Section 1 Short title
This Act may be cited as the “Establishing Beneficiary Equity in the Hospital Readmission Program Act”.
Establishing Beneficiary Equity in the Hospital Readmission Program Act
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.
Sec. 2 Adjusting the Medicare hospital readmission reduction program to respond to patient disparities
Removal of certain readmissions— Section 1886(q)(5)(E) of the Social Security Act (42 U.S.C. 1395ww(q)(5)(E)) is amended by adding at the end the following: “Such term does not include an admission that is classified within one or more of the following: transplants, end-stage renal disease, burns, trauma, psychosis, or substance abuse.” .
Adjustment for dual eligible population— 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) Adjustment for dual eligibles—In applying clause (i), the Secretary shall provide for such risk adjustment as will take into account a hospital’s proportion of inpatients who are full-benefit dual eligible individuals (as defined in section 1935(c)(6)) in order to ensure that hospitals that treat the most vulnerable populations are not unfairly penalized by the program under this subsection.”
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 2014.
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 subsection (b), is further amended by adding at the end the following new clause:
“(iv) Consideration of exclusion of noncompliant patient cases based on V codes—In promulgating regulations to carry out this subsection for the applicable period with respect to fiscal year 2015, the Secretary shall consider the use of V codes for potential exclusions of cases in order to address the issue of noncompliant patients.”
Effective date; budget neutral implementation—
The amendments made by this section shall be effective for applicable periods with respect to fiscal year 2015 and each succeeding fiscal year.
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 amendments made by this section do not result in an increase in aggregate expenditures under such section.