail Finn, too, for yeoman's work.
Mr. Speaker, I urge a unanimous vote.
I yield back the balance of my time.
Mr. BRADY of Texas. Mr. Speaker, I rise today in support of H.R.
5273, the Helping Hospitals Improve Patient Care Act of 2016.
First, I'd like to thank Chairman Tiberi and Ranking Member McDermott
for their leadership on this important legislation.
At the Ways and Means Committee, we are working to deliver health
care solutions that will expand access, increase choices, and improve
the quality of care for the American people.
The Helping Hospitals Improve Patient Care Act helps advance all
three of those goals. And the bill does so in a fiscally responsible
manner that helps strengthen and preserve Medicare for the long-term.
At its core, our bipartisan legislation is about supporting the
delivery of high-quality, affordable care to families and seniors
throughout the country. It will especially help people who live in low-
income and rural communities.
Our bill includes straightforward solutions to help hospitals and
health care providers transition to--and preserve--the new site-neutral
payment policies. This will give providers the certainty they need to
best serve their patients, now and into the future.
This bill is an excellent illustration of what we can accomplish
through regular order. It's the product of many innovative solutions,
proposed by many members on both sides of the aisle.
The solutions in this bill will make a real difference when it comes
to the delivery of high-quality care for the people of our districts.
In fact, the University of Texas' MD Anderson Cancer Center located
in Houston has already embraced this bill. MD Anderson officials said,
``This ensures our ability to continue providing the highest quality
and level of cancer care to patients in the communities we serve.''
And MD Anderson is just one of many hospitals and cancer treatment
centers throughout the country that we help with H.R. 5273.
This bill is particularly personal for me because it builds from the
hospital discussion draft I released as Health Subcommittee Chairman
back in November 2014.
In the Helping Hospitals Improve Patient Care Act, we push forward
two critical building blocks of that discussion draft.
First, Speaker Ryan's crosswalk bill that better coordinates care
between inpatient and outpatient settings.
Second, Congressman Jim Renacci's readmission policy, which helps
hospitals in low-income communities serve their patients.
There are still many policies from our hospital discussion draft that
are worthy of debate. We'll continue to work with Members and
stakeholders to pursue additional reforms that make our health care
system work better for patients and providers in our communities.
I'm grateful to all the members--on and off our committee--who worked
hard to craft and advance the Helping Hospitals Improve Patient Care
Act.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Ohio (Mr. Tiberi) that the House suspend the rules and
pass the bill, H.R. 5273, as amended.
The question was taken; and (two-thirds being in the affirmative) the
rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
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