Sec. 102. Establishing beneficiary equity in the Medicare hospital readmission program
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Section 1886(q)(3) of the Social Security Act ( 42 U.S.C. 1395ww(q)(3) ) is amended— in subparagraph (A), by inserting subject to subparagraph (D), after purposes of paragraph (1), ; and by adding at the end the following new subparagraph: In determining a hospital’s adjustment factor under this paragraph for purposes of making payments for discharges occurring during and after fiscal 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. 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. In carrying out this subparagraph, the Secretary shall not impose any additional reporting requirements on hospitals. 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. . 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: 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. . 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. 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: 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. . 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: 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. .
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Sec. 102
Establishing beneficiary equity in the Medicare hospital readmission program
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