Sec. 306. Payment bundling for post-acute care (PAC) under Medicare
614 words·~3 min read·
/bill/114/hr/3777/ih/section-306A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Title XVIII of the Social Security Act is amended by adding at the end the following new section: The Secretary shall establish a retrospective bundled payment arrangement (in this section referred to as the PAC bundled payment system ) under which, in accordance with the provisions of this section, actual payments made under this title to post-acute care providers with respect to post-acute care services furnished to targeted beneficiaries during a bundle period are adjusted (through additional payment or recoupment, as applicable), based on a benchmark established by the Secretary for such bundle.
The PAC bundled payment system shall be established to be applied to services furnished in fiscal years beginning with fiscal year 2020. In this section: The term targeted beneficiary means an individual who is entitled to benefits under part A and enrolled under part B and not enrolled under part C. The term post-acute care services means post-acute care, including home health services, skilled nursing services, inpatient rehabilitation services, and inpatient hospital services, for which payment may otherwise be made under this title and which are furnished during a bundle period to a targeted beneficiary.
The terms post-acute care provider means each of the following: A home health agency. A skilled nursing facility. A rehabilitation facility. A long-term care hospital. The term bundle period means, with respect to a bundle of post-acute care services for a targeted beneficiary who was discharged from an inpatient hospital stay, a period beginning on the first date on which post-acute care services within a bundle specified under subsection
(c)is furnished to an individual not later than 30 days after such discharge and ending 30, 60, or 90 days, as specified by the Secretary for such bundle, after such first date. The Secretary shall establish under the PAC bundled payment system bundles of post-acute care services consisting of MS–DRGs, other than such MS–DRGs included under the Comprehensive Care for Joint Replacement Model carried out by the Centers for Medicare & Medicaid Services under section 1115A, that represent the highest 50 percent of expenditures under this title attributable to post acute care, and shall periodically update such bundles, based on the most recent available data. The PAC payment system shall be designed consistent with the following: The Secretary shall annually establish a payment benchmark for each bundle of post-acute care services specified under subsection
(c)for such year. The Secretary shall, through annual reconciliation, adjust the payments made to a post-acute care provider with respect to post-acute care services included within a bundle so specified furnished to a targeted beneficiary during a bundle period during the year so that total payments for such provider with respect to such services within such bundle furnished to such beneficiary during such period equals such benchmark for such bundle. In establishing the payment amount for a bundle of post-acute care services, the Secretary may consider patient characteristics and other factors that are designed to take into account variations in treatment costs within the bundle. The payment rates established for such bundles shall be set to result in, in the aggregate, a reduction in the spending otherwise made under parts A and B for post-acute care services included in such bundles of 2.85 percent by not later than fiscal year 2025. The payment rates for bundles of post-acute care services shall be updated each fiscal year based on a market basket of the services included within such bundles. The bundles under this section, collectively, shall be established by the Secretary so as to provide for payment for at least 50 percent of all post-acute care services provided under this title during each fiscal year under the PAC bundled payment system. .