H.R. 2580 — what changed

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:

changed “(7) Treatment of high cost outlier payments

changed “(A) Reduction factor in establishing Adjustment to the standard Federal payment rate for estimated high cost outlier pool—Under payments—Under the system described in paragraph (1), for rate fiscal years beginning on or after October 1, 2016, in adjusting the Secretary shall reduce the standard Federal payment rate for outlier payments, as if the Secretary shall apply a reduction factor 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 to establish an outlier pool.of estimated aggregate payments for standard Federal payment rate discharges for each such fiscal year.

changed “(B) Limitation on payment amounts—In reimbursing high cost outlier payments under such system for such rate years, payment amounts—Notwithstanding subparagraph (A), the Secretary shall structure pool set the fixed loss amount for high cost outlier payments such that the amounts paid in a rate year for estimated aggregate amount of high cost outlier payments do not exceed an amount equivalent made for standard Federal payment rate discharges for fiscal years beginning on or after October 1, 2016, shall be equal to 99.0625 percent of the outlier pool established under subparagraph (A) 8 percent of estimated aggregate payments for such standard Federal payment rate discharges for each such fiscal year.

changed “(C) Waiver of budget neutrality—Any reduction in payments resulting from the application of subparagraphs (A) and subparagraph (B) shall not be taken into account in applying any budget neutrality provision under such system.

changed “(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).”(6), except for the standard Federal payment rate portion of blended payment rates determined under subparagraph (B)(iii)(II) of such paragraph.”